Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, Odisha, India.
Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India.
Int Rev Psychiatry. 2021 Feb-Mar;33(1-2):81-112. doi: 10.1080/09540261.2020.1761136. Epub 2020 Jun 30.
Autism is a grand challenge in global mental health to be dealt with on a priority basis. Phenotypic knowledge, biological understanding, and evidence-based intervention studies are all from western countries. We know very little about autism in the low- and middle-income countries (LMIC). Lack of infrastructure and difficulties in operationalizing research has widened the knowledge gap. We performed a comprehensive scoping review of research in Autism Spectrum Disorder in India to have an overall impression, identify gaps, and formulate evidence-based recommendations for further study. We searched PubMed, SCOPUS, and Cochrane Library to identify relevant Indian studies. A hundred and fifty-nine publications met the inclusion criteria. Most of the research contribution in autism is from few tertiary care medical centres, technological institutes, and not-for-profit organizations. We identified various themes of research like clinical profile, interventions, biomarkers, psychological, social, epidemiological, and risk factors. Evidence-based intervention studies, translation and adaptation of standard diagnostic instruments, and qualitative research on the experience of autism appeared to be state of the art. However, epidemiological studies, biomarkers identification, risk assessment studies were of low quality. There is a need for nationwide studies with representative sampling on epidemiology, biomarkers, and risk factors for a complete evaluation of the actual burden and biology of autism in India. Also, there is a need to design implementation research to evaluate the effectiveness of evidence-based interventions in routine healthcare settings. We recommend that future research should fill these gaps in understanding autism and improving its outcome in India.
自闭症是全球精神健康领域的一个重大挑战，需要优先加以应对。表型知识、生物学理解和基于证据的干预研究都来自西方国家。我们对中低收入国家（LMIC）的自闭症知之甚少。基础设施的缺乏和研究实施的困难加大了知识差距。我们对印度自闭症谱系障碍的研究进行了全面的范围综述，以获得整体印象，确定差距，并为进一步研究制定基于证据的建议。我们在 PubMed、SCOPUS 和 Cochrane Library 中搜索了相关的印度研究。有 159 篇出版物符合纳入标准。自闭症研究的大部分贡献来自少数三级保健医疗中心、技术研究所和非营利组织。我们确定了各种研究主题，如临床特征、干预措施、生物标志物、心理、社会、流行病学和危险因素。基于证据的干预研究、标准诊断工具的翻译和改编以及自闭症体验的定性研究似乎处于先进水平。然而，流行病学研究、生物标志物识别和风险评估研究的质量较低。印度需要进行全国性的研究，采用代表性抽样方法，对自闭症的流行病学、生物标志物和危险因素进行全面评估，以充分了解自闭症在印度的实际负担和生物学特性。此外，还需要设计实施研究，以评估基于证据的干预措施在常规医疗保健环境中的有效性。我们建议未来的研究应填补这些理解自闭症和改善印度自闭症预后的空白。
