Missed Diagnosis of Autism in an Australian Indigenous Psychiatric Population

Abstract

Autism spectrum disorders may be missed in Indigenous population groups. This has implications for treatment and service provision. Clinicians need to be mindful of the diagnostic possibility that an autism spectrum disorder might be masquerading as schizophrenia in the context of intellectual disability and atypical presentation.

Under-detection of autism among First Nations children in British Columbia, Canada

“…Research results from international publications offer possible explanations. Autism may present itself in such a manner that it is mistaken for something else, such as schizophrenia (Roy & Balaratnasingam, 2010), but the presentation of autism can also be affected by culture (Mandell & Novak, 2005). Publications indicate that ethnic and cultural factors such as possible differences in genetic vulnerability (Byrstyn et al, 2010) and how parents and others view the ways autism presents itself (Kapp, 2011) Along with contextual cultural aspects there is need for structure in the diagnosis procedure (Begeer et al, 2009).…”

“…Publications indicate that ethnic and cultural factors such as possible differences in genetic vulnerability (Byrstyn et al, 2010) and how parents and others view the ways autism presents itself (Kapp, 2011) Along with contextual cultural aspects there is need for structure in the diagnosis procedure (Begeer et al, 2009). In Australia culture and language barriers are considered a possible factor in the underdiagnosis of autism within the aboriginal population (Roy & Balaratnasingam, 2010), which may also be the case in BC. Living in remote areas with poor access to diagnostic and treatment facilities is mentioned in publications from Canada and Australia (Burstyn et al, 2010;Leonard et al, 2011).…”

“…Ethnic bias in autism referral was found in Australia where aboriginal children were more likely to be diagnosed with intellectual disability (Leonard et al, 2011;Roy & Balaratnasingam, 2010). In some ethnic groups it appears that professionals do not further investigate developmental aspects if the child has intellectual disability (Mandell et al, 2009).…”

“…Roy and Balaratnasingam (2010) argue that adult indigenous Australian psychiatric patients have been diagnosed with schizophrenia due to autism symptoms of deficits in social interactions and stereotyped interests masking or presenting themselves as a psychotic episode. Of 215 patients diagnosed with schizophrenia, 14 were selected for an evaluation from a psychiatrist specializing in intellectual ability and the developmental history of the patients were taken into consideration.…”

“…Australian researchers Roy and Balaratnasingam (2010) emphasize that etiological factors are important in diagnosing ASDs and mention Fetal Alcohol Syndrome, FAS, as an important factor due to high alcohol use among indigenous people and stress the need for structure to accurately assess autism within the indigenous population. In the Netherlands…”