Swallowing and Feeding Difficulties in Neurodivergent Children: Awareness,Practices,and Challenges Among Indian Speech-Language Pathologists: A Cross-Sectional Survey

Abstract

This cross-sectional survey study examined awareness, assessment practices, management strategies, and perceived challenges among Indian Speech-Language Pathologists (SLPs) working with feeding and swallowing in neurodivergent children. A cross-sectional online survey was conducted with 136 SLPs practicing pediatric dysphagia management across India. While 85.3% of SLPs recognized feeding difficulties in neurodivergent children, only 58.1% provided dysphagia services. Most (72.1%) considered current assessment tools inadequately adapted, and 91.2% reported difficulty obtaining child cooperation. Differentiating sensory from physiological disorders was the primary assessment challenge (80.9%). Sensory integration strategies (36.8%) and adaptive utensils (48.5%) were commonly used, but limited evidence on sensory difficulties (70.6%) and lack of standardized protocols (52.9%) constrained practice. Nearly all respondents demanded enhanced training (95.6%) and standardized guidelines (86.8%). Indian SLPs demonstrate high awareness and commitment to sensory-informed, family-centered care but face significant barriers including inadequate assessment tools, limited evidence, and insufficient interdisciplinary infrastructure.