Autism Spectrum Disorder (Literature Review)

Autism Spectrum Disorder (Literature Review)

Autism Spectrum Disorders (ASD) are illnesses that affect childhood development, resulting in delays in communicational and behavioral advancement (Rosenberg et al., 2011).  Diagnosis of ASD best occurs early to identify the best way forward for affected children and guide parents on how to handle their kids.  However, Daniels & Mandell (2013) state that there is often a delay in diagnosing ASD, which, in turn, fails to provide treatment at a crucial developmental period for a child. Duvekat et al. (2016) report a difference in the diagnosis of ASD between girls and boys, which prompted them to conduct a study regarding the matter. Zuckerman et al. (2015) also state that despite the initial concern displayed by parents of children with ASD, there is often a delay in diagnosis.  There is a notable difference in the diagnosis of ASD among different cultures. Therefore, this essay aims to inquire; what factors contribute to the various diagnoses of ASD among cultures? This scholarly article seeks to conduct an in-depth literature review concerning this topic.

According to Rosenberg et al. (2011), there are increasing levels of ASD diagnosis in the United States. However, despite children as young as 14 months of age being able to undergo a diagnosis, most parents bring their children at three years of age. Early diagnosis of ASD is critical to maximizing a positive outcome (Rosenberg et al., 2011). Nevertheless, there is a variance in the age of concern that parents bring in their child, resulting in divergent diagnoses. LeBarton & Landa (2018) report that motor skills are an early indicator of the likelihood of ASD in a child. A child’s motor skills at six months of age best predict their likelihood of expressing ASD at 24 to 36 months of age (LeBarton & Landa, 2018). However, the diagnosis performed at six months provides the best results for high-risk infants than low-risk ones. High-risk infants need better monitoring of their development than low-risk infants at six months (LeBarton & Landa, 2018).

Mazurek et al. (2014) report that socioeconomic barriers also contribute to differences in the time of diagnosis among families. Children from low-income families receive a later diagnosis of ASD than those from the middle to high-income families. There are significant disparities in the diagnosis of ASD among families of low socioeconomic status (Mazurek et al., 2014). Mazurek et al. (2014) also state that sociodemographic factors lead to diagnosis disparities, with the likelihood of older children receiving a diagnosis lower. Children with a substantial IQ are also less likely to get an early diagnosis of ASD. Brian et al. (2015) conducted a study to establish stability and variation in ASD diagnosis of children from three years of age and above in high-risk family settings. They found that children who receive a diagnosis at three years of age increased the diagnosis’s stability as long as such occurred between 18-24 months of age. However, the sensitivity of diagnosis weakened as the children got older. Those who received a diagnosis later displayed lower symptoms of ASD (Brian et al., 2015).

Blumber et al. (2015) state that maturation, treatment, or misdiagnosis also contributes to a difference in ASD diagnosis. There is a significant contribution to healthcare providers (Blumber et al., 2015). When parents in particular regions express early concerns regarding their children’s condition, the response invoked by doctors massively contributes to an appropriate diagnosis. Blumber et al. (2015) also state that the type of healthcare provider who provides a diagnosis for ASD leads to a diagnosis difference. The first doctor played a considerable role. Parents report that going to different practitioners leads to the acquisition of new information concerning the diagnosis of ASD in their children. Some doctors prefer to refer their patients to specialists who may create a significant difference in the verdict (Blumber et al., 2015).

According to Mandell et al. (2006), African American children had a likelihood of 2.6 times less than other cultures receiving a diagnosis of ASD during their first visit. Instead, they received a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Mandell et al. (2006) attributed this variation to how parents describe symptoms, interpretation, and expectations of the clinician and symptoms present during diagnosis. Inadequate screening practices also contribute to a difference in the diagnosis of ASD (Mandell et al., 2006). Some pediatricians display inadequate responses to some parental concerns, which immensely differ diagnosis. Some medical practitioners use low sensitivity tools and have insufficient knowledge concerning ASD symptoms (Mandell et al., 2006). ASD also contains symptoms similar to other conditions such as ADHD, which may contribute to a differing diagnosis. Mandell et al. (2006) list mutual symptoms as delayed speech, behavioral advancement difficulties, and poor social responses. Repetitive behaviors may also lead to a diagnosis of Obsessive-Compulsive Disorder (OCD). Such a misdiagnosis primarily occurs among older children who possess a lower likelihood of exhibiting ASD symptoms (Blumber et al., 2015). The differing diagnosis among ASD patients gets aggravated by the fact that the illness strings and developmental and behavioral symptoms present in other illnesses such as mental deterioration (Chakrabati & Fombonne, 2001). Mandell et al. (2006) state that before a child receives a diagnosis of ASD, other conditions must undergo ruling. An appropriate diagnosis is essential to ensure the well-being of affected children. Misdiagnosis may lead to wrong relaying of autistic symptoms to other diseases, which leads to a negative outcome (Mandel et al., 2006).

Charman & Baird (2008) state that there exist clinical challenges to the appropriate diagnosis of ASD in children. Such include the utilization of standard equipment on preschool kids and projection indication ability by a clinical practitioner. There may lack of information on a child’s history of development and distortion of daily activities and behavior (Charman & Baird, 2008). The clinician may also lack data on a child’s social interaction with their peers and their communicative abilities. For an ASD diagnosis to be successful, a clinician should have the ability to recognize non-verbal cues such as social orientation, attention span, and their behavior during play (Charman & Baird, 2008). Such symptoms are best visible during a young age, as children display fewer signs as they get older (Charman & Baird, 2008; LeBarton & Landa, 2018; Brian et al., 2015; Blumber et al., 2015). Some repetitive behaviors are less notable as a child gets older, and the symptoms pattern in younger children is different from that exhibited by older children. There is a need for caution while applying the use of standardized assessment equipment, the International Statistical Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Charman & Baird, 2008). A clinical practitioner’s individual opinion is the best diagnosis, as it is more accurate (Charman & Baird, 2008).

Christensen et al. (2013) conducted a study to assess the relation between prenatal exposure of valproate, a drug used to treat epilepsy, and the increased risk of autism in children. Valproate is used to treat expectant women who have epilepsy and is the best-recommended drug to undertake such (Christensen et al., 2013). The study found that exposure to valproate during pregnancy significantly increases the risk of children acquiring autistic disorders. Children of exposed women experience cognitive delays and malformations, which differs the diagnosis found on non-epileptic women. Women who also used valproate previously in life but halted also had an increased risk of their children acquiring autistic disorders later in life (Christensen et al., 2013). Therefore, different diagnoses of ASD may exist in regions with low use of valproate and those with high drug use.

Ratto et al. (2015) state that practitioners often undermine the role of culture in ASD diagnosis. According to Ratto et al. (2015), Latino mothers usually take their children for ASD diagnosis later. They also displayed a lack of knowledge concerning developmental stages in their children and less likely to report parental concerns. Ratto et al. (2015); Mazurek at al. (2014) attribute socioeconomic differences to the differences in Latino mothers’ diagnosis. Mandell & Novak (2005) report that parental beliefs about childhood development significantly influence their likelihood of taking their child for a diagnosis. Mandell & Novak (2005) attribute such to the lack of adequate information concerning the treatment efficiency of ASD.

Moreover, according to Mandell & Novak (2005), parental experiences with the healthcare system play a huge role in their willingness to engage their children with the same system. Their interpretation of symptoms displayed by their children also plays a significant role in ASD diagnosis. Notably, Antezana et al. (2017) report that children in rural communities face a lesser likelihood of undergoing an ASD diagnosis than their urban counterparts. Such receive attribution to the lack of equipment and facilities, longer distances between parents and medical practitioners, and socioeconomic barriers.

Conclusion and Gaps in Literature

Most of the available literature bases its research on the United States and Europe. There is a notable lack of sources that focus on disadvantaged communities globally, especially in Africa and Asia. There is an essential need to assess the impact of differing diagnoses in such regions that face significant challenges, such as inadequate healthcare and high poverty levels. ASD is a disease that requires early treatment to improve the efficiency of outcomes. The lack of adequate information on ASD treatment, as pointed out by Mandell & Novak (2005), prevents parents from pursuing an early diagnosis of their children, which affects them throughout their lives. Autistic children can live everyday lives; therefore, to ensure such, medical practitioners have considerable responsibility for conducting education and other outreach programs to sensitize parents on the disorders.

References

Antezana, L., Scarpa, A., Valdespino, A., Albright, J., & Richey, J. A. (2017). Rural trends in diagnosis and services for autism spectrum disorder. Frontiers in Psychology, 8, 590.

Blumberg, S. J., Zablotsky, B., Avila, R. M., Colpe, L. J., Pringle, B. A., & Kogan, M. D. (2016). Diagnosis lost: differences between children who had and who currently have an autism spectrum disorder diagnosis. Autism, 20(7), 783-795.

Brian, J., Bryson, S. E., Smith, I. M., Roberts, W., Roncadin, C., Szatmari, P., & Zwaigenbaum, L. (2016). Stability and change in autism spectrum disorder diagnosis from age 3 to middle childhood in a high-risk sibling cohort. Autism, 20(7), 888-892.

Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285(24), 3093–3099

Charman, T., & Baird, G. (2002). Practitioner review: Diagnosis of autism spectrum disorder in 2‐and 3‐year‐old children. Journal of Child Psychology and Psychiatry, 43(3), 289-305.

Christensen, J., Grønborg, T. K., Sørensen, M. J., Schendel, D., Parner, E. T., Pedersen, L. H., & Vestergaard, M. (2013). Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. Jama, 309(16), 1696-1703.

Daniels, A. M., & Mandell, D. S. (2014). Explaining differences in age at autism spectrum disorder diagnosis: A critical review. Autism, 18(5), 583-597.

Duvekot, J., van der Ende, J., Verhulst, F. C., Slappendel, G., van Daalen, E., Maras, A., & Greaves-Lord, K. (2017). Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys. Autism, 21(6), 646-658.

LeBarton, E. S., & Landa, R. J. (2019). Infant motor skill predicts later expressive language and autism spectrum disorder diagnosis. Infant Behavior and Development, 54, 37-47.

Mandell, D. S., & Novak, M. (2005). The role of culture in families’ treatment decisions for children with autism spectrum disorders. Mental retardation and developmental disabilities research reviews, 11(2), 110-115.

Mandell, D. S., Ittenbach, R. F., Levy, S. E., & Pinto-Martin, J. A. (2007). Disparities in diagnoses received prior to a diagnosis of autism spectrum disorder. Journal of autism and developmental disorders, 37(9), 1795-1802.

Mazurek, M. O., Handen, B. L., Wodka, E. L., Nowinski, L., Butter, E., & Engelhardt, C. R. (2014). Age at first autism spectrum disorder diagnosis: the role of birth cohort, demographic factors, and clinical features. Journal of Developmental & Behavioral Pediatrics, 35(9), 561-569.

Ratto, A. B., Reznick, J. S., & Turner-Brown, L. (2016). Cultural effects on the diagnosis of autism spectrum disorder among Latinos. Focus on Autism and Other Developmental Disabilities, 31(4), 275-283.

Rosenberg, R. E., Landa, R., Law, J. K., Stuart, E. A., & Law, P. A. (2011). Factors affecting age at initial autism spectrum disorder diagnosis in a national survey. Autism research and treatment, 2011.

Zuckerman, K. E., Lindly, O. J., & Sinche, B. K. (2015). Parental concerns, provider response, and timeliness of autism spectrum disorder diagnosis. The Journal of pediatrics, 166(6), 1431-1439.