Indian Journal of Psychological Medicine

COMMENTARY
Year
: 2019  |  Volume : 41  |  Issue : 1  |  Page : 91--92

Psychiatrist's perspective: Invited commentary on “Early diagnosis and intervention for autism spectrum disorder: Need for pediatrician–child psychiatrist liaison”


Varghese P Punnoose 
 Department of Psychiatry, Government TD Medical College Alappuzha, Kerala, India

Correspondence Address:
Dr. Varghese P Punnoose
Department of Psychiatry, Government TD Medical College Alappuzha - 688 005, Kerala
India




How to cite this article:
Punnoose VP. Psychiatrist's perspective: Invited commentary on “Early diagnosis and intervention for autism spectrum disorder: Need for pediatrician–child psychiatrist liaison”.Indian J Psychol Med 2019;41:91-92


How to cite this URL:
Punnoose VP. Psychiatrist's perspective: Invited commentary on “Early diagnosis and intervention for autism spectrum disorder: Need for pediatrician–child psychiatrist liaison”. Indian J Psychol Med [serial online] 2019 [cited 2019 Aug 23 ];41:91-92
Available from: http://www.ijpm.info/text.asp?2019/41/1/91/249467


Full Text



Early identification and intervention are vital in the management of neurodevelopmental disorders (NDDs), including autistic spectrum disorders (ASD). Unfortunately, delay in identification and further delay in intervention are the norms in clinical practice. Duration of untreated ASD is a variable that predicts poor outcome.[1] This delay may be due to factors such as a lack of knowledge and awareness among parents, health professionals, and teachers; the stigma of attending a psychiatric service; cultural factors; “everything will be alright as the child grows up” attitude; and lack of facilities accessible to the children in need. Identifying the relative importance of these factors is vital from a public health point of view.

Manohar et al.[2] has looked into the temporal trends from the earliest symptom recognition through pediatric consultation and time of diagnosis to time of the first specific intervention. The figures brought out are somewhat comforting than the ones published in previous studies.[3] This perhaps reflects the better awareness created in the recent times. However, the data drawn from a population referred to a tertiary-level specialized center is unlikely to represent the real-world scenario in primary or community care.

Even in these favorably biased data, the mean delay from the first medical contact to a specific intervention is an unaccep[table 9].4 months. This delay brings up some important questions: What are the causes of the delay for diagnosis at the point of first consultation? What contributed to the delay from diagnosis to the initiation of specific intervention? Had this study addressed these questions, it would have brought up system gaps and deficiencies which contributed to the long duration of untreated ASD and would have justified the title “Need for paediatrician-child psychiatrist liaison.”

Assessment, diagnosis, and interventions of NDDs are among the core competencies of psychiatrists. Psychiatrists' location in the first assessment point of children suspected to have NDDs would significantly cut short the costly delay in diagnosis and initiation of specific therapies. At this point, the factors which prolong the duration of untreated ASD, such as the parental grief, denial, and “everything will be alright as the child grows up” attitude, should be tackled with the professional expertise of a psychiatrist.

Pediatricians, the natural first contact of children with probable NDDs, should be trained to screen for these disorders. This mandatory screening for NDDs at regular intervals in infancy and toddler period, using standardized tools, should be established as a government policy. Psychiatrists should be competent not only to diagnose NDDs but they should be confident to give leadership to the multidisciplinary interventions in close liaison with his/her fellow medical professionals from pediatrics. In clinical practice, many comorbidities such as attention deficit hyperactivity disorder, obsessive compulsive disorders, disruptive disorders, and emotional disorders are widely encountered with ASD. Psychiatrists' role is indispensable in such clinical scenarios. Future psychiatrists and pediatricians should arm themselves with the competencies, skills, and attitudes needed for the collaborative work demanded from them in this interdisciplinary area. Working together, and not cross consultation to the psychiatrist or pediatrician, is the model to be promoted in child mental health. The workforce composition of Early Interventions Centers should be in accordance with this principle. Limiting the psychiatrists' role to one among the several medical consultants would be a disservice to children with ASD.

References

1Clark ML, Vinen Z, Barbaro J, Dissanayake C. School age outcomes of children diagnosed early and later with autism spectrum disorder. J Autism Dev Disord 2018;48:92-102.
2Manohar H, Kandasamy P, Chandrasekaran V, Rajkumar RP. Early diagnosis and intervention for autism spectrum disorder: Need for pediatrician–child psychiatrist liaison. Indian J Psychol Med 2019;41:87-90.
3Daniels AM, Mandell DS. Explaining differences in age at autism spectrum disorder diagnosis: A critical review. Autism 2014;18:583-97.