Clinical Evaluation of Children with Autism at a Multidisciplinary Intervention Centre in India

Background:  

About 10 million individuals in India have Autism. The burden of disability is compounded by limited interventions and even fewer multidisciplinary approaches, targeting children in early life. Few studies in India have mapped clinical profiles of children with Autism.

Objectives:  

This analysis aims to present results of clinical evaluations of children with features of Autism reporting to a multidisciplinary child development centre in Mumbai.

Methods:  

Sample was derived from a published study (n = 1301) that obtained data on assessment and intervention for neurodevelopmental disorders at the aforesaid centre from 2009 to 2012. Children were trans-departmentally assessed across various clinical (developmental paediatric and paramedical) disciplines. Fourth edition of Diagnostic and Statistical Manual of Mental Disorders was referred. Data were descriptively analyzed using Microsoft Excel 2007 and Stata-10. 

Results:  

Out of 1301 children, 145 children (11.1%) were identified with features of Autism. Most children were referred by physicians and paediatricians (70.9%). Mean age at referral was 4.5 years. Only 3 children were referred at less than 2 years. The multidisciplinary centre was the first point of therapy for 60% of families. These findings indicate the delay by parents to seek care. Salient presenting concerns reported by parents were speech delay (88.1%), behavioural concerns (61.8%), and atypical socialization (36.1%) . About 69% of children attended school and most of them attended regular schools (94.5%) with English as medium of instruction (94.1%). However, English was spoken at only 35.4% of homes.

In developmental assessment (n = 134), solitary and destructive play was observed in 99.2% and 26.8% respectively. Thus, most children had not developed parallel play. Hypotonicity was observed in 63.4% of children. Hypersensitivity to tactile and auditory input was noted in 57.8% and 36.3% of children respectively. Hyposensitivity to vestibular and proprioceptive input was noted in 86.4% and 67.1% of children respectively. Toe-walking was present in 23.8% and mouthing of objects in 32% of children. Only 15.6% of children maintained eye-contact. Inability to perform activities of daily living was noted in 92.5% of children. In speech assessment (n = 96), sub-optimal oral-motor and vegetative functioning was present in 64.2% and 76% of children respectively. On assessment, non-verbal communication was noted in 75.6% of children. In speech milestones, delays in uttering one and two meaningful words were seen in 95.7% and 98.9% of children respectively. Receptive and expressive language ages were 16.2 and 14.8 months respectively and unpaired t tests provided statistically significant differences between these ages and the mean chronological age of 48 months. Thus, inability to communicate verbally was the most important reason for care-seeking. Comprehending single, dual and multi-step instructions (on 3^rdedition of Reynell scale) was observed in 12.5%, 2% and 1% of children respectively.

Conclusions: Initial comprehensive evaluations allow developmental therapists to focus on multiple developmental domains, set feasible and individualized therapeutic goals and monitor functional changes, particularly in a multidisciplinary intervention model. Further research is needed to test the impact of these models in developing countries like India.

Background:  

About 10 million individuals in India have Autism. The burden of disability is compounded by limited interventions and even fewer multidisciplinary approaches, targeting children in early life. Few studies in India have mapped clinical profiles of children with Autism.

Objectives:  

This analysis aims to present results of clinical evaluations of children with features of Autism reporting to a multidisciplinary child development centre in Mumbai.

Methods:  

Sample was derived from a published study (n = 1301) that obtained data on assessment and intervention for neurodevelopmental disorders at the aforesaid centre from 2009 to 2012. Children were trans-departmentally assessed across various clinical (developmental paediatric and paramedical) disciplines. Fourth edition of Diagnostic and Statistical Manual of Mental Disorders was referred. Data were descriptively analyzed using Microsoft Excel 2007 and Stata-10. 

Results:  

Out of 1301 children, 145 children (11.1%) were identified with features of Autism. Most children were referred by physicians and paediatricians (70.9%). Mean age at referral was 4.5 years. Only 3 children were referred at less than 2 years. The multidisciplinary centre was the first point of therapy for 60% of families. These findings indicate the delay by parents to seek care. Salient presenting concerns reported by parents were speech delay (88.1%), behavioural concerns (61.8%), and atypical socialization (36.1%) . About 69% of children attended school and most of them attended regular schools (94.5%) with English as medium of instruction (94.1%). However, English was spoken at only 35.4% of homes.

In developmental assessment (n = 134), solitary and destructive play was observed in 99.2% and 26.8%. Thus, most children had not developed parallel play. Hypotonicity was observed in 63.4% of children. Hypersensitivity to tactile and auditory input was noted in 57.8% and 36.3% of children respectively. Hyposensitivity to vestibular and proprioceptive input was noted in 86.4% and 67.1% of children respectively. Toe-walking was present in 23.8% and mouthing of objects in 32% of children. Only 15.6% of children maintained eye-contact. Inability to perform activities of daily living was noted in 92.5% of children. In speech assessment (n = 96), sub-optimal oral-motor and vegetative functioning was present in 64.2% and 76% of children respectively. On assessment, non-verbal communication was noted in 75.6% of children. In speech milestones, delays in uttering one and two meaningful words were seen in 95.7% and 98.9% of children respectively. Receptive and expressive language ages were 16.2 and 14.8 months respectively and unpaired t tests provided statistically significant differences between these ages and the mean chronological age of 48 months. Thus, inability to communicate verbally was the most important reason for care-seeking. Comprehending single, dual and multi-step instructions (on 3^rd edition of Reynell scale) was observed in 12.5%, 2% and 1% of children.

Conclusions: Initial comprehensive evaluations allow developmental therapists to focus on multiple developmental domains, set feasible and individualized therapeutic goals and monitor functional changes, particularly in a multidisciplinary intervention model. Further research is needed to test the impact of these models in developing countries like India.