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The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria

Department of Pediatrics and Medical Genetics, University Hospital “St. George”, 4000 Plovdiv, Bulgaria
Unique Medical Center, 4000 Plovdiv, Bulgaria
Department of Pediatrics and Medical Genetics, Medical Faculty, Medical University, 4000 Plovdiv, Bulgaria
Department of Psychiatry, University Hospital “St. George”, 4000 Plovdiv, Bulgaria
Duke Center for Autism and Brain Development, Deptment of Psychiatry, Durham, NC 27705, USA
Author to whom correspondence should be addressed.
Diagnostics 2021, 11(1), 106;
Received: 30 November 2020 / Revised: 27 December 2020 / Accepted: 6 January 2021 / Published: 11 January 2021
(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Psychosis)
Diagnosis of autism spectrum disorder (ASD) before the age of three years is a challenge. Analyzing the present practice may help reaching that goal. Aim: To investigate developmental abnormalities and diagnostic pathway of ASD patients in pediatric practice. Methods: Retrospective cross-sectional study of 192 children aged 13 months to 17 years 11 months (average 4 years 9 months), investigated in an outpatient and hospital setting from January 2015 to June 2018 by a semi-structured history and clinical examination, and diagnosed with ASD by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Results: Behavioral peculiarities were detected in the history of the first two years of life in 74.8% of the subjects. The first developmental abnormalities were noticed by the parents at ages from 8 to 36 months (mean 15.6 months) and were predominantly in speech (in 94.6%) and non-verbal communication (11.3%). Developmental regression was reported in 42.1% of the patients occurring between the ages of 6 and 50 months (mean 17.9 months), affecting most commonly speech (88.4% of cases), non-verbal communication (29.2%), and behavior (12.8%). By history, the first manifestations of ASD were noticed at ages from 8 months to 84 months (mean 18.5 months), and were disorders of expressive speech (in 66.7% of cases), receptive speech (in 45.8%), non-verbal communication (35.4%), behavior (27.6%), play (8.9%), socialization (5.7%), and joint attention (2.1%). The most common motive for specialized consultation was delay in language development—in 84.6% of children. The age of ASD diagnosis varied between 12 and 132 months (mean 39.7 months), and the time period between first ASD manifestations and diagnosis was in the range of 0 to 79 months (mean 23.3 months). Many symptoms of abnormal social communication, unnoticed by parents, were detected objectively in more than 95% of the cases—absent or rare spontaneous or reciprocal smile; lack of sharing of interest or affect; abnormal eye contact; lack of finger pointing; lack of gaze to a pointed object; poor facial expressions; lack of imaginary play, etc. Conclusions: Almost two years are needed for diagnosing abnormal development in other domains besides speech in ASD patients. Diagnosis before the age of three years can be achieved by focusing parents’ and pediatricians’ attention on social communication and behavior in patients with speech delay or developmental regression. View Full-Text
Keywords: autism; neurodevelopment; age of diagnosis; pediatrics autism; neurodevelopment; age of diagnosis; pediatrics
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MDPI and ACS Style

Ivanov, I.; Pacheva, I.; Timova, E.; Iordanova, R.; Galabova, F.; Gaberova, K.; Petkova, A.; Kotetarov, V.; Panova, M.; Tonchev, N.; Franz, L. The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria. Diagnostics 2021, 11, 106.

AMA Style

Ivanov I, Pacheva I, Timova E, Iordanova R, Galabova F, Gaberova K, Petkova A, Kotetarov V, Panova M, Tonchev N, Franz L. The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria. Diagnostics. 2021; 11(1):106.

Chicago/Turabian Style

Ivanov, Ivan, Iliyana Pacheva, Elena Timova, Ralitsa Iordanova, Fani Galabova, Katerina Gaberova, Aneliya Petkova, Vasil Kotetarov, Margarita Panova, Nikolay Tonchev, and Lauren Franz. 2021. "The Route to Autism Spectrum Diagnosis in Pediatric Practice in Bulgaria" Diagnostics 11, no. 1: 106.

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