Patterns of Referral and Clinical Presentation of Autism Spectrum Disorder in Children at Al Jalila Children Specialty Hospital: A Retrospective Descriptive Study

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is gradually gaining popularity. However, there is minimal scientific research exploring the clinical presentation of this highly complex disorder and the general understanding of such varying presentations by general practitioners and pediatric physicians. This study aims to explore the patterns of referral of patients with ASD to a tertiary hospital in Dubai, United Arab Emirates, and to understand better and analyze the general knowledge of referring physicians through their impression of the patient’s clinical presentation This is a retrospective descriptive study where all the data were collected electronically from past medical records and referral documents taken from Al Jalila Children's Specialty Hospital (AJCH). Patients who were referred were later assessed by the neurodevelopmental specialists using the NICE Guidelines. The data were analyzed statistically and described using different statistical tools. These results were then considered in light of the local clinician's needs for diagnostic support and the possibility of developing a national screening program for ASD. Within a sample of 90 referrals, 69 (76.7%) were predominantly male, 73 (81.1%) were Emirati nationals, and the majority fell within the age group of 0 to 5 years old. Of the 90 referred patients, 53 (58.9%) were diagnosed with ASD by neurodevelopmental specialists using the NICE Guidelines. Physicians were keen on picking up features of speech and language deficits, hyperactivity, and inappropriate or atypical behavior. However, they seemed hesitant and required further assessment when interpreting and reporting features revolving around social communicative skills, interaction and rapport, and evaluating patients’ ideas and imagination. Physicians practicing in the United Arab Emirates (UAE) are advised to assess the full range of clinical symptoms of ASD according to their respective categories as listed in the National Institute for Health and Care Excellence (NICE) guidelines. Furthermore, the Dubai Health Authority (DHA) has published the first edition document titled “Dubai Clinical Practice Guidelines for Autism Spectrum Disorder (ASD) in Children and Adolescents,” designed to align physician recognition and practice with the government's objectives toward all individuals with ASD. Their achievement aligns with the goals of our study as it will make the clinical recognition of ASD clinically more sound and prevent misdiagnosis. Finally, the authors hope that this study aids in developing a national screening program dedicated to general practitioners and pediatric physicians in providing a structured assessment for ASD, which in return will result in early intervention by neurodevelopmental specialists for further diagnosis and management, ultimately improving the quality of life of the patients and their families.