In our day-to-day paediatric practice, often mothers voice their innermost fears, when they ask us, “Doctor, do you think my child is autistic?” It’s not that they really know what autism is, but they have either read about it, or know that someone’s child has been diagnosed as autistic. However, they do know that autism is a bad diagnosis to have. But what exactly is autism? Let us take a look at this, which is difficult to understand, diagnose and treat.
Autism or Autism Spectral Disorders [ASD] includes several disorders that share manifestations in the areas of communication development, social relationships, repetitive and restricted behavioural patterns, and mental retardation. Of the ASDs, autism is the classical disorder, or the prototype. As per definition given in the textbooks of mental health, autism includes delay in language development and usage, problems in social relatedness, and marked restricted and repetitive behavioural patterns.
The spectrum of ASD includes, apart from autism, conditions like Pervasive Developmental Disorders, Asperger’s Syndrome, Childhood Disintegrative Disorders, Pervasive Developmental Disorder Not Otherwise Specified, and Rett’s Syndrome. There are minor differences between these disorders. In some children, intellectual ability may be good, but communication may be bad. In others it may be the other way around. Some conditions may be similar to but may not meet the full diagnostic criteria of autism. Also, the outcomes are slightly different in these different conditions, but for all practical purposes, they are taken together under one head of ASD.
The incidence of autism or ASD is to the tune of 5 or 6 per thousand, and it is 2 – 4 times more common in boys than in girls. Over the last few years, the diagnosis of autism has gone up, due to better diagnostic criteria and to an increased awareness.
The causes of autism are not entirely known, but a strong genetic basis exists. If one of the parents has any traits of ASD, it is highly likely that the child will have a 50 – 100 times more chance of being autistic. The same is true with twins. Brain abnormalities, genetic variations and mutations, vaccinations, food, infections in the pregnant mother, congenital infections in the newborn, metabolic diseases, and unknown environmental factors—all these and more are implicated in the causes of ASD. The latest controversy, which has been scientifically disproved, is that MMR vaccine increases the incidence of autism.
It is said that a child with autism has ‘mind blindness’, a term used to mean that the child cannot understand and learn many human behaviours. Many of them do show some form of brain abnormality or other.
Signs and symptoms
ASD usually manifests by the age of one year, although the child might be three or four years before parents seek medical help. In many families, it is commonplace to disregard problems of retardation or language development, assuming that the child will become alright as she grows older. As a result, children with autism are often brought late for therapy.
The main underlying problem in autism and ASD is that the child is incapable of interacting or communicating with others and does not comprehend social relationships.
Some of the common manifestations that an autistic child can have, and which can help the parents pick up early signs are:
- Does not point to objects when asked
- Cannot cuddle up to his parents
- Lacks attachment
- Does not meet other’s eyes with a normal gaze
- Does a lot of repetitive meaningless, ritualistic movements
- Is poor in speech and language development
- Does a lot of self stimulation
- Can perform self mutilating behaviour, and can injure himself or herself. These may include head banging, lip biting, scratching herself, and hair pulling.
- Often has a poor gait, posture and coordination
- May be prone to convulsions or seizures
- Is often mentally retarded, and might actually lose skills and milestones that have developed earlier
- May have poor bowel and bladder control.
Two videos on Symptoms of Autism
Autism is usually diagnosed on the basis of the history given by parents and by observing the child, for all the aforementioned symptoms. Tests which are done include the IQ [intelligence quotient], DQ [developmental quotient], performance tests, tests for co-ordination, and specific tests like the Social Communication Questionnaire, the M-Chat and the Autism Diagnostic Observation Schedule [ADOS]. These are tests that need to be administered by qualified personnel, like a child psychologist or a psychiatrist.
Apart from this, other tests, including blood, urine, metabolic profile, CT scans and MRI scans are needed to find out a cause for the disease.
A paediatrician, a child psychologist, a neurologist, special educators, speech and occupational therapists, physiotherapists jointly treat the child.
Depending on the problems the child has, each therapist will work on that aspect, like speech, balance, behaviour etc. In addition, medications are sometimes prescribed to cut down on convulsions, repetitive and ritualistic behaviours, to calm down the child. This is decided by the team of specialists treating the child.
Where treatment is concerned, parents should know that earlier the diagnosis and intervention, better the final outcome. Response to treatment depends on the degree of involvement, especially mental retardation. Those with a lesser degree of mental retardation do well as compared to those with severe retardation.
Parents must also realise that there is no magical cure for this disease, and autistic children always have some degree of social impairment, all their lives. Parents also need to be screened for some underlying metabolic or genetic conditions, and would need intensive counselling when they are planning their next child.
Did you know?
- Autism affects approximately 67 million people worldwide
- More children will be diagnosed with autism this year than with diabetes, cancer, and AIDS combined
- Autism does not discriminate by geography, class, or ethnicity
- There is no medical detection or cure for autism.
Links to interesting videos on Autism
- Autism May be Linked to Digestion
- BBC Video: Campaigners across the East Midlands urge the government to improve services for people with autism.
- Keith Duffy on autism: Keith Duffy, Boyzone star and Coronation Street actor, suggests that " sometimes you are in denial "
Books on Autism
- Books on Autism [in association with Amazon.com][All links go to Amazon.com]
- Ten Things Every Child with Autism Wishes You Knew
- 1001 Great Ideas for Teaching and Raising Children with Autism Spectrum Disorders
- Autism Spectrum Disorders: The Complete Guide to Understanding Autism, Asperger’s Syndrome, Pervasive Developmental Disorder, and Other ASDs