AUTISM

Perhaps the most intriguing psychological disorder of the day, Autism is actually one of the multiple disorders on a spectrum known as Autistic Spectrum Disorder (ASD). It manifests in early childhood, and is characterized by abnormalities in social interactions, communication skills, and unusual repetitive behaviors and thoughts.

TYPES OF ASD

Symptoms of ASD vary from child to child, and range from moderate to severe. Broadly, it can be classified into three categories:

  1. Autistic disorder
  2. Asperger Syndrome
  3. Pervasive Developmental Disorder

SIGNS AND SYMPTOMS

Behavioral and developmental features that suggest autism include the following:

  • developmental regression (achieving a milestone, and then unlearning it at a later stage)
  • Absence of pointing, which is a prominent milestone
  • abnormal reactions to environmental stimuli
  • abnormal social interactions
  • absence of smiling when greeted by familiar people
  • abnormal response to physical injury and pain
  • significant lag in language development
  • absence of symbolic play
  • repetitive and sterotypal behavior

Regular screening of infants and toddlers for signs and symptoms of autism is crucial because it allows for early detection and referral for further evaluation and treatment.

CAUSES OF AUTISM

Causes of autism may be divided into two classes, 1) primary and 2) secondary. 90% of the cases are primary, while 10% are secondary.

PRIMARY ASD

Primary ASD is mostly genetic, which means mutations in the individual’s genetic makeup predispose him/her to have Autism. At present, no specific genes have been isolated that may lead to ASD.

Exposure to certain environmental factors during pregnancy may predispose the fetuses to go on to develop ASD. These factors are poorly understood, however, some researchers suggest that factors such as exposure to viral or bacterial infection during pregnancy, maternal smoking, increased age of the father, air pollution and pesticide may all be contributory towards ASD. Especially, women exposed to rubella have a 7% risk of giving birth to a child with ASD. New fathers above the age of 40 years are 6 times more likely to have a child with ASD.

SECONDARY ASD

Some conditions may predispose a person to acquire ASD. These are mainly:

  • Fragile X syndrome – an uncommon genetic condition that leads to peculiar facial features, more common in boys.
  • Tuberous Sclerosis – A rare genetic condition that causes non cancerous tumors to grow all through the body.
  • Rett Syndrome – a rare genetic condition primarily affected girls, leading to ASD along with difficulties with physical movement and development.

TREATMENT

There is no genetic testing available that may screen for ASD before birth. There is no cure present for ASD. However, there are a range of behavioral therapies and education that may improve the skills of persons with ASD.

The AAP (American Association of Pediatrics) recently published a checklist with outlines the most important principles and components for effective interventions. These are as follows:

  • The intervention should be intensive. Your child should be actively involved for at least 25 hours a week, 12 months a year.
  • The intervention should have a low teacher-to-student ratio (i.e. small classes). This is to ensure that your child has plenty of one-to-one interaction with the teacher and that any group work is done in small teams of students.
  • The intervention should involve family members, with a particular emphasis on parent training.
  • The intervention should provide opportunity for interaction with other children without ASD. This so that your child reaches certain developmental goals.
  • The intervention should be highly structured, i.e. based on a series of set routines that your child will hopefully be happy to adopt.
  • The intervention should contain opportunities for your child to apply any newly learnt skills in new environments and situations. For example, visiting new places, or meeting with people your child does not know.

TEACCH

TEACCH is a type of educational intervention that places great emphasis on structured learning by using visual prompts. Research has found that children with ASD often respond better to information that is presented visually.

TEACCH is often delivered at special day centres, but you can also receive training so that you can continue the intervention activities in your own home.

Speech and language therapy (SLT)

Speech and language therapy is a type of skills training designed to improve your child’s language skills, which can improve their ability to interact with others socially.

The therapist uses a number of techniques, such as visual aids, stories and toys, to improve communications skills, such as:

  • listening skills,
  • attention skills,
  • the ability to understand the social and/or emotional context of specific language. For example, being able to tell when the person who is speaking is happy or upset, and
  • the ability to understand non-literal language, such as metaphor or figures of speech.

Beginning the treatment of ASD early in childhood increases the likelihood of a positive outcome. Parents, teachers and other support persons are encouraged to seek out early intervention, and assistance of persons skilled in managing patients with ASD. Parents understandably become exhausted by the relentless performance and altering behaviors of a child with ASD. they greatly benefit from behavioral coaching with a professional therapist/psychologist who can educate them in coping methods for a very demanding and hectic family set up. Parents also benefit from temporary respite from the child.

Dr. Annie

Physician, mom and wife

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