Understanding Physicians’ Perceptions and Attitudes about Autism Spectrum Disorder in Santa Cruz, Bolivia. Raquel Bravo-Clouzet MD. MPH., Kanchana S. Boseroy, MD. FAAP Tucson Medical Center, Tucson Hospitals Medical Education Program, AZ Sociedad Cruceña de Pediatria, Santa Cruz, Bolivia Introduction: The term autism is in use since 1911. One century has passed and countries like Bolivia still lack formal screening for the early identification and diagnosis of children with Autism Spectrum Disorder (ASD). International data reveal Bolivia ranks near the bottom among Latin American countries on health and education. The prevalence rate by the CDC (internationally) is that approximately 1 in 59 children are diagnosed with ASD. Researching available peer-reviewed literature, no prevalence rate of ASD in Bolivia could be obtained. As an initial step, it is important to understand Physicians' knowledge and attitude about ASD and then further steps can be taken to initiate formal screening in order to increase early diagnosis. Methods: A survey was developed to aid in understanding the knowledge and use of screening tools among Physicians in Santa Cruz, Bolivia. Santa Cruz has approximately 1000 pediatricians. An institutional agreement was made between Tucson Hospitals Medical Education Program and the Sociedad Cruceña de Pediatria to conduct a multiple-choice question survey with 18 questions among pediatricians and other primary care physicians. Questions included general demographics, current practice on the screening of patients with ASD, their perception about their knowledge of screening/ evaluation of ASD, their confidence in diagnosis, and their interest in future training. Two hundred fifty-five surveys were completed. Results: Only 24 % of the physicians that answered the survey use a formal screening for ASD; 88% recognized that a formal screening method would increase the diagnoses of ASD; 85% stated they could implement a 5-10 minute screening questionnaire at 18 and 24 months visits; 74% felt “poorly prepared” or “not prepared at all” and only 4% felt “prepared” to diagnose ASD in their patients. A majority of the respondents, 89% are interested in attending a seminar to increase their knowledge in screening/diagnosis of ASD. Conclusions: Physicians in Santa Cruz, Bolivia self-identify as not being confident in using screening tools and diagnosing ASD and are very interested in acquiring knowledge about screening, identification/ evaluation of ASD. The next step of this project includes seminars/workshops to professionals to improve their knowledge in the identification of children with ASD, to decrease the age of identification.

Bland-Altman plot Comparison of assignment of gestational age by trainees and trainer using Bland Altman plot. Mean difference = -0.47, Limits of agreement = (-3.56,2.63), Averages lie between 34.37 and 39.39 weeks. Pre- and Post-Training Survey Results of surveys administered to 20 trainees before and after training in the Dubowitz gestational age assessment.

Bland-Altman plot Comparison of assignment of gestational age by trainees and trainer using Bland Altman plot. Mean difference = -0.47, Limits of agreement = (-3.56,2.63), Averages lie between 34.37 and 39.39 weeks. Pre- and Post-Training Survey Results of surveys administered to 20 trainees before and after training in the Dubowitz gestational age assessment.

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Improving Identification and Diagnosis The vast majority of respondents (88%) agreed that a formal screening method would increase diagnoses of ASD; at the same time, two-thirds of them did not use any standardized questionnaire but were willing to you implement a 5-10 minute screening questionnaire at 18 and 24 months visits (85%). How prepared do you feel to diagnose Autism in your patients?Of all respondents 74% felt “poorly prepared” or “not prepared at all” and only 4% felt “prepared” to diagnose ASD in their patients.

Improving Identification and Diagnosis The vast majority of respondents (88%) agreed that a formal screening method would increase diagnoses of ASD; at the same time, two-thirds of them did not use any standardized questionnaire but were willing to you implement a 5-10 minute screening questionnaire at 18 and 24 months visits (85%). How prepared do you feel to diagnose Autism in your patients?Of all respondents 74% felt “poorly prepared” or “not prepared at all” and only 4% felt “prepared” to diagnose ASD in their patients.

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