KATHMANDU, APRIL 23
Autism Acceptance Month, previously named Autism Awareness Month, in April aims to understand the need for public awareness to promote acceptance, celebrate the differences, and be more inclusive towards autistic individuals around us.
April 2 became officially recognized as World Autism Awareness Day in 2008 with unanimous declarations from the United Nations General Assembly. The goal has been to help improve the quality of life of those with autism.
What is Autism Spectrum Disorder (ASD)?
Autism Spectrum Disorder is a developmental condition and not a disease which presents in early childhood with
-Difficulties in social-communication
-Repetitive, stereotyped interests and behavior
It is called a spectrum disorder because children can present with wide range of symptoms which can cause varying degrees of impairment and disturbance in their daily living. It can range from a child who does not speak or interact with others at all to somebody who can speak but does not know how to interact with people.
Also children's symptoms change with time. Each child with ASD is unique and no two children with ASD might have exactly similar symptoms and behavior.
What are the common symptoms of ASD?
Children with ASD have difficulties manifesting in following ways:
Social Skills
- Difficulty expressing and understanding nonverbal cues (eye contact, facial expression, and tone of voice).
- Not interested in interacting with others or lack of adequate skills to make friends of same age.
- Preference to be alone.
Communication
-History of delay in development of speech and language
- Repeat words and phrases without apparent reason or out of context.
- Difficulty understanding and using appropriate grammar, pronouns (e.g. uses 'you' and 'I' interchangeably).
- Difficulty understanding rules of conversation (e.g. turn taking, abnormal tone and volume of speech).
- Difficulty understanding humor, sarcasm.
Repetitive behaviors
- Hand flapping, spinning, toe walking, rocking
- Lack of creative and pretend play.
- Extreme difficulty adjusting to minor change in routine.
- Extreme preoccupation which is unusual in intensity or choice of object (e.g. plays with wheels of cars or likes rotating objects, collection of dinosaur toys)
- Extreme/absent sensitivity to sound, smell, pain, touch (e.g. covers ears to normal day to day sounds such as pressure cooker/mixer, ignores and does not cry in response to pain)
What is the cause of ASD?
Medical research has yet not been able to pinpoint single cause of ASD. It has been found that the brain growth, structure, activity of individuals with ASD is different from those of typically developing individuals. The cause is multi factorial i.e. combination of genetic and environmental factors. Individuals with certain genetic disorders like Fragile X Syndrome, Rett's Syndrome and metabolic disorders like Phenylketonuria are known to have ASD. Around 10% of children with ASD have an identifiable genetic cause.
Is some food/toxin/vaccine the cause for it?
Environmental factors such as change in atmosphere, food, toxins, habits, even specific vaccines once associated with ASD are not responsible for increase in the number of ASD cases. Vaccines are of utmost importance in order to protect children from vaccine preventable communicable diseases. There is a lot of research going on all over the world searching for the possible causes of ASD. In recent times, excess screen exposure and limited parent child interaction in early childhood has also been associated with features of autism.
How is ASD diagnosed?
There is no medical/lab tests for the diagnosis of ASD. A detailed developmental history from parents and clinical observation of child's development by an experienced professional will aid in the diagnosis. Autism can be identified and diagnosed as early as 2 years of age.
Is there a cure? What is the treatment?
For now, there is no cure for ASD. But there are highly effective treatments available and early identification around 18 months to 3 years followed by early intervention/therapies can result in improvement in overall development of the child. There are multiple therapies based on different models:
Behavior therapy
- Speech and language therapy and occupational therapy are also used in treatment of ASD.
- Stem cell therapy and chelation therapy are not recommended for treatment of ASD. The choice of therapy for a child is something which is very individual and specific and can be known only after assessing the child.
Can medicines cure ASD?
Medicines do not cure ASD. Medicines are prescribed to target specific symptoms like aggression, hyperactivity, self-injurious behavior or anxiety. By treating these symptoms, child will be able to engage and gain from the ongoing therapies.
We are planning for second child. Is there a risk that my other child will also have ASD?
There is 11 to 20 % risk for a child to develop ASD if one sibling is diagnosed of ASD. In absence of any family history of ASD, a child has 1% risk of developing ASD. Hence the risk is increased if a sibling has ASD compared to normal population. In case where a child is diagnosed of any genetic syndrome, the risk further increases depending on that syndrome.
Dr Utkarsh Karki is a Consultant at Child and Adolescent Psychiatry Unit in Kanti Children's Hospital.
