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Zavaleta-Ramírez P, Rosetti MF, Albores-Gallo L, Vargas-Soberanis MA, López ON, Medina-Mora ME. Pathways to a Diagnosis of Autism Spectrum Disorder. Psychiatr Serv 2020; 71:1120-1126. [PMID: 32746716 DOI: 10.1176/appi.ps.201900518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to analyze the pathways to obtaining a diagnosis of autism spectrum disorder (ASD) within the Mexican health system. METHODS Parents of children with ASD (N=186) were approached at specialized health centers and interviewed about the sequence of professionals they contacted that led to a diagnosis. The authors established the pathway to diagnosis, time of first parental concerns, time of first consultation, age of the child at diagnosis, and other measures. A Sankey plot was used to illustrate the complexity of the pathway to diagnosis. Diagnostic delays among children with autism were compared with delays among subsamples of children with Asperger's syndrome. Regression analysis was used to evaluate the effect of socioeconomic and clinical variables on diagnostic delays. RESULTS The median diagnostic delay was 27 months (interquartile range [IQR] 8-36), and three professional contacts (IQR 3-6) were needed to achieve a diagnosis. Patients switched between primary and tertiary care even in later stages of the pathway. Patients with Asperger's syndrome had longer delays than patients with autism, and girls and older patients took more time to receive a diagnosis. Parental concerns regarding language, developmental issues, and perceived developmental regression resulted in shorter diagnostic delays. CONCLUSIONS Pathways to diagnosis of ASD are long and involve multiple contacts, with patients alternating between primary and specialized care. This pattern reflects failures in the diagnostic protocols and referral systems of clinical centers in Mexico, and such issues may be experienced in countries with similarly overwhelmed health care systems.
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Affiliation(s)
- Patricia Zavaleta-Ramírez
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Marcos Francisco Rosetti
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Lilia Albores-Gallo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Manuel Alejandro Vargas-Soberanis
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Omar Nafate López
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Maria Elena Medina-Mora
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
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Chen YL, Shen LJ, Gau SSF. The Mandarin version of the Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiological version for DSM-5 - A psychometric study. J Formos Med Assoc 2017; 116:671-678. [PMID: 28709821 DOI: 10.1016/j.jfma.2017.06.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/21/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Changes of diagnostic coverage and criteria for psychiatric disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013 cause a need for updating the Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiological version (K-SADS-E). This study examined the preliminary psychometric properties, including inter-rater reliability, and convergent and divergent validity of the modified K-SADS-E for DSM-5. METHODS A national survey of a school-based sample of 3242 students in grade 3, 5, and 7 from 44 schools was conducted in Northern, Central, and Southern Taiwan. Psychiatric diagnoses were made by the K-SADS-E interviews. Clinical questionnaires for attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and emotional and behavioral problems were examined using the Chinese version of the Swanson, Nolan, and Pelham IV scale, Social Responsiveness Scale, and Child Behavior Checklist. RESULTS The K-SADS-E showed satisfactory inter-rater reliability (prevalence adjusted bias adjusted kappa = 0.80-1.00) among eight interviewers. The diagnoses of K-SADS-E demonstrated good convergent and divergent validity with most corresponding clinical questionnaires. CONCLUSION Our finding suggests that the K-SADS-E is a reliable and valid instrument for diagnosing child and adolescent psychiatric disorders based on DSM-5. Further study will examine the sensitivity, specificity, and test-retest reliability of the K-SADS-E in clinical and community samples.
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Affiliation(s)
- Yi-Lung Chen
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lih-Jong Shen
- Department of Mental and Oral Health, Ministry of Health and Welfare, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences and Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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