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What is autism?
How is autism caused?
What are the signs and symptoms?
How is it diagnosed?
How is it treated?
What is the status of this problem in India?
Written by : DoctorNDTV Team
Advisor on Child Development & Education,
  • What is autism?

    Autism is a spectrum disorder. Also known as ASD, autism is a developmental and bio-neurological disorder.

    A child with autism has difficulties primarily with social interaction and spoken communication. No two children with autism are alike. The signs and characteristics present themselves in varying permutations and combinations and can range from mild to severe.

    The disorder is evident usually before the child is 30 months old, when age - appropriate social and communication skills, like making and sustaining eye contact, smiling in response to another person or responding when spoken to do not appear in time, or when the child has difficulties in relating to people, plays differently, or displays unusual responses to the environment.

    There may be hypersensitivity or hyposensitivity to any one or more of the following: light, sound, smell, taste, pressure, pain, temperature, light touch, vestibular (sense of balance) or proprioceptive sensations (subconscious awareness of body position). In other words the child would be under-reactive or over- reactive to stimulation in these areas.

    Few Examples:
    • Suddenly closing eyes to light, which could be due to hyper-sensitivity to a particular light.
    • Shutting ears to specific sounds or screaming. Hypersensitivity to the particular sound, which could be hurting to the ears.
    • Smelling or tasting things that are inappropriate. The child could be hyposensitive to smell or taste.
    • Recoiling from touch, screaming when hair or nails are cut.
    • Hypersensitive to touch, feeling pain on the slightest touch.
    Other signs include craving for or recoiling from movement, flapping hands, spinning around, uneven gross and fine motor skills, spinning objects, unusual attachment to certain objects.

    Children with autism play differently. Their play is more stereotypic in nature (like arranging cars in a line). A marked feature of autism is the lack of pretend play.

    Children with autism may prefer to be alone rather than in a group, withdraw from social contact, and appear to be living in a world of their own. They may smile or cry for no apparent reason. An inability to relate to other people and to respond appropriately to stimuli in the environment can also be observed. They may insist on sameness and routines, which seem to give comfort.

    Behaviours like aggression, frustration, or withdrawal, which seem inappropriate, are often due to the children’s sensory integrative dysfunction, which they are unable to articulate and express through spoken communication. Sensory input is not integrated or organised appropriately in the brain. This produces varying degrees of problems in development, information - processing and behaviour.

    Persons with autism have differing intellectual abilities. These abilities lie masked under a more obvious social communication disorder. When viewed through the lens of “Multiple Intelligences” the potential shows up. There may be evidence of musical, bodily-kinesthetic, visual–spatial, logical- mathematical or intra-personal intelligence.

    Some children with autism may have mental retardation or learning disabilities.

    Good observation and assessment results in charting the individual profile, which enables attention to be focused on both abilities and special needs, so that the child is enabled to function optimally.

    Aspergers syndrome (at the high end of the ASD) can be identified when the child is intelligent, verbal but with marked difficulties in social communication, has a preoccupation with a particular area of interest, shows insistence on routines and has certain compulsive behaviors.
  • How is autism caused?

    Autism is not a mental illness, as it was previously believed to be. It is also not a result of bad parenting. However, the exact cause of the disorder is not known.
    In autism, as in all developmental disorders, there appears to be damage to the developing brain, affecting both structure and function.

    Possible causes cited range from genetic factors, maternal health, physical or emotional factors during pregnancy, complications during pregnancy, difficulties during birth and infections in the early developmental period, including the highly-debated adverse affects of vaccines in creating metal toxicity in the brain.

    What is of great concern is the recent increase in numbers of children with autism.

    The disorder results in sensory integrative dysfunction. The dysfunction affects information- processing and behavior adversely, which in turn, permeates different areas of development.
  • What are the signs and symptoms?

    The characteristics of autism are also the symptoms of autism. The most commonly seen symptoms in an autistic child are:
    • Avoidance of eye contact: for example, sometimes the child may give the feeling of "looking through you".
    • Withdrawal from people, by turning away face or body.
    • Hypersensitivity to sounds - the child may cover his ears or try and burrow under pillows to block out sounds. The child may show extreme reactions to sounds like the whirring of a car engine in the distance or the ringing of the telephone. (Similarly with other senses)
    • Difficulties with speech - Some children with autism are verbal others are not. Even those who are verbal use speech functionally. In some cases a child may begin to speak at the appropriate age, but regress around 16 to 18 months and stop speaking altogether. There may be reversal of pronouns (substitution of "you" for "I"), continuous repetition of previously heard words (echolalia) and a flat tone of voice.
    • The child may also show stereotypic or repeated actions. The child may spin or twirl objects with intense concentration, and any attempt to disengage him from it may lead to a tantrum.
    • There is a marked absence of pointing to objects in young children with autism. If a child wants to reach out for an object, he may grab an adult's hand near him and then try and pick the object.
    • A child with autism typically does not show emotions or reactions to situations outwardly.
    • He may not cry when hurt and may not show sadness when his parents are not near him. (This does not mean the child does not experience emotions).
    • The child may not like to be picked up and may stiffen whenever there is an attempt to cuddle him.
    • Generally, he does not play with other children and does not desire company.
  • How is it diagnosed?

    There are no blood tests or X-rays to detect autism. It is usually the parents who are able to detect the first signs of their child being different. A psychiatrist or child psychologist diagnoses it after a series of tests and observations in different environments to evaluate the child's social behavior and language skills. If possible, expert opinion should be sought.

    More than formal testing, in which a child with autism would not function optimally, observations, play-based assessments and interviewing the parents will help the specialist assess the child.
  • How is it treated?

    There is no medical cure for autism. The aim of treatment is to enable the child’s potential to develop, minimize disruptive behaviors (by attending to the underlying causes for the behavior) and to include the child effectively in mainstream society. In order to achieve this, the treatment approach is multi-faceted. The earlier the treatment starts, the greater the chances of the child being effectively adjusted into society. Early intervention programs that focus on possible diet allergies, sensory integration therapy, communication and holistic development are vital. The early years constitute a critical developmental period and the child’s experiences at this stage have a lasting impact on future development.

    Children with autism process information differently. They are often visual learners and need alternate teaching strategies. They benefit from a clear structure and regular routines.

    Treatment modalities suggested are:

  • ABA (Applied Behavior Analysis)
  • The TEACH method (Treatment and Education of Autistic and Related Communication Handicapped Children)
  • The CFGF diet (Casein- Free, Gluten- Free diet)
  • Vitamin /Mineral therapy
  • The LOVAAS method
  • THE DELACATO method
  • Sensory Integration Therapy
  • PECS (picture exchange communication system)
  • Use of social stories
  • Use of facilitated communication

    Each method has something to offer. However the condition calls for an eclectic approach to treatment that combines biomedical, sensory integration therapies and learning paced at the child’s level. The child’s needs and abilities must outweigh the selection of any one specific methodology.

    Early intervention with parents, understanding and empathizing with their child’s condition, and helping him through his sensory difficulties are vital.

    Caregivers may focus on changing the outward behaviours, which are socially inappropriate. They need information which enables them to understand the underlying deep sensory need that finds expression only through these behaviours.
  • What is the status of this problem in India?

    Autism occurs in approximately 1 out of every 500 people. With the current population, it is estimated that there are about 1.5 million persons with autism in India. This disability has been grossly under-estimated in the past and has only recently been given legal recognition. Autism has been included as a disability in the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation Act), 1995 and the National Trust Act (1999) (for the welfare of persons with Autism, Cerebral Palsy, Mental Retardation, and Multiple Disabilities).

    More special schools catering to the needs of the autistic are being opened. The Government is now allotting funds for its better management. There are also individual support groups like Action for Autism, which have been set up to provide services related to the disability.
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