Autism is a brain disorder that affects 1 in 100 people around the world, and is seen to be increasing in incidence, probably because of increasingly better identification rather than an actual increase in cases. This condition often results in impaired thinking, feeling and social functioning – our most uniquely human attributes. Autism typically affects a person’s ability to communicate, form relationships with others, and respond appropriately to the external world. (Dr. Naveen Kini)
A few important and common features of the illness:
• The disorder becomes apparent in children generally by the age of 3. Efforts are on all over the world to identify more and more of these children by the age of 12 to 18 months, as early intervention can significantly improve outcome.
• Some people with autism can function at a relatively high level, with speech and intelligence intact.
• Others have serious cognitive (i.e. pertaining to the mental processes of perception, memory, judgment, and reasoning) impairments and language delays, and some never speak.
• Individuals with autism may seem closed off and shut down, or locked into repetitive behaviours and rigid patterns of thinking.
• An infant with autism may avoid eye contact, seem deaf, and abruptly stop developing language.
• The child may act as if unaware of the coming and going of others, or physically attack and injure others without provocation.
• Infants with autism often remain fixated on a single item or activity, rock or flap their hands, seem insensitive to burns and bruises, and may even mutilate themselves.
• Although autism is about 3 to 4 times more common in boys, girls with the disorder tend to have more severe symptoms and greater cognitive impairment.
• Children with autism often have symptoms of various other mental disorders, including ADHD, depressive disorders, obsessive-compulsive disorder etc.
• About one-third of children and adolescents with autism develop seizures (fits).
Causes of Autism:
There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function. Researchers are investigating a number of theories, including the link between heredity, genetics and medical problems. In many families, there appears to be a pattern of autism or related disabilities, further supporting a genetic basis to the disorder.
Other researchers are investigating problems during pregnancy or delivery as well as environmental factors such as viral infections, metabolic imbalances, and exposure to environmental chemicals.
Whatever the cause, a few points are clear
• It is clear that children with autism are born with the disorder or born with the potential to develop it.
• It is not caused by bad parenting.
• Autism is not a mental illness.
• Children with autism are not unruly kids who choose not to behave.
• No known psychological factors in the development of the child have been shown to cause autism.
The question of a relationship between vaccines and autism continues to be debated. A 2001 investigation by the Institute of Medicine, concluded that the “evidence favours rejection of a causal relationship…. between MMR vaccines and autistic spectrum disorders (ASD).” The committee acknowledged, however, that “they could not rule out” the possibility that the MMR vaccine could contribute to ASD in a small number of children. Meanwhile a recent article (2011) in the British Medical Journal, calls the initial study a ‘fraud’.
Myths and misconceptions about autism:
• Contrary to popular belief, many autistic children do make eye contact; it just may be less or different from a non-autistic child.
• Many children with autism can develop good functional language and others can develop some type of communication skills, such as sign language or use of pictures.
• Children do not “outgrow” autism but symptoms may lessen as the child develops and receives treatment.
How is Autism Diagnosed?
Currently, there is no single medical test that will definitively diagnose autism. Instead, the diagnosis is made on the basis of observable characteristics of the individual. It is a spectrum and children may be affected mildly wherein there are only subtle signs of autism, or they may be at the other extreme of the spectrum with severe and florid signs.
Because most children start showing symptoms of autism at about 18-24 months, researchers have developed screening tools, such as the Modified Checklist for Autism in Toddlers (M-CHAT), Autism Behavior Checklist (ABC) and the Autism Spectrum Screening Questionnaire (ASSQ), and are available for use by general pediatricians.
The M-CHAT, more recently updated to M-CHAT-R/F which reduces the incidence of false positives seen in the earlier version and takes five minutes to administer, has been shown to be highly effective in predicting which children will develop autism, Asperger’s or other developmental syndromes.
Of the 23 questions asked in the above test, 3 are of utmost importance. They are:
1. Protodeclarative pointing.
Ask the child, ‘where’s the fan?’, or ‘show me the fan’ (without you pointing at the ceiling fan, only asking). Does the child POINT with his/her index finger at the fan?. You can repeat this with, ‘where’s the Teddy Bear?’ or some other unreachable object, if child does not understand the word ‘fan’.
(To record a YES on this item, the child must have looked up at your face around the time of pointing)
Get the child’s attention, then point across the room at an interesting object and say, ‘Oh look! There’s a (name of toy)!’ Watch the child’s face. Does the child LOOK across to see what you are pointing at?
(To record YES on this item, ensure the child has not simply looked at your hand, but has actually looked at the object you are pointing at.)
3. Pretend play.
Get the child’s attention, then give child a miniature kitchen set and say, ‘Can you make a cup of tea?’, ‘Can you pour a glass of juice?’ Does the child pretend to pour out tea (juice), drink it, etc?
(If you can elicit an example of pretending in some other game like talking on the phone, playing with doll etc, score a YES on this item.)
Consistent failure of these three key items from the M-CHAT at 18 months of age carries an 83.3% risk of autism.
Recently, a new tool , the INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD), has been developed in India. It is to be used by trained personnel and is based on both history from primary caregivers and direct observation of a child aged 2 to 9 years. The INDT-ASD has some distinct advantages. It takes into account various ethnic and religious variables present in this culturally vibrant country, especially in respect to peer interaction and play skills. It is available in various Indian languages, including Hindi, Malayalam, Odia, Konkani, Urdu, Khasi, Gujarati and Telugu. The tool also clearly indicates that in cases where the history obtained is incongruent with observations of the child, which of the information is to be given precedence over the other.
Treatment of Autism:
The behavioural and cognitive functioning of children with autism can improve with the help of psychosocial and pharmacological interventions.
Among psychosocial treatments, intensive, sustained special education programs and behaviour therapy early in life can increase the ability of children with autism to acquire language and the ability to learn.
Many drugs like fluoxetine, sodium valproate, clomipramine, risperidone etc, are increasingly used, especially to curb extreme behaviour like self mutilation, and aggression.
The National Trust was set up to find an answer to the worries of parents – “What will happen to my child when I am no more?”, and works for the welfare of persons with any of the following four disabilities
The ‘Autism Information & Resource Centre’
It is an initiative of the National Trust, which gives comprehensive information about the facts, signs to watch for, the interventions, vocational training and education of children with autism. The website has many FAQs, a blog, a picture gallery as well as a comprehensive list of resource centres, listed state-wise.
The Communication DEALL (Developmental Eclectic Approach to Language Learning)
DEALL is an early intervention program for children with developmental language disorders such as
> Pervasive Developmental Disorder
> Autism Spectrum Disorder
> Specific Language Impairment
> Developmental Verbal Dyspraxia
The individualized therapy program provides motor, social, emotional, cognitive and communication training. The DEALL program provides intensive stimulation (3 hours/day, 5 days/week, over an academic year) by a team of speech language pathologists, occupational therapists / physiotherapists, developmental psychologists/educators with 1:4 staff to student ratio.
Many other treatment methods are still being tried out, but the most important remains ‘early diagnosis, and sustained intensive early intervention programmes’, with which many children go on to lead near normal lives.