Argentina and Autism
The recognition of autism in Argentina follows, by a few years, the recognition of ASD in Europe and the USA. In general, since then, Argentine physicians and other professionals have been using the DSM classification system (APA 1980).
A few studies by Argentine researchers give an idea about the prevalence of ASD. Lejarraga et al. (2008) conducted developmental screening in a large sample (n = 839) of apparently healthy children of 0–5 years of age, in the Municipality of San Isidro, Province of Buenos Aires. In this study, the authors found 11 children with ASD, which indicates a prevalence of 13/1000 (1 in 76 children). Another prospective study was done in 2014 in children of the Province of Santa Fe by Dr. Francisco Astorino and his collaborators (personal communication). The authors of this study found a prevalence of 1/128 in children between 18 and 36 months. No information is available about the prevalence of autism in older children in Argentina.
It is important to understand and acknowledge the strong influence of psychoanalysis among psychologists and psychiatrists in Argentina. Because psychoanalysis puts emphasis on the subjective experiences of the patients, and does not use any systematic classification, it makes it impossible to generate accurate data on prevalence of ASD, or produce replicable descriptions of the treatments.
Legal Issues, Mandates for Service
Until 1970, most Argentine children with disabilities received their grade education in so-called schools for special education (Escuelas de Educación Especial). The process of integrating students with special needs into the regular public school system started in the 1960s, first with integration of children with hearing and blindness disabilities. In the 1970s, the so-called schools for special recovery (Escuelas de Recuperación) were intended to serve children with minor difficulties, referred to such schools by professionals in the public school system. In 2008, the country adhered to the International Convention on Disabled Persons; although, the effort to achieve inclusion of students with autism in the Argentine system of public education is progressing slowly.
In the mid-1980s, it was a remarkable increase in work towards the integration of people with developmental disabilities in Argentina. A new presidential administration created the National Advisory Commission for the Integration of Persons with Disabilities in 1987, to provide a nation-wide platform for the coordination of different actions and proposals to achieve greater social integration of people with disabilities. In 1988, the Ministry of Education and Culture of the Nation launched its National Integration Plan. As a consequence of this renewed focus, many jurisdictions began to engage in school integration projects in those years, mostly supported by special education boards.
The National Education Law of 2006 (Argentine Law 26.026) established the right to inclusive school education throughout the country at all educational levels and modalities, to ensure the integration of the students with disabilities, according to each person’s potential.
In 2005, the government of the City of Bueno Aires approved a Resolution (Buenos Aires City Law 650/2005) for people with disabilities that mandated early diagnosis and early therapeutic intervention, aiming at reducing the incidence of autism and severe communication disorders. This resolution also mandated a survey of these disorders, and highlighted the need for an increase in identification, and appropriate medical care of autism and severe communication disorders.
In 2014, the National Congress passed Law 27.043 on the “Comprehensive and Interdisciplinary Approach of Persons Who Have Autism Spectrum Disorders.” This law established as goals of national interest all actions conducive to the following: (a) a comprehensive and interdisciplinary approach to people with Autistic Spectrum Disorders (ASD); (b) clinical and epidemiological research; (c) professional training in early detection, diagnosis, treatment, and research; and (d) dissemination and access to benefits for persons who have Autism Spectrum Disorders. Several, but not all, of the country’s provinces have adhered to the national law, or have produced similar legislation.
The treatment of these topics generated a public debate around systematic research on diagnostic classifications, the effects of “labeling” when using a diagnosis, and the so-called “pathologization” of children, as well as the appropriate types of early intervention for each child.
Overview of Current Treatments and Centers
Medical Treatment: In Argentina, the overall health-care system is split between four layers of different but often overlapping systems. The country has a public health system, with public health centers and hospitals providing care that is free, or almost free of cost to the patients. These hospital and community health centers are funded by the federal administration, and/or depend on funding provided by provincial and municipal governments. These institutions deliver services to the largest segment of the population. Another layer of health-care services is delivered by social services (Obras Sociales) organized and funded by various workers’ unions (Sindicatos). Most Argentine employers and employees would regularly contribute to these organizations. The quality and volume of health care provided by social services administered by workers’ unions is in direct relationship with the number of workers contributing a portion of their salaries to the unions. Some Obras Sociales have large hospitals in Buenos Aires, and in other cities. Yet another layer of health care is delivered by private HMO (organizaciones prepagas para el cuidado de la salud). People buy a membership, and pay a monthly fee to a HMO to receive a certain level of health care from professionals affiliated to the organization. Some of these HMOs own large clinics and hospitals in many regions of the country. The fourth layer of health care in the Argentine system is found in some private local clinics and hospitals, and also private individual health professionals across the country. With such web of providers, which often overlap in the most populated areas, it is difficult to evaluate current medical treatments for autism.
Treatment options vary greatly according to region of the country, and type of health insurance coverage. A fair assessment of the situation would indicate that treatment options for autism depend on the qualifications of the centers, and the competence of the professionals delivering such care.
Across the country, many relatively small private interdisciplinary centers deliver care to children with autism. Most of these centers offer a combination of multiple treatments, and the number of professionals using evidence-based therapies in these interdisciplinary centers seems to be increasing. The professionals’ combined form of treatments could include therapies such as counseling, speech therapy, occupational therapy, psychomotricity, psicopedagogía (psychology of learning), music therapy, and others. Most interdisciplinary clinics include a physician, usually a child neurologist or child psychiatrist. The counseling received by the children is often based on psychoanalysis (Barcala et al. 2003).
Across the country, an increase in public awareness on the need for early detection of autism is evident; see Ministerio de Salud de la Provincia de Buenos Aires, and Rattazzi (2014). Among professionals, there is also increased emphasis in the use of evidence-based treatments like Denver, SCERTS, TEACCH, floor time, etc. For details, see Cadaveira and Waisburg (2014), García Coto (2001), and Valdez (2016).
Barcala and collaborators (2003) conducted a study in Buenos Aires aiming at obtaining an estimate of accessibility to services for children of autism in the public health system in the city. The authors could not obtain information from all Municipal Hospitals due to insufficient systematization, lack of electronic records, and also because some health care providers reported that they employed psychoanalytical frameworks which precluded them from submitting detailed quantifiable data.
Another comprehensive study by Barcala et al. (2006) presented an excellent picture of the mental health services offered in public hospitals in Buenos Aires. The authors surveyed all the pediatric mental health services (Servicios de Psicopatología Infantil) in the city. Although they were unable to obtain the actual number of children with ASD served in those public hospitals, their study included descriptions of the treatment offered in two psychiatric hospitals with specialized treatments. The authors found that among 32 hospitals, only 9 provided treatment for ASD. Most hospitals offered individual therapy delivered by psychologists, many offered treatments delivered by psicopedagogas (professionals specialized in psychology of learning), while a few treatments were done by occupational therapists. Only two of the hospitals in this study had child psychiatrists on staff, providing pharmacological treatment.
In 2006, the theoretical framework most often employed by the staff at Mental Health Centers in public Hospitals in Buenos Aires was psychoanalysis (Barcala et al. 2006). Although, a recent review of the number of centers and academic courses that include ABA and other developmental/educational approaches (Denver, TEACH, etc.) indicates an increase in the use of evidence-based treatments in Argentina.
Overview of Research Directions
Currently, it appears that the country does not have an institutional research agenda for ASD. A review of existing research supported by the National Council for Scientific and Technical Research (CONICET), the main public-funded research organization in the country, indicates that many individual projects are targeting basic research on autism; however, apparently there are no programs or established research groups focused on autism. Some clinical studies on autism by individual scientists are also supported by CONICET.
Overview of Training
Ongoing training of providers (teachers, health care professionals, and others): Some universities are beginning to offer postgraduate education on ASD. Currently, the most relevant academic program in Autism and Asperger Syndrome is a postgraduate program offered by Universidad Católica Argentina (UCA). This program, directed by Drs. Víctor Ruggieri and Daniel Valdéz, presents content supported by evidence-based science. Also, Facultad Latinoamericana de Ciencias Sociales (FLACSO), another major university in Argentina, offers an online postgraduate course on practices for education and inclusion of children with ASD.
A review of the curricula offered in Psychology Departments at several universities across the country indicated that psychoanalysis continues to be the most commonly taught theory; although many more syllabi by faculty in Argentine universities now include behavioral and evidence-based approaches for the treatment of ASD.
ASD is part of the curricula in medical residencies in child psychiatry, child neurology, and neuropsychiatry at several universities. However, ASD is not included in the curricula for most pediatric residencies. While most pediatric residents would receive a few lectures on ASD, few of these residents would obtain adequate training for ASD detection, let alone treatment of children with ASD. Lessons on autism are taught in most of the Health Allied Schools, like those offering academic training on occupational therapy, physical therapy, speech therapy, and educational psychology; however, autism rarely appears as the main subject in a course.
Social Policy and Current Controversies
One important controversy in Argentina is found in concerns of parents and professionals regarding the classification of behavioral/mental conditions, and pervasive effects of labeling on the individuals. Labeling manifests conflict between accepting the child differences as his/her way of being and the attempt to “cure” or make the child as “normal.”
Most of the formal education for children with special needs continues to be segregated in schools for Special Education. Since relevant legislation passed in 2014, there is major push for achieving greater inclusion of children with ASD in public and private schools. Nevertheless, some parents continue to have concerns about the extent to which the trend would mean a genuine move towards inclusion, and wonder about the possibility of ending up with an actual reduction of services.
In sum, the current diagnosis of autism in Argentina shows increase in awareness and decrease in stigmatization, mainly thanks to the efforts of several parents’ organizations and the effects of their public role in educating the community (see, for example, associations such as TGD padres, http://tgd-padres.com.ar; Programa Argentino para Niños, Adolescentes y Adultos con Condiciones del Espectro Autista (PANAACEA) http://www.panaacea.org/; and Asociación Argentina de Padres de Autistas http://apadea.org.ar/).
References and Reading
- American Psychiatric Association. (1980). Diagnostic and statistical manual. Washington, DC: APA Press.Google Scholar
- Barcala, A., Alvarez Zunino, O., Torricelli, F., Bianchi, V., & Ynoub, R. (2003). Niños/as con trastornos psicopatológicos graves: representaciones sociales de los profesionales de salud mental que trabajan en los servicios de Salud pertenecientes al gobierno de la Ciudad de Buenos Aires. Paper presented at Primeras Jornadas sobre Representaciones Sociales, Investigación y Prácticas. Buenos Aires: Universidad de Buenos Aires.Google Scholar
- Barcala, A., Brio, M., Vila, N., Gotlieb, M., Oliva, M., Baumann, N., Bravo, F., Ciolfi, L., Etcheverry, L., & Lefebvre, T. (2004). Caracterización de la consulta institucional en psicosis y autismo infantil en la ciudad de Buenos Aires. Estudio de caso. Revista de Investigaciones en Psicología, 9(2), 7–24.Google Scholar
- Barcala, A., Torricelli, F., Brio, M. C., Vila, N., Ynoub, R., & Marotta, J. (2006). Prevalencia institucional en psicosis y autismo infantil en la ciudad de Buenos Aires. In Anales de la Fundación Alberto J Roemmers (Vol. XVII). Buenos Aires: Talleres Gráficos de la Prensa Médica Argentina SRL.Google Scholar
- Cadaveira, A., & Waisburg, C. (2014). Autismo: guia para padres y profesionales. Buenos Aires: Paidos.Google Scholar
- García Coto, M. A. (2001). Tratamiento del Autismo: Programa neurocognitivo. In Autismo: enfoques actuales para padres y profesionales de la Salud y la Educacion. Buenos Aires: Fundación para el Desarrollo de los Estudios Cognitivos.Google Scholar
- Guia de ayuda para la detección de los trastornos del espectro autista. (2014). http://regionsanitaria1.com/documents/GUIA-TEA-2014%20(1).pdf.
- Lejarraga, H., Menendez, A. M., Menzano, E., Guerra, L., Biancato, S., Pianelli, P., Del Pino, M., Fattore, M. J., & Contreras, M. M. (2008). Screening for developmental problems at primary care level: A field programme in San Isidro, Argentina. Paediatric and Perinatal Epidemiology, 22, 180–187.CrossRefPubMedGoogle Scholar
- Valdez, D. (Ed.). (2016). Autismos, Estrategias de Intervencion entre lo clínico y lo Educactivo. Buenos Aires: Paidos.Google Scholar
- Facultad Latinoamericana de Ciencias Sociales. Academic program on Necesidades educativas y prácticas inclusivas en trastornos del espectro autista. http://flacso.org.ar/formacion-academica/necesidades-educativas-practicas-inclusivas-y-trastornos-del-espectro-autista/
- Universidad Católica Argentina, Postgraduate program Diplomatura en Autismo y Síndrome de Asperger. http://www.uca.edu.ar/index.php/site/index/es/uca/facultad-de-ciencias-medicas/cartelera/diplomatura-en-autismo-y-sindrome-de-asperger/