Autism Spectrum Disorder (ASD) is:
- A neurological disorder in brain development
- Characterized, in varying degrees, by difficulties in social interaction and communication skills, repetitive behaviors.
- Many individuals with an autism spectrum disorder have significant cognitive impairments, although some have typical or even above average IQs.
- 30-50% of people with autism also have seizures.
- Experts believe that Autism presents itself during the first three years of a person's life.
- According to the National Institute of Mental Heath between 2 and 6 per 1,000 people have some form of autism/pervasive development disorder in India [Dr. Varsha Dutta in Autism Information Series-2]
- Specific data is not available for India [http://www.autism-india.org/autism-india]
- In the United States, about 1 in 68 children has been identified with autism spectrum disorder (ASD) according to estimates from CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network.
- US data suggests that ASD is 5 times more common among boys (1 in 42) than among girls (1 in 189).
- US data also indicates that ASD occurs in every ethnic and and socioeconomic groups.
The former version of DSM IV categorized the different subtypes of Autism. This subdivision is no longer recognized by the most updated and current version of DSM V. According to DSM V guidelines, Autism types will now be collectively recognized by one diagnostic terminology - The Autism Spectrum Disorder (ASD).
The following "red flags" may indicate your child is at risk for an autism spectrum disorder. If your child exhibits any of the following, please don’t delay in asking your paediatrician or family doctor for an evaluation:
- No big smiles or other warm, joyful expressions by six months or thereafter
- No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
- No babbling by 12 months
- No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
- No words by 16 months
- No meaningful, two-word phrases (not including imitating or repeating) by 24 months
- Any loss of speech, babbling or social skills at any age
- Speaking in an abnormal tone of voice, or with an odd rhythm or pitch
- Repeating words or phrases over and over without communicative intent
- Difficulty communicating needs or desires
- Doesn’t understand simple statements or questions
- Takes what is said too literally, missing humor, irony, and sarcasm
- Unusual or inappropriate body language, gestures, and facial expressions
- Lack of interest in other people or in sharing interests or achievements
- Unlikely to pursue social interaction; comes across as aloof and detached; prefers to be alone
- Difficulty understanding other people’s feelings, reactions, and nonverbal cues
- Resistance to being touched
- Difficulty or failure to make friends with children the same age
Restricted and repetitive patterns of behavior
- Repetitive body movements (hand flapping, rocking, spinning); moving constantly
- Obsessive attachment to unusual objects (rubber bands, keys, light switches)
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment
- A strong need for sameness, order, and routines (e.g. lines up toys)
- Excessive resistance to change, follows a rigid schedule
- Fascinated by spinning objects, moving pieces, or parts of toys (e.g. spinning the wheels on a race car, instead of playing with the whole car).
There is no known single cause for autism, there may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors:
- Specific genes.
- Children who have a sibling with ASD are at a higher risk of also having ASD.
- Children born to older parents are at a higher risk of having ASD
- Environmental factors such as:
- being born before 35 weeks of pregnancy (premature birth)
- exposure to alcohol or medications such as sodium valproate (a medication sometimes used to treat epilepsy) during pregnancy
- Use of psychiatric drugs by the mother during pregnancy
Presently, there is no blood test, brain test or other medical test that can diagnose or conclusively identify the presence of autism. Instead, specially trained physicians and psychologists administer autism-specific behavioural evaluations. The diagnosis is made based on the history of the child’s development provided by those who know the child well, as well as clinical observation of the child. No definitive diagnosis can be made before the age of 3.
- Every child should be screened for developmental milestones during routine well visits, from birth to at least 36 months of age.
- If concerns are raises about a child's development, evaluations should be done.
- These evaluations should include hearing and lead exposure tests as well as an autism-specific screening tool such as the M-CHAT.
A typical diagnostic evaluation involves a multi-disciplinary team of doctors including:
- Child Psychiatrist
- Speech and language pathologist and
- Occupational therapist
- DSM-5 (DSM-V)
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the current edition and has been designed for use across clinical settings with community populations.
It can be used by a wide range of health and mental health professionals like
- Psychiatrists and other physicians
- Social workers
- Occupational and rehabilitation therapists
Read more at <http://www.psychiatry.org/practice/dsm>
The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a 2-stage parent-report screening tool to assess risk for Autism Spectrum Disorder (ASD). The M-CHAT-R/F is an autism screening tool designed to identify children 16 to 30 months of age who should receive a more thorough assessment for possible early signs of autism spectrum disorder (ASD) or developmental delay.
The Childhood Autism Rating Scale (CARS) is a behaviour rating scale intended to help diagnose autism. CARS was developed by Eric Schopler, Robert J. Reichier, and Barbara Rochen Renner. The childhood-autism rating scale was designed to help differentiate children with autism from those with other developmental delays, such asintellectual disability.
There is no medicine to cure autism. Medicines are helpful only for specific target symptoms associated with autism such as aggression towards self and others, seizures, etc.
Treatments and therapies include:
- Applied Behavioural Analysis (ABA)
- Relationship Development Intervention (RDI)
- Training and Education of Autistic and Related Communication Handicapped Children (TEACCH)
- Speech-Language Therapy (SLT)
- Sensory Integration (SI)
- Physical Therapy (PT)
- Occupational Therapy (OT)
- Social Skills
- Picture Exchange Communication System
- Auditory Integration Therapy
Parents are advised to be cautious about new and alternative methods. If any parent wishes to consider alternatives therapies, then they should satisfy themselves of the scientific validity of these therapies, consult fellow parents for feedback and make an informed decision.
- Ayurvedic Treatments
- Treatment for Biological & Medical Conditions Associated with Autism (DAN – Defeat Autism Now)
- Children with autism and PDD are eligible for an educational program appropriate to their individual needs.
- Educational programs should focus on improving communication, social, academic, behavioural, and daily living skills.
- Behaviour and communication problems that interfere with learning can be planned with assistance of a professional
- Classroom environment should be structured so that the program is consistent and predictable
- Information is best learned when presented visually as well as verbally
- Interaction with non-disabled peers is important as they provide as role models for appropriate language, social and behavioural skills
7. Useful Reference
Books to read
• The Autistic Brain: Thinking Across the Spectrum Written by Temple Grandin and Richard Panek, Houghton Mifflin Harcourt
• The Reason I Jump: The Inner Voice of a Thirteen-Year-Old Boy with Autism Written by Naoki Higashida, Random House of Canada
• Wasted Talent by Krishna Narayan
• Ten Things Every Child with Autism Wishes You Knew by Ellen Notbohm
• Look Me in the Eye: My Life with Asperger's by John Elder Robison
• How Can I Talk If My Lips Don't Move?: Inside My Autistic Mind by Tito Rajarshi Mukhopadhyay