Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Case Report
Journal Review
Letter to Editor
Letter to the Editor
Original Article
Review Article
View/Download PDF

Translate this page into:

Review Article
36 (
); 155-159

Nursing professional’s understanding and screening practices in the identification of children with autism spectrum disorder: A scoping review

Department of Nursing, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
Corresponding author: Rajalakshmi Ramu, Department of Nursing, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ramu R, Govindan R. Nursing professional’s understanding and screening practices in the identification of children with autism spectrum disorder: A scoping review. Karnataka Paediatr J 2021;36:155-9.



Early identification and intervention of childhood autism spectrum disorder (ASD) is recognised to have a valuable impact on a child’s life. Nurses who are adequately prepared with the necessary screening practices to do early identification of the children with risk for ASD and knowledge surrounding ASD may enhance the screening practices in the child care delivery system.


This study was to discuss nurses’ knowledge and understanding about childhood ASD and its’ screening practices among nurses.


The scoping review approach was adopted for the present study utilised by reviewing electronic databases from inception to 2021.


The authors have searched 160 related studies from above-said database and found only 10 full-text studies based on the objective and research question. Based on the review, researchers understood that the Nursing Professionals have scant to moderate knowledge and understanding on childhood ASD and its ‘Screening Practices.’ Effective training programmes and continuing nursing education would hasten the early identification and intervention process in this arena.


Autism Spectrum Disorder
Screening Practice


American child psychologist Leo Kanner first described autism disorder in 1943. ‘Autism spectrum disorder (ASD) is a neurodevelopmental disorder of the brain that is characterised by impairments in social interaction, communication, and repetitive patterns of behaviour.[1] These behaviours can range from mild to severe.[2] According to a study conducted in 2012,” ASD is estimated to worldwide prevalence of 6.2/1000.[3] According to the statistical reports given by the Centers for Disease Control and Prevention[4] and other authors,[5] ASD has increased to one out of every 68 children.[6] It is predicted that India will have more than 2 million children with autism under the age of 10 years,[7] at present, around 3 million people affected in the Indian subcontinent. It indicates high prevalence found in India recently (one in 65 children 2–9 years of age).[8] The World Health Organization[9] has recommended monitoring of child development as part of routine childcare in health care delivery systems.


The awareness of medical pathophysiology, clinical features, and management in autism might lead to primary care autism prevention strategies.[10] The healthcare professionals need to know about some of the important clinical clues for possible autism while performing general examination of the children, such as: delay or absence of spoken language, not responsive to other people’s facial expressions/feelings, lack of pretend play, unable to share pleasure, impairment in non-verbal communication, not pointing at an object or person, lack of gaze monitoring, social play, unusual or repetitive hand and finger mannerisms, unusual reactions, or lack of reaction to sensory stimuli. If any of the above-said clinical clues are found in a toddlers, further assessment may be needed to evaluate the possibility of autism.[11] Early diagnosis is important that leads to a better outcome in autism. It has been proved that the level of healthcare professional’s understanding and knowledge of autism influences the average age of diagnosis and provision of further information to caregivers.[12,13]

Screening for Neuro-Developmental Disorder would help in early identification and better intervention, further, it leads to a reduction in disability and improves better outcome. ‘Early developmental screening and surveillance for conditions such as ASD are not done regularly in India. The Indian Academy of Pediatrics and American Academy of Pediatrics (AAP)” recommended the need for a screening programme to be carried out. The periodic examinations at the 15th, 18th, and 24th months are particularly useful in providing information about possible autism since characteristics of autism often begin to emerge during the 2nd year of life.[14,15]

Facilitating early diagnosis and standardised early screening, on-going developmental surveillance is essential.[14] It is recommended that all children should undergo for a physical examination and screening process.[16] Along with medical professionals,[6] nurses have a duty to provide high-quality care to children with and without problems.[4] It is identified that medical[17,18] and nursing professionals are having inadequate knowledge about ASD screening practices.[19]

Nurses are the primary and secondary healthcare providers[20] and members of multidisciplinary teams and who gives care to the children in hospitals and community.[21] Inadequate knowledge and understanding about childhood autism and screening practices toward identifying children at risk for and with ASD, among these health care professionals might be a major barrier to do early identification and interventions.[22] Thus, improving nurse’s understanding, knowledge and skill regarding screening and early identification of the children at risk for and with the ASD are essential.

Moreover, several factors that influence understanding and knowledge about childhood autism among nurses need to be explored.[19] There is a dearth found in nursing research related to the current topic. Hence, the present researchers found it to be essential to do further review in this area.

Research question

Does the nurses have sufficient knowledge and understanding on childhood ASD and its Screening Practice?


This study was to discuss nurses’ knowledge and understanding about childhood ASD and its screening practices among nurses.


The Scoping review approach was adopted for the present study. The inclusion criteria were original studies published in the peer-reviewed journal focused on nurses’ knowledge and understanding about childhood ASD and Nurses’ Screening Practice which was published in English, till April 2021. PubMed, MEDLINE, Google Scholar, Psych INFO, Pro-Quest, EBSCO, JAMA and Cochrane Database of Systematic Reviews, along with grey literature and conference proceedings were searched using the keywords such as ‘Nurses’ knowledge,’ understanding Screening Practice’ and ‘childhood ASD.’


The electronic-based studies were examined and assembled according to the research question and objective. The authors searched 160 related studies from above-said database and found only 10 full-text studies based on the objective and research question. Out of 10 full-text studies, three were experimental design study, three cross-sectionals descriptive study, two mixed method approach, one qualitative study and one comparative study. All 10 studies were discussed about nurses’ knowledge on ASD. Out of 10 studies, only three studies were discussed about screening practices along with nurses’ knowledge and understanding, other seven studies were discussed only about nurses’ knowledge about ASD alone. The results have been depicted in [Table 1]. Based on the review, researchers understood that the Nursing Professionals have scant to moderate level of knowledge and understanding on childhood ASD and its ‘Screening Practices.’[19,22-30]

Table 1:: Summary and interpretation of the review of literatures.
Author’s name/year Research design/place Study population/sample size Purpose of the study Result/Conclusion
Strunk/2009[23] Mixed method explorative/state of Virginia School health nurses/n=231 To explore the school Nurses Knowledge on autism A need for school nurses to enhance their knowledge of ASD, to familiarise themselves with the policy and healthcare networks that they collaborate with and to communicate effectively with students, parents, educators and community members in dealing with ASD
Igwe et al. 2011[24] Comparative study/Nigeria Paediatrics and Psychiatric nurses/n=80 To compare the knowledge about ASD among two groups Psychiatric nurses had more knowledge than Paediatric nurses
Ghulman et al./2017[22] Descriptive cross-sectional survey/Riyadh Paediatric nurses/n=125 To assess the base line knowledge regarding ASD They found nurses had insufficiency in understanding ASD/need for continuing education is essential
Barry et al./2009[25] Experimental design with pre- and post-intervention/University of Vermont Primary care providers including nurses/n=40 To support the adoption of best practices around developmental and autism screening in the primary care setting Result showed, quality improvement found toward Screening practices
King et al./2010[26] Experimental design with pre-and post-intervention/USA (Physician, staff and another healthcare providers)/n=17 to implement guideline adherent developmental screening Post-intervention screening varied among practices
Sena et al./2015[27] Qualitative approach and exploratory research design/Brazil Nurses/n=15 To assess knowledge and practice on family health strategy for ASD Inadequate knowledge and practice due to lack of training
Queisser/2016[28] Experimental study/Ohio Nurses/n=60 To assess effectiveness of evidence-based intervention package. (educational compound toolkit on ASD and screening practices) The post-test revealed that there was an increased knowledge in nurses towards ASD
Gardner et al./2016[19] Descriptive survey/New Jersey Nurse educators/n=295 To assess the Knowledge and perception Nurse educators had inadequate knowledge about ASD to educate nursing students
Winslow/2017[29] Mixed method research/St. Cloud State Nursing students/n=36 Assessed the effectiveness of training programme on ASD and screening practices The post-test revealed that there was an increased knowledge in nurses toward ASD and its screening practices
Govindan and Ramu/2020[30] Cross-sectional survey/India Community psychiatric nurses/n=50 To assess the nurses’ knowledge on ASD The study result revealed that nurses had insufficiency in understanding ASD and they need more information

ASD: Autism spectrum disorder


It is very difficult to detect autism in young children. Most of the children are not diagnosed until the age of 4 years or even later, especially in low socioeconomic status children. Clear evidence exists that early detection and subsequent early intervention can lead to significantly better prognosis, including improved language, social relationships, adaptive functioning as well as fewer maladaptive behaviours and facilitate early diagnosis and standardised early screening.[31] The AAP recently recommended universal screening for ASDs at the 18–24 months well-child paediatric visit.[15] Giarelli et al. found in their study and said that a limited amount of ASD material has been presented within the nursing curriculum.[32,33] Further few researchers have explained in their study about importance of Nurses’ knowledge regarding ASD to initiate referrals to specialists by having nurses who are adequately prepared with the necessary tools to screening and early identification of the children with risk for ASD and knowledge surrounding with ASD, may enhance the screening practices in child care delivery system.[33] One of the research findings revealed even nursing educators having the inadequate knowledge to educate the nursing students. These findings indicate need of the nursing curriculum incorporated with ASD components.[19] Scarce knowledge and understanding regarding childhood ASD alone is not the only barrier in screening children with and at risk for ‘Childhood Autism:’ among nurses. Indeed, there are some other obstacles including ambiguity in roles, wide-ranging working settings, lack of time to conduct screening and evaluations and more work load were also discussed by some of the researchers.[25] Most of the studies revealed that nursing professionals having lack of awareness about referral and early intervention services to reduce the developmental disabilities in children. The above-mentioned barriers must be studied in detail as they may be region and context specific and specifically addressed especially if one really wants to improve the developmental outcomes of children in the community. Few authors found the effectiveness of educational intervention on nursing professional’s knowledge.[25,26,28] Based on these evidence-based research, we understand that continuing nursing education might also improve the nurses’ knowledge.

This review article might have number of limitations. This review was not a systematic review; authors took an effort but might have missed out some articles. Further, each study has the different research approach, designs, methodology and materials, but two of the studies were used the same survey questionnaire.[22,24]


Health care professionals including nurses working with children in the community and clinical settings can utilise the study findings to screen children as early as possible during children’s visit to the health care settings for various purposes such as immunisation and other health care needs. Nursing administrators can conduct a training programme to all level of nursing professionals. Nurse educators can incorporate curriculum changes toward the importance of ASD screening for risk and early identification in the regular academic programme for nursing students. Authorities of Government and private health care delivery systems can implement the strategies to conduct programme toward screening practices.


Based on this review, it is evident that the nurses are having inadequate understanding on childhood ASD with respect to identification, screening practices. Further, most of the studies found that nurses would like to receive additional information about ASD and its screening practices. It is important that authorities who are the policy makers with respect to nursing education take note of these findings.


The corresponding author thanks the second author for the valuable guidance and intellectual contributions.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. . Diagnostic and Statistical Manual of Mental Disorders. . (5th ed). Arlington, VA: American Psychiatric Association Publishing; Available from: [Last accessed on 2018 Nov 10]
    [Google Scholar]
  2. , . Pervasive developmental disorders in preschool children: Confirmation of high prevalence. Am J Psychiatry. 2005;162:1133-41.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , , et al. Global prevalence of autism and other pervasive developmental disorders: Global epidemiology of autism. Autism Res. 2012;5:160-79.
    [CrossRef] [PubMed] [Google Scholar]
  4. . Prevalence of Autism Spectrum Disorder among Children aged 8 Years-Autism and Developmental Disabilities Monitoring Network, 11 Sites. . Available from: [Last accessed on 2018 Nov 10]
    [Google Scholar]
  5. . Autism Facts and Statistics. . Developmental Disabilities Institute. Available from: [Last accessed on 2018 Nov 10]
    [Google Scholar]
  6. , , , . Knowledge about childhood autism among health workers (KCAHW) questionnaire: Description, reliability and internal consistency. Clin Pract Epidemiol Ment Health. 2008;4:17.
    [CrossRef] [PubMed] [Google Scholar]
  7. , , , , . Diagnostic accuracy of Indian scale for assessment of Autism (ISAA) in chidren aged 2-9 years. Indian Pediatr. 2015;52:212-6.
    [CrossRef] [PubMed] [Google Scholar]
  8. , , , , , , et al. Consensus statement of the Indian academy of pediatrics on evaluation and management of autism spectrum disorder. Indian Pediatr. 2017;29:1-18.
    [Google Scholar]
  9. . Meeting of Experts on Community-Based Approaches to Autism; Bangkok, Thailand, 15-17 September 2010, Regional Office for South-East Asia Geneva: WHO; . p. 15-7.
    [Google Scholar]
  10. . Can awareness of medical pathophysiology in autism lead to primary care autism prevention strategies? N Am J Med Sci. 2013;6:134-44.
    [Google Scholar]
  11. , , . Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120:1183-215.
    [CrossRef] [PubMed] [Google Scholar]
  12. , , , . Incorporating developmental screening and surveillance of young children in office practice. Indian Pediatr. 2014;51:627-35.
    [CrossRef] [PubMed] [Google Scholar]
  13. , , , , , , et al. Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics. 2015;136:S41-59.
    [CrossRef] [PubMed] [Google Scholar]
  14. , , . Developmental delay: Timely identification and assessment. Ind Pediatrics. 2010;47:415-22.
    [CrossRef] [PubMed] [Google Scholar]
  15. . Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics. 2006;118:405-20.
    [CrossRef] [PubMed] [Google Scholar]
  16. , , . Referral profile of a child development clinic in Northern India. Indian J Pediatr. 2011;79:602-5.
    [CrossRef] [PubMed] [Google Scholar]
  17. , , , , , , et al. Medical undergraduate perception on the knowledge of autism spectrum disorder (ASD): Survey-based study at different levels of curriculum. FMEJ. 2015;5:3.
    [Google Scholar]
  18. , , , , , . A survey of Autism knowledge and attitudes among the healthcare professionals in Lahore, Pakistan. BMC Pediatr. 2011;11:107.
    [CrossRef] [PubMed] [Google Scholar]
  19. , , . Survey of nursing faculty preparation for teaching about autism spectrum disorders. Nurse Educ. 2016;41:212-6.
    [CrossRef] [PubMed] [Google Scholar]
  20. . Research on autism spectrum disorders in India. Andra Pradesh J Psychol Med. 2011;12:69-72.
    [Google Scholar]
  21. , , , , , , , et al. Toddlers at risk for autism spectrum disorders from Kerala, India-a community-based screening. Asian J Psychiatr. 2018;31:10-2.
    [CrossRef] [PubMed] [Google Scholar]
  22. , , . Assessment of the knowledge of pediatric nurses in childhood autism in Riyadh, KSA using KCAHW questionnaire. IOSR J Nurs Health Sci. 2017;6:27-37.
    [Google Scholar]
  23. . School nurses' knowledge of autism spectrum disorders. J Sch Nurs. 2009;25:445-52.
    [CrossRef] [PubMed] [Google Scholar]
  24. , , , , . Assessment of knowledge about childhood autism among paediatric and psychiatric nurses in Ebonyi state, Nigeria. Child Adolesc Psychiatry Ment Health. 2011;5:1.
    [CrossRef] [PubMed] [Google Scholar]
  25. , , , . Developmental and Autism Screening in Primary Care. . The Project Submitted for the Developmental and Autism Screening in Primary Care Practice in University of Vermont. Available from: [Last accessed on 2018 Nov 10]
    [Google Scholar]
  26. , , , , , , et al. Implementing developmental screening and referrals: Lessons Learned from a national project. Pediatrics. 2010;125:350-60.
    [CrossRef] [PubMed] [Google Scholar]
  27. , , , . Practice and knowledge of nurses about childhood autism. J Res. 2015;7:2707-16.
    [CrossRef] [Google Scholar]
  28. . Assessing nurses' knowledge about autism spectrum disorders. A thesis submitted to Capella University in November 2016 In: Partial Fulfilment of the Requirements for the Degree in Doctor of Nursing Practice. .
    [Google Scholar]
  29. . . Partial Fulfilment of the Requirements for the Degree in Master of Science. Available from [Last accessed on 2018 Nov 10]
    [Google Scholar]
  30. , . Nurses' knowledge and understanding about autism. Indian J Community Med. 2020;45:382-3.
    [CrossRef] [PubMed] [Google Scholar]
  31. , , . Screening for autism in infants, children, and adolescents. Int Rev Res Ment Retard. 2006;32:197-227.
    [CrossRef] [Google Scholar]
  32. , , , , , , et al. Universal autism screening for toddlers: Recommendations at odds. J Autism Dev Disord. 2016;46:1880-2.
    [CrossRef] [PubMed] [Google Scholar]
  33. , , . Continuing education for nurses in the clinical management of autism spectrum disorders: Results of a pilot evaluation. J Contin Educ Nurs. 2012;43:169-76.
    [CrossRef] [PubMed] [Google Scholar]
Show Sections