Abstract:
Objectives: To evaluate the feasibility and effectiveness of the Communication Observation Card (COC) for community-based identification of Autism Spectrum Disorder and other neurodevelopmental disorders in children younger than two years of age.
Methods: A prospective community-based developmental surveillance programme was conducted in Kumaratchi Block, Cuddalore District, Tamil Nadu, India, from December 2025 to May 2026.
Fifty-six Anganwadi workers and primary healthcare workers were trained to use the Communication Observation Card, which incorporates five age-specific communication milestones: social smile (2 months), eye-to-eye contact (2–4 months), response to name (7–12 months), pointing to an object with one finger (7–15 months), and use of two meaningful words (12 months).
Children demonstrating delay or absence of one or more milestones were referred to a monthly developmental assessment clinic conducted by a Developmental Paediatrician at the PHC. Data were collected using standardized Google Forms. Feasibility and user acceptability were assessed through structured digital questionnaires completed by frontline workers.
Results: The total population of children aged 12–24 months in Kumaratchi Block was 1,985. During the study period, 850 children (42.8%) underwent developmental surveillance using the Communication Observation Card.
Fifty children (5.9% of those screened) were identified with suspected neurodevelopmental concerns and referred for specialist evaluation. The mean age at referral was 16 months.
Following developmental assessment, 30 children (60% of referrals; 3.5% of screened children) were diagnosed with Autism Spectrum Disorder. Among children with ASD, 18
(60%) were male and 12 (40%) were female. Ten children with neurodevelopmental disorders were identified before 18 months of age.
Among the remaining children, diagnoses included Global Developmental Delay (n=8), Down syndrome (n=5), Motor Developmental Delay (n=5), and Undiagnosed Genetic/Neurodevelopmental Syndromes (n=2).
All referrals originated from Anganwadi workers trained in the use of the COC. Of the 56 workers trained, 32 (57.1%) completed the feasibility survey. All respondents (100%) reported that the COC was easy to understand, simple to administer, and feasible for incorporation into routine community-based developmental surveillance.
Conclusions: The Communication Observation Card (COC) is a simple, low-cost, and feasible community-based developmental surveillance ,can be effectively implemented by Anganwadi and healthcare workers. The COC enabled early identification of Autism Spectrum Disorder and other neurodevelopmental disorders before two years of age and demonstrated excellent acceptability among frontline workers. Integration of COC-based developmental surveillance into routine child health services may strengthen early detection pathways, facilitate timely referral, and improve access to early intervention in resource-limited settings.
