Objectives: 

Training pediatricians in low- and middle-income countries (LMICs) in early diagnosis and comprehensive management of autism spectrum disorder (ASD) is crucial to ensure optimal developmental outcomes for a substantial number of children with ASD in this region. This study evaluates the relevance and effectiveness of an evidence-based telementoring model Extension for Community Healthcare Outcomes (ECHO) Autism in increasing pediatricians' access to best-practice care for children with ASD in LMIC contexts.

Methods: 

ECHO Autism was launched by a ‟hub” team of multidisciplinary ASD experts at a child development center in Mumbai, India. The culturally modified model included 13 biweekly sessions conducted annually using video-conferencing technology. Sessions combined expert-delivered didactics and facilitated case-based discussions on best-practice methods in screening, diagnosing, and managing autism and its comorbidities. Sixty-two physicians, including 59 pediatricians across 2 cohorts (2019–2020), participated in the mixed-methods study to evaluate participants' reactions, knowledge, behaviors, and impact on children and families.

Results: 

Participants represented a broad geographic reach across India (n = 47) and other LMICs (n = 15). Both quantitative and qualitative data revealed high levels of participant satisfaction and improved knowledge and self-efficacy in ASD diagnosis and management. Qualitative themes highlighted the adult-learning processes of ECHO Autism that participants considered novel and beneficial, such as reflective discussions, respectful mentoring, having a parent as ‟expert,” and cultural relevance, alongside changes in practice behaviors.

Conclusion: 

ECHO Autism clinics facilitated by local experts in LMICs can improve access to early diagnosis and evidence-based, comprehensive management for children with ASD and their families by positively influencing pediatricians' knowledge, attitudes, and practice behaviors.

中文翻译：

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印度 ECHO 自闭症医生的声音——对中低收入国家自闭症远程指导模型的评估

目标： 

培训低收入和中等收入国家 (LMIC) 的儿科医生对自闭症谱系障碍 (ASD) 进行早期诊断和综合管理，对于确保该地区大量自闭症儿童的最佳发育结果至关重要。本研究评估了基于证据的远程指导模型扩展社区医疗保健结果 (ECHO) 自闭症在增加儿科医生在 LMIC 环境中获得 ASD 儿童最佳实践护理的相关性和有效性。

方法： 

ECHO Autism 由多学科 ASD 专家组成的“中心”团队在印度孟买的一个儿童发展中心发起。文化改良模型包括每年使用视频会议技术进行的 13 次双周会议。会议结合了专家提供的教学法，并促进了关于筛查、诊断和管理自闭症及其合并症的最佳实践方法的基于案例的讨论。包括 2 个队列（2019-2020 年）的 59 名儿科医生在内的 62 名医生参与了混合方法研究，以评估参与者的反应、知识、行为以及对儿童和家庭的影响。

结果： 

参与者代表了印度（n = 47）和其他中低收入国家（n = 15）的广泛地理范围。定量和定性数据都显示了参与者的高度满意度，并提高了 ASD 诊断和管理的知识和自我效能。定性主题强调了参与者认为新颖和有益的 ECHO 自闭症的成人学习过程，例如反思性讨论、尊重的指导、将父母作为“专家”和文化相关性，以及实践行为的变化。

结论： 

由中低收入国家当地专家推动的 ECHO 自闭症诊所可以通过积极影响儿科医生的知识、态度和实践行为，提高 ASD 儿童及其家人获得早期诊断和循证综合管理的机会。