Autism Spectrum Disorders (ASD) represent a range of neurodevelopmental disorders characterized by difficulties in social interaction, communication, and repetitive behaviors. Pediatric ASD has grown in prevalence globally, with many cases identified at increasingly young ages, allowing for early intervention strategies that can significantly improve long-term outcomes for affected children. Despite this progress, a substantial awareness gap persists among parents and caregivers, especially in regions with limited access to diagnostic and support services. In states like Himachal Pradesh, where healthcare access can be challenging due to geographic and resource constraints, understanding the level of parental awareness regarding ASD is crucial to formulating effective public health responses and early intervention strategies.[1-4].Previous studies have highlighted the role of parental awareness in the early identification of ASD symptoms, which include atypical communication, repetitive behavior patterns, and sensory sensitivities. However, misconceptions and limited knowledge about ASD frequently delay diagnosis, as parents often interpret early symptoms as temporary or attribute them to developmental differences. In areas like Himachal Pradesh, where autism-specific resources and support networks are scarce, parental understanding of ASD is likely influenced by traditional beliefs, limited healthcare infrastructure, and restricted access to specialized medical guidance. This can impede early intervention and limit the child’s opportunities for beneficial therapies, affecting both their development and family dynamics.[5-7]

This study aimed to assess parental awareness of Pediatric Autism Spectrum Disorders in Himachal Pradesh, examining factors such as the identification of early ASD symptoms, awareness of available diagnostic and intervention options, and common misconceptions. Through this research, specific gaps in knowledge and areas of misunderstanding were identified, providing insight into the challenges faced by parents in recognizing and managing ASD. The findings serve as a foundation for targeted educational initiatives and public health strategies tailored to improve ASD awareness and promote timely interventions, thereby fostering a supportive environment for children with ASD and their families in Himachal Pradesh.

Aims & Objectives

This study aimed to evaluate parental awareness of Pediatric Autism Spectrum Disorders (ASD) in Himachal Pradesh by examining their ability to identify early symptoms, understand available diagnostic and intervention options, and recognize prevalent misconceptions about ASD. The objective was to assess the level of knowledge among parents regarding ASD-related behaviors, to identify awareness gaps, and to uncover specific misconceptions that may hinder early intervention. Findings from this study intend to inform public health initiatives and educational programs, enhancing early diagnosis and supportive care for children with ASD in Himachal Pradesh.

• Research Approach: This descriptive study was designed to assess the current levels of awareness among parents about Pediatric Autism Spectrum Disorders, including knowledge of symptoms, understanding of intervention pathways, and prevalence of misconceptions.

• Research Design: A cross-sectional survey approach was utilized to gather data on parental awareness across a representative sample in Himachal Pradesh, providing a snapshot of knowledge and understanding related to ASD in various demographic segments.

• Study Area: The study was conducted across diverse districts within Himachal Pradesh, a region marked by a mix of urban and rural populations, each with unique levels of healthcare accessibility and educational exposure. This geographic diversity enabled the study to capture insights from parents with varied backgrounds and differing degrees of access to autism-related resources.

• Study Duration: Data collection spanned a three-month period from August to October 2024, ensuring that responses reflected a wide demographic and captured variability in awareness across the region.

• Study Population: The target population included parents and primary caregivers aged 18 and above, residing in Himachal Pradesh for a minimum of 12 months, ensuring familiarity with local healthcare resources and ASD-related community support structures.

• Sample Size: A sample size of 400 participants was determined using a 95% confidence level, an expected 50% awareness level regarding ASD, and a 5% margin of error. A 5% anticipated non-response rate was also factored in to ensure data robustness.

• Study Tool: A structured questionnaire, distributed via Google Forms, served as the primary data collection tool. The questionnaire comprised two main sections:

  • Socio-demographic Details: This section captured participants’ age, gender, education level, occupation, and area of residence, which facilitated the analysis of demographic factors on awareness levels.

  • Knowledge Assessment: Twenty structured questions assessed parental knowledge of ASD symptoms, familiarity with diagnostic and intervention options, and common myths or misconceptions about ASD. Each correct answer received one point, with scores categorized as follows: >80% (Very Good), 60-79% (Good), 41-59% (Fair), and <40% (Poor). Pre-testing of the questionnaire was conducted to ensure clarity, and validation was provided by experts in child psychology and public health.

• Data Collection: The questionnaire was shared online through various platforms such as WhatsApp, Facebook, Instagram, and LinkedIn, enabling diverse participation. Data collection was supervised by field experts and continued until the target of 400 responses was achieved, ensuring adherence to methodological standards and data accuracy.

• Data Analysis: Responses were initially organized and cleaned using Microsoft Excel, followed by statistical analysis in Epi Info V7. Frequencies, percentages, and correlations were calculated to provide an in-depth understanding of awareness levels and trends among different demographic segments.

• Ethical Considerations: Ethical guidelines were rigorously observed to ensure participant confidentiality and anonymity. No personally identifying information was collected, and informed consent was obtained from each participant, who was informed of their right to withdraw at any time. This approach maintained compliance with ethical standards for human research.

A total of 400 parents participated in the study, providing insights into their awareness regarding Pediatric Autism Spectrum Disorders (ASD). 

Table-1: Sociodemographic Variables of Study Participants 

The sociodemographic profile of participants in this study highlights a diverse and representative sample of parents and caregivers in Himachal Pradesh, with 59% female and 41% male respondents, reflecting a higher proportion of mothers or female caregivers. The majority of participants (32%) were aged 26-35 years, followed by 36-45 years (24%), indicating that most respondents were in the primary caregiving phase for children likely within the ASD diagnosis age range. Educational attainment varied, with 35% having undergraduate degrees and 27% completing secondary school, while 6.25% had no formal education, indicating a mix of literacy levels across the population. Occupation-wise, 32% were employed in private or government services, 22.75% identified as homemakers, and 20% engaged in agriculture or labor, representing the region's occupational diversity. A substantial majority of participants (66%) resided in rural areas, consistent with Himachal Pradesh’s demographic makeup. Monthly household incomes varied, with 35.5% earning INR 20,001-40,000, reflecting a mix of lower- and middle-income households. Family structures were predominantly nuclear (67%), and most respondents (69.25%) had lived in Himachal Pradesh for over 10 years, ensuring familiarity with local healthcare practices.

Table-2: Parental Knowledge Regarding Pediatric Autism Spectrum Disorders in Himachal Pradesh

In Table 2, the distribution of knowledge scores reveals varying levels of parental awareness of ASD, with 26% (104 participants) demonstrating Very Good knowledge, scoring between 16-20 points, indicating a comprehensive understanding of ASD symptoms and intervention pathways. The largest portion, 32.5% (130 participants), falls into the Good category with scores between 12-15 points, reflecting general knowledge yet lacking depth in certain areas, particularly regarding early intervention and the specific signs of ASD. Another significant portion, 27.5% (110 participants), placed in the Fair category, scoring 8-11 points; this group displayed a foundational understanding but showed gaps in recognizing early ASD symptoms and available support resources. Finally, 14% (56 participants) scored in the Poor category (<8 points), revealing limited awareness and understanding, suggesting they may struggle to identify ASD symptoms or understand intervention options effectively. This distribution underscores the importance of targeted educational initiatives to bridge these knowledge gaps, especially for those in the Fair and Poor categories, ultimately enhancing early identification and intervention for children with ASD in Himachal Pradesh.

Figure-1: Knowledge Scores on Pediatric Autism Spectrum Disorders among Study Participants

The findings of this study provide a comprehensive look into the parental awareness of Pediatric Autism Spectrum Disorders (ASD) in Himachal Pradesh, highlighting areas of both understanding and misconception. As summarized in Table 1, many parents demonstrated awareness of common ASD indicators, with 63.5% correctly identifying early signs like delayed speech and limited social interaction, reflecting a basic awareness of ASD's presentation. Furthermore, 69.5% recognized that symptoms can appear as early as age two, indicating an understanding of the early onset of the disorder. However, gaps persist in understanding certain critical aspects; for example, only 59% of participants correctly identified that pediatricians and psychologists typically diagnose ASD, pointing to some uncertainty regarding diagnostic procedures. Another significant area of misconception was around community support, as only 52% of parents reported being aware of resources available for ASD in their region, highlighting the need for improved outreach and resource awareness.

The responses in Table 1 further show that while a majority (71%) recognized the benefits of early intervention, 58.5% misunderstood that intellectual disability does not always co-occur with ASD, reflecting a misconception that could impact their expectations and approach to intervention. The findings also reveal gaps in the understanding of behavioral management strategies, as 61.5% acknowledged behavioral therapy as beneficial, yet many still believed in the sufficiency of medication alone. Such misconceptions indicate that while parents may be open to intervention, their understanding of comprehensive ASD management is often incomplete. Notably, a majority (67%) correctly understood that ASD is lifelong and unlikely to be “outgrown,” illustrating a general comprehension of the chronic nature of ASD, but further reinforcing the need to clarify that effective management, not a cure, is the goal of treatment.

Table 2 provides insight into the overall distribution of knowledge scores among parents, revealing a mixed level of understanding across the sample. Approximately 26% of participants scored in the “Very Good” range (16-20 points), indicating comprehensive awareness and an ability to recognize key symptoms, understand early intervention benefits, and debunk common myths. However, the largest proportion (32.5%) of participants fell into the “Good” category, reflecting a general awareness of ASD but with some misconceptions or incomplete knowledge, particularly in areas such as the specific roles of therapies and the diversity of ASD presentations. Another 27.5% scored within the “Fair” range, displaying foundational knowledge but likely struggling with more nuanced aspects of ASD, such as sensory sensitivities or diagnostic procedures. Finally, 14% scored poorly (<8 points), demonstrating limited awareness, likely impacting their ability to recognize or seek early intervention for ASD.This distribution in Table 2 underscores the critical need for targeted education initiatives focused on clarifying early symptoms, treatment options, and available community resources. These findings suggest that while foundational awareness exists among parents, there is a need for more accessible, evidence-based information to address specific misconceptions, particularly for those in the Fair and Poor knowledge categories. Bridging these knowledge gaps through targeted educational programs and community resources could empower parents with a deeper understanding of ASD, ultimately fostering a more supportive environment for early identification and intervention in children with ASD in Himachal Pradesh.[8-12]

Limitations
This study provides valuable insights into parental awareness of Autism Spectrum Disorders (ASD) in Himachal Pradesh; however, several limitations should be noted. The reliance on an online survey may have limited the participation of parents without internet access, potentially skewing responses towards those with better access to information and resources. Additionally, as the data is self-reported, there may be a response bias, where participants overestimate their awareness or provide socially desirable answers. The study's focus on assessing awareness rather than practical application or behavior may also limit our understanding of how parental knowledge translates into real-world intervention and support for ASD. Expanding future studies to include in-person surveys and observational methods could provide a more inclusive and holistic understanding of parental awareness across diverse demographic groups.

The findings of this study reveal a complex picture of parental awareness regarding Pediatric Autism Spectrum Disorders in Himachal Pradesh, with both encouraging areas of knowledge and significant gaps in understanding. Many parents demonstrated a foundational awareness of ASD symptoms, early intervention benefits, and the chronic nature of the disorder; however, misconceptions regarding diagnostic processes, treatment strategies, and the role of intellectual disability persist. The distribution of knowledge scores highlights the critical need for targeted educational programs, especially for those with foundational or limited knowledge, to ensure parents are equipped with accurate information on recognizing ASD symptoms, accessing appropriate resources, and supporting their children’s developmental needs. By addressing these knowledge gaps, public health initiatives and community resources can play an essential role in promoting early identification and intervention, ultimately enhancing outcomes for children with ASD and fostering a more supportive community for affected families across Himachal Pradesh.

The authors declare that they have no conflict of interest

 No funding sources

The study was approved by the Jawaharlal Nehru Medical College, Aligarh Muslim University(AMU).

1. Alrehaili et al. "Exploring Early Childhood Autism Spectrum Disorders: A Comprehensive Review of Diagnostic Approaches in Young Children." Cureus 15.12 (2023), e50111. DOI: https://doi.org/10.7759/cureus.50111.

2. Hyman et al. "Identification, Evaluation, and Management of Children With Autism Spectrum Disorder." Pediatrics 145.1 (2020), e20193447. DOI: https://doi.org/10.1542/peds.2019-3447.

3. Crowell et al. "Parenting Behavior and the Development of Children with Autism Spectrum Disorder." Comprehensive Psychiatry 90 (2019), pp. 21-29. DOI: https://doi.org/10.1016/j.comppsych.2018.12.004.

4. Dababnah et al. "Early Screening for Autism Spectrum Disorders: A Primer for Social Work Practice." Child and Youth Services Review 33.2 (2011), pp. 265-273. DOI: https://doi.org/10.1016/j.childyouth.2010.11.014.

5. Arun and Chavan. "Survey of Autism Spectrum Disorder in Chandigarh, India." Indian Journal of Medical Research 154.3 (2021), pp. 476-482. DOI: https://doi.org/10.4103/ijmr.IJMR_2005_19.

6. Raina et al. "Prevalence of Autism Spectrum Disorder among Rural, Urban, and Tribal Children (1-10 Years of Age)." Journal of Neurosciences in Rural Practice 8.3 (2017), pp. 368-374. DOI: https://doi.org/10.4103/jnsrp.jnsrp_208_17.

7. Srivastava et al. "A Narrative Review of Autism Spectrum Disorder in the Indian Context." Journal of Indian Association for Child and Adolescent Mental Health 19.4 (2023), pp. 336-343. DOI: https://doi.org/10.15508/jiaacm.2023.19.4.336.

8. Dingfelder and Mandell. "Bridging the Research-to-Practice Gap in Autism Intervention: An Application of Diffusion of Innovation Theory." Journal of Autism and Developmental Disorders 41.5 (2011), pp. 597-609. DOI: https://doi.org/10.1007/s10803-010-1081-2.

9. Brookman-Frazee et al. "Parenting Interventions for Children with Autism Spectrum and Disruptive Behavior Disorders: Opportunities for Cross-Fertilization." Clinical Child and Family Psychology Review 9.3-4 (2006), pp. 181-200. DOI: https://doi.org/10.1007/s10567-006-0017-4.

10. AlAlmaeiAsiri et al. "Assessment of Parental Knowledge, Awareness, and Perception About Autism Spectrum Disorders in Aseer Region, Southwestern Saudi Arabia." International Journal of General Medicine 16 (2023), pp. 557-564. DOI: https://doi.org/10.2147/IJGM.S358276.

11. Wang et al. "Parents' Knowledge and Attitude and Behavior Toward Autism: A Survey of Chinese Families Having Children with Autism Spectrum Disorder." Translational Pediatrics 11.9 (2022), pp. 1445-1457. DOI: https://doi.org/10.21037/tp-22-45.

Babakr et al. "Understanding Parent's Knowledge and Perception About Autism Spectrum Disorder (ASD) in the City of Jeddah, Kingdom of Saudi Arabia." Journal of Healthcare Sciences 2.9 (2022), pp. 264-272.