**Author details**

Michael Siller1\*, Lindee Morgan2 , Meghan Swanson3 and Emily Hotez4 \*Address all correspondence to: msiller@hunter.cuny.edu

1 Psychology Department, Hunter College of The City University of New York, New York, USA

[9] Center for Disease Control and Prevention. Prevalence of Autism Spectrum Disor‐ ders – Autism and Developmental Disabilities Monitoring Network, United States,

Promoting Early Identification of Autism in the Primary Care Setting: Bridging the Gap Between What We Know and

What We Do

21

http://dx.doi.org/10.5772/53715

[10] Kim, Y.S., Leventhal, B.L., Koh, Y.J., Fombonne, E., Laska, E., Lim, E.C., et al. Preva‐ lence of Autism Spectrum Disorders in a Total Population Sample. American Journal

[11] Wiggins, L.D., Baio, J., and Rice, C. Examination of the Time between First Evalua‐ tion and First Autism Spectrum Diagnosis in a Population-Based Sample. Journal of

[12] Daniel, K.L., Prue, C., Taylor, M.K., Thomas, J., and Scales, M. 'Learn the Signs. Act Early': A Campaign to Help Every Child Reach His or Her Full Potential. Public

[13] Grimshaw, J.M., Shirran, L., Thomas, R., Mowatt, G., Fraser, C., Bero, L., et al. Chang‐ ing Provider Behavior - An Overview of Systematic Reviews of Interventions. Medi‐

[14] Gataullina, L., Stereotypes in Media. 2003. Available from: http://serendip.bryn‐

[15] Haddon, M. The Curious Incident of the Dog in the Night-Time. 1st ed. New York:

[17] Adams, C. A Real Boy: A True Story of Autism, Early Intervention, and Recovery.

[18] Maurice, C. Let Me Hear Your Voice: A Family's Triumph over Autism. 1st ed. New

[19] Farnall, O. and Smith, K.A. Reactions to People with Disabilities: Personal Contact Versus Viewing of Specific Media Portrayals. Journalism & Mass Communication

[20] Jones, S.C. and Harwood, V. Representations of Autism in Australian Print Media.

[21] Baird, G., Cass, H., and Slonims, V. Diagnosis of Autism. British Medical Journal

[22] Grinker, R.R. Unstrange Minds: Remapping the World of Autism. New York, NY:

[23] Fife, B.L. and Wright, E.R. The Dimensionality of Stigma: A Comparison of Its Im‐ pact on the Self of Persons with HIV/AIDS and Cancer. Journal of Health and Social

[16] Leimbach, M. Daniel Isn't Talking. 1st ed. New York: Nan A. Talese; 2006.

2006. MMWR Surveillance Summaries 2009;58(SS10): 1-20.

Developmental and Behavioral Pediatrics 2006;27(2): S79-S87.

mawr.edu/local/scisoc/sports03/papers/lgataullina.html.

of Psychiatry 2011;168(9): 904-912.

Health 2009;123, Supplement 1(0): e11-e16.

cal Care 2001;39(8): Ii2-Ii45.

New York: Berkley Books; 2005.

Quarterly 1999;76(4): 659-672.

2003;327(7413): 488-493.

Behavior 2000;41(1): 50-67.

Perseus Books; 2007.

Disability & Society 2009;24(1): 5-18.

Doubleday; 2003.

York: Knopf; 1993.

2 Autism Institute, College of Medicine, Florida State University, Tallahassee, USA

3 Psychology Department, Hunter College of The City University of New York, New York, USA

4 Graduate Center, The City University of New York, New York, USA

#### **References**


[9] Center for Disease Control and Prevention. Prevalence of Autism Spectrum Disor‐ ders – Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR Surveillance Summaries 2009;58(SS10): 1-20.

\*Address all correspondence to: msiller@hunter.cuny.edu

20 Recent Advances in Autism Spectrum Disorders - Volume I

chology and Psychiatry 2010;51(9): 989-997.

The Journal of Pediatrics 2011;159(3): 458-465.

2007;120(5): 1183-1215.

munity Health 2011; 65(6): 503-510.

vation Schedule (ADOS). Autism Research 2010;3(4): 162-173.

veillance and Screening. Pediatrics 2006;118(1): 405-420.

USA

USA

**References**

796-806.

1 Psychology Department, Hunter College of The City University of New York, New York,

3 Psychology Department, Hunter College of The City University of New York, New York,

[1] Ozonoff, S., Iosif, A.M., Young, G.S., Hepburn, S., Thompson, M., Colombi, C., et al. Onset Patterns in Autism: Correspondence between Home Video and Parent Report. Journal of the American Academy of Child and Adolescent Psychiatry 2011;50(8):

[2] Bhat, A.N., Galloway, J.C., and Landa, R.J. Social and Non-Social Visual Attention Patterns and Associative Learning in Infants at Risk for Autism. Journal of Child Psy‐

[3] Pierce, K., Carter, C., Weinfeld, M., Desmond, J., Hazin, R., Bjork, R., et al. Detecting, Studying, and Treating Autism Early: The One-Year Well-Baby Check-up Approach.

[4] Kim, S.H. and Lord, C. Restricted and Repetitive Behaviors in Toddlers and Pre‐ schoolers with Autism Spectrum Disorders Based on the Autism Diagnostic Obser‐

[5] American Academy of Pediatrics. Identifying Infants and Young Children with De‐ velopmental Disorders in the Medical Home: An Algorithm for Developmental Sur‐

[6] Plauche´ Johnson, C., Myers, S.M., and Council on Children With Disabilities. Identi‐ fication and Evaluation of Children with Autism Spectrum Disorders. Pediatrics

[7] Center for Disease Control and Prevention. Prevalence of Autism Spectrum Disor‐ ders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, Unit‐

[8] Fountain, C., King, M.D., and Bearman, P.S. Age of Diagnosis for Autism: Individual and Community Factors across 10 Birth Cohorts. Journal of Epidemiology and Com‐

ed States, 2008. MMWR Surveillance Summaries 2012;61(SS03): 1-19.

2 Autism Institute, College of Medicine, Florida State University, Tallahassee, USA

4 Graduate Center, The City University of New York, New York, USA


[24] Brown, L., Macintyre, K., and Trujillo, L. Interventions to Reduce HIV/AIDS Stigma: What Have We Learned? Aids Education and Prevention 2003;15(1): 49-69.

Health Education: Theory, Research, and Practice, San Francisco: Jossey-Bass; 2002.

What We Do

23

http://dx.doi.org/10.5772/53715

Promoting Early Identification of Autism in the Primary Care Setting: Bridging the Gap Between What We Know and

[41] Individuals with Disabilities Education Improvement Act, Pub. L. No. 108-446.

[42] Werner, E.E., Honzik, M.P., and Smith, R.S. Prediction of Intelligence and Achieve‐ ment at Ten Years from Twenty Months Pediatric and Psychologic Examinations.

[43] Sices, L., Feudtner, C., McLaughlin, J., Drotar, D., and Williams, M. How Do Primary Care Physicians Manage Children with Possible Developmental Delays? A National

[44] Hix-Small, H., Marks, K., Squires, J., and Nickel, R. Impact of Implementing Devel‐ opmental Screening at 12 and 24 Months in a Pediatric Practice. Pediatrics

[45] Bricker, D. and Squires, J. Ages and Stages Questionnaire: A Parent-Completed,

[46] Bricker, D. and Squires, J. Ages & Stages Questionnaires: A Parent-Completed, Child-Monitoring System (ASQ). 2nd ed. Baltimore, MD: Brookes Publishing; 1999.

[47] Robins, D.L. Screening for Autism Spectrum Disorders in Primary Care Settings. Au‐

[48] American Academy of Pediatrics. The Pediatrician's Role in the Diagnosis and Man‐ agement of Autistic Spectrum Disorder in Children. Pediatrics 2001;107(5):

[49] Sand, N., Silverstein, M., Glascoe, F.P., Tonniges, T., Gupta, B., and O'Connor, K. Pe‐ diatricians' Reported Practices Regarding Developmental Screening: Are Guidelines

[50] Radecki, L., Sand-Loud, N., O'Connor, K.G., Sharp, S., and Olson, L.M. Trends in the Use of Standardized Tools for Developmental Screening in Early Childhood:

[51] King, T.M., Tandon, S.D., Macias, M.M., Healy, J.A., Duncan, P.M., Swigonski, N.L., et al. Implementing Developmental Screening and Referrals: Lessons Learned from a

[38] Novelli, P. Healthstyles 2007 Survey. Unpublished dataset. 2007.

[40] Social Security Act, 42 U.S.C. Chapter 7, Subchapter V, §§ 701-710. (1989).

Survey with an Experimental Design. Pediatrics 2004;113(2): 274-282.

Child-Monitoring System. Baltimore, MD: Paul H. Brookes; 1995.

Used? Do They Help? Pediatric Research 2004;55(4): 68a-68a.

2002-2009. Pediatrics 2011;128(1): 14-19.

National Project. Pediatrics 2010;125(2): 350-360.

[39] Novelli, P. Docstyles 2007 Survey. Unpublished dataset. 2007.

Child Development 1968;39(4): 1063-1075.

p99-120.

(2004).

2007;120(2): 381-389.

tism 2008;12(5): 537-556.

1221-1226.


Health Education: Theory, Research, and Practice, San Francisco: Jossey-Bass; 2002. p99-120.


[24] Brown, L., Macintyre, K., and Trujillo, L. Interventions to Reduce HIV/AIDS Stigma: What Have We Learned? Aids Education and Prevention 2003;15(1): 49-69.

[25] Lyons, M. and Ziviani, J. Stereotypes, Stigma, and Mental-Illness - Learning from Fieldwork Experiences. American Journal of Occupational Therapy 1995;49(10):

[26] Nissenbaum, M.S., Tollefson, N., and Reese, R.M. The Interpretative Conference: Sharing a Diagnosis of Autism with Families. Focus on Autism and Other Develop‐

[27] Shaked, M. The Social Trajectory of Illness: Autism in the Ultraorthodox Community

[28] Coulthard, P. and Fitzgerald, M. In God We Trust? Organised Religion and Personal Beliefs as Resources and Coping Strategies, and Their Implications for Health in Pa‐ rents with a Child on the Autistic Spectrum. Mental Health, Religion & Culture

[29] Nickerson, K.J., Helms, J.E., and Terrell, F. Cultural Mistrust, Opinions About Men‐ tal-Illness, and Black-Students' Attitudes toward Seeking Psychological Help from

[30] Rideout, V., Hoff, T. Shouting to Be Heard: Public Service Advertising in a New Me‐

[31] Autism Speaks. Autism Speaks 2010 Annual Report. 2010; Available from: http:// www.autismspeaks.org/sites/default/files/documents/as\_annual\_report\_2010-

[32] Bertrand, J.T. and Anhang, R. The Effectiveness of Mass Media in Changing HIV/ AIDS-Related Behaviour among Young People in Developing Countries. Preventing HIV/AIDS in Young People: A Systematic Review of the Evidence from Developing

[33] Sood, S. and Nambiar, D. Comparative Cost-Effectiveness of the Components of a Behavior Change Communication Campaign on HIV/AIDS in North India. Journal of

[34] Hornik, R.C. Public Health Communication: Evidence for Behavior Change. 4th ed.

[35] Shulman, R. Child Study Center Cancels Autism Ads. The Washinton Post 2007, De‐

[36] Randolph, W. and Viswanath, K. Lessons Learned from Public Health Mass Media Campaigns: Marketing Health in a Crowded Media World. Annual Review of Public

[37] Prochaska, J.O., Redding, C.A., and Evers, K.E. The Transtheoretical Model and Stages of Change. In: K. Glanz, B.K., Rimer, F.M., Lewis (Eds.) Health Behavior and

White Counselors. Journal of Counseling Psychology 1994;41(3): 378-385.

in Israel. Social Science & Medicine 2005;61(10): 2190-2200.

1002-1008.

1999;2(1): 19-33.

web\_01.pdf.

cember 20.

Health 2004;25: 419-437.

mental Disabilities 2002;17(1): 30-43.

22 Recent Advances in Autism Spectrum Disorders - Volume I

dia Age. 2002: Menlo Park, CA.

Countries 2006;938: 205-241.

Health Communication 2006;11: 143-162.

Mahaw: Lawrence Erlbaum Associates, Inc.; 2002.


[52] Bethell, C., Reuland, C., Schor, E., Abrahms, M., and Halfon, N. Rates of Parent-Cen‐ tered Developmental Screening: Disparities and Links to Services Access. Pediatrics 2011;128(1): 146-155.

[64] Farmer, A.P., Légaré, F., Turcot, L., Grimshaw, J., Harvey, E., McGowan, J., and Wolf, F.M. Printed Educational Materials: Effects on Professional Practice and Health Care

Promoting Early Identification of Autism in the Primary Care Setting: Bridging the Gap Between What We Know and

What We Do

25

http://dx.doi.org/10.5772/53715

[65] Center for Disease Control and Prevention. Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum. 2011; Available from: http://www.cdc.gov/

[66] Bauer, S.C., Smith, P.J., Chien, A.T., Berry, A.D., and Msall, M. Educating Pediatric Residents About Developmental and Social-Emotional Health. Infants & Young Chil‐

[67] Honigfeld, L., Chandhok, L., and Spiegelman, K. Engaging Pediatricians in Develop‐ mental Screening: The Effectiveness of Academic Detailing. Journal of Autism and

[68] Institute of Healthcare Improvement The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)

[69] Young, P.C., Glade, G.B., Stoddard, G.J., and Norlin, C. Evaluation of a Learning Col‐ laborative to Improve the Delivery of Preventive Services by Pediatric Practices. Pe‐

[70] Russ, S.A., Hanna, D., DesGeorges, J., and Forsman, I. Improving Follow-up to New‐ born Hearing Screening: A Learning-Collaborative Experience. Pediatrics 2010;126:

[71] Cavaleri, M., Gopalan, G., McKay, M. M., Apel, A., Bannon, W. M., & Bigley, M. F. Impact of a Learning Collaborative to Improve Mental Health Service Use among Low-Income, Urban Youth and Families. Best Practices in Mental Health: An Interna‐

[72] Goin-Kochel, R.P., Mackintosh, V.H., and Myers, B.J. How Many Doctors Does It Take to Make an Autism Spectrum Diagnosis? Autism 2006;10(5): 439-451.

[73] Howlin, P. and Moore, A. Diagnosis in Autism: A Survey of over 1200 Patients in the

[74] Veness, C., Prior, M., Bavin, E., Eadie, P., Cini, E., and Reilly, S. Early Indicators of Autism Spectrum Disorders at 12 and 24 Months of Age: A Prospective, Longitudinal

[75] Harrington, J.W., Patrick, P.A., Edwards, K.S., and Brand, D.A. Parental Beliefs

[76] Schofield, P.E., Butow, P.N., Thompson, J.F., Tattersall, M.H.N., Beeney, L.J., and Dunn, S.M. Psychological Responses of Patients Receiving a Diagnosis of Cancer.

dren 2009;22(4): 309-320 310.1097/IYC.1090b1013e3181bc1094da1090.

Developmental Disorders 2012;42(6): 1175-1182.

Outcomes. Cochrane Database of Systematic Reviews 2008(3).

ncbddd/actearly/act/class.html.

diatrics 2006;117(5): 1469-1476.

tional Journal 2006;2(2): 67–79.

UK. Autism 1997;1(2): 135-162.

Comparative Study. Autism 2012;16(2): 163-177.

About Autism. Autism 2006;10(5): 452-462.

Annals of Oncology 2003;14(1): 48-56.

S59-S69.


[64] Farmer, A.P., Légaré, F., Turcot, L., Grimshaw, J., Harvey, E., McGowan, J., and Wolf, F.M. Printed Educational Materials: Effects on Professional Practice and Health Care Outcomes. Cochrane Database of Systematic Reviews 2008(3).

[52] Bethell, C., Reuland, C., Schor, E., Abrahms, M., and Halfon, N. Rates of Parent-Cen‐ tered Developmental Screening: Disparities and Links to Services Access. Pediatrics

[53] DosReis, S. and Weiner, C.L. Autism Spectrum Disorder Screening and Management Practices among General Pediatric Providers. Journal of Developmental and Behavio‐

[54] Gillis, J.M. Screening Practices of Family Physicians and Pediatricians in 2 Southern States. Infants & Young Children 2009;22(4): 321-331 310.1097/IYC.

[55] Selden, T.M. Compliance with Well-Child Visit Recommendations: Evidence from the Medical Expenditure Panel Survey, 2000-2002. Pediatrics 2006;118(6): E1766-

[56] Miller, J.S., Gabrielsen, T., Villalobos, M., Alleman, R., Wahmhoff, N., Carbone, P.S., et al. The Each Child Study: Systematic Screening for Autism Spectrum Disorders in

[57] American Academy of Pediatrics Task Force on Mental Health. Enhancing Pediatric Mental Health Care: Strategies for Preparing a Primary Care Practice. Pediatrics

[58] Robins, D., Fein, D., Barton, M., and Green, J. The Modified Checklist for Autism in Toddlers: An Initial Study Investigating the Early Detection of Autism and Pervasive Developmental Disorders. Journal of Autism and Developmental Disorders

[59] Kleinman, J.M., Robins, D.L., Ventola, P.E., Pandey, J., Boorstein, H.C., Esser, E.L., et al. The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders. Journal of Autism and Develop‐

[60] Davis, T.C., Mayeaux, E.J., Fredrickson, D., Bocchini, J.A., Jackson, R.H., and Mur‐ phy, P.W. Reading-Ability of Parents Compared with Reading Level of Pediatric-Pa‐

[61] Schonwald, A., Huntington, N., Chan, E., Risko, W., and Bridgemohan, C. Routine Developmental Screening Implemented in Urban Primary Care Settings: More Evi‐

[62] Pinto-Martin, J.A., Dunkle, M., Earls, M., Fliedner, D., and Landes, C. Developmental Stages of Developmental Screening: Steps to Implementation of a Successful Pro‐

[63] Freemantle, N., Harvey, E.L., Wolf, F., Grimshaw, J.M., Grilli, R., and Bero, L.A. Printed Educational Materials: Effects on Professional Practice and Health Care Out‐

dence of Feasibility and Effectiveness. Pediatrics 2009;123(2): 660-668.

gram. American Journal of Public Health 2005;95(11): 1928-1932.

comes. Cochrane Database Systematic Reviews 2000(2): CD000172.

2011;128(1): 146-155.

24 Recent Advances in Autism Spectrum Disorders - Volume I

ral Pediatrics 2006;27(2): S88-S94.

1090b1013e3181bc1094e1021.

2010;125(Supplement 3): S87-S108.

mental Disorders 2008;38(5): 827-839.

tient Education Materials. Pediatrics 1994;93(3): 460-468.

2001;31(2): 131-144.

a Pediatric Setting. Pediatrics 2011;127(5): 866-871.

E1778.


[77] Kosinski, M., Rogers, W.H., Safran, D.G., Taira, D.A., Tarlov, A.R., and Ware, J.E. Linking Primary Care Performance to Outcomes of Care. Journal of Family Practice 1998;47(3): 213-220.

cation Skills and Occupational Stress in Oncology: A Randomised Study. Br J Cancer

What We Do

27

http://dx.doi.org/10.5772/53715

[90] Waisman Center of the University of Wisconsin-Madison, Wisconsin Medical Home Webcast Series. 2011. Available from: http://www.waisman.wisc.edu/connections. [91] Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. Random‐ ized, Controlled Trial of an Intervention for Toddlers with Autism: The Early Start

Promoting Early Identification of Autism in the Primary Care Setting: Bridging the Gap Between What We Know and

[92] National Research Council. Educating Children with Autism. USA: National Acade‐

[93] Odom, S.L., Boyd, B.A., Hall, L.J., and Hume, K. Evaluation of Comprehensive Treat‐ ment Models for Individuals with Autism Spectrum Disorders. Journal of Autism

[94] Boyd, B.A., Odom, S.L., Humphreys, B.P., and Sam, A.M. Infants and Toddlers with Autism Spectrum Disorder: Early Identification and Early Intervention. Journal of

[95] Downs, R.C. and Downs, A. Practices in Early Intervention for Children with Au‐ tism: A Comparison with the National Research Council Recommended Practices. Education and Training in Autism and Developmental Disabilities 2010;45(1):

[96] Mandell, D.S., Wiggins, L.D., Carpenter, L.A., Daniels, J., DiGuiseppi, C., Durkin, M.S., et al. Racial/Ethnic Disparities in the Identification of Children with Autism

[97] Lindsay, S., King, G., Klassen, A.F., Esses, V., and Stachel, M. Working with Immi‐ grant Families Raising a Child with a Disability: Challenges and Recommendations for Healthcare and Community Service Providers. Disability Rehabilitation

[98] Welterlin, A. and LaRue, R.H. Serving the Needs of Immigrant Families of Children

[99] Williams, M.E., Atkins, M., and Soles, T. Assessment of Autism in Community Set‐ tings: Discrepancies in Classification. Journal of Autism and Developmental Disor‐

[100] Kim, C., Disare, K., Pfeiffer, M., Kerker, B.D., and McVeigh, K.H. Effects of Individu‐ al and Neighborhood Characteristics on the Timeliness of Provider Designation for Early Intervention Services in New York City. Journal of Developmental and Behav‐

Spectrum Disorders. American Journal of Public Health 2009;99(3): 493-498.

2004;90(1): 106-114.

my Press; 2001.

150-159.

2012;34(23):2007-17.

ders 2009;39(4): 660-669.

ioral Pediatrics 2009;30(1): 38-49.

Denver Model. Pediatrics 2010;125(1): E17-E23.

and Developmental Disorders 2010;40(4): 425-436.

with Autism. Disability & Society 2007;22(7): 747-760.

Early Intervention 2010;32(2): 75-98.


cation Skills and Occupational Stress in Oncology: A Randomised Study. Br J Cancer 2004;90(1): 106-114.

[90] Waisman Center of the University of Wisconsin-Madison, Wisconsin Medical Home Webcast Series. 2011. Available from: http://www.waisman.wisc.edu/connections.

[77] Kosinski, M., Rogers, W.H., Safran, D.G., Taira, D.A., Tarlov, A.R., and Ware, J.E. Linking Primary Care Performance to Outcomes of Care. Journal of Family Practice

[78] Marks, K.P., Glascoe, F.P., and Macias, M.M. Enhancing the Algorithm for Develop‐ mental-Behavioral Surveillance and Screening in Children 0 to 5 Years. Clinical Pe‐

[79] Golnik, A., Ireland, M., and Borowsky, I.W. Medical Homes for Children with Au‐

[80] Heidgerken, A.D., Geffken, G., Modi, A., and Frakey, L. A Survey of Autism Knowl‐ edge in a Health Care Setting. Journal of Autism and Developmental Disorders

[81] Warren, Z., Stone, W., and Humberd, Q. A Training Model for the Diagnosis of Au‐ tism in Community Pediatric Practice. Journal of Developmental and Behavioral Pe‐

[82] Kobak, K.A., Stone, W.L., Ousley, O.Y., and Swanson, A. Web-Based Training in Ear‐ ly Autism Screening: Results from a Pilot Study. Telemedicine and E-Health

[83] Dietz, C., Swinkels, S.H.N., van Daalen, E., van Engeland, H., and Buitelaar, J.K. Pa‐ rental Compliance after Screening Social Development in Toddlers. Archives of Pe‐

[84] Pandey, J., Verbalis, A., Robins, D.L., Boorstein, H., Klin, A., Babitz, T., et al. Screen‐ ing for Autism in Older and Younger Toddlers with the Modified Checklist for Au‐

[85] Fallowfield, L. and Jenkins, V. Communicating Sad, Bad, and Difficult News in Med‐

[86] Baile, W.F., Buckman, R., Lenzi, R., Glober, G., Beale, E.A., and Kudelka, A.P. Spikes —a Six-Step Protocol for Delivering Bad News: Application to the Patient with Can‐

[87] Eid, A., Petty, M., Hutchins, L., and Thompson, R. "Breaking Bad News": Standar‐ dized Patient Intervention Improves Communication Skills for Hematology-Oncolo‐ gy Fellows and Advanced Practice Nurses. Journal Of Cancer Education: The Official Journal Of The American Association For Cancer Education 2009;24(2): 154-159.

[88] Roter, D.I., Hall, J.A., Kern, D.E., Barker, L., Cole, K.A., and Roca, R.P. Improving Physicians' Interviewing Skills and Reducing Patients' Emotional Distress: A Randomized Clinical Trial. Archives of Internal Medicine 1995;155(17): 1877-1884.

[89] Delvaux, N., Razavi, D., Marchal, S., Bredart, A., Farvacques, C., and Slachmuylder, J.L. Effects of a 105 Hours Psychological Training Program on Attitudes, Communi‐

tism: A Physician Survey. Pediatrics 2009;123(3): 966-971.

diatrics & Adolescent Medicine 2007;161(4): 363-368.

tism in Toddlers. Autism 2008;12(5): 513-535.

icine. Lancet 2004;363(9405): 312-319.

cer. The Oncologist 2000;5(4): 302-311.

1998;47(3): 213-220.

2005;35(3): 323-330.

2011;17(8): 640-644.

diatrics 2011;50(9): 853-868.

26 Recent Advances in Autism Spectrum Disorders - Volume I

diatrics 2009;30(5): 442-446.


[101] Durkin, M.S., Maenner, M.J., Meaney, F.J., Levy, S.E., DiGuiseppi, C., Nicholas, J.S., et al. Socioeconomic Inequality in the Prevalence of Autism Spectrum Disorder: Evi‐ dence from a US Cross-Sectional Study. Plos One 2010;5(7).

**Chapter 2**

**Indicators of Autism in Iranian Children**

Autism occurs in every country of the world. However its prevalence varies greatly across nations with higher rates being reported in more affluent, English speaking countries. The lower rates in less developed countries have been attributed to a lack of knowledgeable per‐ sonnel in child assessment and diagnostic services and their slow response to parental con‐ cerns [1]. While this is certainly a major impediment to early identification, other social and cultural factors may play a part. In particular, expectations of children's development and behaviours may mean that parents attach less significance to certain early indicators of Au‐ tism across different cultures [2]. If this were so, then screening and other assessment tools developed in Western countries may not be sufficiently sensitive to detect early signs of Au‐

This chapter summarises the findings from two studies in Iran that identified the items that best discriminated children who had a diagnosis of autism. In the first study, the Gilliam Autism Rating Scale - Second edition GARS ll [4] was used. Comparisons are drawn be‐ tween three groups of children aged 3 to 16 years: those with a compared diagnosis of Au‐ tism; children with intellectual disabilities and those whose development was considered to

The second study focussed on the Autism Diagnostic Interview- Revised (ADI-R) [5]. This tool was developed for use by clinicians to assist in making a diagnosis of autism usually after referral that follows from the use of a screening tool such as GARS. In all the perform‐ ance of 333 children (84%) with a confirmed diagnosis of Autism could be confirmed with those of 64 (16%) who were not given this diagnosis although they had screened positive.

The findings from these two major studies together identify those indicators of autism that appear to be more culturally specific to Iranian or similar cultures. However comparisons are drawn with similar data from other countries to underline the universality of certain au‐

and reproduction in any medium, provided the original work is properly cited.

© 2013 Samadi and McConkey; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

Sayyed Ali Samadi and Roy McConkey

http://dx.doi.org/10.5772/52853

**1. Introduction**

tism in other societies [3].

be normal.

Additional information is available at the end of the chapter

