Autism

What is Autism?

Autism, more properly called Autistic spectrum disorder (ASD), is a range of disorders in which a child’s brain doesn’t develop normally. It affects how a person interacts with the world. It can cause difficulties with socializing, communicating, learning, and behaviour. There is a wide range of symptoms, skills, and levels of deficits in functioning that can occur in people with ASD.

What are the symptoms of ASD?

Symptoms of ASD are usually observed early in life but sometimes they are not apparent until the child is older. Commonly, the symptoms are recognized between two and three years of age. Parents’ initial concerns may include a delay in spoken language, for example babbling or speaking fewer than 10 words by the time the child is 2 years of age. Some children regress or lose the use of speech. Others present with unusual speech like a frequent repetition of phrases(echolalia), incomprehensible vocalisations, or just reduced use of words.

Caregivers may be concerned that the child doesn’t speak to or appear to understand others, “the child doesn’t show interest in communicating”. Skills of social interaction seem to be missing or unusually reduced. They usually prefer playing alone, they don’t enjoy social situations that other children like, they are not keen on imitating peers or sharing social interests or achievements; they are often intolerant of others encroaching into their personal space. When they join others in a social activity they may seem aggressive or disruptive.

People with ASD have difficulty using and interpreting nonverbal cues such as gestures, eye contact, facial expression, and body postures. For example, he or she may not appreciate or understand an angry facial expression or posture of the caretaker.

Babies with ASD may resist cuddling, avoid eye contact, or decline to spread out arms in anticipation of being picked up. However, not all children with ASD have these behaviours.

Another common feature of ASD is stereotyped behaviour: repetitive body movements, such as rocking, swaying, finger flicking or hand flapping. Many have rigid routines that must be followed exactly such as always following the same route from one place to the other, or eating foods in a particular order. They insist on ‘sameness’ and strongly prefer that things be ‘just right.’

Younger children with ASD may have an unusual preoccupation with certain qualities of objects or experiences such as lights, spinning objects, or even odours. Older ones may have an intense interest in dates, cartoon characters, car makes schedules or planes.

Many people with ASD have an unusual response to sounds, tastes, colours, or touch. An example would be refusing to eat food with certain textures or colours.

An observation that may support a concern about autism is an unbalanced cognitive skill profile. Cognitive skills include the ability to think, remember, and process information. A child with poorly developed motor and social skills may perform, at a level that is beyond what is expected for age, in

particular areas of knowledge, reading or vocabulary. Some individuals even have special skills in memory, mathematics, music, art, or puzzles, despite significant difficulties in other areas

How common is ASD?

The number of children diagnosed with ASD has been increasing worldwide. It is not clear whether the increase has been because more children with ASD symptoms are being identified than previously or if the condition has truly become more common over time or both. The prevalence of ASD varies with studies but it is estimated that up to 25 out of every 10000 children have the condition. ASD is more commonly diagnosed in boys than in girls, approximately 4 times more.

What causes autism?

It is not clear what causes ASD. Scientists believe that both environment and genetics likely play a role in ASD. Environmental factors such as exposure to toxins before or after birth, infections in the mother during pregnancy, and complications during delivery may be responsible in a small proportion of cases. Defects in genes that control brain development and regulate how brain cells communicate with each other could disrupt normal brain growth very early during development. Those born in families with an ASD subject are at greater risk of developing ASD.

Some people believe, incorrectly, that ASD is caused by exposure to certain vaccines or vaccine components. Current evidence indicates that there is no harmful association between Measles, Mumps, and Rubella(MMR) vaccine and ASD even among children already at higher risk of ASD.

What medical conditions are associated with ASD?

Approximately 1 out of every 3 children with ASD has an intellectual disability, that manifests as delay in language or difficulty in learning. About 3 out of every 10 ASD subjects suffer recurrent seizures. Up to 25 per cent of those with ASD could have certain specific medical conditions or syndromes. Some have impairments in vision and hearing.

Studies indicate that many of those with ASD might have some form of diagnosable mental illness. Depression, anxiety and obsessive-compulsive disorder are particularly common in younger adults with ASD. Sleep disorders are also common

How is ASD diagnosed?

Children with symptoms that suggest ASD, should be evaluated by a team that has expertise in diagnosing and managing the condition. This team usually includes a developmental-behavioural paediatrician, child psychologist, neurologist, psychiatrist, speech therapist, and other professionals. The diagnosis of ASD also may be made by a single clinician who has the expertise and experience in diagnosing ASD. The evaluation usually includes a complete medical history, physical and neurologic examination, and assessment of the child’s social, language, and cognitive skills.

When to seek help

Caregivers who notice that their child has one or more symptoms of ASD should talk to the child’s primary health care clinician.

If the clinician’s evaluation suggests the possibility of ASD, the child should be referred for a complete evaluation for ASD. Early diagnosis and treatment of ASD can modify some behaviours consistent with ASD and improve the ability to socialize. Early intervention for children with disabilities can help to minimize delays and maximize the child’s chance of reaching normal milestones in development.

How is ASD treated?

Currently, there is no cure for ASD. Interventions are designed to remedy specific symptoms. Behavioural and educational interventions include training sessions that are structured and skill-oriented to help children narrow the deficits in social and language skills. Family counselling for the parents and siblings of children with ASD helps families cope with the particular challenges of living with a child with ASD.

There are medications that can help with related symptoms such as anxiety, depression, and obsessive-compulsive disorder. Seizures can be treated with anti-seizure medications. Severe behavioural problems could be alleviated using certain medicines.

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