Aka (ASSESSMENT KIT FOR AUTISM): PRELIMINARY DEVELOPMENT of AN Indian SCREEN for Young Children

Background: Culture specific, inexpensive screening instruments for autism spectrum disorders (ASD) are required to facilitate timely diagnosis, especially in South Asian countries such as India where awareness about ASD is still limited. Additionally, there is an increased need to create a workforce who can identify children at risk early and send them to specialists for detailed assessments.

Objectives: The objective was to complete the preliminary development of a new tool to screen for ASD. AKA is a tool designed for children aged 18 months and above to help differentiate those with ASD from those with severe behavioural disorders and those who are developing typically. It reflects the conceptualizations of autism as per the DSM-IV-TR criteria.

Methods: A review of existing screening tools and observational methods was conducted to develop an outline of potential components. Initial feedback was obtained after selected toys and components were provided to different potential users who were both experienced (at least five years of experience conducting functional and academic assessments of children with autism) and individuals training to become special educators with no prior background with autism. Expert review was also used to provide face validity.

Results: Based on the process above, development of an initial screening kit was developed with three components.

1         A “quick scan” of child behaviours, completed by asking parent or persons who spend most time with the child a set of five questions.

2         Suggested activities for the professional to conduct that will provide more information on the child’s behaviours.

3         Suggested questions for people who spend the most time with the child to get information about usual patterns of behaviour and activity, since all the relevant information may not be evident in one sitting with the child.

The intention of AKA is that it can be completed by teachers, special educators, community-based rehabilitation professionals and caregivers in a variety of settings including child guidance clinics, schools, day-care centres and homes.

AKA was designed with an assortment of items that would be of interest to young children irrespective of their gender, educational, cultural and socio-economic background. Objects included are culturally familiar, child–friendly, easily available, and inexpensive and require no complicated manipulations for either the child or the administrator.  A unique aspect of AKA is the inclusion of a companion resource to provide the administrator with an overview on ASD; suggestions on creative activities and questions for an interview; and key behaviours to observe and enquire about to capture the qualitative development in a child.

Conclusions: Validation of the AKA has not yet occurred.  If validated, the AKA can be a useful tool for screening autism in low resource countries because of the instrument’s flexibility and unique elements that demystify ASD and make it practical and reachable to various professionals in the field.