Identificação precoce dos sinais de risco para transtorno do espetro autista no ambulatório de puericultura de um serviço de referência do Distrito Federal: trainamento no uso da Grade Preaut

Abstract

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as restricted and repetitive behaviors and interests. Early diagnosis is associated with timely intervention and attenuation of the severity of phenotypic and genetic expression. ASD originates in the early years of life; however, its clinical presentation is heterogeneous, and early signs may be evident shortly after birth, making its identification, treatment, and the formulation of public health policies a major challenge. Objective: To identify the prevalence of positive signs of psychic risk for the development of ASD in infants aged four to fifteen months followed at a reference service in the Federal District using the PREAUT Grid—a screening tool validated in Brazil, originally developed in France and grounded in psychoanalytic principles—while also training healthcare professionals responsible for child health care to incorporate the PREAUT Grid into routine clinical practice. Methods: This was an observational, cross-sectional, and descriptive study conducted between March and July 2025, including infants aged four to fifteen months. Risk signs and associated factors for ASD were assessed using the PREAUT Grid and a structured questionnaire containing sociodemographic and perinatal variables considered relevant in the literature, including chronological age (months), gestational age (weeks and days), sex (female or male), type of delivery (vaginal or cesarean), Apgar scores at 1 and 5 minutes, birth weight (grams), and parental age (years), need for neonatal ICU admission, need for oxygen therapy, prenatal care received by the mother, gestational period at which prenatal care began and number of visits, maternal illnesses during pregnancy, use of neuropsychiatric medications by the mother, and other clinical conditions.. The study was carried out at the Pediatric Outpatient Clinic – Growth and Development, located in the Child and Adolescent Unit of a university hospital in the Federal District. The research comprised four stages: participant selection, data collection, training of the healthcare team in the use of the PREAUT Grid, and statistical analysis of the association between the outcome variable and predefined covariates. The PREAUT Grid consists of four questions assessing mother–infant interaction, with a maximum score of 15 points. When the initial score is below three, two additional questions are applied. Based on the observed behaviors, infants are classified as “positive” or “non-positive” for psychic risk potentially leading to ASD, with “positive infant” defined as the study outcome. The minimum estimated sample size was 123 infants, considering 80% power, a 95% confidence level, a 5% alpha error, and an estimated prevalence of 50%. Data analysis included descriptive statistics, measures of central tendency and dispersion, and estimation of prevalence with corresponding 95% confidence intervals. For the in-service training, the target audience—professionals responsible for child health care—was defined, theoretical topics were selected, and lecturers with expertise in the field were chosen from within the institution. The number of available slots was determined by the auditorium capacity. The course was advertised through the Doity platform with institutional authorization. The total workload was 20 hours, and practical training took place in the pediatric outpatient clinic. Results: The first product, a scientific article entitled “Prevalence of positive signs of psychic risk for autism spectrum disorder in infants attending child health care clinics”, identified a prevalence of 5.7% of positive risk signs for ASD. The sample was predominantly male (60.98%), born by cesarean section (58.20%), with birth weight greater than 2500 g (81.30%), and born at term (≥37 weeks; 80.49%). Most infants had a 5-minute Apgar score greater than 7 (91.87%). Most mothers were aged 20–34 years (69.92%), and most fathers were aged 40 years or younger (83.90%). Maternal diseases during pregnancy were reported in 73.17% of cases, with gestational diabetes (30.77%) and other clinical conditions (30.77%) being the most frequent. Most infants did not experience fetal distress (83.47%), did not require neonatal intensive care (76.23%), or oxygen therapy (66.67%). Almost all mothers attended prenatal care (99.17%), initiated in the first trimester (88.03%), with more than six consultations (91.38%). The in-service training, entitled “I Course on Infant Development: Training in the Early Identification of Autism Risk and Practical Use of the PREAUT Grid.”, yielded satisfactory results, with 55 participants, including professionals from nursing and psychology, highlighting its multiprofessional nature. High participant engagement was observed. These findings support the feasibility of implementing the PREAUT Grid in public child health services in the Federal District to promote early identification of ASD risk and reduce delayed diagnoses. The project aligns with the research line Quality of Care for Women’s, Children’s, and Adolescents’ Health. Discussion: The 5.7% prevalence of ASD risk signs identified using the PREAUT Grid supports the feasibility of early detection of developmental vulnerabilities within the first year of life. The predominance of male infants aligns with epidemiological evidence, while the fact that most infants were born at term with adequate birth weight highlights the multifactorial nature of ASD. Communication- and interaction-related behavioral signs become increasingly discriminative toward the end of the first year of life, supporting the use of screening tools during this period. Although early markers show limited stability, attentional, motor, and relational changes may precede formal diagnosis. Systematic use of tools such as the PREAUT Grid—especially when combined with other instruments—can enhance developmental surveillance and timely referral. The professional training demonstrated the feasibility of qualifying healthcare teams for early risk identification within child health care settings. Incorporating standardized tools and continuing education can improve care quality and reduce reliance on late referrals. As a screening tool rather than a diagnostic instrument, the PREAUT Grid enables early parental guidance and longitudinal follow-up, aligning with preventive and health promotion models. Its integration into routine care may also improve service organization and reduce tertiary care overload. Conclusion: The findings highlight the importance of expanding research and professional training initiatives aimed at early identification of ASD risk. Qualified healthcare professionals play a critical role in establishing timely diagnoses and initiating appropriate interventions, thereby improving quality of life for affected individuals and their families. The study demonstrated the prevalence of psychic risk signs for ASD in infants and reinforces the need for complementary diagnostic approaches in children under two years of age. The proposed method is innovative and has the potential to inform child health policies, professional training, and clinical practice, particularly in nursing, given the role of nurses in primary child health care. The training course developed represents a technical product with potential local, regional, and national impact. Further large-scale, longitudinal studies are recommended to better characterize the sociodemographic and psychosocial profile of ASD cases and strengthen early detection strategies.