Diagnostic Practices and Awareness of Autism Among Indian Pediatricians: A Decade of Data

Background: As in many countries, pediatricians in India are an early point of contact for families of young children with autism. Due to the relatively small number of psychologists and child psychiatrists, pediatricians represent a critically important source for obtaining a diagnosis. Correspondingly, their practices may be directly associated with the increase in children who have received a diagnosis in recent years. In the absence of epidemiological studies in India, reported beliefs and practices from professionals can illustrate trends in the diagnosis of autism.

Objectives: This study examined beliefs about autism and characteristics considered in making a diagnosis among a national sample of pediatricians in India, drawing comparisons to a similar sample from 1998.

Methods: All members of the Indian Academy of Pediatrics were invited to receive free informational materials (posters, brochures, and a book of frequently asked questions) and were requested to complete a survey. Participants were asked about their location and years of practice; number of cases seen and diagnosed; recommendations upon diagnosis; opinions about 26 statements about autism; and were asked to indicate which characteristics they considered necessary, helpful but not necessary, and not helpful in making a diagnosis of autism. Responses were received from 584 pediatricians.

Results: Participants had an average of 16.7 years of experience (SD = 10.6). They reported seeing a mean of 23.8 cases during their career (SD = 43.9) and diagnosing a mean of 12.8 (SD = 24.4) cases. This is approximately three times the number of cases seen and twice the number of cases reportedly diagnosed by pediatricians in 1998 (p < .0001 for both). Among pediatricians who have diagnosed at least one child, significantly more recommend special education (66%; c²=4.188, p < .05) and significantly fewer recommend medication (23%; c²=5.269, p < .05) as compared to a decade ago. Pediatricians reported an average of 8 characteristics they considered necessary to make a diagnosis; lack of eye contact, lack of social responsiveness and rigid or stereotyped play activities were the three most endorsed items. However, a sizeable percentage of pediatricians also endorsed other characteristics as necessary, such as attention deficits (46%), mutism (33%) and sudden, unexplained mood changes (25%). In addition, a portion of pediatricians agreed with statements such as “emotional factors play a major role in the etiology of autism,” (50%), “Autistic children's withdrawal is mostly due to cold, rejecting parents” (30%) and “Autistic children do not show social attachments, even to parents” (70%). Nearly the entire sample (96%) agreed that autism is under-recognized and often missed in general practice and that “there is a lack of awareness regarding Autism among professionals in this country” (97%).

Conclusions: Awareness of autism among pediatricians in India has improved considerably over the past decade; physicians report significantly more direct experience with children with autism than in the past. Preliminary descriptive results suggest that many beliefs considered outdated in the West are also on the decline in India, although others persist. These data suggest critical areas to target in order to improve diagnostic practices.