Nepal urgently needs a National Autism Plan. Start with a simple question at clinics: "Does your child respond to their name?" Use screening tools like the M-CHAT checklist, which has been adapted for Nepali contexts
What if a child wanted to speak but couldn't, not out of rebellion, but because the world felt too loud, too bright, too much? Would you know how to help or look away if you are overwhelmed and unsure?
Now imagine Nepal as a large, joyful festival where every child is welcome. But some children with autism are left on the sidelines, not because they don't want to join, but because no one knows how to include them.
According to Autism Care Nepal Society, there may be between 150,000 and 300,000 autistic individuals in Nepal. Yet the 2021 Census counted only 4,886 out of 29.1 million people. That's like seeing only a few stars in a sky full of them.
The World Health Organisation estimates that 1 in 160 children globally are autistic.
So why are so few reported in Nepal? Because most cases go undiagnosed, especially outside cities. According to the World Bank's 2021 report in rural areas, where 81 per cent of Nepal's population lives, a child who doesn't speak or avoids eye contact might be labelled "lazy" or "cursed". Many families don't seek help, not out of neglect, but out of fear.
A 2019 study in Frontiers in Psychiatry found 60 per cent of parents avoided seeking support due to gossip or belief in traditional healing. One story shared by AutismCare Nepal Society shows this reality. A mother noticed her son wasn't speaking like other toddlers, but could recognise bulbs and numbers. Relatives told her,"Boys talk late." He didn't respond to his name but reacted to music.
A visiting therapist from India introduced the word "autism". It was new to the family. Online searches matched his behaviours. The parents eventually travelled abroad to confirm the diagnosis. "It felt like they were describing someone else's child," the mother said. But with years of therapy, her son now expresses emotions and needs. "Understanding changed everything."
That understanding, however, is complex. Nepal has just 150 psychologists and even fewer trained therapists (Nepal Health Research Council, 2022). Most hospitals don't screen for autism. Schools? Only 1 per cent of the 35,000 are inclusive (Ministry of Education, 2023). And therapy costs of $15 to $40 per session are unaffordable for families where 25 per cent live on less than $1.90 per day.
Despite this, solutions exist. Speech therapy helps children communicate. A child in Pokhara might learn to tell jokes. One in Rolpa might point to a photo and say "water". A 2020 Journal of Autism and Developmental Disorders study found that 68 per cent of children with early speech therapy improved communication. In a country with 123 languages, therapy must be local. Use images of dal, goats or a tiffin box, not just apples and doughnuts.
However, therapists are rare, especially in rural Nepal. A 2022 pilot project in Chitwan trained 20 health workers to coach parents in speech basics. They reached 50 families. Why not scale that across the country?
Behavioural therapy, especially Applied Behaviour Analysis (ABA), also makes a difference. ABA breaks skills into small, teachable steps. A teen in Biratnagar might learn job skills. A child in Doti might calm with a hug or a high-five. A 2018 Paediatrics study found ABA improved life skills by 47 per cent. WHO also supports it. While music and play feel good, evidence-based therapies show measurable gains.
Nepal's health budget in 2024 exceeds Rs 86 billion, but less than 1 per cent is spent on mental health. One Lancet study showed that half the children receiving ABA gained 10–20 IQ points. Speech therapy has improved communication for over 70 per cent of autistic children. These aren't just statistics; they're turning points in lives that were once misunderstood.
Nepal urgently needs a National Autism Plan. Start with a simple question at clinics: "Does your child respond to their name?" Use screening tools like the M-CHAT checklist, which has been adapted for Nepali contexts. Allocate 5 per cent of the health budget to train 500 therapists by 2035. Offer incentives to serve rural areas. Nepal's 12 medical schools could lead this effort.
Let's take services where they're needed most. Mobile therapy vans, powered by Nepal's 40,000 female community health volunteers, can reach remote places like Humla or Bajura. Tech can help, too. Imagine an app with a "momo" button that lets a child signal hunger. However, picture cards are still essential, with only 60 per cent internet coverage in rural areas.
Hospitals and schools must also be involved. District hospitals used by 80 per cent of rural Nepal should have autism-trained professionals. Of 7,000 public schools, let's aim for 10 per cent of teachers to be trained in inclusive education by 2030, aligning with Nepal's Inclusive Education Policy 2020.
Public awareness matters, too. Families can't seek help if they're ashamed. What if a single radio message changed how a village sees autism? Radio Nepal reaches 85 per cent of households and can air stories in Nepali, Maithili and Bhojpuri. Local community centres can host "Autism Is Okay" talks to replace fear with empathy.
This is not just a health issue. It's a matter of rights. Nepal has signed the UN Convention on the Rights of Persons with Disabilities. Every child has the right to healthcare, education and dignity, including children with autism. Are we keeping that promise?
Autism isn't about fixing children; it's about helping them grow. With support, they can thrive. If you're a parent, ask about early signs. If you're a teacher, notice the quiet child. If you're a policymaker, fund what works. Change starts with recognition. And recognition begins with us.
Every child deserves to be seen, heard, and supported. It's time Nepal listened.
KC is a Public Health scholar with a deep interest in children's well-being
