Recently, there have been a lot of debate in social media about autism. Scientific data show a rise in autism diagnosis rates in children. Many parents feel that doctors are over-diagnosing the disorder. So, what’s the truth behind the data? Here are the excerpts from a discussion with Dr Suhas Chandran from the Department of Psychiatry, JSS Hospital, Mysore.
What is autism?
– Autism is a neurodevelopmental condition. It affects the brain’s normal development of social and communication skills. The terms such as Classic Autism or Kanner’s Autism (named after the first psychiatrist to describe autism) or pervasive developmental disorder (PDD) have been used interchangeably to describe the disorder.
What is the prevalence and incidence of autism?
– According to the Centre for Disease Control and Prevention, one out of every 88 children under the age of 10 years old suffer from autism or autism like disorder. These are broadly called Autism Spectrum Disorders (ASD). The rate of incidence of autism is increasing 10-17% per year in the US according to the Autism Society of America. Incidence extrapolations for India for Autism are 11,914 cases per year, 250 per month, 57 per week, 8 per day, 1.4 per hour.
At what age do one start to see the symptoms of autism?
– The symptoms are first observed by the time a kid reaches 3 years. Boys are four times more likely than girls to be autistic. Autism is not caused by a person’s upbringing, their social circumstances or bad parenting and it is not the fault of the child with the condition. The disorder has a strong genetic basis, though the root causes are not completely understood yet. ASD is a wide-spectrum disorder. This means that no two people with autism will have exactly the same symptoms. The combinations of symptoms may differ. Also the intensity of symptoms may vary greatly. Many autistic children are perfectly normal in appearance, but spend their time engaged in puzzling and disturbing behaviours that are markedly different from those of typically developing children.
What are the common symptoms of autism?
The common symptoms are as follows:
-Aggressive, self-injurious behaviour
-Odd/ritualistic behaviour like rocking back and forth, waving hands
-Resistance to change in normal routines
-Language: not/ slowly developed
-The child prefers to spend time alone
-Has little interest in making friends
-Lack of attachment is often noted
-Less responsive to social cues, poor eye contact
-Lack of spontaneous / imaginative play
-Does not imitate other’s actions
-Hypersensitivity to touch and sound
-Sleep problems: Some children may have features suggestive of mental retardation (now known as intellectual disability) and a seizure disorder along with a combination of the above symptoms.
What is Asperger syndrome?
Asperger syndrome is an ASD where the child generally has normative language development and skills, but struggles in other areas, such as social interactions.
What are the misconceptions and misinformation regarding autism?
– It is absolutely imperative for a parent, a teacher, and other caregivers to watch for signs of autism. The earlier a child is diagnosed, the sooner he starts getting the necessary treatment and care, the more successful his treatment will be. Long before receiving the diagnosis of ASD, parents do suspect that something is different about their child but what often comes in the way of an early or an accurate diagnosis could be misconceptions and misinformation regarding autism. These include:
-Autism affects only the rich.
-Individuals with autism do not speak at all.
-All children with autism are lost in their own world.
-Autism is a western disorder. It is rarely seen in the subcontinent.
-Autism is a result of poor parenting and a proper home environment can cure the child.
How early can the health care professionals diagnose ASD?
– Health professionals can reliably diagnose ASD in kids as young as 16 months old. They rely on behavioural observations, medical screenings and a child’s developmental history for their diagnosis. Then, families and experts work together to come up with a tailored integrated treatment plan. Children with autism shows significant development even in the core areas of impairment if the intervention provided is appropriate to the child. Reversing autism is one of medicine’s toughest challenges. Though there is no absolute cure for the core symptoms, drugs are available to treat overt symptoms such as anxiety, repetitive behaviours and irritability.
What is the role of behavioral therapy?
– Behavioural modifications are however the gold standard where therapists work with children to modify their behaviour and develop social skills with a combination of techniques, like positive reinforcement and chaining — breaking a skill down into small chunks so it’s easier to learn. Programs and services aimed at helping children with autism enhance their quality of life, like speech therapy and occupational therapy, which teach specific daily living skills. Remember adulthood lasts a lot longer than childhood and we must enable these children with these skills. Some children have special skills say ‘isolated islets of intelligence’ referred to as savant skills – heightened ability in math, music etc.
What is the goal of therapy?
– Not all people with autism have an incredible gift or savantism but the goal of therapy is to potentiate what a child can do rather than emphasize on what the child cannot do, to focus more on their strengths and interests rather than behaviours that negatively impact their life. The idea is if they can’t learn the way we teach, then we teach the way they learn. It is not surprising that parents, and some educators, would be taken with the possibility of a quick cure. In contrast, behaviour based education requires tedious hours of one-on-one work not just by professionals but also by parents who will be the child’s best therapist, once again reiterating why it is important to diagnose early.
What are the current needs in India in terms of dealing with autism?
– With the exception of a few parent initiated support groups, few families of children with disabilities in India have access to mental health professionals for correction of the myths or an outlet for their own feelings of grief and helplessness. There is urgent need for services to support parents with coping strategies to deal with the stress of parenting a child with autism.
What is your final take on autism and related disorders?
– Ignorance is not bliss: Early diagnosis and early intervention should be the mantra in Autism
– The most important thing to remember is that autism doesn’t mean a child isn’t smart, or won’t go on to do great things later in life. Researchers now believe that some of our greatest minds — people like Albert Einstein, Isaac Newton, and Mozart to name a few may have had a form of autism. Think of it: a disability is usually defined in terms of what is missing, but autism is as much about what is abundant as what is missing, an over-expression of the very traits that make our species unique.
To quote Dr. Temple Grandin, an American professor and a prominent Autism spokesperson “The most interesting people you’ll find are ones that don’t fit into your average cardboard box. They’ll make what they need; they’ll make their own boxes”.