First Contact in The Diagnosis Process of Autism Spectrum Disorder: Comparison of The Knowledge Levels of Pediatricians and Primary Care Physicians Working in The Province of Diyarbakir and Investigation of Influencing Factors

Öz

Objective: This study aims to evaluate the knowledge level and clinical approach of pediatricians and primary care physicians who first come into contact with children regarding autism spectrum disorder (ASD). Methods: This cross-sectional study included 188 physicians who agreed to participate. Data were collected using the Childhood Autism Knowledge Scale for Healthcare Professionals (KCAWH) and a questionnaire containing sociodemographic information. Data were analyzed based on sociodemographic characteristics, ASD knowledge scores, and case referral practices. Results: The mean total KCAWH score of the participants was found to be 13.85 ± 2.12. There was no statistically significant difference between the total knowledge scores of pediatricians and primary care physicians (p>0.05). A one-way ANOVA test for total knowledge scores across age groups revealed a statistically significant difference (F(2.185) = 3.717; p = 0.026). According to the post-hoc analysis results, the knowledge scores of physicians in the 27-40 age group (14.12 ± 2.17) were found to be significantly higher than those in the 41-50 age group (13.23 ± 1.83) (p = 0.047). Female gender was identified to be the strongest independent factor predicting knowledge level in the regression analysis (p=0.016). Conclusion: Screening processes, which play an important role in early diagnosis, need to be improved, and physicians need to be supported with practical and routine training.

Anahtar Kelimeler

• Autism Spectrum Disorder
• Early Diagnosis
• Primary Care Physician

Otizm Spektrum Bozukluğu Tanı Sürecinde ilk Temas: Diyarbakır İlinde Çalışan Pediatrist ve Birinci Basamak Hekimlerinin Bilgi Düzeylerinin Karşılaştırılması ve Etkileyen Faktörlerin İncelenmesi

Öz

Amaç: Bu çalışma, çocuklarla ilk teması kuran pediatrist ve birinci basamak hekimlerinin otizm spektrum bozukluğu (OSB) konusundaki bilgi düzeylerini ve klinik yaklaşımlarını değerlendirmeyi amaçlamaktadır. Yöntemler: Kesitsel tipteki bu araştırmaya, çalışmaya katılmayı kabul eden 188 hekim dahil edilmiştir. Sağlık çalışanlarında Çocukluk Çağı Otizmi Bilgi Ölçeği (SÇ-OBA) ve sosyodemografik bilgileri içeren bir anket ile veriler toplanmıştır. Veriler; sosyodemografik özellikler, OSB bilgi puanları ve vaka yönlendirme pratikleri üzerinden analiz edilmiştir. Bulgular: Katılımcıların SÇ-OBA toplam puan ortalaması 13.85 ± 2.12 olarak saptanmıştır. Pediatristler ile birinci basamak hekimlerinin toplam bilgi puanları arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p>0.05). Yaş grupları arasında toplam bilgi puanı açısından yapılan tek yönlü ANOVA testinde istatistiksel olarak anlamlı bir fark saptanmıştır (F(2, 185) = 3,717; p = 0,026). Post-hoc analiz sonuçlarına göre; 27-40 yaş grubundaki hekimlerin bilgi puanlarının (14.12 ± 2.17), 41-50 yaş grubuna (13.23 ± 1.83) göre anlamlı düzeyde yüksek olduğu belirlenmiştir (p = 0.047). Kadın cinsiyetinin yapılan regresyon analiziyle bilgi düzeyini yordayan en güçlü bağımsız faktör olduğu belirlenmiştir (p=0.016). Sonuç: Erken tanı için önemli bir yeri olan tarama süreçlerinin iyileştirilmesi ve hekimlerin pratik ve rutin eğitimlerle desteklenmesi gerekmektedir.

Anahtar Kelimeler

• Otizm Spektrum Bozukluğu
• Erken Tanı
• Aile Hekimi
• Pediatrist

Kaynakça

1. 1.American Psychiatric Association. Diagnostic andstatistical manual of mental disorders. 5th ed.TextRevision. Washington, DC: American PsychiatricAssociation; 2022:50-67.
2. 2.Shaw KA, Williams S, Patrick ME, et al. Prevalenceand early identification of autism spectrum disorderamong children aged 4 and 8 years—Autism andDevelopmental Disabilities Monitoring Network, 16Sites, United States, 2022. MMWR Surveill Summ.2025;74:1-22.
3. 3.Zwaigenbaum L, Bauman ML, Choueiri R, et al. Earlyintervention for children with autism spectrumdisorder under 3 years of age: recommendations for practice and research. Pediatrics. 2015;136:60-81.
4. 4.Courchesne E, Campbell K, Solso S. Brain growthacross the life span in autism: age-specific changes inanatomical pathology. Brain Res. 2011;1380:138-45.
5. 5.Maksimović S, Marisavljević M, Stanojević N, et al.Importance of early intervention in reducing autisticsymptoms and speech–language deficits in childrenwith autism spectrum disorder. Children (Basel).2023;10(1):122.
6. 6.Franz L, Goodwin CD, Rieder A, Matheis M, DamianoDL.Early intervention for very young children with orat high likelihood for autism spectrum disorder: Anoverview of reviews. Dev Med Child Neurol.2022;64(9):1063-76.
7. 7.Lipkin PH, Macias MM. Promoting optimaldevelopment: identifying infants and young childrenwith developmental disorders through developmentalsurveillance and screening. Pediatrics. 2020;145(1).
8. 8.American Academy of Pediatrics.Policy Statement:Identifying infants and young children withdevelopmental disorders in the medical home: Analgorithm for developmental surveillance andscreening. Pediatrics. 2006;118(1):405-20.

9. 9.T.C Sağlık Bakanlığı. Ulusal Ruh Sağlığı Eylem Planı(2021-2023). Ankara: T.C Sağlık Bakanlığı Yayınları;2021.
10. 10.Çitil G, Çöp E, Açıkel SB, et al. Assessment of theknowledge and awareness of pediatric residents andpediatricians about autism spectrum disorder at asingle center in Turkey. J Community Psychol.2021;49(7):2264-75.
11. 11.Gölbaşı H, Demirel Y, Karaca SN, Çiçek AU, Sarı SA.Sivas İl Merkezi’nde otizm spektrum bozukluğunun(OSB) yaygınlığı ve aile sağlığı merkezleri sağlıkçalışanlarının OSB farkındalıkları. Cukurova Med J.2021;46(3):998-1008.
12. 12.Effatpanah M, Shariatpanahi G, Sharifi A, RamaghiR, Tavakolizadeh R. A preliminary survey of autismknowledge and attitude among health care workersand pediatricians in Tehran, Iran. Iranian J ChildNeurol. 2019;13(2):29-35.
13. 13.Alpdoğan Y, Sazak E, Omak S. Investigation ofKnowledge and Awareness of Family Physicians onAutism Spectrum Disorder in Turkey. J Kirsehir EducFac. 2023;24(2).
14. 14.Tölük B, Polat Ö, Yılmaz S. Knowledge level andawareness of parents with 18-36 month-old childrenabout autism spectrum disorder. Turk J Fam Med PrimCare. 2021;15(3):531-9.
15. 15.Daniels AM, Mandell DS. Explaining differences inage at autism spectrum disorder diagnosis: A criticalreview. Autism. 2014;18(5):583-97.
16. 16.Bakare MO, Ebigbo PO, Agomoh AO, Menkiti NC.Knowledge about childhood autism among healthworkers (KCAHW) questionnaire: description,reliability and internal consistency. Clin PracEpidemiol Ment Health. 2008;4(1):17.
17. 17.Özgür BG, Aksu H, Eser E. Validity and reliability ofthe Turkish version of the knowledge about childhoodautism among health workers questionnaire.Psychiatry Clin Psychopharmacol. 2019;29(4):765-73.
18. 18.Pınar ZV, Küçük E, Köle MT, Akın Y. Knowledge AndAwareness of Autism Spectrum Disorder AmongPediatricians: A Cross-Sectional Study from Turkey.Acta Med Nicomedia. 2025;8(3):363-71.
19. 19.Garg P, Lillystone D, Dossetor D, Kefford C, Chong S.An exploratory survey for understanding perceptions,knowledge and educational needs of generalpractitioners regarding autistic disorders in NewSouth Wales (NSW), Australia. J Clin Diagn Res: JCDR.2014;8(7):PC01-09.
20. 20.Sabucuoğlu M, Cebeci S, Rahbar MH, Hessabi M.Autism spectrum disorder and attention deficithyperactivity disorder: Knowledge and attitude offamily medicine residents in Turkey. Turk J Fam MedPrim Care. 2015;9(2):46-53.
21. 21.McNally Keehn R, Swigonski N, Enneking B, et al.Diagnostic accuracy of primary care clinicians across astatewide system of autism evaluation. Pediatrics.2023;152(2):061188.
22. 22. Hayat AA, Meny AH, Salahuddin N, et al. Assessmentof knowledge about childhood autism spectrumdisorder among healthcare workers in Makkah-SaudiArabia. Pak J Med Sci. 2019;35(4):951-57.
23. 23.Eseigbe EE, Nuhu F, Sheikh TL, et al. Knowledge ofchildhood autism and challenges of managementamong medical doctors in Kaduna State, NorthwestNigeria. Autism Res Treat. 2015;2015(1):892301.
24. 24.Tamur Y, Celasin NŞ. Aile sağlığı merkezlerindegörev yapan sağlık profesyonellerinin otizmkonusundaki bilgi ve erken tanıya yönelik görüşleri.Turk J Fam Med Prim Care. 2022;16(3):517-31.
25. 25.Rhoades RA, Scarpa A, Salley B. The importance ofphysician knowledge of autism spectrum disorder:results of a parent survey. BMC pediatrics.2007;7(1):37.
26. 26.Kılınçel Ş, Baki F. Analysis of pediatricians’knowledge about autism. J Surg Med. 2021;5(2):153-7.
27. 27.McNally Keehn R, Ciccarelli M, Szczepaniak D, et al.A statewide tiered system for screening and diagnosisof autism spectrum disorder. Pediatrics.2020;146(2):e20193876.
28. 28.Rahbar MH, Ibrahim K, Assassi P. Knowledge andattitude of general practitioners regarding autism inKarachi, Pakistan. J Autism Dev Disord.2011;41(4):465-74.
29. 29.Arslan R, Yanık D. Sağlik Çalişanlarinin ÇocuklukÇaği Otizmi Hakkinda Bilgi Düzeylerinin ÇeşitliDeğişkenler Açisindan İncelenmesi. Inonu Univ SağlıkHizmet Mesl Yuksekokulu Derg. 2022;10(3):930-40.
30. 30.Salama HM. Assessment of family physicians’knowledge of childhood autism. Fam Med CommHealth. 2017;5(4):266-74.
31. 31.Lyubarova R, Salman L, Rittenberg E. Genderdifferences in physician burnout: driving factors andpotential solutions. Perm J. 2023;27(2):130-6.
32. 32. Bernzweig J, Takayama JI, Phibbs C, Lewis C, PantellRH. Gender differences in physician-patientcommunication: evidence from pediatric visits. ArchPediatr Adolesc Med. 1997;151(6):586-91.
33. 33.Heidgerken AD, Geffken G, Modi A, Frakey L. Asurvey of autism knowledge in a health care setting. JAutism Dev Disord. 2005;35(3):323-30.
34. 34.Pirinççi S, Aksu H, Abacıgil F, Okyay P. Tıp fakültesi6.sınıf öğrencilerinde otizm spektrum bozukluğu ileilgili bilgi ve farkındalık düzeyi. Turk J Child AdolescMent Health. 2019:97-102
35. 35.Unigwe S, Buckley C, Crane L, et al. GPs’ confidencein caring for their patients on the autism spectrum: anonline self-report study. Br J Gen Pract. 2017.