Autism

Autism, or autism spectrum disorder (ASD), refers to a wide range of conditions which is characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. People with autism have trouble with communication. They have trouble understanding what other people think and feel. It is difficult for them to express themselves, either with words or through gestures, facial expressions, and touch.

Autism has many subtypes, most of those influenced by a combination of genetic and environmental factors.  ASD can range from a minor problem to a disability that needs full-time care in a special facility. People with autism might sometimes have problems with learning. The skills might develop unevenly. For example, they could have trouble communicating but be unusually good at art, music, math, or memory. Therefore, they might do especially well on tests of analysis or problem-solving.

Statistics

According to the latest data from WHO, about one in 100 children has autism. In the case of scenario in Nepal, it is estimated that there are about 2,50,000 to 3,00,000 Persons with Autism (PWAs) among which, 60,000 to 90, 000 are severely affected. The latest numbers of children with autism could be higher because of changes in how it is diagnosed, not because more children have a disorder. Research reveals that early intervention for people with autism leads to positive outcomes later in life.

Signs and symptoms              

Symptoms usually appear before 3 years of age. Some even show signs from birth.

Common symptoms include:

• Lack of eye contact
• A narrow range of interests or intense interest in certain topics
• Doing something over and over, for example: repeating words or phrases, rocking back and forth
• High sensitivity to sounds, touches, smells, or sights that seem ordinary to other people
• Not looking at or listening to other people
• Not looking at things when another person points at them
• Not wanting to be held or cuddled
• Problems understanding or using speech, gestures, facial expressions, or tone of voice
• Talking in a sing-song, flat, or robotic voice
• Trouble adapting to changes in routine

Some children with autism may also have seizures. However, this might not start until adolescence.

Causes              

The exact cause of autism is unknown but seems to be related to problems in parts of the brain that interpret sensory input and process language.

Autism is four times more common in boys than in girls. It can occur in people of any race, ethnicity, social background, family income, lifestyle, or educational level. But there are some risk factors:

• Genetic: Autism runs in families
• A child with an older parent has a higher risk of autism.
• Pregnant women are exposed to certain drugs or chemicals, like alcohol or anti-seizures medications.
• Other risk factors include maternal conditions such as diabetes and obesity.

Diagnosis

It can be difficult for a definite diagnosis of autism. Doctors focus on behavior and development.

For children, diagnosis usually takes two steps.

• A developmental screening to know whether the child is on track with basic skills like learning, speaking, behavior, and moving. It is suggested that children should be screened for these developmental delays during their regular checkups at 9 months, 18 months, and 24 or 30 months of age. Children are routinely checked specifically for autism at their 18 month and 24-month checkups.
• If a problem is found during these screenings, a more complete evaluation is required which might include hearing and vision tests or genetic tests. A developmental pediatrician or a child psychologist who specializes in autism disorders is needed.

If someone was not diagnosed with autism as a child but notices showing signs or symptoms, the appointment should be fixed with the doctor.

Treatment

There’s no cure for autism. But early intervention can make a big difference in the development of a child with autism. Thus, consult with the doctor as soon as possible if you think your child is showing symptoms of ASD.

There are two main types of treatment:

1. Applied behavioral analysis (ABA): It involves the systematic study of the child’s functional challenges, which is used to create a structured behavioral plan for promoting positive behavior and discouraging negative behavior. For example:

 

• Social skills training: Done in a group or individual setting, this intervention helps children with autism improve their ability to navigate social situations
• Speech & language therapy: It can improve the child’s speech patterns and understanding of language
• Occupational therapy: This address adaptive skills deficits with activities of daily living, as well as problems with handwriting Occupational therapy can help with life skills like dressing, eating, and relating to people.
• Parent management training: Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism
• Special education services: Under an Individual Education Plan provided by their school, which accommodates for their social communication deficits, restricted interests, and repetitive behaviors, children with autism can achieve their fullest potential academically. This includes special day classes for very young children to address language, social, and life skills.
• Treating co-occurring conditions: Children with autism experience insomnia, anxiety, and depression more often than peers without autism. They also more often have ADHD (Attention Deficit Hyperactivity Disorder). Children with autism may have an intellectual disability and this needs to be addressed. The impact of these conditions can be reduced with the proper services, which include all of the above, in addition to psychotherapy and/or medication treatment

 

2. Medicines: A child psychiatrist can evaluate for co-morbid depression, anxiety, and impulsivity if appropriate medicines can be helpful. For example, autism-related irritability can be reduced by medications such as aripiprazole and risperidone (the two medications approved by the Food and Drug Administration for irritability associated with autism), prescribed judiciously by a knowledgeable clinician in collaboration with the child’s parents.

Complementary treatments may be given to boost learning and communication skills in some people with autism. These include music, art, or animal therapy, like horseback riding and even swimming with dolphins.

Having an autistic child in a family affects the whole family that can be stressful, time-consuming, and expensive. So, paying attention to the physical and emotional health of the whole family is important. Many national and local advocacy organizations provide information, resources, and support to individuals with autism spectrum disorder and their families.

References:

1. Autism [Internet]. WHO; 2022 Mar 30 [Cited on 2022 Mar 31]. Available from:  Autism (who.int)

2. Autism [Internet]. Lalitpur, Nepal: Autism Care Nepal Society; Cited on 2022 Mar 28. Available from: PREVALENCE – AutismCare Nepal Society (autismnepal.org)

3. What is Autism? [Internet]. Autism Speaks; Cited on 2022 Mar 29. Available from: What Is Autism? | Autism Speaks

4. Pathak N. Autism [Internet]. WebMD; 2021 Sept 28 [Cited on 2022 Mar 31]. Available from: What Is Autism? (webmd.com)

5. Jadhav M, Schepper MA. Autism [Internet]. Washington DC, USA: American Psychiatric Association; 2021 Aug [Cited on 2022 Mar 31]. Available from: What Is Autism Spectrum Disorder? (psychiatry.org)

 

Bipsana Shrestha

Registered Nurse

Danphe Care