Pediatric Rehabilitation Fellow EsSalud Lima, Lima, Peru
Objectives: To describe the characteristics of children with autism spectrum disorder (ASD) treated at the Pediatric Rehabilitation Service of Edgardo Rebagliati Martins National Hospital (PRS-ERMNH) in Peru.
Design: Cross-sectional descriptive study. Electronic medical records of children under 14 years of age with ASD treated at the PRS-ERMNH during 2022 were reviewed. The child developmental assessment in those under five years of age was conducted using the REBA-PED screening test. The collected data from the Excel spreadsheet was imported into the R software. Numeric variables were reported as means and standard deviations or medians and interquartile ranges. Categorical variables were presented as absolute and relative frequencies.
Results: 120 children with ASD were evaluated. The median age was five years, and mostly were male and received general or inclusive education. The median age of ASD diagnosis was 3.83 years. 77.5% did not have disability documentation. 78.3% did not have a complete psychological evaluation. Less than half received physical therapy. The median time since the last physical, occupational and speech and language therapy sessions was 3, 8 and 3.5 months, respectively. In child developmental assessment in those under five years of age, 53.5% exhibited a global developmental delay, 19.5% had a significant delay, and 12.4% had a mild delay. Additionally, 70.8% displayed some warning signs of developmental delay. 71.8% had no comorbidities, and in those who did, the most common was Attention Deficit Hyperactivity Disorder (12.5%).
Conclusions: The median age of ASD diagnosis was over three years, and more than 75% of patients did not have a complete psychological assessment or disability documentation. Some were not receiving rehabilitation therapies, and the median time since the last session varied between three and eight months. These findings emphasizes the need to enhance early diagnosis, inclusive education and disability documentation strategies, as well as to establish more timely rehabilitation interventions.
Scientific Paper Best Paper Award Abstract:
Objectives: Autism spectrum disorder (ASD) is characterized by developmental delays, difficulties in social interaction and communication, and restrictive and repetitive patterns. Despite its high prevalence, few studies have been conducted in Physical Medicine and Rehabilitation (PM&R) settings. The aim of this study was to describe the characteristics of children with ASD treated at the Pediatric Rehabilitation Service of Edgardo Rebagliati Martins National Hospital (PRS-ERMNH) in Peru.
Design: We conducted a cross-sectional descriptive study based on information from the electronic medical records of children under 14 years of age diagnosed with ASD and treated at PRS-ERMNH between January 1st and December 31st, 2022. The child developmental assessment in those under five years of age was conducted using the Rebagliati Hospital Child Development Assessment Profile (REBA-PED) screening test. Following the approval of the ethics committee, we requested the list of all children with a confirmed diagnosis of ASD who were seen in medical consultation in 2022 at PRS-ERMNH. Subsequently, we manually reviewed the electronic medical records to extract the relevant data into a Microsoft Excel database. We imported the collected data from the Excel spreadsheet into the R software, version 4.1.0, where we performed all the analyses and generated graphs. Numeric variables were presented as means and standard deviations or medians and interquartile ranges (IQR), depending on the data distribution as determined by normality tests. Categorical variables were presented with absolute and relative frequencies.
Results: We evaluated 120 children aged 14 or younger diagnosed with Autism Spectrum Disorder (ASD) in 2022 at PRS-ERMNH. The median age was five years (IQR 4-7), with a majority being male (79.2%) and coming from Lima (90.0%). Most attended general (63.54%) or special (29.17%) education. Among those in general education, only 6 (9.84%) received inclusive education. Regarding health, the majority had normal weight for their age (79.2%) and appropriate height for their age (95.0%). Behavioral issues were seen in 24.2%, and musculoskeletal disorders in 12.5%. Of the 27 children with IQ assessments, most had mild (48.1%) or moderate (37.0%) intellectual disabilities. The most common ICD-10 codes used were F84.0 (87.5%) and F84.5 (6.67%). The median age of ASD diagnosis was 3.83 years (IQR 3-5), with Neurology (42.5%) and Psychiatry (26.7%) being the most frequent specialties for diagnosis. However, 77.5% did not have disability documentation, with a median time of 1 year (IQR 0-2) since diagnosis. Most had previous evaluations by Neurology (60.0%) and Psychiatry (64.2%). However, 78.3% had incomplete psychological evaluations. Some children received private therapies (26.7%), with 49.2% receiving physical therapy, 95.0% occupational therapy, and 90.0% speech therapy. The median time since the last rehabilitation session varied by type: 3 months for physical therapy (IQR 1-6), 8 months for occupational therapy (IQR 1-24), and 3.5 months for speech and language therapy (IQR 1-20). In the child developmental assessment in those under five years of age, 53.5% had a global developmental delay, 19.5% had a significant delay, and 12.4% had a mild delay. Additionally, 70.8% displayed some warning signs of developmental delay. Regarding comorbidities, 71.8% had none, and the most common was Attention Deficit Hyperactivity Disorder (12.5%), followed by neurological malformations (9.2%), epilepsy (4.2%), insomnia (3.3%), anxiety (1.7%), and depression (1.7%). Psychiatry (33.3%), Pulmonology (13.3%), Neurology (12.5%), Genetics (10.0%), and Gastroenterology (10.0%) were the medical specialties with the most patient visits. The most frequently used medications were antipsychotics (35.8%), primarily risperidone, antihistamines (10.8%), salbutamol (10.8%), methylphenidate (6.7%), and antiepileptics (5%).
Conclusions: This study provides an in-depth insight into the characteristics of children with ASD treated at PRS-ERMNH in Peru during 2022. The median age at the diagnosis of ASD was over three years, and over 75% of patients did not have a complete psychological evaluation or disability documentation. In less than 10% of those receiving regular education, it could qualify as inclusive. Some were not receiving rehabilitation therapies, and the median time since the last session varied between three and eight months, depending on the type. These findings highlight the urgent need to enhance early diagnosis, inclusive education and disability documentation strategies for children with ASD, as well as to establish more timely PM&R interventions in the Peruvian context.
