Autism is a neurodevelopmental disability that affects 1-3% of children globally. Epidemiological studies among Indians living in India and the United States suggest a vast underestimate of prevalence. This is due to unique cultural factors that impact identification and healthcare access in both ethnocultural communities. However, the shared cultural challenges among both Indians in India and Indiana presents a rich opportunity to build a global research collaboration that seeks to understand the influence of indigenous viewpoints on autism diagnosis as well as support the development of culturally grounded autism detection methods. Reciprocal innovation is a key framework for designing and implementing sustainable and scalable health system solutions across diverse settings. Leveraging these principles,

the objective of this application is to build a collaborative US-India partnership to deepen our understanding of the knowledge, attitudes, and practices (KAP) regarding autism detection and diagnosis in individuals of Indian origin. The aims of this proposal are aligned with CTSI priority health challenges: infant and maternal health, mental health, and increasing access to quality healthcare.

In Aim 1, we will travel to Nagpur, India to establish a collaborative team to co-develop and refine a reciprocally beneficial approach to understanding knowledge, attitudes, and practices regarding autism diagnosis among Indians. Additionally, the US team will also deepen collaboration with Hindu Temple of Central Indianapolis to understand how cultural viewpoints impact autism service access in Indian-American communities. We will specifically target bi-directional information exchange about facilitators and barriers for autism detection and diagnosis, and the feasibility of improving screening and

diagnosis among Indian populations in both settings.

In Aim 2, we will conduct a pilot KAP evaluation of autism detection in both communities using a mixed methods sequential explanatory approach. We will disseminate a KAP screening tool to caregivers in both regions; the quantitative results will inform the

development of qualitative interviews that will be conducted with Indian and Indian American caregivers.

Expected Outcomes: The immediate outcome of this planning award will be 1) a scoping review on autism identification in both ethnocultural groups and 2) the submission of a reciprocal innovation demonstration proposal in the 2025 CTSI cycle focused on adapting and implementing autism screening in India and Indian- American communities in Indiana. The long-term goal of this work is to develop an NIH-R level proposal to conduct an implementation-effectiveness trial of a culturally-adapted autism screening process in the US and India.