© Borgis - Postępy Nauk Medycznych 1/2013, s. 58-64
*Monika Suchowierska, Paula Walczak
Wiedza na temat autyzmu badana u lekarzy pediatrów w Polsce
Knowledge about autism among Polish pediatricians
Department of Psychology, University of Social Sciences and Humanities, Warszawa, Poland
Head of Department: Ewa Trzebińska, PhD
Praca dotyczy sprawdzenia poziomu wiedzy na temat autyzmu wśród lekarzy pediatrów. Przeprowadzono badanie mające na celu odpowiedzenie na pytania jaki jest poziom wiedzy lekarzy pediatrów dotyczący autyzmu oraz czy różni się on w zależności od wielkości miasta, w którym pracują pediatrzy. W badaniu wzięło udział łącznie 50 lekarzy (25 z Warszawy i 25 z Włocławka). Wszystkie osoby badane miały taki sam rodzaj specjalizacji, czyli pediatrię. Do badania wykorzystano „Kwestionariusz wiedzy o autyzmie”, bazujący na badaniach Pisuli (1). Wyniki badań pokazały, że wiedza lekarzy pediatrów jest zróżnicowana w zależności od zagadnienia związanego z autyzmem. W niektórych pytaniach, pediatrzy wykazali się dobrą wiedzą na temat autyzmu, a inne zagadnienia okazały się być dla nich problemowe. Natomiast nie ma różnicy w poziomie wiedzy między pediatrami z Warszawy i z Włocławka. Obie grupy badanych miały porównywalną liczbę poprawnych odpowiedzi na pytania z kwestionariusza. Podsumowując wyniki badań można stwierdzić, że wiedza lekarzy pediatrów na temat autyzmu jest niekompletna. Niewątpliwie, ma to niekorzystny wpływ na proces diagnozowania. Edukacja na temat zaburzeń rozwoju prowadzona w placówkach medycznych byłaby zatem bardzo potrzebna, gdyż wczesne rozpoznanie objawów autyzmu prowadzi do poprawy rokowań.
Our current research concerns knowledge about autism among Polish pediatricians. A study was conducted in order to answer the question what is the level of knowledge of pediatricians on autism and whether it differs depending on the size of the city in which they work. The study involved a total of 50 physicians (25 from Warsaw and 25 from Wloclawek). All the respondents specialized in the same field, that is pediatrics. In the study, the Autism Questionnaire based on the research of Pisula (1) was used. The results showed that the pediatricians’ knowledge varies depending on the topic associated with autism. In case of some of the questions, the pediatricians showed high familiarity with the issue giving many good answers, but some areas proved to be problematic for them. We did not show any difference in the level of knowledge on autism among pediatricians from Warsaw and Wloclawek. Both groups had almost the same number of correct answers in the questionnaire. Summing up the results of this research, one can conclude that the pediatricians’ knowledge about autism is incomplete. Undoubtedly, such situation may have a negative impact on the diagnostic process and, in the long run, on the future of an autistic child. Providing education to medical students and practicing doctors about the various aspects of autism would therefore be very useful, as their expertise will most likely lead to a better prognosis for autistic children.
Autism is one of the most severe developmental disorders. Children with autism show deficits in communication and social behavior as well as present rigid patterns of activity and interests (2). Currently, autism is diagnosed more often than a few decades ago (3). There are therapeutic methods whose effectiveness is supported by numerous scientific studies (4). Early diagnosis of autism has an impact on the prognosis and functioning of the autistic children. The first group of professionals that the concerned parents report to are the pediatricians. It is important for pediatricians to have adequate knowledge of developmental disorders, as it can help in the timely and correct screening as well as diagnosis of autism. Moreover, having good understanding of various issues related to autism can help the primary care providers fulfill their management responsibilities (i.e., delivering high quality medical care, guiding parents to effective interventions and sources of accurate information) after the diagnosis has been made.
Despite the fact that nearly seventy years have passed since Kanner (5) first described autism, the disorder still has not been examined thoroughly (6). The American scientists from the Center for Autism Research at The Children’s Hospital of Philadelphia and the Department of Medicine in Pennsylvania published an article in which they review state-of-the-art knowledge about autism. According to them, there has been much progress in understanding autism, the role of the early diagnosis and intensive therapy (7). Nevertheless, this knowledge often does not “filter down” to primary health care providers. Studies concerning the level of knowledge about autism among those professionals were carried out in the USA (8, 9), Pakistan (10), Nigeria and other African countries (11).
In Poland, Łęczycka (12) conducted a study in order to become acquainted with the state of knowledge about autism. A questionnaire that included 12 questions related to the subject in question was created. 390 people were surveyed. The respondents were the nursing students, students of psychology, medicine and educational pedagogy, nursery workers, special education school teachers, regular teachers and pediatricians (12). Of the respondents, nearly 62% heard about the term autism only on a theoretical level. 23.4% never met an autistic child. Less than a half, namely 47.2% of the respondents did not know how common such a disorder was. When asked about the time the first symptoms of autism emerge, only 31% of people knew the correct answer. The answers to the question about the cause of autism were varied. The majority of respondents considered that the cause was the damage to the central nervous system (21.7%). There were however responses indicating that the mother was to blame for the emergence of autism. 124 people did not reply to the question about the symptoms characteristic of the disorder. Little over 20% of the respondents pointed at the limited interactions with the social environment. Only a few took into consideration all symptoms. More than half of the respondents (57.2%) did not know whether children with autism were mentally handicapped, and even more of them, that is 69.2%, did not have any information about the disorders comorbid with autism. More than half of the respondents (57.7%) believed that there were methods to improve the functioning of people with autism. According to the respondents, the best place for the child’s development was the family environment (41.8%). When it comes to treatment that would help a child in normal functioning, 62.8% of people did not give any answer. The others mentioned music therapy, physical therapy, Sherborne Developmental Movement Method, psychotherapy and pharmacology. The latter form was suggested by doctors and regular teachers.
Summing up the results of the research, Łęczycka notes that knowledge about autism is incomplete and often varied. This fact also draws attention to little knowledge on fundamental issues, such as symptoms of autism or types of recommended therapies. According to the author, the state of knowledge of childcare workers as well as teachers in nursery and primary schools is particularly alarming. The study group also included pediatricians. Łęczycka claims that they are a specific group, because of the responsibility they bear. Parents turn to them first, therefore the doctors’ knowledge should be complete and thorough so that they would be able to help parents recognize the symptoms and diagnose the disorder. The study shows that, unfortunately, their knowledge is insufficient to meet this challenge (12).
In subsequent years, research on the knowledge about autism was carried out by Pisula and colleagues (1, 13). In the first study (1), Pisula surveyed 93 psychology students. A questionnaire consisting of 18 questions was used. The questions pertained to a variety of issues related to autism (e.g., age of diagnosis, symptoms, etiology). The question concerning the incidence of autism gave rise to difficulties. As many as 71.2% of respondents did not know the correct answer. Most people knew the correct answer to the question about the first symptoms of autism (45.9%), indicating that they appeared prior to 3 years of age. More than a half, that is 55.7%, pointed out correctly that autism was more common in boys than girls. The answers about the causes of autism were somewhat varied. 41% of the respondents could not give the correct answer, 26.2% reported psychological reasons, another 18% – biological causes, and 10% stated that the causes of the disorder were unknown. In another question about the causes of autism, 34.4% of respondents blamed the mothers for their lack of love and emotional warmth. A little less, that is 32.8%, believed that the parents had some personality disorders that affected their child well-being. Most people (78.7%) answered that the main symptoms of autism were the social functioning difficulties, rigid patterns of behavior and interests (77%) as well as communication impediments (67.2%). About 44% of respondents did not know that mental retardation was a comorbid disorder linked with autism. As much as 27.9% of the respondents reported schizophrenia as a comorbid disorder with the disease in question. Less than a half, namely 44.3% of the students, claimed that it was possible to improve the functioning of the child, and a little less, that is 37.7%, believed that the chances were rather slim. A large number of people – 90% – considered that autism did not fade with age. In the questionnaire, there were also questions about therapy for children with autism. Most respondents (52.5%) suggested holding therapy, the others behavior modification (36%), non-directive therapy (23%) and the remaining 14.8% of people pointed to the Option Method as a treatment for autism. A large number of people (80.3%) pointed out that the home was the best place to work with the child, while only 32.8% suggested specialist health centers. Summing up the results, Pisula notes that in some areas connected with autism, such as the first and major symptoms of the disorder, the students achieved quite satisfactory results, whereas in other domains, such as the causes of autism, their knowledge was definitely insufficient (14).
Pisula and Rola (13) conducted another study on the knowledge about autism. This time, they surveyed special education teachers, regular teachers and the third year students of special education. Among them, a few mentioned the triad of impairments characteristic of autism (14.3% of teachers in special education, 10% of students and 8.6% of regular teachers). The most frequent characteristic was connected with problems of social functioning. Most respondents stated that people with autism did not speak at all. As much as 72.5% of the students, 69.8% of regular teachers and more than 50% of teachers in special schools were deeply convinced of this fact. About 25% of all respondents claimed that autistic children were aggressive, hyperactive, and often eried. In the results described, one should pay attention to the question of the importance of psychogenic factors in the development of autism. As much as 50% of students felt that the cause was the lack of love and warmth on the part of mothers. The same response was also given by 41.9% of the regular school teachers and 28.6% of special education teachers. 32.5% of students also believed that autism may be traced to parents who have personality disorders. The teachers gave a similar answer (27.9% of regular school teachers and 23.8% of special education teachers, respectively). The answers concerning the therapeutic methods were quite varied, but the holding therapy was mentioned most often. Such an answer was given by 25% of students, 13.9% of regular school teachers and 11.9% of special education teachers (14).
Summarizing both studies, Pisula points out that the knowledge of autism is not satisfactory, especially since the majority of respondents declared their interest in the subject of autism because of the job they do and the fields of study they chose. The main problem noticed by Pisula is that more than half of the respondents insisted on believing that the causes of autism were lack of love from the mother and other psychogenic factors. At the same time, the respondents suggested as the best method of treatment giving children love and warmth, which, in their opinion, the autistic children lacked. Such opinions will definitely affect the perception of autism as well as may hinder the cooperation between the parents of children with developmental disorders and the specialists (14).
In the year 2008 in the Lubuskie voivodship, a study concerning the needs of individuals with autism in the opinion of the medical community was carried out (15). It involved 71 physicians with specialization in: pediatrics, family medicine, neurology and psychiatry. Most of the respondents were female (68%). The age range was form 26 to over 60 years old. Less than half of the respondents (45%) declared that in their work they had contact with an autistic child. The survey included a question of how respondents assessed their own knowledge about autism. Only 1% of them stated that it was good. More than half of respondents (51%), deemed it as moderate and 48% as poor. Asked about the symptoms of autism, only one person identified correctly all of them. Most respondents indicated as a symptom of autism poor eye contact, whereas 43% suggested aggression toward people and objects and 28% indicated poor mobility. However at the same time, when asked to determine impairments in the main areas of functioning, 85% of respondents correctly indicated three of them: communication, behavior and social interactions. It is worth noting that the doctors also pointed to lack of relation with parents, showing no emotions, hindered intellectual development, hearing impairment and motor difficulties as symptoms of autism. Asked about the causes of autism, 95% of the respondents stated that the reasons were not known, and there were many theories related to this issue, especially to genetic and metabolic causes. A small percentage suggested as the source of autism emotional detachment of the mother. More than half of the physicians (55%) disagreed with the statement that autism was a mental illness, and 34% confirmed this thesis. The questionnaire also asked about the importance of pharmacology to cure or improve the functioning of people with autism. 40% of people opted for the pharmacological methods, stating they can cure and improve the functioning, while 49% disagreed with the idea, and 11% did not give any response at all. Asked about the sensory disturbances that occur in people with autism, 48% of people indicated hypersensitivity and 42% believed that all types of sensory disturbances may occur in autistic children. While 13% of respondents indicated that children with autism experience hyposensitivity, the same number of people did not know the answer to that question. The last question inquired about factors that would facilitate the doctors’ work with autistic people. A large number (80%) indicated greater availability of training and information.
Summarizing the results, a similar conclusion to the previous studies can be drawn, namely that the physicians’ knowledge about autism is varied and in some areas insufficient. Therefore, the authors suggest that the best way to improve the situation would be to start an active and bilateral cooperation between the institutions engaged in the promotion of knowledge about autism and autistic people and the medical environment.
Taking into consideration research results described above, a decision was made to examine the current state of knowledge on autism among pediatricians in Poland. This is a very important professional group, because most parents report to them if they see worrying symptoms in their child (9). Parents expect from the pediatrician to state whether the problem exists and give advice on how to proceed (16). Unfortunately, the symptoms are usually trivialized and the parents are reassured that their child will overcome the difficulties with age (17). The following hypotheses were proposed: 1) knowledge of pediatricians varies depending on the topic associated with autism and 2) in a big city (Warsaw) knowledge of autism among pediatricians will be more complete than among a medium-sized city physicians (Wloclawek).
Pediatricians participated in the study, which was conducted in two Polish cities, namely in Wloclawek, which represented a medium-sized city, and in Warsaw, which represented a very large city. A total of 50 physicians participated: 25 people from Wloclawek and 25 people from Warsaw. The study included a total of 41 women (21 from Wloclawek, 20 from Warsaw) and 9 men (4 of Wloclawek, 5 of Warsaw). All the surveyed specialized in one field, that is pediatrics. The medical practice as pediatricians for women from Warsaw ranged from 7 years to 28 (M = 21.8, SD = 4.96), for men from 20 to 30 years (M = 25.4, SD = 4.15), whereas in Wloclawek it ranged from 8 years to 48 years (M = 26.04, SD = 9.32) for women and for men, the number was between 25 and 31 years (M = 27.5, SD = 2.64). The study was conducted between February and April 2012. The average amount of time per one survey was about 15 minutes. The experimenters met individually with each participant at their place of work.
In the study, the “Questionnaire on the knowledge of autism” was used (it is available on request from the author for correspondence). This questionnaire is a modified version of a survey used in Pisula’s research (1). It consists of 11 groups of questions. For each question, one chooses either “yes” or “no”, depending on the answer one considers to be correct. The questions refer to the key issues in autism (e.g., the factors that contribute to the development of autism, diagnostic criteria, comorbid disorders, prognosis for the people affected by autism, effective methods of intervention, the incidence of autism, the characteristic behavior of people with autism, the diagnosing methods).
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