Mobile App

Diagnostic Tool For

Autism Spectrum Disorder

Available on Google Play Store and iOS

Training module for AIIMS

modified INCLEN diagnostic
Autism Helpline tool for autism spectrum
disorder (INDT-ASD)
Email : pedneuroaiims@yahoo.com,
autismhelp.pedsaiims@gmail.com
Mobile: 9868399037

Web/ Microsite Child Neurology Division, Department of Pediatrics, All India Institute of
http://pedneuroaiims.org Medical Sciences, Delhi in collaboration with INCLEN Trust international, Delhi
m://pedneuroaiims.org

(Divyangjan)

(Divyangjan)
 AIIMS Modified INDT-ASD Tool for Autism Spectrum Disorder
New Tool Developed By
Sheffali Gulati, Jaya Shankar Kaushik, Biswaroop Chakrabarty,
Lokesh Saini, Savita Sapra, N K Arora, RM Pandey,
Rajesh Sagar, VK Paul, Shobha Sharma

How to use the tool:

Website: http://www.pedneuroaiims.org; Mobile: m.pedneuroaiims.org
For Any Queries, please Email: pedsneuroaiims@gmail.com

Previous Tool Developed By INCLEN-NDD Project

Investigators: NK Arora (Project Leader), MKCNair (Principal Investigator),
Jennifer Pinto-Martin (Co-PI), Donald Silberberg (Co-PI), Sheffali Gulati
(Network Co-ordinator) and INCLEN Study Group

Available online at:

http://www.ncbi.nlm.nih.gov/pubmed/24953575
[Indian Pediatr. 2014 May;51(5):359-365]

Download from:
The National Trust Website
http://www.thenationaltrust.gov.in/content/innerpage/download.php
 Training module for AIIMS modified INDT-ASD tool for
Autism spectrum disorder

Learning objectives:
1. To describe the diagnostic criteria and core symptoms of autism spectrum disorder
2. To clinically evaluate a child with suspected autism spectrum disorder using AIIMS
modified INDT ASD tool

Training module for AIIMS modified

INDT-ASD tool for Autism spectrum disorder
Introduction
Autism is a neurodevelopmental disorder characterized by impairment in reciprocal socialization,
qualitative impairment in communication along with repetitive behaviour. The two key domains of
autism spectrum disorder includes deficit in social communication/ interaction and restrictive and
repetitive behavior. Autism spectrum disorder is diagnosed based on DSM-5 criteria. DSM-5 diagnosis
of autism spectrum disorder includes qualitative impairement of social interaction, social
communication and restrictive and repetitive behaviour. It is a behavioural disorder that has multiple
etiologies including genetic and environmental. It is a lifelong disorder with evolution of symptoms as
the child grows with need for sustained support.
Autism spectrum disorder (ASD) is a common Neurodevelopmental disorder across the globe. All the
epidemiological studies show a significantly greater number of boys than girls with autism. Male to
female ratios vary from 2:1 to 3:1. Prevalence of ASD in United States as per the recent data was 1 in
every 68 children*. However, incidence of ASD was estimated at 1:54 in males and 1:252 in females*. In
a recent study by INCLEN to study the prevalence of neurodevelopmental disorders in children,
prevalence of autism spectrum disorder in India was estimated at 1.4% (unpublished data). In a study by
INCLEN (unpublished data) to estimate the prevalence of neurodevelopmental disorders in children,
the prevalence of autism spectrum disorder in Indiawas estimated at 1.1% (range=0.7-1.7). The
prevalnece in rural areas was 1.1% (0.7-1.8), while in urban areas, it was estimated to be 1.2% (0.5-2.7)

*Centers for Disease Control and Prevention, Autism and Developmental Disabilities Monitoring
Network. Identified Prevalence of Autism Spectrum Disorders. 2012. [Internet]. 2015.
Available from: http://www.cdc.gov/ncbddd/autism/data.html.

1
Diagnosis of autism spectrum disorder
Diagnostic and statistical manual of mental disorder (DSM) provides a common language for clinician,
researchers, insurers, and families. As per DSM-IV classification, following criteria needs to fulfill to
label a child as autism: qualitative impairment in social interaction (2 out of 4 item), qualitative
impairments in communication (1 out of 4 items) and restricted repetitive and stereotyped patterns of
behaviour, interests and activities (1 out of 4 items). A child would be considered autistic when 6 out of
12 criteria were fulfilled. DSM has launched its fifth revision wherein there is transition from autism and
pervasive developmental disorder to autism spectrum disorder (DSM-5). DSM-5 clubs the three core
domains into two core domains with social communication and interaction into one domain and
restrictive, repetitive behaviour or interest being the other domain. Additionally, sensory symptoms
were included in the latter domain.
As per DSM-5 revision, following criteria needs to be fulfilled to label a child as autism spectrum
disorder:
A. Persistent deficits in social communication and social interaction (3 out of 3 items)
B. Restricted, repetitive patterns of behavior, interests or activities (2 out of 4 items)
C. Symptoms must be present in the early developmental period (essential)
D. Symptoms cause clinically significant impairment in social, occupational, or other important
areas of current functioning (essential)
E. These disturbances are not better explained by intellectual disability (intellectual developmental
disorder) or global developmental delay (essential).

INCLEN diagnostic tool for autism spectrum disorder (INDT-ASD tool)

INDT-ASD tool for diagnosis of autism was diagnosis of autism by primary care physician to reach a
diagnosis of autism. The tool was developed by team of 49 national and international experts. The
experts include pediatrician, pediatric neurologist, epidemiologist, clinical psychologist, special
educator. The team developed an appropriateness criteria and the tool was developed over 2 day
workshop. The tool has two sections: Section A has 29 symptoms/items and Section B has 12 questions
pertaining to response based on section A. It takes 45-60 minute to administer the tool. The tool has
combination of parental response and observation. The tool was initially developed in English and then
forward and backward translated to Hindi and English.
Diagnostic performance of INDT ASD tool are as follows: Diagnostic accuracy [AUC=0.97 (0.93,
0.99); P<0.001], Sensitivity 98%, specificity 95%, PPV 91%, NPV 99%*. Concordance rate between
the INDT-ASD and expert diagnosis for 'ASD group' was 82.52% [Cohen's κ=0.89; 95% CI (0.82, 0.97);
P=0.001]. The convergent validity with CARS (r = 0.73, P= 0.001). Merits of INDT-ASD include high
diagnostic accuracy, adequate content validity, good internal consistency, high criterion validity, high to
moderate convergent validity and easy to administer. Few of major concerns especially in light of
revision of DSM-IV to DSM-5 it needs upgradation. Moreover, the present tool lacks severity scoring
for grading the severity of autism. In the light of revision of DSM-IV to DSM-5, the present tool needs
upgradation
*Juneja M, Mishra D, Russell PSS, Gulati S, Deshmukh V, Tudu P, et al. INCLEN Diagnostic Tool for Autism
Spectrum Disorder (INDT-ASD): development and validation. Indian Pediatr. 2014 May;51(5):359–65.

2
Why move from DSM-IV to DSM-5
1. DSM-5 provides a single umbrella diagnosis for disorders including autism, asperger syndrome,
rett syndrome, childhood disintegrative disorder, pervasive developmental disorder-not
otherwise specified (PDD-NOS) as autism spectrum disorder.
2. Symptoms of autism spectrum disorder are specific (NOT pervasive) to impairment in social
interaction and communication with presence of restrictive, repetitive behaviour.
3. There are concerns of validity of category labelled as pervasive developmental disorder-not
otherwise specified (PDD-NOS) and Childhood disintegrative disorder (CDD)
4. There are concerns of PDD-NOS being labelled as mild developmental disorder and Asperger as
'odd' behaviour. Moreover, overuse of PDD-NOS leads to diagnostic confusion and may
contribute to epidemic of autism
5. Symptoms of autism spectrum disorder are not salient among children with Rett syndrome.
Moreover, Rett syndrome is a recognized genetic syndrome that can have symptoms of autism
spectrum disorder.
6. Developmental regression in autism spectrum disorder has a wide range in timing and nature of
loss of skills, hence precise existence of childhood disintegrative disorder has been challenged
by many author worldwide.
7. Literature has suggested that there is a considerable overlap between high functioning autism
and Asperger syndrome questioning the need for separate category for the latter.

Clinical consensus criteria (CCC) for Autism spectrum disorder as per DSM-5*

1. Persistent deficits in social communication and social interaction across contexts, not accounted
for by general developmental delays, and manifest by all 3 of the following:
a. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of
normal back and forth conversation through reduced sharing of interests, emotions, and affect
and response to total lack of initiation of social interaction
b. Deficits in nonverbal communicative behaviours used for social interaction; ranging from
poorly integrated verbal and nonverbal communication, through abnormalities in eye contact
and body-language, or deficits in understanding and use of nonverbal communication, to total
lack of facial expression or gestures.
c. Deficits in developing and maintaining relationships, appropriate to developmental level
(beyond those with caregivers); ranging from difficulties adjusting behaviour to suit different
social contexts through difficulties in sharing imaginative play and in making friends to an
apparent absence of interest in people
2. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of
the following:
a. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple
motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).

3
 b. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or
excessive resistance to change; (such as motoric rituals, insistence on same route or
food, repetitive questioning or extreme distress at small changes).
c. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong
attachment to or preoccupation with unusual objects, excessively circumscribed or
perseverative interests).
d. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of
environment; (such as apparent indifference to pain/heat/cold, adverse response to
specific sounds or textures, excessive smelling or touching of objects, fascination with
lights or spinning objects).
3. Symptoms must be present in early childhood (but may not become fully manifest until social
demands exceed limited capacities)
4. Symptoms together limit and impair social, occupational and other areas of daily functioning.
5. These disturbances are not better explained by intellectual disability or global developmental
delay.

*American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington,
VA: American Psychiatric Association; 2013.

4
Merits of DSM-5 over DSM-IV
There is large number of merits of DSM-5 diagnosis of autism spectrum disorder over previous DSM-
IV.
1. It includes a single umbrella diagnosis for all ASD and dilution of ambiguous terms like
pervasive developmental disorder and its subtypes like PDD-NOS.
2. It ensures appropriate services and insurance coverage to those who did not benefit earlier:
Asperger, PDD-NOS. This has a major implication among countries where medical insurance
exists for providing autism services. All children previously diagnosed as autism, PDD-NOS,
Asperger (DSM-IV) will continue to obtain the medical benefits.
3. One of the major advantages of DSM-5 is that it allows co morbidities like ID, ADHD, Genetic
disease (Rett, Fragile X, Tuberous sclerosis). Hence under DSM-5 it is possible to have
diagnosis like ASD with ADHD, ASD with ID and ASD with Fragile X. In addition, DSM-5
separates children with isolated communication problems into social communication disorder
(SCD) rather than PDD-NOS.

Symptoms of autism spectrum disorder

A. Deficits in social emotional reciprocity
a. There may be lack of joint attention in the form of inability to share his/her interest by
pointing to parents the object of intrest like a dog/cat/flower/train
b. There may be lack of initiation of conversation to talk about his interests or achievements
c. There may be lack of sharing of his/her emotions, happiness or distress with parents
d. There may be lack of initiation of conversation or lack of adding significant content for
the conversation to continue.
e. Child may prefer to play alone and not mix up with other children
f. There may be an impairment of involvement in rule based games
B. Deficit in non verbal communicative behaviour
a. Poor integration of verbal behaviour and non verbal behaviour
b. They may have poor eye contact
c. There may be impairment in use of appropriate gestures during social interaction
d. There may be total lack of facial expression while interacting with parents or strangers
C. Deficits in developing, maintaining and understanding of relationship
a. They may not enjoy the company of other children
b. There may be lack of friends with whom he/she can chat, share or play together
c. They may play with children of younger or older age group
d. There may be lack of imaginative play
D. Stereotyped, repetitive motor movement or speech
a. Child may repeat certain words or phrases regardless of the meaning that he/she has
heard

5
 b. Child may repeat few words or phrases he/she heard in television regardless of meaning
or context
c. He/she may have pronoun reversal with replacement of “I for me” and “me for you”
d. He/she may speak out of context or irrelevantly
e. Child may show excitement by flapping his hands, wring his hands, rocking, spinning or
making some unusual finger or hand wringing
E. Insistence on routines: child unreasonably insist on doing things in a particular way and/or
become upset if there is any change in the daily routine
F. Highly fixed or restricted interest: Child may prefer to play with a particular part of a
toy/object rather than the whole toy/object
G. Sensory symptoms:
a. Child may show indifference or excessive reaction to pain
b. He/she may show abnormal interest in feeling the textures
c. He/she may show abnormal reaction to sounds by covering their ears
d. He/she may have excessive smelling or touching of object in unsual manner
e. He/she may have fascination with lights or moving objects

Co morbidities of autism spectrum disorder

Co morbidities of autism spectrum disorder includes epilepsy and a wide range of psychiatric disorders,
behavioural problems, sleep related problems. Table depicts the list of comorbid conditions that are
common among children with autism spectrum disorder.

Co-morbid conditions of autism spectrum disorder

Broad category Co morbid condition
Psychiatric Anxiety (43-84%)
Depression (2-30%)
Obsessive compulsive disorder (37%)
Oppositional defiant disorder (7%)
Behavioural problems
Behavioural Disruptive
Irritable
Aggressive behaviour (8-32%)
Self injurious behaviour (34%)
Sensory disturbances Tactile (80-90%)
Auditory sensitivity (5-47%)
Neurological Seizures and epilepsy (5-49%)
Tics (8-10%)
Gastrointestinal GERD (8-59%)
Constipation (8-59%)
Sleep disturbances Sleep disruptions (52-73%)

6
Early diagnosis of autism
Symptoms of autism are known to appear as early as infancy and in first 2 years of life. Hence, identifying the child
at early age is essential for early intervention of autism. Average age at diagnosis of autism is 3 years. Hence there is
a long delay between parent's initial concerns and eventual diagnosis. Moreover, there is lack of sensitive tools to
identify the symptoms at such early age and there is a natural variability in the nature and timing of early signs of
autism. Early diagnosis of autism often gives answer to parents concerned about their child's atypical development
and leads to transition from unfocused worry to mobilized efforts to learn about the disorder. This ensures that it
allows the most appropriate treatment to be selected and delivered.
Symptoms of autism in infants include decreased imitation, decreased social responses: responses to their name,
looking at other people, social smiles, fewer appropriate facial expressions, increased sensory and stereotypic
behaviours and decreased nonverbal communication and gestures. Symptoms in toddlers include typical play for
developmental level but little or no pretend play, history of normal or near normal motor development and lack of
expected language, social, and gestural development for nonverbal developmental level.
As per American Academy of Neurology (AAN), autism spectrum disorder was suspected when one of following
features is present:
• No babbling or pointing or other gesture by 12 months;
• No single words by 16 months
• No 2-word spontaneous (not echolalic) phrases by 24 months
• Loss of language or social skills at any age.

Differential diagnosis
1. Social (pragmatic) communication disorder (SCD): children with marked deficit in social communication
but whose symptoms otherwise do not meet the criteria for autism spectrum disorder must be considered
for SCD
2. Intellectual disability (ID): It is essential to differentiate intellectual disability from autism spectrum
disorder (ASD) although both can co exist and the current DSM-5 gives the liberty to label “ASD with ID”
3. Landau Kleffner syndrome: children with autism spectrum disorder with later age at onset of regression
must always be considered for a possibility of landau-kleffner syndrome. A sleep electroencephalogram
could help in identifying this rare potentially treatable epileptic encephalopathy of childhood.
4. Undiagnosed hearing impairment may often masquerade symptom of pretending to be deaf making a
suspicion of autism spectrum disorder. However, children with isolated hearing impairment often have
good non verbal communication and absence of restrictive, repetitive movement or speech.

Diagnostic criteria:
Consensus Clinical Criteria (CCC): Autism Spectrum Disorder (ASD) is defined as group of developmental
disorders characterized by persistent deficit in social communication and interaction across multiple contexts along
with presence of restricted, repetitive pattern of behaviour, interest, or activities. The criteria for diagnosis is based
on best currently available evidence and / or consensus among national and international experts, using minimal
investigations to serve the needs of resource-constrained settings.

Instructions for Evaluation

1. In evaluating a child, clinicians rely on questionnaires and direct observation (both structured and
unstructured settings) to arrive at a diagnosis
2. In the current program, DSM-5 criteria are used for the diagnosis of autistic spectrum disorders
3. For the ease of application, a part of DSM-5 criteria have been converted into a questionnaire. This consists
of questions to elicit responses in two relevant categories:
a. Persistent deficit in social communication and interaction across multiple contexts
b. Presence of restricted, repetitive pattern of behaviour, interest, or activities
4. This symptom cluster of two domains is associated with onset at early developmental age with resultant
impairment in daily activities.

7
1Clinical consensus
Test Mannual criteria (CCC) for Autism spectrum disorder as per DSM-5*

Clinical consensus criteria (CCC) for Autism spectrum disorder as per DSM-5*

1. Persistent deficits in social communication and social interaction across contexts, not
accounted for by general developmental delays, and manifest by all 3 of the following:
a. Deficits in social-emotional reciprocity; ranging from abnormal social approach and
failure of normal back and forth conversation through reduced sharing of interests,
emotions, and affect and response to total lack of initiation of social interaction
b. Deficits in nonverbal communicative behaviours used for social interaction; ranging
from poorly integrated verbal and nonverbal communication, through abnormalities
in eye contact and body-language, or deficits in understanding and use of nonverbal
communication, to total lack of facial expression or gestures.
c. Deficits in developing and maintaining relationships, appropriate to developmental
level (beyond those with caregivers); ranging from difficulties adjusting behaviour to
suit different social contexts through difficulties in sharing imaginative play and in
making friends to an apparent absence of interest in people

2. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two

of the following:
a. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple
motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
b. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior,
or excessive resistance to change; (such as motoric rituals, insistence on same route or
food, repetitive questioning or extreme distress at small changes).
c. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as
strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interests).
d. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of
environment; (such as apparent indifference to pain/heat/cold, adverse response to
specific sounds or textures, excessive smelling or touching of objects, fascination
with lights or spinning objects).

3. Symptoms must be present in early childhood (but may not become fully manifest until social
demands exceed limited capacities)

4. Symptoms together limit and impair social, occupational and other areas of daily functioning

5. These disturbances are not better explained by intellectual disability or global developmental
delay.

*American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington,
VA: American Psychiatric Association; 2013.

8
Figure depicting the analysis of AIIMS modified INDT ASD tool

9
AIIMS Modified INDT-ASD Diagnostic Tool for Autism Spectrum Disorder
Tool interpretation:
AIIMS Modified INDT ASD tool for autism spectrum disorder is based on DSM 5. The tool has

S.No Item Function Number of Interpretation

questions
1 Section A1a Social emotional reciprocity 8 questions Mandatory
item
Section A1b Non verbal communication 4 questions Mandatory
item
Sections A1c Relationships 3 questions Mandatory
item
2 Section A2a Stereotyped movement or 7 questions At least 2
speech items out of 4
Section A2b Routines 1 question items from
Section A2c Fixed interests 1 question A2a to A2d
Section A2D Sensory symptoms 4 questions
Footnote*: At least 1 question in each item must be marked in shaded or circled response to consider that item to be
present

Final interpretation:
diagnose as autism spectrum disorder (ASD: Present) (Section B: Question 1 to 4)
To
1. All sections A1a, A1b, A1c must be fulfilled
2. Atleast 2 out of 4 items from section A2a, A2b, A2c, A2d must be present
3. Onset must be in early developmental period
4. These symptoms must have resulted in impaired functioning

Example 1:
3 year boy brought with complaints of poor eye contact and delayed speech. He was born of non
consanguineous marriage, first in birth order. His neonatal period was eventful, was born by normal
delivery with birth weight of 3.2 Kg, cried immediately at birth and was discharged the next day. He
subsequently attained age appropriate motor milestones but his speech was delayed. Parents have often
observed him to be “in his own world”, often not responding to commands when called. He often reacts
by excessive jumping and spinning when he gets excited. Mother has noticed that when offered a toy he
does not play with it, rather spins its wheels and throws it away. He likes playing with toffee wrappers
and threads. A pediatrician suspected autism spectrum disorder and referred the case for evaluation.
Let us apply the AIIMS modified INDT ASD tool to see whether he fulfills the criteria for diagnosis of
autism.

10
Tool Analysis

Section A1a

Question (i) On asking the parents does

the child ever point to bring his

attention, mother replied “no”. You also

observe that when you ask the child to

point to an object he does not point. *

shows that we give importance to what

parents report. Hence we mark as “no”.

Circle shows that “no” is considered a

feature of autism. Hence section A1a is

fulfilled as even one question being

positive will be considered an autistic

feature.

Question (ii): Not applicable (age<4

years)

Question (iii): Ask parents about his

solitary play. Here answer of “yes” is

autistic response.

11
 Answers to question IV, V, VII are

autistic response, whereas question VI

and VIII are not applicable. Any ways

we already have more than one response

being in circle (autistic) against section

A1a. Hence, we consider Section A1a is

fulfilled.

Section A1b

Question (i) Mother replied that “my

child enjoys being taken in the lap”.

Hence the response would be marked

“yes”.

Question (ii): Mother replied that “my

child maintains a good eye contact”.

However, you observed that eye contact

was very poor. See asterix*. Here

observation will take precedence. Hence

final response would be marked “no”

which is autistic. Hence Section A1b is

fulfilled.

Question (iii) and (iv) were marked as

per the parental response and

observation.

12
 Section A1c

Question (i): Mother replied “No he

does not enjoys the company of other

children and he prefers to play alone and

does not mix with other children”.

Hence answer will be marked “no”.

Answer of “no” is a circled response.

Hence the section A1c is fulfilled.

Question (ii): Not applicable

Question (iii): Not applicable

Section A2a

Question (i): mother replied “no” “he

does not repeat the words”. Nor did you

observe immediate echolalia on

observation. Hence response is “no”

Question (ii): Mother replied no to

delayed echolalia. But you observed that

he was using same words which you

were conversing with parents few

minutes ago without any context. Hence

delayed echolalia was present. See

asterix*. Here observation will take

precedence. Hence final response would

be marked “no” which is autistic. Hence

13
 Section A2a is fulfilled.

Question (vi): Mother replied “yes, he

jumps and rocks by showing

excitement”. You also observed that he

had hand flapping movement. Hence we

mark as “yes”. Circle shows that “yes” is

considered a feature of autism. Hence

section A2a is fulfilled.

Similarly, question vii was marked.

Section A2b

Mother replied that “no, my child does

not have any fixed routines”. Hence

section A2b is not fulfilled.

Section A2c

Mother replied “no my child does not

enjoy playing with toys, he loves its

wheels”. Hence we mark a response of

“yes”. Response of “yes” makes the

section A2c fulfill the criteria.

Section A2d

Mother replied “no” to all sensory

symptoms and nor did you observe any

of abnormal sensory symptoms. Hence

section A2d is not fulfilled.

14
 Section B

1. Number of criteria is 3 out of 3

as Section A1a, A1b, A1c all
1 were fulfilled

1 2. Number of criteria in A2 is 2 out

4 as A2a, A2c were fulfilled.

1 3. Yes there is onset at early

development (he is 3 years)

1 4. Yes, It has resulted in impaired

functioning
1
5. Hence ASD is present as 3 out 3
in section A1 and atleast 2 out 4
in section A2 are fulfilled
1
6. Total number of criteria is 5 out
of 7
1
7. Summary assessment: ASD
present
0
8. No, these symptoms cannot be
We observed delayed echolalia which was denied by mother explained by Intellectual
disability.
Dr X 02.02.16
9. Additional comments: We
observed delayed echolalia
which was denied by mother.

Example 2:
2 year boy brought with complaints of delayed speech and poor response to sound. He was born of non
consanguineous marriage, third in birth order. He was born by normal delivery with birth weight of 3.2
Kg, cried immediately at birth, developed jaundice on day 2 of life requiring exchange transfusion,
remained admitted for 10 days in NICU and then was discharged the next day. He subsequently was late
in attainment of all milestones. He currently does not speak and respond to any amount of calling. A
pediatrician suspected autism spectrum disorder and referred the case for evaluation.
Let us apply the AIIMS modified INDT ASD tool to see whether he fulfills the criteria for diagnosis of
autism.

15
Section A: AIIMS modified INDT ASD tool for autism spectrum disorder
Section A Questions Response Number of response Analysis
in circle
(autistic symptom)
A1a Question i Yes Section A1a fulfills
Question ii
Question iii No
Question iv No Yes
Question v Yes
Question vi
Question vii Yes
Question
viii
A1b Question i Yes Section A1b does
Question ii Yes not fulfill
Question iii Yes
Question iv Yes
A1c Question i Yes Section A1c does
Question ii not fulfill
Question iii
A2a Question i No Section A2a does
Question ii No not fulfill
Question iii
Question iv
Question v
Question vi No
Question vii No
A2b Question i No Section A2b does
not fulfill
A2c Question i No Section A2c does
not fulfill
A2d Question i No Section A2d does
Question ii No not fulfill
Question iii No
Question iv No

Section B AIIMS modified INDT ASD tool for autism spectrum disorder
Section B Response Analysis
Question 1 0 Only one out of three in
Question 2 0 section A1 and none in
Question 3 1 section A2 out of four
Question 4 1 fulfilled. Hence child does
Question 5 0 not have ASD.
Question 6 0 Final diagnosis: No autism
Question 7 0 spectrum disorder
Question 8 1

16
Example 3:
10 year old boy brought with complaints of inability to understand commands and delayed speech with
difficulty in comprehending commands. He was born of non consanguineous marriage, third in birth
order. He was born by normal delivery with birth weight of 3.2 Kg but did not cry at birth. He developed
neonatal seizures and was subsequently admitted in NICU for 15 days. All his milestones were delayed
with sitting achieved at 3 years, walking by 4.5 years. His present concerns are poor speech, into his own
world, does not understand most of commands. A pediatrician suspected autism spectrum disorder and
referred the case for evaluation. Let us apply the AIIMS modified INDT ASD tool to see whether he
fulfills the criteria for diagnosis of autism.

17
Section A: AIIMS modified INDT ASD tool for autism spectrum disorder
Section A Questions Response Number of response Analysis
in circle
(autistic symptom)
A1a Question i Yes Section A1a fulfills
Question ii Yes
Question iii Yes
Question iv No Yes
Question v Yes
Question vi Yes
Question vii Yes
Question No Yes
viii
A1b Question i Yes Section A1b fulfill
Question ii Yes
Question iii No Yes
Question iv Yes
A1c Question i Yes Section A1c does
Question ii Yes not fulfill
Question iii No
A2a Question i No Section A2a does
Question ii No not fulfill
Question iii No
Question iv No
Question v No
Question vi No
Question vii No
A2b Question i No Section A2b does
not fulfill
A2c Question i No Section A2c does
not fulfill
A2d Question i No Section A2d does
Question ii No not fulfill
Question iii No
Question iv No

Section B AIIMS modified INDT ASD tool for autism spectrum disorder
Section B Response Analysis
Question 1 0 Only two out of three in
Question 2 0 section A1 and none in
Question 3 1 section A2 out of four
Question 4 1 fulfilled. Hence child does
Question 5 0 not have ASD.
Question 6 0 Final diagnosis: No autism
Question 7 0 spectrum disorder
Question 8 1

18
 Schemes of The National Trust
Disha – Early Intervention & School Readiness
Scheme Description
· Day care facility for children with NT disabilities in the age group of 0-10 years for at least 4-6
hours per day for a batch size 20
· Training and counseling to children and the parents to enable mainstreaming of children
· Professional services by special educators, therapists and counselors
· Availability of optional transport facility
· Continuous evaluation of children and mapping of development chart
· Assistance and guidance for admission to schools
· KPIs monitored shall be – PwD strength, LIG:Non LIG ratio, PwD development, PwD
mainstreaming, Parent Counselling
Set-up 1,55,000 Immediately after enrolment
Monthly for 3 months (min. PwD is
Sustenance 4,500 per Differential PwD per month
20% of batch size, i.e. 4)
Monthly 4,500 per eligible PwD per month Monthly on 1:1 ratio for LIG:Non
Recurring (+1000 Transport allowance) LIG and All BPL
Vikaas - Day Care
Scheme Description
· Day care facility for PwD above 10 years of age for at least 6 hours in a day (between 8 am – 6
pm) for a batch size 30
· Training and counseling to PwDs in the age group of 10+ years for enhancing interpersonal and
vocational skills, besides mainstreaming
· Professional services by special educators, therapists and counselors
· Availability of optional transport facility
· Enable family members to fulfill other responsibilities
· Provision for setting up Work Centers
· KPIs monitored shall be – PwD strength, LIG:Non LIG ratio, PwD development, Gainful
employment of PwD
Set-up 1,95,000 Immediately after enrolment
Monthly for 3 months (min. PwD is
Sustenance 3,850 per Differential PwD per month
20% of batch size, i.e. 6)
Monthly 3,850 per eligible PwD per month Monthly on 1:1 ratio for LIG:Non
Recurring (+1000 Transport allowance) LIG and All BPL
Work Centre Rs. 25,000 to Rs. 1,00,000/- Case to case basis

19
 Samarth – Respite Care Residential Scheme
Scheme Description·
· Residential facilities including meals for orphans/abandoned, families in crises, destitute, BPL
and LIG PwDs in all age groups for a batch size 30.
· Provision to shift an adult resident to GHARAUNDA if stay in Samarth exceeds 5 years and
PwD is an adult
· Professional services by special educators, therapists and counsellors for age-specific
vocational and pre-vocational activities
· RO should own the location or its should be on a lease of minimum 5 years with renewable clause
· KPIs monitored shall be – PwD strength, LIG:Non LIG ratio, PwD registration with Niramaya
scheme, PwD development, Gainful employment of PwD, Inclusion events organized

Set-up 2,90,000 Immediately after enrolment

Monthly for 3 months (min. PwD is
Sustenance 7,000 per Differential PwD per month
20% of batch size, i.e. 6)
Monthly Monthly on 1:1 ratio for LIG:Non
7,000 per eligible PwD per month
Recurring LIG and All BPL
Work Centre Case to case basis
Rs. 25,000 to Rs. 1,00,000/-

GHARAUNDA – Group Home for Adults

Scheme Description
· Residential facilities including meals and all other facilities for life long stay of adult PwDs (>18
years of age) for a batch size 20.
· Professional services by special educators, therapists and counsellors for age-specific
vocational and pre-vocational activities
· RO should own the location or its should be on a lease of minimum 10 years with renewable
clause
· Provision of crisis fund per Gharaunda Centre to be maintained with the National Trust – INR
10,00,000/-
· KPIs monitored shall be – PwD strength, LIG:Non LIG ratio, PwD registration with Niramaya
scheme, PwD development, Gainful employment of PwD, Inclusion events organized

Set-up 2,90,000 Immediately after enrolment

Monthly Monthly on 1:1 ratio for LIG:Non
10,000 per eligible PwD per month
Recurring LIG and All BPL

Crisis Fund 10,00,000/- On need basis

Work Centre Rs. 25,000 to Rs. 1,00,000/- Case to case basis

20
 Niramaya – Health Insurance
Scheme Description
· Health Insurance for PwDs under NT Act
· Full premium to be paid by the National Trust
· Benefits include surgery, hospitalization, OPD, medicines, dentistry, medical tests, therapies
etc. up to Rs.1 Lakh
· No requirement of health check-up or age proof
· No bar for government or private hospitals/practitioners
· Enrollment on monthly basis through Registered Organizations (RO)
· Facilitation through 34 regional claim centers
· Annual enrolment fee for BPL Rs. 250/-, Non BPL Rs. 500/- and PwD with Legal Guardian
(Other than natural parents) FREE.
· KPIs monitored shall be: turnaround time for the application, Niramaya status report

Health Insurance 1,00,000 per PwD per year As and when PwD will claim

Gyan Prabha – Education Support

Scheme Description
· Encourage PwDs to pursue vocational training/higher education/ professional courses
· Wide range of courses like medical, engineering, law, management and regular graduation and
post graduation covered
· No age or income limit for eligibility
· Recurring fixed amount for the specified courses covering course fees, transportation, books,
OPEs (max 10%) etc. on presenting proofs except OPE
· Funding shall be provided for maximum duration of course or till when course is completed by
PwD as applicable
· KPIs monitored shall be: turnaround time for the application, Gyan Prabha status report

Sustenance 5,200 per PwD per month Depending on course structure:

2,000 per PwD per month Monthly, semester wise, trimester
Graduation/ Post Graduation
wise or annually.
Vocational Course 1,600 per PwD per month
Transportation allowance 20,000/- per PwD per annum
(for any course) or actuals, whichever is less

21
 Sahyogi – Care Associate Training
Scheme Description·
· Creating a pool of skilled care associates through theoretical and on-the-job training to support
PwDs and their families
· Two types of courses – Primary (3 months), Advanced (6 months) having both theory and
internship
· Parents and guardians are also eligible to apply for the courses. However, they shall not be
involved in internship period of course
· Meeting(s) for placement amongst families, institutions and trained care associates on a
quarterly basis
· KPIs monitored shall be – trainee strength, trainee attendance, internship opportunities,
placement, RO visit status report
On time on acceptance
Set up Cost 1,00,000/- for both primary and advanced
of proposal
Primary – 4,200 per trainee per batch On completion of
Trainee Cost Advanced – 8,000 per trainee per batch training
Primary – upto 5,000 per trainee per batch
On completion of
Trainee Stipend Advanced – upto 10,000 per trainee per batch
training
*Stipend for all, including parents/ guardians of PwD

Prerna – Marketing Assistance

Scheme Description
· Funding for participation in fairs and/or exhibitions at district, state, regional and national level
· NT to sponsor up to four events in a financial year
· Minimum participation of 51% PwDs in production of saleable items/articles
· An incentive of 10% for RO on sales turnover verified by Office of DC/DM/LLC/Social Welfare
· NT shall also reimburse the expenses that ROs incurred in designing and publishing brochures
marketing the products prepared by PwDs
· KPIs monitored shall be: Event participation and Growth rate of PwD supported

Support for participation National Level – INR 30,000/- 50% on approval of event
in events Regional Level ( participation of proposal
min 5 states) - INR 25,000/-
State Level - INR 20,000/- 50% on completion of event
District Level - INR
Incentive on Sales 10,000/- 10% of total sales Annually
Turnover
Reimbursement for 10,000 per RO per year Annually
brochures

22
 Sambhav – Aids and Assistive Devices
Scheme Description
· Additional centres to be set up in cities of India with population of more than 5 million (as per
2011 Census)
· Demonstration of aids, assistive devices, software & an accessible model of Kitchen, Living
Room & Bathroom etc. for enabling and empowering the PwDs
· Management coordinator at these Sambhav centres shall be deployed by NT
· ROs to provide one demonstrator/facilitator and one maintenance staff
· Sambhav centre can procure new aids/ assistive devices and same shall be reimbursed by NT
within maximum limit allowed
· KPIs monitored shall be: increased no. of visitors, organizing visits to the centre (for ROs,
educational institute and Medical institute)
Set up Cost 10,00,000/- (Stage I – 5,00,000 Stage I – on approval of application
and Stage II – 5,00,000) Stage II – On completion of setup
period
Monthly Recurring 40,000/- per month To be paid bi-annually
Cost
Reimbursement for On actuals with maximum limit of
Annually
new devices INR 3,20,000/- per annum

Badhte Kadam – Awareness & Community

Scheme Description
· Awareness generation for general public and community stakeholders through various activities
for example exhibition, rallies, workshops, media outreach etc.
· Innovative/special proposals to be sanctioned separately
· Create platforms for collaborative initiatives between govt. officials, medical fraternity, legal
professionals & educational institutes for the betterment of PwDs
· Outreach activities in areas where NT is under represented
· Maximize benefits of NT schemes
· KPIs monitored shall be: activities completed, enabling changes in society and gathering
feedback

Distributing Handouts, posters etc. 20,000/- Workshops with govt officials, 17,000/-
at Educational/ financial/ medical legal/ medical/ bank/educational
institutes professionals
Sessions with voluntary 15,000/- Social inclusion event like cricket 16,000/-
organizations like CRY or MAD match
13,000/- per Sessions in schools/ colleges/ 8,000/-
Organize Roadshows
day other educational institute

23