Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico.
Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Clin Child Psychol Psychiatry. 2024 Jan;29(1):232-244. doi: 10.1177/13591045231193817. Epub 2023 Aug 4.
Low- and middle-income countries face heterogeneity in the way clinicians' approach Autism Spectrum Disorder (ASD) diagnosis and treatment. The current study analyzes the diagnostic tools, laboratory tests, pharmacological and psychosocial interventions received by patients during the steps to diagnosis and treatment of two specialized care centers. Researchers interviewed families with a child with ASD receiving services at either a child psychiatric or a pediatric hospital. Of the total sample, 47% reported clinicians not using a diagnostic tool, 20% reported not receiving any psychosocial intervention, and 88% reported receiving a pharmacological prescription. Patients at the pediatric hospital were more likely to receive interventions with some components of Applied Behavioral Analysis, Early Start Denver Model, Treatment and Education of Autistic and Related Communication Handicapped Children, and Sensory integration therapy; while patients at the psychiatric hospital were more likely to undergo learning, daily living skills, and socialization therapies. Patients at the psychiatric hospital received significantly more requests to obtain auditory and vision tests whilst genetic testing and imaging were more common in the pediatric hospital. The range and variability in terms of diagnostic tools, laboratory tests, and treatment options observed for both sites reflect a lack of consensus. Recommendations to improve ASD diagnostic and treatment in Mexico are given.
中低收入国家的临床医生在自闭症谱系障碍 (ASD) 诊断和治疗方法上存在异质性。本研究分析了两个专门护理中心在诊断和治疗步骤中患者接受的诊断工具、实验室检查、药物和心理社会干预措施。研究人员对在儿童精神病院或儿科医院接受服务的自闭症儿童家庭进行了访谈。在总样本中,47%的报告称临床医生未使用诊断工具,20%的报告称未接受任何心理社会干预,88%的报告称接受了药物处方。在儿科医院的患者更有可能接受应用行为分析、丹佛早期启动模式、自闭症及相关沟通障碍儿童的治疗和教育、感觉统合治疗等部分干预措施;而在精神病院的患者更有可能接受学习、日常生活技能和社交疗法。在精神病院的患者接受听觉和视觉测试的请求明显更多,而儿科医院则更常见基因检测和影像学检查。两个地点在诊断工具、实验室检查和治疗选择方面的范围和可变性反映出缺乏共识。为改善墨西哥的 ASD 诊断和治疗提出了建议。