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Concerns about Autism & Child development

One of the most common disorders of our time is Autism or ASD (Autism spectrum disorder). Autism is a developmental disorder that affects a child's social interactive skills, communication abilities and manifests itself as behavioral challenges also. Research in the field of autism is ongoing and there is still a lot that needs to be understood about the risks and causes of this complex disorder. Since the effects of this condition is so varied, each child diagnosed with ASD may appear unique, with distinct behavioral and social challenges. As the scientific community actively discovers more about autism's complexities, more doubts and riddles build-up about everyday challenges the parents may face with regard to their child. On the 11th of November 2017, Nayi Disha Resouce Center organized an interactive session with neuro-developmental pediatrician Dr.Ajay Sharma, at Progressive Physiotherapy Center, Begumpet, Hyderabad. This interactive session opened up avenues to openly discuss, clarify and seek counsel from the expert, while providing the opportunity to interact with parents walking the same path.

Listed below are the questions raised by concerned parents, and the answers delivered in response by Dr.Ajay Sharma. We highly encourage parents to kindly post more queries, should they have any, in the comments section. We will do our level best to try and get all your questions answered from the expert sources available to us.

About the expert : Dr Ajay Sharma is a consultant neurodevelopmental paediatrician in London, UK. He has extensive clinical and teaching experience of child development and developmental disorders. He has written articles and book chapters, and has co-authored and edited books on child development. He is currently working part time as a neuro-developmental paediatrician in community children’s services at Guy’s and St Thomas’ Hospital, UK.

Can MMR vaccination cause autism?

MMR does not cause autism. The scientific studies associating autism with vaccination have been retested and disproved since. It is possible that in children with autism who underwent vaccination, the underlying deficiencies or complexities may have been present throughout. These deficiencies may have just shown up after vaccination. The human mind easily forms associations, which can lead to a lot of confusion and anxiety among parents. It is now safe to rest the case, and accept that MMR vaccination has no relationship with the development of autism.

At what age is autism diagnosed in a child?

Diagnosis of autism in children normally happens in these age groups:
1) 12- 18 months: A definite diagnosis is possible in this age group.
Red flag for diagnosis: The child shows no interest in people. (9 months is too early to catch this delay in social communicative skills in the child)
2) 3 years – 4 years: The biggest group of diagnosed children.
Red flag for diagnosis: The child doesn’t engage in pretend play. How these children communicate is different from how other kids their age communicate.
3) 6 years: The child is unable to play with other kids.

If my child has autism by virtue of genetic defects, there is little we can do as parents, to reverse those effects. In such instances, what can we as parents do, to help the child?

Parents can help their child by carefully observing their child, paying attention to what a child needs, or what makes the child difficult to engage in learning. Once you have identified the problems try and understand what can be done to make the situation better. Remember: Half the cause for autism may be genes, but half or more than half, is our role as parents. Even when the child’s developmental ability to learn anything is reduced (due to genetic defects for example), learning can be introduced to help the child by taking advantage of the brain’s capacity to learn and be flexible.This ability of the brain is referred to as neuroplasticity, details of which are shared in the next Q&A.

What is neuroplasticity?

Neuroplasticity is the ability of the brain to shape itself based on experiences. Learning and behaviour can thus be shaped dynamically at any age, driven mostly by the person’s experiences. Though, neuroplasticity is at its best in the early years of life (relate this to a child’s ability to learn a language much faster than an adult), the learning capacity of the brain does continue to occur, but at a reduced rate as the person grows older. Here are a few examples to better understand this process.
1) The brain can learn sounds during the first 2 years of life. After this, the brain cannot learn new sounds. That window is closed. But the brain can still learn letters, words or learn a new language.
2) The brain can learn accents up to 8 years only. After that, a person’s pronunciation may be affected, and the person is no longer able to learn a different accent.
3) The timeline between birth to 4 years is a sensitive period for vision development and learning. For people who have a squint eye, the brain does not allow the affected eye to focus on one object, thusrejecting images projected by that eye. In order to bring back the ability of the affected eye, doctors put a patch and cover the good eye (initially for couple of hours). Now, the brain is forced to use the affected eye and bring it back to work.
4) The same ability of neuroplasticity is used by physiotherapists to get a person to use their non-functional limb.
Thus, the brain always remains in learning mode. Neuroplasticity works even when the door to learn something closes.
To make neuroplasticity work with children, the following factors must be considered:
 Utilize a structured teaching plan for the child
 Engage the child to put in effort during the learning process
 Provide the child with motivation for learning
 Have the power of faith. Have faith in the power of your efforts.

My child used to utter certain words at a certain age, but now has stopped using those words. Gradually, he has become non-verbal. With therapy, he is now starting to make babbling sounds. Can regression happen in children with autism?

Yes, it does. It happens in 1/3rd of children with autism. This happens normally between 18 to 24 months of age. As a child develops, he/she shifts gears to higher levels of growth, progressively with age.

Why does regression occur in some children with autism?

Due to factors we are not entirely clear about, at certain times the child’s body is unable to turn on certain genes required to support higher stages of growth. As an analogy to explain regression, let us assume a child’s brain’s function requires it to turn on 3 genes at 3 months of age, and 5 genes at age 5months and so on. For whatever reason, the genes that need to be turned on at 5months are unable to turn on 2 of the 5 genes that control brain function. This signals the brain to revert back to the lower level of growth (from age 5months to 3months) where just 3 genes are sufficient and support brain development of a child. It is the brain’s way of becoming comfortable with a lower level of gene function. Thus, children revert back to what they can work with. This shows up as regression, which is mainly due to genetic influences.

Do regulated or special diets help reduce challenges in children with autism?

Whether you want to pursue a special diet or not, remember the golden rule: never do anything that can harm your child.
Some children may be allergic, and may be sensitive to gluten/ milk/ lactose. The consumption of these substances may cause diarrhoea or other symptoms. Under such circumstances regulating the diet can be a source of relief for the child. In some children, chocolates, additives/ food colors or sugars may cause hyperactivity. In such instances, maintaining a food diary and making note of all the food responses of your child will help you understand the source of his/her discomfort. Use this information to identify foods that can contribute to feelings of restlessness or hyperactivity. Once identified, eliminating those specific foods may be beneficial. If any particular food does make a child hyperactive, then not giving those foods will not make the child less hyperactive.
Thus, blindly following a specialized diet (such as GSCF) will be less beneficial to the child’s condition. If you do make the personal choice of pursuing a special diet, do talk to a dietician and make sure the child’s special diet is balanced and healthy to ensure proper bone growth, and one that wouldn’t contribute to malnutrition or vitamin deficiencies. Please bear in mind that changing the diet doesn’t make it less important to pursue other therapies. Even when on a diet, other therapeutic interventions must continue.
As a rule, give your child 10 drops of multivitamin syrup up to 2 years of age, after which older children maybe given on a requirement basis. Multivitamin drops being one of the cheapest drugs available in the market, continue to be unused by most parents.

Can movement therapy like Yoga, exercise or physical activity reduce complications in autism?

When we pursue any physical activity our brain becomes alert and is more willing to learn new things. This makes us more responsive to any activity. As a result, the brain also wants its sensory needs met. It becomes more active and willing to learn new things in response.

If motivating my child is key to help him/her learn, then how does one achieve it?

Here are a few ways of providing your child with motivation to learn and engage -
 Give them responsibility: E.g. Making the child the leader of a class.
 Give them opportunities to be successful. Merely an attempt at work is enough, not necessarily excelling at it.
 Reward them in response to their completed tasks.
 In older kids, create aspiration. Make them desire things, and let them become creative with things they can do.
 If they don’t want to do a certain task then pursue them to engage in things they want to do, and then slowly build their interest to pursue the disinterested task.

My child who was diagnosed with autism, overcame it. He underwent academic hurdles, but was able to excel at football. So, we didn’t push him to pursue academics and concentrated on his football training. Now a teenager, my son is unable to get selected i

It is entirely possible the child, who is now an adolescent is dealing with teenage issues here. Instead of pushing the child to play football, casually encourage him to engage in something else that is of his interest. Gradually he may be able to overcome his fear of rejection and pursue his interests, whether old or new. As parents, we have to accept our children as they are. Acceptance of this fact may show us ways to help our children.

Can a child with Down syndrome also develop ASD?

Yes, it is entirely possible. Both conditions can occur in the same child.

How do I help my child overcome sensory overload?

First, provide the child with the sensory input that is needed. Then, dedicate a separate space for the child to de-stress for 1 hour after the activity. This resting time will help the child cope with the situation better.

My child is sensitive to sounds such as the pressure cooker, but not sensitive to loud drums sounds. How is this possible?

Children as sensitive to specific type of sounds. They maynot necessarily be sensitive to the volume or ‘loudness’ of asound.

My child doesn’t understand sarcasm or jokes. How do I make them understand?

One good way of teaching them the concept of a joke or sarcasm is by introducing social stories as a means of explanation.

Could you provide some tips for behaviour management in children and adolescents?

A few key pointers that must be considered for effective behaviour management -
• Focus on the reward, not the punishment.
• Discipline is most overrated. Use it wisely.
• Use affection generously.
• Firmness rather than anger is needed for behaviour control.
• Follow a certain routine or structure to regulate a specific behaviour.
• Appreciating the stage the child is at can help calm the child.
• Beating the child breeds fear, and fear does not have a long standing effect. It can increase aggression and teach the child to beat others.
• Give specific instructions when instructing your child. For example -
“I will be angry with you if you hit others“
“I will be angry if you cross the road (without me)”
“I will be angry if you shout at kids”
“I will not be angry if you stomp on the sofa”
• Follow-up after specific instructions have been handed out to the child. If they continue to pursue unwanted behaviour then instruct them that they lose certain playtime privileges, such as TV or games. T
• Last but not the least, you as a parent must GET OVER IT. Do not dwell on it and bring it up in conversation with the child at a later date.The child mayhave probably forgotten the context to begin with, and repetitions of the incident woudn’t help with behaviour management.

My child is calm and well behaved the whole day, but when a family member such as the father comes home, I notice a sudden change in behaviour. Behaviour traits such as head banging increase. Why is that?

It is clear that the child engages in the behaviour to seek attention from the family member.It is possible that the child is aware that the father would let him/her get away with the behaviour.
The solution in such instances is to talk to the family members privately, and discuss how both must reactwhen the behaviour starts.This will help the child behave uniformly with everybody.