Written by Dr Riddhi Mehta, Consultant Developmental Pediatrician, Jaslok Hospital and Research Centre
What is Autism Spectrum Disorder?
Autism spectrum disorder (ASD) is a neurodevelopmental condition that affects the way a child communicates and relates to other people. Most children with ASD generally have difficulties in the areas of social interaction, use of verbal and non-verbal communication in social settings, restricted interests and play skills with repetitive patterns of behavior. However the degree to which it impacts each child’s functioning may vary.
How common is it?
According to the Centers for Disease Control and Prevention in the US, about 1 in 59 children in their country has been identified with ASD. According to a study done by Inclen Trust International, about 1 in 100 children in India, between the ages of 2-9 years, have Autism.
ASD is about 4 times more common among boys than girls and occurs among all racial, ethnic and socio-economic groups.
Why does it happen?
There are many likely causes for ASD including genetic, biological and environmental factor. There is a higher risk noted in siblings of children with ASD, children born to older parents and in those with certain genetic condition like Fragile X syndrome. Vaccines (including MMR) have not been found to be associated with ASD.
What does it look like?
Children with ASD do not look any different from their peers. However, the earliest concerns raised up by parents are:
- Not responding to their name even though they hear other sounds
- Not maintaining eye contact
- Not pointing at objects to share interests or not looking when another person points
- Repeating words or phrases said to them more than using spontaneous language
- Not interacting with other children
- No pretend play
- Unusual responses to touch, smell, taste or textures of thing
Some children can have an uneven developmental profiles with above average skills in one area of development and significant difficulties in another.
Who can diagnose?
The assessment is generally done by developmental pediatricians, psychiatrists or neurologists who use a combination of clinical observations (of the child’s play, communication and social interaction) and standardized tests to make a diagnosis.
How early can a child be diagnosed?
A diagnosis of ASD can often be made by 18 months and fairly reliably by 2 years.
Red flags for ASD are:
If a child does
• babble or coo by 12 months
• use gestures (point, wave) by 12 months
• say single words by 16 months
• say two-word phrases on his or her own within 24 months
Or
• A child who has lost any of his language or social skill particularly before the age of 3 years without any apparent cause or a reason.
Is there a cure?
There is currently no cure or medication for ASD, although doctors may prescribe a medication to address some medical issue associated with autism, like seizures.
Research shows that early intervention can improve a child’s development. Early intervention services include therapy like speech therapy to help the child communicate better and occupational therapy to help with motor skills and sensory processing. In addition, there are other behavioral approaches like Applied Behavioral Analysis (ABA) which use a structured way of teaching positive behaviours.
There are a number of complementary and alternate therapies or interventions available for children with ASD, but few are supported by research. Caution should be used by parents before adopting any of these treatments.
What is the prognosis?
Each child with ASD is unique and has his/her own strengths and challenges. While they may have different learning styles, the thinking and problem-solving abilities of people with ASD can range from gifted to having significant difficulties. Some people may need a lot of help in their daily lives; others need less. Although the symptoms of autism usually remain throughout life, the difficulties in most children improve with intervention and a supportive and inclusive environment that allows him/her to reach their maximum potential. Outcomes are usually better when the child has good language skills, better overall cognitive skills and when intervention begins early.
As Temple Grandin, an autism self-advocate and professor of animal science, said about Autism, “I am different, NOT less”