Hasty diagnosis is derailing autism care

Autism, or Autism Spectrum Disorder (ASD), is not a disease, but a complex neuro-developmental condition. Over the last decade, social awareness regarding autism has grown significantly in Bangladesh. However, as a mental public health specialist, I find the systemic weaknesses in the identification and service delivery processes at the grassroots level deeply concerning. Specifically, the hurried and unscientific manner in which disability allowances are determined at the upazila and district levels poses a major threat to both the rights of affected children and the state’s future planning.

At the primary level, the responsibility for identifying disabilities rests with medical officers at upazila health complexes. Most of these officers lack specialised clinical training in ASD or neurodevelopmental disorders. The MBBS curriculum covers this subject only briefly, making it nearly impossible for a general practitioner to accurately diagnose a child by analysing complex behavioural traits. During the selection process for disability allowances, when hundreds of applicants gather, decisions are often made within minutes based on superficial physical examinations or anecdotal evidence from parents or guardians. This culture of haste is a red flag for public health. Autism is not something that can be detected with a stethoscope or based on a blood test; it requires prolonged observation and a rigorous evaluation of the child’s social and communication skills. In the absence of specialised training, these rushed decisions frequently lead to misdiagnosis.

Every scientific determination requires a gold standard or an objective tool. While the developed world utilises internationally recognised scientific protocols to identify autism, Bangladesh has yet to mandate a simplified, scientific national standard diagnostic tool that a general physician at the grassroots level can use easily. Due to the lack of a uniform guideline, different doctors apply different criteria. Consequently, children with hearing impairments or intellectual disabilities are sometimes mistakenly issued autism cards, while those truly on the spectrum are excluded due to inadequate assessment. This not only results in inaccurate national statistics but also deprives those in genuine need of appropriate therapy and support.

Furthermore, the repercussions of misdiagnosis extend far beyond the individual, impacting state-level policymaking. When inaccurate data enters our Disability Information System (DIS), it inevitably compromises government planning and budget allocations. If public health policies are built on flawed data, the core issues remain unaddressed, leading to a waste of state resources and the marginalisation of rightful beneficiaries.

There needs to be radical reform in the autism diagnosis process. Every medical officer at the upazila level must undergo intensive, short-term training to help them recognise the clinical symptoms of autism accurately. Furthermore, a validated screening tool, translated into Bangla, must be made mandatory. We also need to move away from relying on a single physician and instead form multi-disciplinary teams comprising social service officers, physiotherapists, and psychologists. Dedicated time and spaces must be allocated for these assessments to ensure every child receives the attention they require. Finally, a digital monitoring system should be established to allow experts at the district or divisional levels to randomly verify the data sent from the upazilas.

Sympathy for individuals with autism is not enough; ensuring their civic rights is a moral obligation for the state and for all of us. With the existing perfunctory assessments, we are not just creating flawed statistics but also jeopardising the future of thousands of children. Let us look beyond the formalities and commit to fixing structural flaws. An accurate diagnosis is, after all, the first and most vital step towards effective care.

Dr Imdadul Haque Talukdar, is a public mental health specialist and adjunct assistant professor of psychology in the Department of History and Philosophy at North South University.

Views expressed in this article are the author's own. 

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