To provide an overview of results of 25 clinical studies in children with autism spectrum disorder(ASD) in last two decades at a tertiary care centre in India.

More than 3000 autistic children have been managed in last 18 years. Nearly 1000 children were enrolled in 25 studies involving diagnosis(early signs of autism, AIIMS modified INDT-ASD tool(mobile app), oxidative biomarkers), pathogenesis(clinical/whole exome sequencing, chromosomal microarray, vitamin D, other micronutrients, blood heavy metals, quantitative EEG, functional MRI brain, gut microbiota dysbiosis, advanced paternal age affecting sperm epigenome), co-morbidities(epilepsy, sleep disturbance, executive function, quality of life-QoL, parenting stress, coping strategy, depression in mothers) and management of autism(predictors of response to Applied Behavior Analysis-ABA, Gluten Free Casein Free Diet, communication based parental intervention, weighed compression vest-WCV). Other endeavors include training of >350 physicians in four national workshops to diagnose and certify ASD over last 3 years. Tele-consultation services have also been initiated.

AIIMS modified INDT tool and early signs of autism diagnostic tool have good psychometric properties. About 11% children with autism were found to have some genetic etiology. Autistic children were found to have higher blood lead levels(p=0.01), abnormalities in quantitative EEG and executive function(p<0.0001). 78% autistic children had sleep disturbances, 21% had epilepsy. 76% mothers had depression.Caregivers of autistic children with hyperactivity and epilepsy had more impaired QoL. WCV was found to reduce hyperactivity, inattention and withdrawn behavior(p=0.02, 0.03, 0.04 respectively).Younger age, higher education of parents, absence of epilepsy/hyperactivity and longer duration of ABA are associated with favorable response.

Innovative research targeting novel diagnostics and therapeutics are imperative for improving care of autistic children.