Effect of Multidisciplinary Intervention on Clinical Outcomes of Children with Autism Spectrum Disorder in Mumbai, India

Samir H. Dalwai, Deepti Kanade Modak, Ameya P Bondre, Sajeda Ansari, Dania Siddiqui, Diksha Gajria


Purpose: To analyse clinical outcomes in terms of functional changes in children with Autism Spectrum Disorder (ASD), before and after receiving a multidisciplinary developmental intervention programme.

Methods: Structured goal-oriented multidisciplinary intervention, individualised to each child, was implemented through 5 child development centres in Mumbai, India, in 2014-2015. Secondary data analysis of 38 children diagnosed with ASD, in the age group of 2.1 - 6.1 years, was conducted.  All children received occupational therapy and speech therapy, and parental counselling was also done. The average number of intervention sessions were 48-72 for occupational therapy (twice or thrice a week), 24-48 for speech therapy (once or twice a week) and 5-6 for parental counselling (once a month). Childhood Autism Rating Scale (CARS) and Vineland Social Maturity Scale (VSMS) were used for assessment, before and after intervention.

Results: Mean positive difference in CARS total scores through paired t-test was 4.18 (p < 0.0001). Significant positive changes in functional ability were observed in most of the sub-scales (relating to people; object use; visual response; verbal and non-verbal communication; taste, smell and touch response and use; level and consistency of intellectual response and general impression). Paired t-test also showed significant positive changes on all VSMS sub-scales, except Socialisation.

Conclusions: The model used in this multidisciplinary intervention, and adherence to its protocols, has the potential to improve functional ability (or the child’s adaptation to his/her condition) in children with ASD, in a region with limited awareness of developmental disabilities.

Limitations: Separate effects of factors outside the intervention could not be tested due to inadequate sample sizes for sub-analyses. Results also need to be validated by tests that do not depend on parental reporting (e.g., CARS and VSMS) but assess the performance of the child instead.


Child development centre; autism; Mumbai; individualized therapy-education program

Full Text:



American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5®).5th ed. Arlington, VA: American Psychiatric Publishing.

Arnold LE, Lofthouse N, Hurt E (2012). Artificial food colours and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics; 9(3): 599-609. doi: 10.1007/s13311-012-0133-x.

Datta D (2013). Autism is rising alarmingly in India. How far is the new science from finding a cure? New research busts old myths and brings new hope. India Today. [Accessed on 1 December 2015]. Available from: http://indiatoday.intoday.in/story/autism-autisitic-mind-western-syndrome-myths-about-autism-autistic-children/1/322242.html

Desai M, Divan G, Wertz F, Patel V (2012). The discovery of autism: Indian parents’ experiences of caring for their child with an autism spectrum disorder. Transcult Psychiatry; 49(3-4): 613-637. doi:10.1177/1363461512447139

Divan G, Vajaratkar V, Desai M , Strik-Lievers L, Patel V (2012). Challenges, coping strategies, and unmet needs of families with a child with autism spectrum disorder in Goa, India. Autism Res; 5(3): 190-200. doi: 10.1002/aur.1225.

Doll EA (1953). The measurement of social competence: A manual for the Vineland Social Maturity Scale. US: Educational Test Bureau Educational Publishers.

Duggal C, Dalwai S, Bopanna K, Datta V, Chatterjee S (2014). Childhood developmental and psychological disorders: Trends in presentation and interventions in a multidisciplinary child development centre. Indian J Soc Work; 75: 495-522.

Center for Disease Control and Prevention – CDC (2014). Facts about Autism. Autism Speaks. Online resource. [Accessed on 23 November 2015]. Available from: https://www.autismspeaks.org/what-autism/facts-about-autism

Gentile DA, Swing EL, Lim CG, Khoo A (2012). Video game playing, attention problems, and impulsiveness: Evidence of bidirectional causality. Psychol Pop Media Cult; 1(1): 62-70.

Ministry of Home Affairs (2011). Census 2011 report. New Delhi: Ministry of Home Affairs, Government of India.

Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L , Strupp B (2007). Developmental potential in the first 5 years for children in developing countries. Lancet; 369(9555): 60-70. doi: http://dx.doi.org/10.1016/S0140-6736(07)60032-4.

Juneja M, Sharma S, Mukherjee SB (2010). Sensitivity of the autism behaviour checklist in Indian autistic children. J Dev BehavPediatr; 31(1): 48–49. doi:10.1097/DBP.0b013e3181c7241a.

Kalra V, Seth R, Sapra S (2005). Autism – experiences in a tertiary care hospital. Indian J Pediatr; 72(3): 227 – 230. doi: 10.1007/BF02859263

Kishore MT, Basu A (2011). Early concerns of mothers of children later diagnosed with autism: Implications for early identification. Res Autism SpectrDisord; 5(1): 157–163.

Nimbalkar S, Raithatha S, Shah R, Panchal DA (2014). A qualitative study of psychosocial problems among parents of children with cerebral palsy attending two tertiary care hospitals in western India. ISRN Family Medicine; 2014(2014): 1-6. doi:http://dx.doi.org/10.1155/2014/769619

Pontifex MB, Saliba BJ, Raine LB, Pichietti DL, Hillman CH (2013). Exercise improves behavioural, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder. J Pediatr; 162(3): 543-551. doi: 10.1016/j.jpeds.2012.08.036.

Quach J, Hiscock H, Ukoumunne OC, Wake M (2011). A brief sleep intervention improves outcomes in the school entry year: A randomised controlled trial. Paediatrics; 128(4): 692-701. doi:10.1542/peds.2011-0409

Raina SK, Kashyap V, Bhardwaj AK, Kumar D, Chander V (2015). Prevalence of autism spectrum disorders among children (1-10 years of age) – Findings of a mid-term report from Northwest India. J Postgrad Med; 61(4): 243-246. doi:10.4103/0022-3859.166512.

Schopler E, Reichler RJ, DeVellis RF, Daly K (1980). Towards objective classification of childhood autism: Childhood Autism Rating Scale (CARS). J Autism Dev Disord; 10(1): 91–103. doi:10.1007/BF02408436

Silberberg D (2014). Neurodevelopmental disorders in India: From epidemiology to public policy. World Neurology. [Accessed on 1 December 2015]. Available from: http://www.worldneurologyonline.com/article/neurodevelopmental-disorders-india-epidemiology-public-policy/

Smith AL, Hoza B, Linnea K, McQuade JD, Tomb M, Vaughn AJ, Shoulberg EK, Hook H (2013). Pilot physical activity intervention reduces severity of ADHD symptoms in young children. J AttenDisord; 17(1): 70-82. doi: 10.1177/1087054711417395

Society of Parents of Children with Autistic Disorders – SOPAN (2015). What is the prevalence of autism in India? Online Resource. [Accessed on 23 November 2015]. Available from: http://sopan.org/blog/#

Venkataramakrishnan R (2015). Everyone in India thinks they are ‘middle class’ and almost no one actually is. [Accessed on 1 December 2015]. Available from: http://scroll.in/article/740011/everyone-in-india-thinks-they-are-middle-class-and-almost-no-one-actually-is

Wilcox C, Washburn R, Patel V (2007). Seeking help for attention deficit hyperactivity disorder in developing countries: A study of parental explanatory models in Goa, India. Soc Sci Med; 64(8): 1600-1610.

World Population Review (2015). Mexico population 2015. Online Resource. [Accessed on 23 November 2015]. Available from: http://worldpopulationreview.com/countries/mexico-population/

DOI: http://dx.doi.org/10.5463/dcid.v28i2.508


  • There are currently no refbacks.

Copyright (c) 2016 Samir H. Dalwai, Deepti Kanade Modak, Ameya P. Bondre, Sajeda Ansari, Dania Siddiqui, Diksha Gajria

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Supported by:


© Disability, CBR & Inclusive Development