Autism Spectrum Disorders (ASDs)

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The character of an autistic man was truly lived by Sean Penn in his move 'I am Sam'. The movie depicts the life of an autistic man who was blessed with a child and finally left to care for his child.

Data from the US indicates that more than 3 in 1000 children in the age group of 3 to 10 years could be suffering from ASDs. The figures are expected to be similar in other parts of the world. 

Autism Spectrum Disorders (ASDs) are complex brain disorders that include 1) Classical autism 2) PDD-NOS (pervasive Development Disorder not otherwise specified) and 3) Asperger’s syndrome.

autism

All these conditions are characterized by varying degrees of problems in three areas:

  • Impairment in social interaction
  • Impairment in communication skills
  • Restricted and repetitive behavior

Classical autism is the severe end of ASDs. Asperger’s is the milder form in which autistic features are present but language is well developed. Those who do not fit the criteria for autism or Asperger’s are diagnosed as having PDD-NOS.
ASDs can be reliably detected by the time a child is three years old. Some babies may appear to be “different” right from birth because they do not respond to people the way other babies do or keep their attention fixed at one point for prolonged periods.

Symptoms of Autism

Symptoms of autism are highly variable as the impairment in all the three areas mentioned above can range from mild to very severe.  Problem in social interaction is however regarded as the hallmark feature of autism.

What does impaired social interaction mean?

The desire and ability to socialize is usually assumed to be an inherent human trait present right from early infancy. Babies showit by turning towards the voice and smiling at people. But what if their brain was wired in such a way that they did not care to, or were not able to socialize? What if they could not differentiate between an angry and a happy face? Perhaps this is what happens in varying degrees in children with autism.

Some ways in which impairment in social interaction manifests are:

  • Avoidance of eye contact
  • Not showing affection 
  • Not responding to affection
  • Inability to read feelings from tone of voice or facial expression
  • Inability to understand the other person’s perspective 
  • Inability to reciprocate as expected in a conversation 

The severity of impairment varies greatly from case to case and not all features are seen in the same person.  In some cases, inability to regulate emotions and aggression (breaking things, hurting others) may also be noted, which makes social interaction even more difficult.  Some children may also at times bang their head, pull their hair or bite their own arm out of frustration.

Impairment in communication

As with all aspects of autism, impairment with communication can manifest in many ways. Some  autistic infants may not show the communication skills expected at their age, such as responding to name, pointing to toys or saying a couple of words. In many cases, language skills develop by five to nine years of age, but some children remain mute throughout their life. If speech does develop they may have an unusual way of speaking such as:

  1. Talking in single words
  2. Repeating what they hear (echolalia)
  3. Repeating the same phrase again and again
  4. Problems in pronoun use (So if an autistic person is asked “What are you doing”? The person may reply  “You are playing” )
  5. Mild cases may have impressive vocabulary but inability to sustain meaningful conversation
  6. Non-verbal language such as facial expressions, movements, and gestures may not match what they are saying and tone of voice fails to reflect feelings.
  7. Many have a high-pitched, sing-song, or flatand  robot-like voice.

Restricted and repetitive behavior

An easily recognizable manifestation of repetitive behavior is continuous rocking of body or flapping of arms. Some children may often walk on their toes or suddenly freeze in position. There can be several other types of repetitive and restrictive behavior ranging from subtle to extreme, such as:

  1. Spinning themselves or toys for prolonged periods
  2. Preoccupation with putting toys or objects in a queue instead of playing with them as expected 
  3. Getting extremely upset with slight change in any routine such as mealtime, bath time etc.
  4. Obsession with a narrow topic of interest such as train schedules or airplanes

What causes Autism?

The current understanding of the cause of autism is limited. In fact, Autism was described as a distinct disorder with characteristic features only in the 1940s. People with ASDs have irregularities in several regions of the brain and in the way their brain cells communicate with each other. Both genetics and environment appear to play a role in the causation. Researchers have identified several genes associated with ASDs. It is postulated that ASDs could result from abnormal brain development in the fetal period. Twin studies show that if one twin is affected, there is a 90 percent chance the other twin will be affected.  If a couple has one child with ASD, the risk of having a second child with the disorder is one in 20. The way a child is treated or raised does not cause autism.

Treatment of autism

Currently there is no known cure for autism, i.e. autism cannot be made to go away (just like diabetes or hypertension). However treatment can help children with autism achieve the highest possible level of functioning. Marked improvement in the symptoms of autism can be achieved with appropriate and consistent intervention. Early diagnosis has a big impact as intervention before the age of five years gets much better results.
Parents in India can find obtaining a correct diagnosis a challenge as even healthcare professional may misdiagnose autism as hyperactivity or just “slowness”. Strong advocacy is needed to improve the facilities for diagnosing and treating autism.
Educational/behavioral interventions:  Intensive skill-oriented training sessions can help children develop social and language skills.  Family counseling helps parents and siblings cope with the challenges of living with a child with ASD.

Medications:  Medicines may be prescribed for associated symptoms such as anxiety, depression, or obsessive-compulsive disorder. Sometimes antipsychotic medicines and medicines used to treat hyperactivity are also used depending on the symptoms.

A number of controversial therapies or interventions are available for people with ASD, but hardly any are backed by scientific studies.

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