Autism Screening, Assessment and Parent-Mediated Intervention

Autism Spectrum Disorder (ASD), a neuro-developmental disorder of variable severity, is characterized by impairments in social interaction and communication, and restrictive or repetitive patterns of behavior, signs of which begin during early childhood and last throughout the lifespan. It is much more common in today’s society than we realize, with almost 1-1.5% of children falling in the autism spectrum. Though the Indian Academy of Pediatrics recommends screening for ASD at 18 and 24 months since early detection is key in helping a child with Autism live a more normal life, it is not being done due to lack of awareness and time in a busy pediatric clinic. Hence there is a substantial delay in identifying ASD.

Research suggests that early intervention and autism-appropriate education at key developmental stages are required for autistic children to gain essential social skills and live more productive lives; it also helps parents learn early-on how to help their child to communicate, learn skills, form friendships and manage behaviours. But, the professionals required to provide intervention services are few compared to the number of children who need intervention. Hence many children do not get adequate and timely intervention, and the child’s developmental lag worsens.

Our 3-year project envisages universal screening for children below 6 years in Thiruvananthapuram district, Kerala, and training for the parents to be the primary therapists for their children.

We want to increase the awareness among health professionals to identify the “red flags” of ASD and do a population screening to identify children “at risk” who would otherwise be missed in a pediatric clinic. 6 medical camps will be organized across the district, where children below 6 years of age who show symptoms suggestive of ASD based on parental report or after assessment by a health professional would be administered ASD specific screening tests. This will be followed by a detailed diagnostic assessment by a team of pediatrician, occupational therapist, speech pathologist and psychologist.

Parents of the children confirmed to be autistic would be enrolled for a 3 to 4-weeks of intensive training on parent-mediated intervention delivered by an interdisciplinary team of occupational therapist, speech language pathologist, psychologist and special educator. This training will be followed by mandatory monthly 1-day follow-up sessions for a year. A medical social worker will connect to the parents regularly. Children who need more intensive training would be given additional intervention.

The early detection of ASD, followed by the implementation of evidence-based interdisciplinary intervention comprising of occupational therapy, speech therapy, behaviour therapy and autism-appropriate education will result in progress in all domains such as language and communication, sensory symptoms, activities of daily living, behaviours, motor skills and social skills. The sessions at the 3 to 4-weeks intensive training on parent-mediated intervention will be held for 3 hours per day - the therapist demonstrating for 2 hours and parents emulating the therapist for 1 hour. Parents will thus be empowered to train their children in all these domains and hence the progress will be faster, more sustained and will help the children to generalize their skills.

3 interdisciplinary teams of professionals will be conducting the parent-mediated intervention program simultaneously; each of the 3 members of a team will train a group of 5 parents each. Thus, 45 children will be undergoing the intervention program at any point. Assuming we will be able to do 10 such sessions of the 3-week program in a year, 450 children will benefit from the program every year for the project duration of 3 years.