Jayanath Subhashini, Ozonoff Sally
Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Psychiatry and Behavioral Sciences, UC Davis MIND Institute, Sacramento, USA.
Malays J Med Sci. 2020 Oct;27(5):78-89. doi: 10.21315/mjms2020.27.5.8. Epub 2020 Oct 27.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder. This is the first study to examine first parental concerns in ASD in Malaysia. We examined: i) age and type of first parental concerns (AOC); ii) association between AOC and severity; iii) time lag between AOC and diagnosis; and iv) factors associated with diagnostic delay.
Medical records of 366 patients (aged 1-18 years) with ASD, at the Developmental Paediatrics Clinic of University of Malaya Medical Centre (UMMC), Kuala Lumpur, were reviewed for this 16-month retrospective cohort study. A validated coding system was used for initial parent concerns. Severity was classified via the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) criteria. Time lag between AOC and age at diagnosis (AOD) was calculated. Potential predictors of delayed diagnosis were extracted.
Three-quarters (75.1%) of parents had concerns by 36 months. Speech/language/communication concerns were most frequent (60.1%). Number of first concerns was significantly correlated with severity (social communication/interaction, SCI [ = 0.019] and restricted, repetitive patterns of behaviours and/or interests/activities, RRB [ < 0.001]). AOC and AOD were significantly negatively correlated with SCI and RRB ( < 0.001). Medians; AOC: 24 months, AOD: 46 months and time lag: 17 months. Higher initial screen time was associated with diagnostic delay ( = 0.031).
First parental concerns and AOD were comparable to studies across countries. Speech/communication delays may represent universal first parental recognition of ASD.
自闭症谱系障碍（ASD）是一种神经发育障碍。这是第一项在马来西亚研究家长对ASD的首要担忧的研究。我们研究了：i）家长首要担忧的年龄和类型（AOC）；ii）AOC与严重程度之间的关联；iii）AOC与诊断之间的时间间隔；以及iv）与诊断延迟相关的因素。
对吉隆坡马来亚大学医学中心（UMMC）发育儿科诊所的366例年龄在1至18岁之间的ASD患者的病历进行了为期16个月的回顾性队列研究。使用经过验证的编码系统来记录家长最初的担忧。根据《精神疾病诊断与统计手册》第5版（DSM-5）标准对严重程度进行分类。计算AOC与诊断年龄（AOD）之间的时间间隔。提取诊断延迟的潜在预测因素。
四分之三（75.1%）的家长在36个月时就有担忧。言语/语言/沟通方面的担忧最为常见（60.1%）。首要担忧的数量与严重程度显著相关（社交沟通/互动，SCI[=0.019]以及局限的、重复的行为模式和/或兴趣/活动，RRB[<0.001]）。AOC和AOD与SCI和RRB显著负相关（<0.001）。中位数；AOC：24个月，AOD：46个月，时间间隔：17个月。较高的初始筛查时间与诊断延迟相关（=0.031）。
家长的首要担忧和AOD与各国的研究结果相当。言语/沟通延迟可能是家长对ASD普遍的首要认知表现。
