Autism spectrum disorder (ASD) is a developmental disorder and not a disease. It affects three critical areas of a child’s development: social communication, interaction and cognition, leading to impairment. Such children also tend to have repetitive behaviours and restrictive interests. ASD are neurological in origin and should not be labelled as a mental disorder. Children with autism show deviancies in their normal development. The presentation of ASD features can vary from individual to child and throughout the development of a particular child. The autism experience is varied, with individuals showcasing a range of strengths and weaknesses. The puzzle pattern of autism reflects the diversity of the spectrum. An early diagnosis and appropriate training can result in significant progress in the child’s development. CDC has recently reported the prevalence to be 1 in 68 children. The increase in the prevalence is debated to be a true increase or because of an increase in awareness of autism. First-degree relatives of ASD patients are 20-80 fold more likely to be affected. As high as 50% in families with two or more children with ASD. The risk of autism increases by 15% in another child, and boys are two to three times more likely to be at risk than girls. The sibling of an autistic child may have mild subclinical traits of abnormal social behaviour, language deficits and sensory sensitivities.
As early diagnosis and intervention can make a significant difference in a child’s development. Symptoms to be noticed in children with autism are:
On average, children start responding to their name by the age of 8-9 months of age and by their first birthday, all children should respond to their name. Not responding to their name can mean many causes, such as hearing loss, probable autism and developmental delay. Gestural pointing is a core developmental milestone that develops around 14-15 months. Its absence in a toddler, persistent hand leading, and lack of pointing with the index finger are typical deficits in children with early autism. Parents must observe for eye contact with their child, not pointing to items and repetitive behaviours, and must visit a developmental paediatrician. The repetitive behaviours and obsessions may be normal in a young child and fade with age. However, if these symptoms are persistent and continuously present, it may point towards “autism spectrum disorder”, attention deficit hyperactivity disorder” or obsessive-compulsive disorder. Children with high-functioning autism may speak in sentences and use gestures but may have deficits in social communication. They may have other signs, such as flapping of hands and rearranging objects. In case of suspicion of autism, consult a developmental paediatrician.
A higher incidence of prenatal and perinatal complications may be associated with advanced prenatal maternal and paternal age at birth, maternal gestational bleeding, gestational diabetes, and first-bone baby. History of birth trauma, fetal distress, low birth weight, low Apgar score congenital malformation, ABO or Rh factor incompatibility, hyper bilirubinaemia. Childhood vaccination has no role in the causation of autism. After considerable research, vaccination has been proven to prevent common childhood illnesses, which can have serious consequences. Parents should always consult a paediatrician and seek advice in case of any concern.
On neuroimaging, there is involvement in the cortical and limbic systems, with decreased Purkinje granules cells in the cerebellum. Neuronal size decreases, dendritic arborisation increases, and neuronal packing increases. Amygdala enlargement occurs, and the total neuron number decreases.
A developmental behavioural paediatrician is the best person to begin consultation with. The paediatrician will assess, counsel, investigate, and design an appropriate intervention. The paediatrician will also monitor the intervention process to check if the child is progressing well.
It allows children to enter into intensive therapies early in the hope that the severity of autism will lessen, and also, some children will outgrow the diagnosis of autism. Early intervention helps these children to develop and enhance their skills to reach their full potential when the young brain has plasticity. A late diagnosis can lead to language problems and secondary behavioural issues like hyperactivity, extreme sensitivity to crowds, bright light, loud noises, sleep disturbance, depression, learning difficulties and aggression. These children are highly dependent on their primary caregivers for daily activities. Children with autism have difficulties with appropriate reception, assimilation and modulation of various senses, causing behavioural impairment.
Children with autism can have a range of medical issues such as constipation, diarrhoea, abdominal pain, gastroesophageal reflux, disrupted sleep, decreased appetite, restricted food habits, mood disorders, headache, pica, food allergies, anxiety and seizures, etc., which a paediatrician can deal.
As a parent of an autistic child, one has to Learn about Autism Spectrum Disorder, educate yourself about the treatment options, ask questions and participate in all treatment decisions. Figure out triggers responsible for disruptive behaviours and what elicits positive responses. If you understand what affects your child, you will be better at troubleshooting problems and preventing or modifying situations that cause difficulties.
Accept your child's quirks, celebrate small successes and stop comparing your child to others. Feeling unconditionally loved and accepted will help your child at most. Be consistent in the therapy, which continues in more than one place. Stick to a highly structured schedule, with regular meals, therapy, school and bedtime. Reward good behaviour and create a home safety zone, setting boundaries and protecting the house. Learn to pick up nonverbal cues, their sounds, facial expressions, and gestures when they are tired, hungry, or want something. Make time for fun and pay attention to your child’s sensitivities. Plan a treatment based on the child's interest, with a predictable schedule and regular reinforcement of behaviour.
Find ASD support groups, share information, get advice and lean on each other for emotional support. Focus on the normal development the child has achieved, and help the child develop step by step. While each step takes time, it usually continues once an improvement is seen. Ensure you get appropriate and genuine professional assistance for your child. Core elements of autism-like social communication and interaction impairment and repetitive and restricted interest,
must be reversed by Applied Behavioural Analysis, behavioural therapies, speech and language and occupational therapy. The repetitive behaviours in children with autism can be decreased by the short-term by distracting the child with an equally or more attractive option in the long-term by improving the child’s social functioning so he can use it meaningfully in pretending to play. Medication is only required to control the comorbidities of autism, such as anxiety and hyperactivity.
Hyperactivity in an autistic child is a sign they struggle to participate meaningfully and satisfactorily in their environment. This inability results from the child’s impairment in learning social interaction, social behaviour, and communication. Thus, improving his social interaction, social behaviour and communication, as well as understanding his inabilities better and decreasing the level of challenge he faces daily, allows him to connect better with the world. Rarely, medication such as methylphenidate and atomoxetine also help. The sensory interaction difficulties in autism can create behavioural impairments, which can be treated with “sensory integration therapy” in early intervention.
Complementary and alternative medicine (CAM) approaches like music therapy to promote communication and expression and yoga to promote attention and decrease hyperactivity levels. Melatonin, which is deemed safe and efficacious, reduces sleep-onset latency in children.
Psychosocial intervention involves early intensive behaviour and developmental intervention, parent training approaches, social skill training, and cognitive behavioural therapy for comorbid symptoms – neurofeedback management of insomnia. Educational interventions and computer-based approaches and virtual reality. There are ASD-specific self-help groups set up by parents or non-governmental organisations that offer various kinds of support to children and their parents.
In accordance with the Constitution of India and the Rights of Persons with Disability Act 2016, several government schemes and programs are available to people with autism and their families. A disability certificate is required to access these schemes.
