World Autism Day 2022: Guide to Parents for Managing and Taking Care of Autistic Children

Autistic spectrum disorder (ASD) is a term used to describe a condition with a combination of deficit in the field of social communication skill along with repetitive sensory or motor behaviour. There is an increased sex predilection for ASD in male children. When parents have a concern regarding delayed speech, lack of eye contact or repetitive behaviour like spinning  of a  wheel of  a toy car they need to  take  a  professional help for  screening the child for  possible  ASD. The screening can be offered as early as 18 months of age.  Modified check list for autism (M - CHAT) is the most common screening tool employed for this purpose. Children who are under regular care under a paediatrician, those with close contact with grandparents and those having a normal elder sibling have a better chance for early diagnosis.

The standard practice is for diagnosis is to get an assessment using a Childhood Autism Rating Scale (CARS), assessment of speech and motor skills and the evaluation of intelligence quotient (IQ). Attention deficit hyperactivity disorder (ADHD) is the most common association with ASD. Social anxiety, separation anxiety or phobias also affect many children with ASD. Irritability and aggression are yet another two common features of ASD in children. Epilepsy is an association in around 8% of children with ASD.

The diagnosis of ASD can be made in children as young as 15-24 months. The greatest  improvements are  made  by children who have begun to make progress in language and non verbal skills by 3 years of age and this reiterates the need for  early identification so that remedial measures can be instituted at  the  earliest.

Participation of parents for early intervention between 2-3 years of age have predicted more positive adult outcome. The prevalence of ASD around the globe has been estimated to be around 1% by WHO. Advanced maternal age (≥ 40 years) and paternal age (≥ 50 years) has been observed as an association for autism. Maternal medications (valproic acid exposure) have been shown as an increased risk factor for ASD. Studies have shown that there is no relation between ASD and vaccination. Folic acid supplementation before pregnancy has shown to impart some protection against ASD. Fragile X syndrome and tuberous sclerosis are two genetic disorders well known to be associated with ASD.

Testing for Fragile X syndrome and chromosomal microarray are the two basic genetic tests offered for these children and once a definitive diagnosis has been made from any of these tests, that not only help the couple for future prenatal diagnosis but also goes a long way for prognostication in the affected child and for helps family for getting connected with specific  family support groups.

 The main emphasis  should be given for teaching parents and caregivers for establishing a joint  engagement and balanced  play with  the child  so that  this strategy helps the  autistic children  to take  more  initiative. The treatment strategy that has been time tested is applied behaviour analysis (ABA) which emphasises on play therapy, social interaction and initiation of communication and are administered by a therapist trained to handle children with ASD. At least 15-20 hours of training per week is needed to achieve a substantial improvement. Group therapy programmes are extremely useful to reduce anxiety symptoms in children with ASD. Medications are given for control of irritability and agitation. ADHD needs medical treatment for improvement of attention span. 

With early diagnosis and remedial measures, especially with parent mediated interventions, more children with ASDs are able to speak, read and live in the community and be independent to varying levels.

(Dr. Sheela Nampoothiri, Clinical Professor, Department of Paediatric Genetics, Amrita Hospital, Kochi)

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