Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Indian Journal of Community Medicine

Epidemiological Profile of Children With Autism in Comparison With Other Communicatively Challenged Children Attending Early Intervention Centre

Author(s): S. Jayarama, J. S. Bhat

Vol. 29, No. 3 (2004-07 - 2004-09)


Objectives: To study the epidemiological profile of children with autism.

Study Design: Cross-sectional hospital based, structured, interview and observational study.

Setting: Early Intervention Centre in a multidisciplinary teaching hospital.

Participants: Children attending Early Intervention Centre.

Statistical Analysis: Chi-square test for association, Fisher's exact test and Z-test for proportions.

Results: Children with autism were identified before 3 yrs of age. Autism was more in the males than females. Most of the autistics were residing in the urban area and in a nuclear family. Autism was identified by the mother in all the subjects studied. Autistic children were exposed to more than one language in the home. Conclusion : The autistic children are identified early by the mother in spite of living in a nuclear family.

Key words: Autism, early intervention, communication disability.


The early identification and intervention has been one of the key issues in the movement of the disability in the second half of the 19th century1. This focus has helped in reducing in handicapping effects of the disability. Autism, the most common problem of a group of conditions called pervasive developmental disorder is the third most developmental disorder following mental retardation and cerebral palsy2. The prevalence rate of autism has been increasing over years for unknown reasons3. The causative factors have been postulated though not proved and so the treatment effectiveness keeps varying. Autism is a disorder that affects the person's ability to communicate, form relationships with others and respond appropriately to the environment4. Though many of the symptoms of autism are the same, each person is affected differently and to a varying degree of severity.

It is important to study different aspects of this disability from all possible angles. This study is a small attempt towards this move.


A total of 95 children attending the Early Intervention Center were the subjects for this study. This study was conducted over duration of six months during the second half 2002 in the Early Intervention Center at a multidisciplinary teaching hospital.

The focus was mainly on the autistic children against other communicatively challenged children such as mentally retarded, cerebral palsied, hearing impaired and childhood aphasics. Each child was evauluated by a team of specilalists comprising of pediatrician, neurologist, ophthalmologist, psychologist, speech and language pathologist and physiotherapist before arriving at the diagnosis. Each child taken up for the study was exposed to the early intervention centre everyday. All the children on roll at the time of the study were the subjects for the study. The study was cross sectional study design based on structured interview with the mother as well as retrieval of the data from the subject's case file.

Results and Discussion

Most of the children were identified before the age of two years in all the subjects taken up for the study as shown in the Table I. As for the mean age of training, there was no difference in the autisitc group, but in the others category there were more children from the less than three years group. A child with autism challenges communication, interaction and learning, with noticeable changes in the child's behaviour in relation to the environment5. During the first two years of life, child with autism shows clear differences in comparison with normal which is obvious to even untrained ears and this is evident here with almost 84% children diagnosed before the age two. As the child grows, the demarcation line becomes even stronger. The initial doubt of the disability and mothers tendency to postpone the observation doesn't get stretched beyond four years as shown in the table with almost 100% children diagnosed before four years.

Table I: Age of Identification and The Mean Age of Children On Roll

  Autism Others
Age of Identification
Less than 2 yrs 25 (83.3%) 60 (92.3%)
2-4 yrs 5 (16.7%) 0  
More than 4 yrs 0     (7.7%)
Mean Age
Less than 3 yrs 15 (50%) 40 (61.5%)
More than 3 yrs 15 (50%) 25 (38.5%)

Autism is the third most development disability and is found to be so even in this study2. The higher rate here could be attributed to the fact that children with other disability reach special schools where as such a facility was not available for autism in this place of study.

The male children with autism were more than the females in this study with almost double the number. In the others category there was no clear-cut difference.[x2=1.276,p>0.05] Several researchers have found similar differences between two sexes. In fact autism is found to strike males about four times more than females6. The female number was less in general too perhaps owing to the fact that male child receives priority in education over females in India. Moreover a female autistic child, unlike the male child often has accompanying intellectual disability5 and may reach a special school for the retarded for that reason.

In this study most of the autistic children (83.3%) were from urban area and none of them were from rural area. Table II shows the details of place of residence. This particular pattern of distribution was not observed in the others category. This was very highly significant statistically with p value less than 0.0001. The finding that none of the autistics were from the rural area could be because of the differences in the standards of acceptance in the child's behavior in the rural and urban area. It could be also reflecting the lack of awareness in the rural area about this disability. The awareness about the disability is more in the urban area and so are consultations for the same. Studies have shown that the prevalence rate of the autism is increasing over the years.

As for the type of family was concerned, 83.3% of the autistic children were living in the nuclear family as shown in the Table II. In the others category 76.9% were living in the joint family. This was statistically very highly significant [x2=62.384 p < 0.0001].

Table II : Place of Residence and Type of the Family of the Children Attending Early Intervention Center

  Autism Others
Place of Residence
Urban 25 (83.3%) 30 (46.1%)
Rural 0   20 (30.8%)
Semi-urban 5 (16.7%) 15 (23.1%)
Type of Family
Joint 5 (16.7%) 50 (76.9%)
Nuclear 25 (83.3%) 15 (23.1%)

The cause of autism is still obscure3,5,6. However it has been proved that autism doesn't occur because of unhappy homes, bad parenting and the like. Majority of the autistic children in this study were from a nuclear family. This factor has a say during the intervention plan of the autistic child wherein the living pattern of the joint family are favourable for generalization on the learnt behavior which is one of the major concerns in the autistic training. This finding could be viewed from another angle too. Urban setup is replicated with nuclear family and it is also a fact that the training facilities are available in the urban set up.

Table III shows the details of identification of the disability. The mother, in all the cases taken up for the study identified autism. For other disabilities the identification was not by mother alone but with others in the family and in some by the consultant. Autism affects the interpersonal communication. The child’s relation with the environment are quantitatively so different that it is noticed at home itself. Moreover the fact that the child is most of the time in the company of the mother during the first few years of life justifies the identification of the problem by the mother in all the autistic children. Mother child relation is reciprocal, continues and ongoing, hence, a unique behavior pattern of the child often strikes the mother as shown here.

Table III : Person Who Noticed the Disability First

Noticed by Autism
Mother 30 (100%) 40 (61.5%)
Father 0   0  
Other Family Member 0   15 (23%)
Consultant 0   10 (15.3%)

As shown in the Table IV, more than 50% of the children with autism were exposed to more than one language. Where as this was opposite in the others category with 80% of the children receiving stimulation in only one language. This was very highly significant statistically. [c2=16.98, p < 0.001]. Autism affects the communication and language abilities of the child to such an extent that language ability of the child is considered as a factor for the prognosis of the training6. It is for this reason that a child with autism suffers more in a multilingual setup like that of India. Many times the language used for training differs from the mother tongue. The child would have had stimulation and exposure in the mother tongue during the critical period of language development. Subsequent change of language is one of the main hurdles in a communicatively challenged group such as autism. This particular aspect needs to be attended to.


In our study the autistic children are identified early by the mother in spite of living in a nuclear family. Autism is a pervasive disorder.

Table IV: Details of the Language Exposure to the Child

Language Autism Others
Unilanguage 10 (33.3%) 50 (76.9%)
Multilanguage 20 (66.7%) 15 (23%)
Total 30 (100%) 65 (100%)

It is a symptom complex. Though the studies are yet to conclude on the causative factors, it is a common observation that people with autism can be helped. A combination of early intervention, special education, and family support and in some cases, medication, on a regular and consistent manner helps people with autism to live near normal life. However, the autism still remains as an unknown entity from different angles and similar studies in greater depth are essential to unveil the enigma.


  1. Chandrashekhar B, Malla N, Vishalakshi. Early identification of autism issues and solutions, The J of Indian Speech and Hearing Association, 2002; 16:71-82.
  2. Neuwirth S. Autism. Bethesda: National Institute of Mental Health, Information Resources; 1997.
  3. Cohen D, Volkmar F. Handbook of autism and pervasive developmental disorders. , New York: Wiley; 1997.
  4. Singhal N. Autism. Health dialogue, Christian Medical Association 2003; 33.
  5. Volkmar, F R. Autism and Pervasive Developmental Disorders. New York: Cambridge University Press;1998
  6. Bernstein K D, Tiegerman-Farber E. Language and communication disorders in children. Boston: Allyn and Bacon, A Pearson Education Company; 1997.

Kasturba Medical College, Mangalore - 575001

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica