Autism Awareness; Can Health Care Providers Recognize the Signs

Abeer Mohammed Alharbi

Assistant Professor at King Saud bin Abdulaziz University for Health Sciences, Consultant Developmental and Behavioral Pediatrics, Department of Pediatrics, Riyadh Saudi Arabia

*Correspondence to: Dr. Abeer Mohammed Alharbi, Assistant Professor at King Saud bin Abdulaziz University for Health Sciences, Consultant Developmental and Behavioral Pediatrics, Department of Pediatrics, Riyadh Saudi Arabia.

Copyright © 2018 Dr. Abeer Mohammed Alharbi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction
Autism spectrum disorders (ASD) is a lifelong neurodevelopmental disorder characterized by significant weakness in social communication and behavioral challenges. About 1 in 68 children have ASD according to estimates from the US Centers for Disease Control and Prevention (CDC) [1]. Although (ASD) prevalence is rising globally, health care provider’s knowledge about autism considered relatively low all over [2], a similar observation has been noticed in Saudi Arabia (SA), moreover limited research and lack of evidence about autism in (SA) can have negative consequences on the process of diagnosis and treatment which can ultimately jeopardize prognosis. Autism is a complex disorder and presentations can vary between individuals, furthermore many specialties and (HCPs) across multiple health setting usually involved in the diagnosis and treatment plan at different stages and ages throughout the life of autistic individuals. The importance of (HCPs) Knowledge and awareness about autism features and associated behavioral problems are a critical issue and has been explored by many studies [3]. A clear recommendation by the American Academy of Neurology stated that children should be screened for autism symptoms and signs at every well-child visit during infancy [4]. In addition, researches determined the effectiveness of early diagnosis and intervention on the long-term favorable prognosis [5]. Although pediatrician and family physician are commonly the first health professional to be contacted by the parents to express their concerns, a study by Dosreis et al. 2006 found that autism screening rate was low (8%) among pediatrician [6]. Moreover, there are insufficient studies elaborating Perception and knowledge of autism among other health care providers such as; nurses and allied health professionals, dentist, and other specialties. A study done in Turkey by Luleci et al. 2016 exploring the Knowledge and awareness about autism among pharmacists indicated that pharmacist knowledge is inadequate and need to improve [7]. HCPs are considered as a stakeholder in managing autism, knowledge about autism features and associated health and behavior problems should be enriched in order to improve early detection and diagnosis and facilitate timely intervention and better outcome.

This study aimed to explore the knowledge about autism among healthcare providers (HCPs) in Saudi Arabia and to Assess (HCPs) proficiencies to recognize the signs and associated symptoms of autism.

Method

Study Design and Participants
A cross-sectional study was conducted at King Abdulaziz Medical City /King Fahad National Guard hospital /Riyadh, Saudi Arabia, on 2013, month of April, during autism awareness week campaign, Survey questionnaire was distributed randomly among multiple health care professionals including; Pediatrician, family practice, and neurologist, psychiatrist, speech, language pathologist, nurses, and clinical psychologist. A total of two hundred and seventy-one staff completed questionnaires and returned back to the event coordinators

Measure
Survey Questionnaire was build up by the author in English and translated to the Arabic Language, the questionnaire consisted of three sections, the first section consisted of the demographic variables of study participants (age, gender, health specialty, and years of experience, etc.). The second section was about autism features which were assessed using 3 points Likert scale with 1- as yes, 2 - as No and 3 - as I don’t know. The third section was questions related to comorbid conditions could be presented with autism. This questionnaire showed good test-retest reliability. With good overall internal consistency.

Statistical Analysis
Descriptive analyses statistics were presented as frequency and percentages for the categorical variables, Chisquare test for contingency tables and, Fisher exact test for nonparametric Variables and by 2-tailed t-test for parametric variables data Statistical Package for Social Sciences(SPSS) version 21 was used for analysis

Ethical Consideration
The study was approved by the ethical review board of King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.

No written consent was obtained, but the cover letter at the beginning of the survey stated that the Information obtained will be used for research purposes only, and the employment status and Treatment plan would not be affected by acceptance or refusal to take part in the study.

Results
Total of two hundred and seventy-one (HCPs) filled up survey questionnaire and returned back. More than half of participants were male 56.8% compared to female 43.2%. younger and middle age group (between 20 - 40 year) represent 39% of study Participants while 5.2% only older than 50 years old participated in this study. Healthcare providers type was 16.6% physician, 2.2% of them were a pediatrician, 18% Nurses and 65% other specialties including Pharmacist, nutrition Specialist, Occupational therapist, social workers, and interestingly 7% medical Students. Also Study indicated that 57.2% of respondents thought that autism was a Neurodevelopmental disorder while 17.3% didn’t think so, and 25.5% didn’t know (Table 1) Responses were variable for the age of presentation (50.6%) stated that autism started in childhood while (30%) believe it started in infancy and (20%) commented that they were unsure (Table 2). Many of responder had misconceptions that autism is childhood schizophrenia (30%). Awareness about the core features of autism revealed that majority of responders (75%) were aware that people with autism have difficulties in language and 84% in Social interaction (Table 3,4). Most participants (75%) felt that there is a marked impairment in non-verbal behaviors such as body language and eye contact (Table 5). Moreover, 75.5% believed that people with autism have repetitive movements for instance hand flapping and 60% aware that autistic children like routine. When asked about associated symptoms, approximately half of participants 49% said that autism could be associated with mental retardation while 22% did not think there is an association, and 30% of responder not sure (Table 6). Nevertheless, 50% of the responder’s felt that autism could be associated with abnormal feeding habit while 32% were unsure and responses were almost equally distributed between participants who thought autism could be associated with convulsion 35.8% and 29.0% who didn’t believe and the 35.0% who are not sure

Discussion
This study was conducted to assess the level of awareness and knowledge about autism among health care providers across different health sitting in Saudi Arabia, Riyadh area and to identify how easy to recognize the signs and associated symptoms of autism. Also study found that physician participation were low (16.6%) comparing to non - physician (HCPs) 65%, moreover pediatrician was lower (2.2%), although pediatrician usually considered the first to receive parents’ concerns, The low rate of pediatrician participation could be explained by many factors including; survey questionnaire was distributed during autism awareness week campaign in which study group was variable depending on (HCPs)who attend the campaign not targeting specific specialty, and this was one of the study objectives to explore the knowledge across multiple health care providers.

Also study revealed that 57% of participant aware that autism is neurodevelopmental disorder, this level of awareness similar to what was mentioned in other studies (Dillenburger et al. 2013). In this study the participants are inconsistent about age of presentation 50% thought autism can presented at childhood. and this considered late recognition in which early detection and diagnosis can be easily missed which can lead to loss of opportunities to intervene early and sequentially affecting outcome negatively [8]. In addition, vast majority of study participants were knowledgeable about core features of autism and they can have recognized that children with autism has difficulties in language and social communication skills which can interfere with peer relationship in addition they are mostly preoccupied and unusual attachments to certain objects, and this observation was consistent with findings of previous studies [2], (Bakare et al. 2009). And this finding was not surprising and this could be explained by the fact that autism became the most popular disorder over the last decades that has relatively higher prevalence rate than other childhood disorders [9]

That mandate public and health care facilities awareness and attention, in addition this awareness and knowledge could partly reflect the successful yearly autism awareness Campaign that have been implemented over years in our tertiary health care facilities (KAMC/MNGHA/Riyadh) throughout month of April (International Autism awareness month) [10]. Furthermore, this study finding conducted on highly specialized tertiary care facilities that has experts in childhood developmental disorders and the study finding do not reflect the knowledge among other (HCPs) working in primary health cares or community services and rural areas, therefore Study findings cannot be generalized and this could be considered as one of study limitations. However, these findings may promote and support further researches about autism, additionally further education and increase awareness through various modes is critical to improve the knowledge about autism to facilitate early recognition and diagnosis and Better prognosis and services delivery [11].

Conclusion
In spite of the fact that autism prevalence is rising, yet the healthcare provider’s awareness and knowledge about autism was insufficient. The study findings reflect the intense efforts that have been done over the past few years’ in Saudi Arabia to raise autism awareness in public and healthcare facilities. In addition, although there were small numbers of physicians contributed in this study, yet the knowledge about ASD was relatively good among HCPs, and this can facilitate early detection of autism cases and timely referral to the right treatment path. Moreover, this study highlights the importance of autism awareness campaigns as a critical source in spreading accurate and essential information about autism.

Acknowledgment
The author acknowledges the support from the Pediatric Autism Team at King Abdulaziz Medical City in the data collection. I thank Dr. Aiiat Alwahid DBpeds Consultant for her great assistant in Preparation study questionnaire.

Conflicts of Interest
The author has no conflicts to declare. And no external fund was received.

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