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      Symptom Recognition to Diagnosis: Pathway to Care for Autism in a Tertiary Care Medical Centre

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          Abstract

          Objective  There is no systematic report on pathway to care in autism from tertiary care medical centers of India. The present study was aimed to evaluate the pathways to care among parents of children with autism-seeking treatment at a tertiary care medical center.

          Methods  Cross-sectional, observational study involving parents of 38 children with autism spectrum disorder diagnosed with INCLEN diagnostic tool. Pathway to care was assessed using World Health Organization Encounter Form.

          Statistical Analysis   IBM Statistical Package for Social Sciences (SPSS) 20.0 was used for analysis; categorical variables were assessed using Chi-square test keeping statistical significance at 0.05%.

          Results  A total of 74% parents reported going to a general practitioner and 13% reported going to a child psychiatrist as point of first contact. Among them, 71% parents reported seeking care with a child psychiatrist in a tertiary medical center at the fourth point of contact. Also, 84% parents believed in biomedical explanation of autism. Majority of parents sought for speech therapy and medicines for their child with autism which is in tune with their biomedical explanation. Parents were the first to identify developmental concerns, average age of symptom recognition being 2.2 years. Average age of intervention initiation was 40 months, 8 months prior to diagnosis of autism.

          Conclusions  Early symptom recognition and initiation of interventions is encouraging. Despite having a biomedical explanation of autism and ability to recognize developmental concerns, there is a lag of 4 years in diagnosis and reaching a specialized child psychiatry setup. This lag is a cause of concern owing to the impact on access to evidence-based interventions.

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          Most cited references14

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          From Kanner to DSM-5: autism as an evolving diagnostic concept.

          Seven decades have elapsed since Leo Kanner described the syndrome he termed early infantile autism. Over this time, and particularly over the past two decades, noteworthy changes have occurred in how the condition is conceptualized. Here we provide an overview of these changes, beginning with a brief discussion of the significance of classification in general before discussing Kanner's original paper and subsequent changes. We touch on relevant issues, such as comorbidity, dimensional aspects of diagnosis and screening, and the complex issue of diagnosis relative to eligibility for services. Approaches to diagnosis have tended to swing from emphasizing overarching groups (lumping) to focusing on potentially distinct subgroups (splitting). Autism raises particular problems given the broad range of syndrome expression over age and developmental level. The most recent revision of the American Psychiatric Association's diagnostic taxonomy marks a significant departure from its predecessor and has been the focus of much debate. It remains unclear which of the currently existing categorical approaches will ultimately be most widely applied. We hope to convey a sense of areas in which consensus has been achieved and areas of continued controversy.
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            The pathways to psychiatric care: a cross-cultural study.

            This paper describes the referral pathways taken by 1554 patients newly referred to the mental health services in 11 countries, and documents factors associated with delays in referral. The pathways in centres relatively well provided with psychiatric staff were dominated by general practitioners and to a lesser extent hospital doctors: the relatively less well resourced centres showed a variety of pathways with native healers often playing an important part. Delays were remarkably short in all centres regardless of psychiatric resources, but in some centres we found longer delays on pathways involving native healers. Somatic problems were a common presentation in all centres, and in some centres there was a tendency for patients presenting with somatic problems to have longer delays than those with symptoms of depression or anxiety. The implications of these findings are discussed in the context of an ongoing programme of WHO research activities aimed at improving the quality of mental illness care available in community settings.
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              The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting

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                Author and article information

                Journal
                J Neurosci Rural Pract
                J Neurosci Rural Pract
                10.1055/s-00043281
                Journal of Neurosciences in Rural Practice
                Thieme Medical and Scientific Publishers Private Ltd. (A-12, Second Floor, Sector -2, NOIDA -201301, India )
                0976-3147
                0976-3155
                January 2020
                03 March 2020
                : 11
                : 1
                : 164-169
                Affiliations
                [1 ]Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
                [2 ]Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
                Author notes
                Address for correspondence Suravi Patra, MD Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, Odisha, 751019India patrasuravi@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-6017-5222
                Article
                JNRP1900093
                10.1055/s-0040-1701778
                7055625
                32140022
                092232a0-b3ab-4aa4-a0ea-75a813256ae0

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

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                Original Article

                Neurosciences
                autism,pathway to care,india
                Neurosciences
                autism, pathway to care, india

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