Why is early diagnosis of Autism still a challenge in India?

Early diagnosis and intervention are crucial for managing Autistic Spectrum Disorder (ASD), improving cognitive and social-emotional functions in affected children. Despite no specific biomarker test available, observation of behaviour is essential. In India, challenges such as lack of acceptance, cultural differences, and high cost hinder early diagnosis. Multidisciplinary approaches and parental involvement are vital for effective management.

Autistic Spectrum Disorder (ASD) is a complex developmental condition involving persistent challenges with social communication, restricted interests and repetitive behaviour. Early diagnosis is essential in improving the outcomes of children with ASD. Early interventions can have a positive impact on cognitive, language, and social-emotional functioning.

How to diagnose ASD?

There is currently no specific blood test or biomarker available to accurately diagnose ASD. Appropriate diagnosis therefore requires careful review of the history and direct observation of children’s child’s behaviour.

Besides typical presentations like speech delay, reciprocating without communicative intent, repetitive actions, early markers for ASD often manifest and if detected, could facilitate early diagnosis.

Some of the early markers of ASD are as follows:

Lack of joyful expressions

Lack of eye contact

Lack of communicative intent with parents

Lack of vocalization to communicate with parents

Lack of recognition of parent’s voice

Lack of response to name calls but alert to environmental sounds

Delayed onset of babbling past 9 months of age

Absence of pre-speech gestures like waving hands, pointing fingers

Restrictive and repetitive behaviour

Hyperreactivity to sensory inputs like noise, smell or texture

What is the cause of ASD?

The cause of ASD is thought to result from disrupted neural connectivity and is primarily impacted by genetic variations affecting early brain development. Numerous genes involved in brain development have been associated with ASD. There is also possible evidence of environmental contributions to ASD. Older maternal or paternal age may increase the risk of ASD.

Why is early diagnosis of ASD challenging in India?

Several environmental and social factors contribute to the diagnostic challenges in India, such as

Lack of acceptance: Most parents hesitate to seek help and fail to accept that their child has some issue even when addressed by a doctor during a routine health visit. Most of us want to believe our child is doing good.

Cultural differences: Some parents may ignore early signs of ASD as “late blooming” or believe that boys speak later than girls, thus delaying intervention.

Accessibility and cost: Comprehensive assessments can be expensive and mostly available in urban centres, making it harder for lower-income families to get an early diagnosis.

Alternative approaches: Parents tend to seek help from unqualified practitioners, alternative medicine providers such as herbal medicines,

Prevalence of pseudoscience: People tend to believe in myths such as vaccination as a cause of autism, supernatural causes, etc., leading to further delay in intervention.

Lack of consistent screening practices: In India, routine autism screening in pediatric health check-ups is not mandatory, unlike in some western countries, leading to missed early signs of ASD.

Early screening and accurate diagnosis are crucial, as they play a pivotal role in determining the future outcomes for these children. Managing ASD requires a multidisciplinary approach involving professionals from various fields, including developmental pediatricians, child psychiatrists, psychologists, occupational and speech therapists, and more importantly, the involvement of parents/caregivers is crucial in the entire process.

Dr. E. Dinesh Kumar M.D(Pediatrics), Consultant Pediatrician, Prashanth Hospital, Velachery.

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