Publications by authors named "Rena Shrestha"

4 Publications

  • Page 1 of 1

Implementing and evaluating Social Attention and Communication Surveillance (SACS) to prospectively identify autism in very young children in Nepal.

Res Dev Disabil 2021 Aug 15;115:104013. Epub 2021 Jun 15.

Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia. Electronic address:

Background: Although Autism Spectrum Disorder (ASD) can be identified as early as 12 months and diagnosed by 24 months, the mean age of diagnosis of ASD in Nepal is ∼58 months, with children missing the opportunity for early intervention.

Aims: This study implemented and evaluated a Nepali version of the Social Attention and Communication Surveillance (SACS-N) tool, to identify children between 11-30 months who are at "high likelihood" of ASD in a local community in Nepal.

Methods: Sixty Female Community Health Volunteers (FCHVs) were trained to monitor and identify the early signs of ASD using SACS-N.

Results: Overall, 1926 children were monitored with the SACS-N, with 11 children (0.57 %) referred for further assessments at 11-15 months (n = 4), 16-21 months (n = 4), and 22-30 months (n = 3). Of these children, 10 children had a developmental disorder, including ASD and Global Developmental Delay; no information was available on one child who migrated. Hence, the positive predictive value (PPV) of SACS-N for all developmental disorders was 100 %. Of seven children attending a gold standard diagnostic/ developmental assessment, three had ASD (43 % PPV for ASD). The estimated prevalence of ASD ranged between 0.16 % to 0.26 %.

Conclusion: Community-based developmental monitoring of ASD and other developmental delays by FCHVs is a feasible, cost-effective and sustainable approach to promoting early identification of ASD in Nepal. Further training and awareness of autism is needed for more accurate and increased referral rates using the SACS-N, including regular supervision of FCHVs.
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http://dx.doi.org/10.1016/j.ridd.2021.104013DOI Listing
August 2021

Changes in Knowledge on the Signs of Autism in Young Children (11-30 Months) among Female Community Health Volunteers in Nepal.

J Autism Dev Disord 2021 Mar 11. Epub 2021 Mar 11.

Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.

Nepalese Female Community Health Volunteers' (FCHVs) knowledge on social attention and communication development and the early signs of autism was evaluated before, immediately after, and 12-months following training on typical and atypical social-communicative development in infants/toddlers, early signs of autism, and monitoring of key "markers" of autism using Social Attention and Communication Surveillance. FCHVs (N = 60) significantly improved their knowledge about autism and reported increased perceived confidence in monitoring and referring young children at high likelihood of autism following training, which was sustained one year later. FCHVs also reported a positive impact of training on their work. These findings indicate the effectiveness of training in improving FCHVs' knowledge and perceived confidence to monitor and refer young children at high likelihood of autism.
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http://dx.doi.org/10.1007/s10803-021-04944-7DOI Listing
March 2021

Age of Diagnosis of Autism Spectrum Disorder in Nepal.

J Autism Dev Disord 2019 Jun;49(6):2258-2267

School of Psychology and Public Health, Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.

The current study investigated the age of diagnosis (AoD) of autism spectrum disorder (ASD) in Nepal by using de-identified data on 246 children with a diagnosis of ASD registered at AutismCare Nepal Society from 2010 to 2015. The mean AoD in children was 58 months (range 14-187 months). Majority of children were male (76%), lived in the Kathmandu valley (75%), and were from upper caste groups (62%). The mean diagnostic age of ASD in Nepal is much later than the age at which a reliable diagnosis is possible, indicating the need to reduce the gap between the age at which it is possible to diagnose ASD, and the average age at which ASD is currently diagnosed.
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http://dx.doi.org/10.1007/s10803-019-03884-7DOI Listing
June 2019

Symptom recognition to diagnosis of autism in Nepal.

J Autism Dev Disord 2014 Jun;44(6):1483-5

Department of Child Health, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal,

Awareness and knowledge about autism is almost non-existent in Nepal. Children who eventually get the diagnosis often miss their opportunity for early intervention. The current study shows that medical help was seeked at mean age of 27.9 + 14.5 months and most of them were for delayed language and the first preference for parents were pediatricians. The mean age of diagnosis of autism was 55.6 months. The time length between help seeking to diagnosis was 29.4 months with longest time lag of 13 years. Delay in recognition of symptoms, delay in health seeking and lack of awareness even in treating physicians might be the reason for advanced age at diagnosis of autism in Nepal.
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http://dx.doi.org/10.1007/s10803-013-2005-6DOI Listing
June 2014
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