The identification and diagnosis of children with autism currently rely on behavioral presentation and developmental history. Cultural norms and other socio-demographic factors can influence what is expected or non-expected behaviors in a developing child. Perceptions, beliefs, and causal attribution of early signs can influence families’ help-search behaviors. Lack of recognition of autism’s first manifestations can critically delay the age of diagnosis, the provision of informed guidance to families, and the implementation of adapted interventions during the critical period of early development. Furthermore, a lack of understanding of early signs as the manifestations of a developmental condition may increase stigma and non-conventional explanations. Still, cultural and socio-demographic factors are largely understudied, particularly in low-and middle-income settings. Based on the hypothesis that non-specialists such as family members and friends are one of the first sources of referral in Latin American contexts, we aimed to study the general population’s perceptions and the explanatory causes of autism’s early signs. One-hundred-and-eighty-three Ecuadorian adults responded to a questionnaire developed for this study, describing sixteen ASD-related behaviors. Results indicated that, with the exemption of language impairment and self-injurious behaviors, a substantial proportion of participants did not endorse many behaviors as “concerning and requiring professional attention.” Also, language impairment was the only behavior identified as related to a developmental disorder. Additionally, most participants attributed the majority of behaviors listed in the questionnaire to causes unrelated to ASD, such as child personality. We discuss the impact of those findings in clinical practice and on awareness programs.

Individuals with special education needs have been particularly affected by the COVID-19 pandemic as they have been shown to be at high risk of losing medical and institutional support at a time when people are being asked to stay isolated, suffering increased anxiety and depression as a consequence. Their families have often found themselves under tremendous pressure to provide support, engendering financial hardship, and physical and emotional strains. In such times, it is vital that international collaborations assess the impact on the individuals and their families, affording the opportunity to make national and international comparisons of how people have coped and what needs to be done to optimize the measures taken by families, associations and governments. This paper introduces one such collaboration.

Early identification of children with autism is necessary to support their social and communicative skills and cognitive, verbal, and adaptive development. Researchers have identified several barriers to early diagnosis. Data collected in low- and middle-income contexts—where the vast majority of children in the world live—is scarce. In Ecuador, as in many other countries, estimates are lower compared to the global prevalence. Health authorities estimate a prevalence of 0.28% (0.18%–0.41%) in children aged five years old or less. Based on the hypothesis that, as in many parts of the world, children in Ecuador are not routinely screened and that this situation may result from poor recognition of this condition, our objective was to identify potential obstacles to case identification in pediatric settings. Several barriers, consistent with those identified in other countries, were reported by 153 participants on a survey, including lack of time, lack of resources to refer, fear of unnecessarily alarming families, and lack of information to guide families with concerns. The vast majority of participants are aware of the need for a screening tool for autism detection but report a lack of knowledge of its formal application. Most of the barriers reported in this study could be overcome by educational programs tailored to professional needs in order to support the well-being of children with autism and their families.

Los trastornos del neurodesarrollo corresponden a un grupo de cuadros clínicos de base neurobiológica. En el caso particular del trastorno del espectro autista (TEA), las dificultades centrales están dadas por deficiencias de la comunicación / interacción social y por la presencia de patrones de comportamiento restrictivos o repetitivos. El diagnóstico y el tratamiento se basan actualmente en criterios comportamentales. Según datos recogidos en diferentes países, al menos 1 niño sobre 100 se desarrolla con alguna forma de autismo. Visto los resultados positivos asociados con las intervenciones tempranas, desde hace algunos años se realizan importantes esfuerzos con el objetivo de disminuir la edad la identificación. En entornos pediátricos es indispensable una familiarización con los criterios actuales de diagnóstico, los procesos de evaluación comportamental y etiológica, las condiciones médicas y comportamentales asociadas (trastornos del sueño y de la alimentación, convulsiones, síntomas gastrointestinales) que afectan la funcionalidad y la calidad de vida del niño y su familia. Con el objetivo de promover prácticas basadas en evidencia sobre identificación y diagnóstico, varias guías clínicas y estándares de práctica han sido publicados en diferentes países. El siguiente artículo revisa y sintetiza estas recomendaciones sobre la identificación y el diagnóstico del TEA en los primeros años de vida. Esta revisión ha sido efectuada a la luz de recomendaciones de la comunidad internacional que recalcan la necesidad de programas y servicios locales basados en evidencia y sensibles culturalmente, particularmente en contextos de medianos y bajos ingresos.