Abstract:Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder. This is the first study to examine first parental concerns in ASD in Malaysia. We examined: i) age and type of first parental concerns (AOC); ii) association between AOC and severity; iii) time lag between AOC and diagnosis; and iv) factors associated with diagnostic delay.
Methods: Medical records of 366 patients (aged 1–18 years) with ASD, at the Developmental Paediatrics Clinic of University of Malaya Medical Centre (UMMC), Kuala… Show more
“…Specifically, (Koegel and Schreibman, 1976 ) reported on a child with ASD who appeared to be deaf for complex sounds (white noise) but responded to environmental sounds at normal thresholds. A review of 1st birthday home videos revealed that children with ASD often failed to orient to their name being called (Osterling and Dawson, 1994 ), have a clear preference for noise or non-verbal sounds over speech and vocalizations (Klin, 1991 , 1993 ) or frank impairment for speech sounds (Ceponiene et al, 2003 ; Jeste and Nelson, 2009 ; Bidet-Caulet et al, 2017 ; Jayanath and Ozonoff, 2020 ).…”
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by repetitive behaviors, poor social skills, and difficulties with communication. Beyond these core signs and symptoms, the majority of subjects with ASD have some degree of auditory and vestibular dysfunction. Dysfunction in these sensory modalities is significant as normal cognitive development depends on an accurate representation of our environment. The hearing difficulties in ASD range from deafness to hypersensitivity and subjects with ASD have abnormal sound-evoked brainstem reflexes and brainstem auditory evoked potentials. Vestibular dysfunction in ASD includes postural instability, gait dysfunction, and impaired gaze. Untreated vestibular dysfunction in children can lead to delayed milestones such as sitting and walking and poor motor coordination later in life. Histopathological studies have revealed that subjects with ASD have significantly fewer neurons in the auditory hindbrain and surviving neurons are smaller and dysmorphic. These findings are consistent with auditory dysfunction. Further, the cerebellum was one of the first brain structures implicated in ASD and studies have revealed loss of Purkinje cells and the presence of ectopic neurons. Together, these studies suggest that normal auditory and vestibular function play major roles in the development of language and social abilities, and dysfunction in these systems may contribute to the core symptoms of ASD. Further, auditory and vestibular dysfunction in children may be overlooked or attributed to other neurodevelopmental disorders. Herein we review the literature on auditory and vestibular dysfunction in ASD. Based on these results we developed a brainstem model of central auditory and vestibular dysfunction in ASD and propose that simple, non-invasive but quantitative testing of hearing and vestibular function be added to newborn screening protocols.
“…Specifically, (Koegel and Schreibman, 1976 ) reported on a child with ASD who appeared to be deaf for complex sounds (white noise) but responded to environmental sounds at normal thresholds. A review of 1st birthday home videos revealed that children with ASD often failed to orient to their name being called (Osterling and Dawson, 1994 ), have a clear preference for noise or non-verbal sounds over speech and vocalizations (Klin, 1991 , 1993 ) or frank impairment for speech sounds (Ceponiene et al, 2003 ; Jeste and Nelson, 2009 ; Bidet-Caulet et al, 2017 ; Jayanath and Ozonoff, 2020 ).…”
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by repetitive behaviors, poor social skills, and difficulties with communication. Beyond these core signs and symptoms, the majority of subjects with ASD have some degree of auditory and vestibular dysfunction. Dysfunction in these sensory modalities is significant as normal cognitive development depends on an accurate representation of our environment. The hearing difficulties in ASD range from deafness to hypersensitivity and subjects with ASD have abnormal sound-evoked brainstem reflexes and brainstem auditory evoked potentials. Vestibular dysfunction in ASD includes postural instability, gait dysfunction, and impaired gaze. Untreated vestibular dysfunction in children can lead to delayed milestones such as sitting and walking and poor motor coordination later in life. Histopathological studies have revealed that subjects with ASD have significantly fewer neurons in the auditory hindbrain and surviving neurons are smaller and dysmorphic. These findings are consistent with auditory dysfunction. Further, the cerebellum was one of the first brain structures implicated in ASD and studies have revealed loss of Purkinje cells and the presence of ectopic neurons. Together, these studies suggest that normal auditory and vestibular function play major roles in the development of language and social abilities, and dysfunction in these systems may contribute to the core symptoms of ASD. Further, auditory and vestibular dysfunction in children may be overlooked or attributed to other neurodevelopmental disorders. Herein we review the literature on auditory and vestibular dysfunction in ASD. Based on these results we developed a brainstem model of central auditory and vestibular dysfunction in ASD and propose that simple, non-invasive but quantitative testing of hearing and vestibular function be added to newborn screening protocols.
“…As shown in Figure 2 , 13 of the 30 included studies were conducted in upper-, middle-, and lower-income countries. 18–29 The other 16 studies were conducted in high-income countries, including six in the US, 20 , 30–34 four in the United Kingdom (UK), 35–37 two in Spain, 21 , 22 two in Germany, 38 , 39 two in Australia, 23 , 24 and one in Saudi Arabia. 40 Figure 2 Distribution of means according to the level of development of the countries in the studies.…”
Section: Resultsmentioning
confidence: 99%
“… 33 However, in the Venezuelan study, higher social and economic status and higher parental education levels were associated with earlier diagnosis. 48 Whereas, Jayanath and Ozonoff’s 18 Malaysian study showed that sociodemographic factors were associated with a later diagnosis. One study found that Hispanic children in the US tended to receive services for ASD later than non-Hispanic White children.…”
Section: Resultsmentioning
confidence: 99%
“…The first signs and symptoms were described in several studies. 18 , 23 , 28 , 35–37 , 42 , 45 , 46 , 50 Speech delay was the most recognized concern between high-income (50.3%) and low/middle-income countries (53.5%), as described in Figure 4 . Figure 4 Proportion of early signs reported by study.…”
Section: Resultsmentioning
confidence: 99%
“…As shown in Figure 2, 13 of the 30 included studies were conducted in upper-, middle-, and lower-income countries. [18][19][20][21][22][23][24][25][26][27][28][29] The other…”
Purpose
This study aimed to assess whether high-income countries have a lower mean age at the time of diagnosis of autism spectrum disorder (ASD) than low- and middle-income countries.
Method
We reviewed studies related to ASD diagnoses and the time of first concerns in low-, middle-, and high-income countries, published in PubMed, SciELO, Lilacs, and ScienceDirect. Thirty articles were included: 13 from low- and middle-income countries and 17 from high-income countries.
Results
The average delay between initial concerns and diagnosis was 32.33 months, with initial concerns averaging 23.64 months and diagnosis at 55.97 months. No statistical differences were found between countries with low-, middle-, and high-income.
Conclusions
This review found a considerable delay in ASD diagnosis despite an early presence of recognized signs and symptoms. It highlights the urgent need for standardized tools for early ASD diagnosis.
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. Despite the absence of a cure, early diagnosis and intensive early intervention can improve the outcomes. However, little is known about the median age at ASD diagnosis in Malaysia or the child/family characteristics associated with early diagnosis. Therefore, this study aimed to determine the median age at ASD diagnosis among Malaysian children presenting to the country's largest public tertiary neurodevelopmental center and to investigate the possible demographic, child, and family characteristics associated with an early age at diagnosis. Data were collected between February 2017 and February 2019 from a database maintained by the child development unit of the country's largest publicly funded tertiary hospital, containing data from an ethnically diverse population. Among Malaysian children attending the clinic, the median age at ASD diagnosis was 48 months. Early autism diagnosis (<36 months of age) was associated with increased severity of social communication and interaction impairments, coexisting intellectual impairment, children from high socioeconomic status families, and children who receive joint care from their families and a maid or babysitter. The study findings highlight the socioeconomic inequalities in the country, a lack of parental awareness of early ASD signs, and the presence of cultural influences on the age at diagnosis of ASD.
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