[Early detection and stability of diagnosis in autism spectrum disorders]. / Deteccion precoz y estabilidad en el diagnostico en los trastornos del espectro autista.

INTRODUCTION: Early intervention for children with an autism spectrum disorder (ASD) depends on early and reliable detection. In general, diagnosis is stable, but evidence shows the need to go deeper into the factors that influence this stability. PATIENTS AND METHODS: A sample of 142 children with ASD (118 boys and 24 girls) with a median of 33 months of age and an interquartile range of 12 in the first evaluation. In the follow-up the median was 47 months and an interquartile range of 29. The following tests were applied to evaluate the children: Merrill-Palmer Scale-R, Leitter-R, WIPPSI-III, WISC-R and WISC-IV; as well as Vineland Scale and ADOS-G, based on clinical diagnosis to DSM-IV-R and DSM-5. For the evaluation of the diagnostic stability, contingency tables were performed for diagnostic assessments based on clinical judgment and the results of the ADOS-G. Repeated measures ANOVA was used to analyze the differences between measures of cognitive functioning, adaptive behavior and diagnosis. RESULTS: The clinical diagnosis based on DSM-IV-TR, DSM-5 and clinical judgment remains stable over time in 96% of cases. If the diagnostic stability is measured based on the results of ADOS-G (n = 30), 87% of cases diagnosed maintained the diagnosis. The ANOVA showed statistically significant differences for measures of within-subject factors and global social age, but not for diagnosis. CONCLUSION: The diagnostic stability can be improved by utilizing clinical judgment and the participation of a multidisciplinary team.

TITLE: Deteccion precoz y estabilidad en el diagnostico en los trastornos del espectro autista.Introduccion. La intervencion temprana en los niños con un trastorno del espectro autista (TEA) depende de una deteccion precoz y fiable. Aunque de manera general se habla de un diagnostico estable, se ha evidenciado la necesidad de profundizar mas en los factores que influyen en dicha estabilidad. Pacientes y metodos. Los participantes de la muestra fueron 142 menores con TEA (118 varones y 24 mujeres), con una mediana de 33 meses y un recorrido intercuartilico de 12 en la primera evaluacion, y con una mediana de 47 meses y un recorrido intercuartilico de 29 en el seguimiento. Los diagnosticos se realizaron con las siguientes pruebas: escala Merrill-Palmer revisada, escala de Leiter revisada, escala de inteligencia de Wechsler para preescolar y primaria III y escala de inteligencia de Wechsler para niños revisada y IV; ademas de la escala Vineland y la escala de observacion diagnostica del autismo generica (ADOS-G), basandose el diagnostico clinico en los criterios diagnosticos del Manual diagnostico y estadistico de los trastornos mentales, cuarta edicion, texto revisado (DSM-IV-TR), y quinta edicion (DSM-5). Para la evaluacion de la estabilidad diagnostica, se realizaron tablas de contingencia para las valoraciones del diagnostico en funcion del juicio clinico y los resultados de la ADOS-G. Resultados. El diagnostico clinico basado en los criterios del DSM-IV-TR, el DSM-5 y el juicio clinico se mantiene estable a traves del tiempo en un 96% de los casos. Si se valora la estabilidad diagnostica teniendo en cuenta los resultados del ADOS-G (n = 30), el 87% de los casos mantiene el diagnostico. El ANOVA muestra diferencias estadisticamente significativas para las medidas del factor intrasujeto del cociente intelectual y la edad social global, pero no para el diagnostico. Conclusiones. La estabilidad diagnostica se beneficia de un uso informado del criterio clinico y de la participacion de un equipo multidisciplinar.

[Pervasive developmental disorders screening program in the health areas of Salamanca and Zamora in Spain]. / Programa de detección precoz de trastornos generalizados del desarrollo en las áreas de salud de Salamanca y Zamora.

OBJECTIVE: To evaluate the results of the Pervasive Developmental Disorders (PDD) screening program currently ongoing in the public health services in the health area of Salamanca and Zamora, Spain, in terms of feasibility, reliability and costs, with the purpose of extending the program at regional and national levels. METHOD: A total of 54 paediatric teams (nurses and paediatricians) from the provinces of Salamanca and Zamora participated in the training sessions for the PDD Screening Programme in September 2005, and agreed to administer the questionnaire M-CHAT(1) to all parents attending their clinics in any of these two visits: 18 months and/or 24 months within the Well-baby Check-up Program. A total of 9,524 children have participated up to December 2012. Additionally, we evaluated the participation and opinions of the paediatric teams using questionnaires, and costs per positive case have estimated. RESULTS: Out of a total of 852 (8.9%) children determined as PDD high-risk with the M-CHAT questionnaire results, 61 (7.1%) were confirmed as positive with the M-CHAT follow-up interview. Of these, 22 were diagnosed with a PDD and 31 other disorders of childhood onset according to DSM-IV-TR(2). Almost three-quarters (74%) of respondents felt the program was totally feasible, and 22% viable, but with reservations (n=54). CONCLUSIONS: This study has been able to show for the first time in Spain, the feasibility of a population-based PDD screening program within the public health system. Training in social and communicative development, and dissemination of the early signs of PDD among paediatricians, as well as the use of the M-CHAT, is essential for progress in the early detection of these disorders.