AUTISM

 

WHAT IS AUTISM?

Autism is a neurodevelopmental disorder that is characterized by:

1.       an impairment in social interaction

2.      .an impairment in communication

3.       restricted repetitive behaviours, interests and activities.

Being neurodevelopmental means that it arises from the brain and affects the child’s ability to learn and develop skills necessary for him to perform his everyday function. For a diagnosis of ASD to be made, the symptoms should have started in the early years of life and the symptoms should not be attributable to any other medical condition.

ASD is a spectrum. Some patients are mildly affected while others are severely affected.

Autism occurs more in boys than in girls.

Some are verbal (can speak) while others  cannot (non-verbal)

WHAT CAUSES AUTISM?

The cause of autism is still unknown.  At first, it was believed that it resulted from the attitude of cold or unloving parents. That is referred to as the refrigerator theory. That has been found to be false. Now, the scientific evidence points more towards an interplay between genetic and environmental factors. This means that the affected person may have some genes that make him susceptible to autism and then certain factors in the environment the child is exposed to trigger the genes to start manifesting.

WHAT ARE THE RISK FACTORS OF AUTISM?

These are some of the risk factors associated with autism: Threatened abortion, advanced age of father or mother at the time of conception, prematurity, birth asphyxia, exposure to mercury and some maternal infections during pregnancy.

WHAT SYMPTOMSWILL A CHILD WITH AUTISM HAVE?

Failure to respond to name. A child with autism may not respond or turn when his name is called though he will turn or go to the place where songs or rhymes he likes are being played.

Decreased eye contact. Children with autism have difficulty looking at people in the face. Their eyes may be fixed on something else. They may look up briefly at someone’s face but the is look is not sustained

Unusual attachment to objects. A child with autism may have difficulty letting go off objects. They may keep a particular item for a long time and show immense displeasure when the item is taken away.

Indifference to parents. From age 6 months, children get to know people who are usually around them. They tend to prefer their mother or parents to others. Children with autism can show no pleasure when their parents arrive or displeasure when they leave.

Speech delay. One very common symptom of autism is speech delay. Typically, children at 18months should have 10 to 15 words. By 2 years they should have 50 to 100 words. Children with autism do not achieve these language milestones early or may not achieve them at all (non-verbal autism).

Regression in the 2^nd year of life. Some children also start developing normally and then lose the developmental milestones they have achieved. This typically occurs between 1 and 2 years. The reason is still unknown.

Children with autism also have no inherent drive to connect or interact with other people.

They may not engage in pretend play or imaginative play. Children between 3 and 5 years play with each other and sometimes pretend to be someone else (a soldier, a teacher etc.) when they play.

Deficits in sharing emotions. Children with autism do not usually look sad when others are sad or happy when others are happy. They may not comfort someone who is crying or sad.

Decrease in nonverbal communication such as pointing, waving and hugging.

Difficulty disengaging or shifting focus or attention from one thing to the other.

Stereotyped complex motor mannerisms such as hand flapping, bouncing, rocking etc.

They usually insist on sameness and may throw a tantrum if the usual order is changed.

 

WHAT ARE THE RED FLAGS OF AUTISM?

These may be early pointers that should tell a parent that the child needs assessment for autism. The presence of these signs do not necessarily mean a diagnosis of autism is definite.

They include:

Toe walking

Meltdowns (can scream or cry for a long time when upset)

Hand flapping

Echolalia (they repeat what you say instead of responding to them appropriately. A child with autism may say, “how are you” in response to the question, “how are you?”

Playing alone

Lack of eye contact

Bruxism (grinding of the teeth)

Lack of warm joyful gaze

Lack of sharing interest

Unusual sensory exploration: they may try things by tasting or smelling them. They may not tolerate loud noise. They may look at things from the corners of their eyes.

Lack of pointing.

Using someone’s hand as tool. They may take your hand and bring it closer to the item they want.

Monotone speech. Those who are able to speak (verbal autism) may have a flat tone to their speech.

 

HOW IS AUTISM DIAGNOSED?

There is no blood test that is used to diagnose autism. If you notice any of these features in your child, look for a paediatrician who can do autism screening using a tool such as the MCHAT-R  . It may be followed up with the use of tools such as ADOS and ADI-r and the DSM 5 criteria to make a diagnosis of autism. Your paediatrician will also look out for other medical conditions that are associated with autism, such as epilepsy, ADHD, allergies, frequent constipation, anxiety, sensory integration issues, specific learning difficulties, dyslexia, etc. while some have learning difficulties, others are also exceptionally gifted in certain areas like mathematics, memorization, arts, etc.

HOW IS AUTISM MANAGED?

Treatment is aimed at helping them overcome the individual challenges like communication, behaviour, attention deficit, social interaction, and also helping them to acquire skills (occupational therapy) that will help them perform day to day activities like brushing of teeth, bathing, feeding themselves, toilet training, etc. Occupational therapy also helps with their sensory integration challenges.  Special educators also help with the integration of the verbal ones into the classroom. Autistic children are also helped to develop their skills and talents.

Programmes such as ABA, Sonrise program, cognitive behavioural therapy help with behaviour and communication.

CAN AUTISM BE CURED?

There is currently no cure and no definite ways of preventing it. Remission has been described in some case reports though. Patients with low IQ may become dependent on others for the rest of their lives. High functioning ones may live independently, hold jobs successfully and marry and have children.

It is important to identify children with autism early and give them early intervention. The response to therapy is better when they are in their early years.

Stephen Wiltshire is a British architectural artist with autism. He can draw a landscape from memory after viewing it once. There are other well known high functioning autistic people. Autism is not a death sentence. People with autism need our love and support and not stigma. Parents with autistic children must keep hope alive. There are new scientific breakthroughs every day, autism can become one of them. April 2^nd is world autism day. My message for you is, “early intervention improves outcome”. And to parents with autistic children, “keep hope alive”.

 

Dr gloria amponsah-Kodua

Paediatrician specialist

Advocate for all-inclusive education