Identification of Early Clinical Features of Autism Spectrum Disorders in Bangladeshi Children- A Cross Sectional Study - Abstract
Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopment disorders with a heterogeneous spectrum of clinical symptomatology related to social interaction and communication. Autism usually appears in children within first three years of life during maximum neuronal development of brain. Several studies showed that children diagnosed before age three had the least stable diagnoses and the most positive outcomes. They explain that early diagnosis of ASD in children and early intervention (i.e., before age three years) appear to have the greatest benefit regarding the disappearance of core symptoms. Therefore, it could be possible to minimize the severity of ASD which lead to our interest to identify the early clinical features of autism spectrum disorder in Bangladeshi children.Aims: To evaluate the early clinical features of autism spectrum disorder before 3 years of age in Bangladeshi children. Method: It was retrospective cross-sectional type of study which was conducted in Department of Paediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka
without interrupting standard care practiced of the department. The duration of the study was one year from October 2021 to September 2022. Children age 3 to 10 years who fulfilled the diagnostic criteria of autism (DSM-5) were selected and enrolled in this study. In confirmed cases of ASD, retrospectively parents of ASD children were asked regarding the early clinical features of their child in Department of Paediatric Neurology, BSMMU. Data were collected in pre-designed structured questionnaire. The study was approved by the Institutional Review Board of BAMMU. In addition, an informed written consent was signed by the parents or the legal guardians of the studied subjects. Data analysis was performed by Statistical Package for Social Science (SPSS), version-22. Results were presented as text and tables. Results: The mean age presentation was 4.27±1.99 years ranged from 2 to 11 years. Almost three fourth 58(72.5%) of patients were male and 22(27.5%) were female and male female ratio was 2.6:1. About three fourth of patients 62(77.5%) were came from urban area of Bangladesh. About three fourth (73.8%) of babies’ mode of delivery was LUCS, thirteen (16.3%) patients had perinatal asphyxia and 8(10.0%) had history of low birth weight.The mean father’s age was 37.7±6.67 years ranged from 26 to 60 years. The mean mother’s age was 29.92±5.82 years ranged from 20 to 45 years. Almost half (48.8%) of the father had completed graduation and above. More than one third (35.0%) of mother had completed graduation and above. The mean age of identification of early ASD features that first observed by mother was 19.9±7.8 month ranged from 12 to 48 months. Nearly three fourth 57(71.2%) of patients had speech delay in comparison to their chronological age followed by speech regression 49(61.2%) in more than half of the cases. No children were observed any social interaction (100%), eye contact (100%), response to call (100%) and joint attention (100%) during first attention of mother. Besides this, joint attention were absent in 76(95%) and stereotyped hand movement were present in 30 (37.5%) cases. ADHD 30 (37.5%) and sleep disturbance 30 (37.5%) were most common co-morbidities in the studied children. Conclusion: The mean age of early ASD features in studied children that first observed by mother was 19.9±7.8 month. During first observation, no children had any social interaction, eye to eye contact, response to call and joint attention. Among other early clinical features speech delay were found in about three-fourth of children and speech regression in more than half and abnormal stereotyped hand movement were found in about one-third cases.