World Autism Day: Early detection, screening can make all the difference in kids

In 2008, United Nation (UN) embarked 2 April as World Autism Day in order to spread awareness on the most common developmental disorder.  For 2019, the UN has adopted “Assistive Technologies, Active Participation” theme to ensure that people with Autism Disorder Spectrum (ASD) get access to affordable assistive technologies. This is so they can exercise their basic human rights and participate fully in the life of their communities. Assistive Technologies are often used to support and enhance communication for individuals with autism, regardless of speech ability. However, the use of assistive technologies is a challenge because of high cost, availability, low awareness and training.

What is an Autism Spectrum Disorder (ASD)?

ASD is a neuropsychological disorder that hampers normal brain function. ASD adversely impacts how a person perceives and communicate with others as well as his/her socializing ability. The spectrum in autism is wide such as behavioral changes and symptoms can be mild impairment of social behavior to more severe functional impairment. There is no single cause for it.

Some early behavioral changes include:

• Problems understanding what has been “conveyed” to them
• Poor skills in pretend play and imitation
• Problems with social interactions
• Repetitive behaviour
• No response to their names
• Socializing with people do not interest them
• Avoid eye contact or physical contact
• Faces difficulty while understanding emotions
• Doesn’t engage in make-believe play

People with ASD are a bit different from other people. They resist cuddling and prefer to be in their own space. They convey their message differently through singsong voice or in a robot-like speech. They prefer to be alone because it is a bit difficult for them to understand the message that has been conveyed to them which could often lead to depression and isolation. As 80 percent of the child’s brain is developed in the first three years, it is important that Autism or ASD be diagnosed as early as possible; management of outcomes are much better in those diagnosed early vs. those diagnosed late. [caption id=“attachment_4871181” align=“alignnone” width=“1280”] Representational image.[/caption]

Screening for Autism or ASD

The behavioral symptoms of autism often appear at an early stage, but due to unawareness, the symptoms are mostly neglected. ASD symptoms could be easily seen in children more than 18 months of age. There are two parts of screening or assessment for Autism:

1. Regular assessment of the child for developmental milestones and functional aspects which include – motor skills (e.g. Sitting, walking etc.), speech and language and social (interaction with family, strangers etc.), hearing or vision impairments etc.

• All children should get tested for hearing impairment before they turn 6 months of age, and developmental assessment should be done by paediatricians, at the minimum at 9 months, 18 months and 24 months of age
• Vision should be checked at 3 years of age by an ophthalmologist.

If there are any problems in these areas, your doctor will suggest close follow up and further management, if needed

2. Specific questionnaire-based assessment of Autism or ASD. There are no lab tests or investigations to diagnose Autism, it is diagnosed on the basis of a detailed assessment of child’s behavior towards family, peers and their communication style etc. There are validated questionnaires available, which can give you a preliminary risk score after you answer questions about your child.

The most accepted one is the M-CHAT questionnaire, which every parent should do when their child turns 18 months of age and repeat at 2 years of age. If scores are high, do not forget to follow up with a developmental paediatrician as soon as you can. It is important to not panic and seek help of experts as mild forms of Autism can be managed well with early behavioural therapy.

Social Impact in India

In India, there are around 3 million people suffering from ASD. To put the numbers in perspective, Autism is found in 1 in 100 children. While globally it is 1 in 160 children. However, there is very less awareness of ASD among Indians as compare to western countries. In India, people suffering from disabilities are outcast and social stigma make it more challenging for both the kid and parents. Children with ASD have different behavioral patterns and require special care and love. As, it is not easily curable, so parents need to be patient. But people with autism are in many cases able to be independent in adult life and fulfill their family role.

Treatment of ASD

There is no curative treatment for ASD, all treatment or management is aligned to improve on the following areas:

• Improve the child’s social functioning and play skills
• Improve his/her communication skills
• Improve adaptive skills
• Decrease negative behaviours
• Promote academic functioning and cognition

The treatment for Autism Spectrum Disorder depends on situation and different needs of the individual. They can embrace completely different forms of therapies to enhance speech and behavior, and medications to manage any kind of medical conditions associated with Autism.

The treatment MUST be under a specialist such as a developmental pediatrician, neurologist or psychologist any other experts needed in the team. Do not attempt to do it on your own, since getting under expert treatment early has shown benefits in ASD.

Behavioral treatments for ASD include:

• Applied Behavioral Analysis: This treatment teaches your child about the difference between positive & negative behavior and how negative behavior can be reduced.
• Developmental, Individual Differences, Relationship-Based Approach (DIR): This kind of treatment is best called Floor Time. That’s because it involves you getting on the ground along with your child to play and do the activities they like. It supports the emotional and intellectual growth of your child by helping them learn how to communicate the emotions.
• The Picture Exchange Communication System: This treatment uses symbols instead of image cards to assist your child while asking questions and communicating through different objects. Information is softened therefore they learn a lot of it
• Occupational Therapy: This kind of treatment helps your child learn life skills like feeding and dressing themselves, bathing, and understanding the way to connect to others. The abilities they learn are meant to assist them to live as independently as they can.
• Sensory Integration Therapy: If your child gets easily upset by bright light, bound sound or the sensation of being touched, this treatment will facilitate him to learn and deal with that sort of sensory information

ASD may not be cured properly, but good treatment and care could actually help in improving the quality of living. The author is a senior consultant in the medical team at Docprime.com.