Analyzing Health Care Provision for ASD Toddlers in Hospitals of Pakistan: A Case Study of Rawalpindi and Islamabad

Abstract

Autism Spectrum Disorder (ASD) represents a neurological condition characterized by deficits in social communication, social interaction, and the presence of restricted and repetitive behaviors. The diagnosis of ASD has presented challenges, as it relies primarily on observational assessments of symptoms. Various screening and diagnostic tools are available for ASD assessment, such as QCHAT-10, QCHAT-25, AQ-10, SCQ, ADOS-2, ADI-R, and CARS etc. However, the heterogeneity of these tools has posed serious challenges for professionals, psychiatrists, and individuals with ASD, affecting their quality of life. Thus, standardization of these tools based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revised (DSM-5), is vital for efficient ASD diagnosis. To address these challenges the study is divided into of four sections. The first section analyzes healthcare provisions and tools used for assessing ASD in Pakistan, while also exploring local trends and tendencies related to ASD diagnosis. The second section establishes the content mapping of ADOS-2 on standard reference guide DSM-5, highlighting its strengths and limitations. The third section involves the development of ADOS-2 screening guidelines (ADOScan1, ADOScan2, and ADOScan3) based on modules 1, 2, and 3 of ADOS-2, ensuring comprehensive coverage of the DSM-5. Finally, the fourth section focuses on developing a web application that aligns any ASD assessment or diagnostic tool on DSM-5. This application categorizes questions into seven subcategories of the DSM-5, providing graphical and tabular outputs to identify strengths and areas for improvement in screening or diagnostic tools. The study's results demonstrate that ADOS-2 falls short in comprehensively addressing the designated domains within DSM-5, particularly in the areas of relationship development and restricted behavior. This underscores the significance of implementing countermeasures to address these areas and revising the structural configuration of the tool. Moreover, examination of the local dataset reveals that the mean age for autism diagnoses in Pakistan is 7.6 years, suggesting potential gaps in public awareness. Therefore, the creation of a web application alongside DSM-5-aligned ADOS-2 screening guidelines signifies a proactive stride in enhancing awareness among caregivers, educators, healthcare practitioners, specialists, researchers, and tool developers. This initiative not only streamlines the diagnostic process but also promotes early interventions for those with ASD, ultimately fostering an improvement in their quality of life.