Clinical Profiles of Children with Early Diagnosis of Autism Spectrum Disorder

Background: Early identification of developmental disabilities is a high priority for the WHO to allow action to reduce impairments through Gap Action Program on mental health. In India, early diagnosis of developmental disorders in children is a challenge on account of poor awareness about developmental milestones, delayed help seeking behavior of parents, poor compliance to well baby clinic visits and limited resources. The average age of diagnosis in India, according to published studies, ranges from 42 months to 55 months.In cities of India, however the scenario is changing on account of higher education, awareness among parents and referring pediatricians and need to seek timely help from Pediatricians. The centre at which the current study was conducted has seen a drop of average age of referral from 5 years and above for children suspected of Autism Spectrum Disorder in 20012 to 3.7years in 2017.

Objectives: To provide a review and meta-analysis of children referred with high index of suspicion for ASD.

Methods: Sample was obtained from a multidisciplinary child development centre in Mumbai, India. Children diagnosed with ASD (based on DSM V) or with a provisional diagnosis of Autism Spectrum Disorder were included in the study. Detailed developmental pediatric evaluations included pre natal, peri natal history and assessment of neurodevelopmental achievement. These children underwent a trans-departmental evaluation which included a Neurodevelopmental exam by a Developmental Pediatrician, hearing evaluation, DSM V and DQ/IQ evaluation by qualified Psychologists, Occupational Therapy and Speech and Language evaluation. Retrospective quantitative analysis revealed key findings.

Results:

915 children were referred to the centre in the year 2017 with developmental concerns. Of these, 260 children underwent a DSM V Evaluation for ASD (Mean Age 3.7 years).55 percent children were above 3 years of age and 113 (43%) children were below 3 years of age and had a provisional diagnosis of ASD. Majority of the children (75%) had moderate degree of autism. 13%of these children had mild autism and 11%had severe degree of autism. 27 percent children had an NICU stay most commonly due to neonatal hyperbilirubinaemia.

A similar study at the centre in 2016 showed 98.3% had no significant neonatal event. About 46 percent of mothers had an antenatal illness in the form of hypothyroidism, PIH, anaemia or infections. The average age of the mother at the time of delivery was 29 years. 32 of the 260 children had average DQ/IQ.86 children had mild subnormality, 48 had moderate subnormality and 11 had severe subnormality in social or intellectual functioning.

Conclusions: Increasing number of children referred at an early age with high suspicion of ASD in metropolitan cities of India necessitates rigorous follow up to provide holistic intervention programs and harness their developmental potential during critical period of brain develpoment. the study emphasises the need to longitudinally map the course of these early diagnosed group for assessing stablity of diagnosis and measure outcomes of intervention when compared to late diagnosis group.need for large scale training of trainers across the country and a model worth emulation for other developing countries.