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 Dr Susan Mary Zachariah,Senior Specialist,Developmental Paediatrics,Aster Medcity, Kochi April 2 is celebrated all world over as World Autism
Awareness Day and April, the month for autism awareness. This month, programmes
and talks are conducted all over the world to educate and enlighten people about
Autism Spectrum Disorder - in order to facilitate early diagnosis and early
intervention. The theme for this year is Assistive Technologies, Active
Participation.
What is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects
communication and socialization. Children with autism may also
have repetitive movements, restricted interests and/or
sensory issues. Currently, studies say that one in 59 children
have autism. That means that nearly every family will either have or
know of someone who has autism.
Children with autism are mostly in their own world. They have difficulties with
making eye contact with people, with using gestures and actions for
communication. Most of them have speech delay, some of them speak, but don’t use
speech to communicate with another person – for example, they may be able to
narrate rhymes, say A – Z and maybe even read; however they do not know how to
ask for what they want, they don’t point out or share things that interest them
with others, they don’t approach other children to play with them. Children with
autism have a lot of sensory issues – some of them get easily upset with loud
noises, or noise of a particular pitch or tone; some like looking at rotating
objects; some walk on toes; etc. Many of them have repetitive body movements
(like rocking, spinning), talk the same thing repeatedly or repeats what others
have said, have difficulty tolerating changes to their routine (like getting
upset on taking a different route to school) or have very narrow interests that
are difficult to divert from (like cars, dinosaurs, etc).
Some children with autism start to show features as early as 6 months of age,
when they don’t look and smile at the mother or other people. They don’t respond
to their name being called, despite having normal hearing. They prefer being
alone, and play with the same things repeatedly. They may not play with toys the
way children usually play with them, instead they might play only with parts of
a toy. For example, while a child without autism might roll the toy car, pretend
to have accidents, or transform a car into a plane, a ship, a train, etc; a
child with autism might just play by spinning the wheels of the car.
As autism is a spectrum disorder, not all children behave the same. Some may
have only mild difficulties and some may have a lot. Like how typical children
have a varying range of IQ, similarly children with ASD also have varying IQs
and abilities. NO TWO CHILDREN WITH AUTISM ARE THE SAME.
Just because children with autism have difficulty expressing themselves, it
doesn’t mean that they don’t understand what happens around them. Almost half of
the children with ASD have average to above average intelligence. They just have
difficulty understanding the social behaviour and norms of society and the world
around them.
What Autism Spectrum Disorder is NOT:
1. Autism is a condition, NOT a disease to be feared.
It is present since birth, though symptoms may be obvious only later. Some
children also develop relatively normally till 1-2 years of age, after which the
symptoms of autism appear.
2. Autism is NOT due to bad parenting – the parents are no way at fault for
having a child with autism.
3. Autism is NOT caused be vaccines - there are numerous studies which prove
that.
4. Autism DOESN’T mean mentally retarded. Some children with autism are very
bright, many have skills in other spheres like music, art, dance, writing, etc.
5. Autism DOESN’T mean that children don’t know and feel empathy - they just
have difficulty expressing it.
6. Autism DOESN’T mean that the child doesn’t want to play with others. Majority
of children struggle with knowing how to approach other children for play.
7. Having autism DOESN’T mean that the child is going to be completely dependent
on his parents lifelong. With early diagnosis and good intensive training, many
children can grow up to be almost independent, requiring some support systems in
place.
Why do children have autism?
The reasons why a child can have autism are not fully known yet. There is both a
genetic component as well as an environmental component, however much more
research is needed. What is known is that children with autism have altered
wiring in their brains - their neuronal circuitry is different from the typical.
Thus they see the world differently.
Many children with autism tend to concentrate on details rather than the whole
picture. Their ‘altered wiring’ makes it difficult for them to imitate others
and thereby learn by watching others. They have difficulty looking at things
from another person’s point of view, and thus can seem to be selfish and lack
empathy.
The different neuronal wiring also means that many children with autism have
difficulties integrating their senses. For example, a child may have difficulty
looking and listening at the same time. Some children get upset with varying
pitches and loudness of sounds, some with shadows.
Why do children with autism behave ‘weirdly’?
When a child’s senses get overwhelmed (like in a crowd where there are multiple
sounds, too many colours, light and shadows), they tend to shut down (similar to
a short-circuit in a house). When they shut down, they withdraw into themselves
and either start shouting to drown out the other noises they hear, or start
showing bizarre-looking movements like rocking self, mannerisms with fingers and
other methods to calm themselves down. These can look very scary and strange to
the outsider, but the truth is that many of us do variations of these when we
are anxious or stressed - we bite our nails, tap our feet, play with our hair,
walk back and forth, grind our teeth, start mumbling prayers, press or squeeze
something that we think will bring us luck and so on..
How can we help children with autism?
1. EARLY DIAGNOSIS and EARLY INTERVENTION is very important to
help a child with autism to reach his/her potential. If there is any doubt
regarding the communication pattern in a child, please consult a professional
immediately. The ideal age to start intervention is less than 3 years of age -
the earlier the better.
2. INTERVENTION : There are multiple techniques of intervention
that help children with autism, and hence each intervention has to be
individualized to the child’s difficulties, strengths and interests. He/she will
need speech therapy, occupational therapy and behavioural therapy, to mention a
few.
3. The role of MEDICINES is very limited and is only for a selected few.
Medicines do not help change the core features of autism - difficulties in
social communication and restricted repetitive behaviour and interests.
4. Use of complementary and alternative medicine like
transcranial magnetic stimulation, hyperbaric oxygen treatment,
accupuncture/accupressure, stem cell transplantation, etc are not
recommended and can be harmful at times.
5. If you see a child with autism have a meltdown, PLEASE DO NOT STARE.
Staring won’t help the child and will only stress the family more. Give them
some space so that the family, who knows their child best, can help the child or
adult with autism, without feeling the pressure and judged by society.
6. PROMOTE INCLUSION: Children with autism are still children -
they deserve to play, to be with other children, to go to school, to visit the
mall, etc. In many schools, these children are not given admission, primarily
due to parental pressure from the other children studying there.
Inclusion helps both children with autism and without - the child with autism
learns acceptable behaviour from others, and the typical child learns kindness,
compassion and tolerance.
7. If you work in any service industry, and see a family
struggling with a child with autism, enquire politely how you may help them -
you may need to maybe dim the lights a little, or alter the volume of the music,
or maybe facilitate a faster checkout. Just a little bit of effort from your
side will make things much more happier for the child and the family, as a
whole.
Autism and Technology:
The rapid technological advances have been both a boon and a hindrance for
children with autism. Since children with autism have difficulty interacting
with others, they prefer the electronic (and primary visual) media over being
with people. They thus tend to get more easily addicted to these, and this then
hinders social development in these children.
On the other side, the advance in technology means that there are other ways to
communicate instead of by speaking. Around 40% of children with autism remain
non verbal (they do not speak despite having gotten regular intensive therapy).
Though they don’t speak, many of them still communicate by typing, using
communication software like Avaaz, Speak For Yourself, Words on Wheels, etc.
Using such apps, children with autism who are non verbal can still communicate
their thoughts and feelings to those around.
In addition to communication, technology can teach children with autism various
skills needed for daily life, as it is possible to give instructions through
pictures rather than through words. Many people with autism are visual thinkers
- it is easier for them to understand pictures than written or spoken word.
Judicious use of technology with using it only for a particular goal and limited
use for entertainment’s sake is one way of helping children with autism become
more communicative and helping them to become more independent.
Let’s join hands together to create an inclusive society where people with
autism can grow and become independent and do well in their particular field of
interest. As Mahatma Gandhi said “The true measure of a society is how
it treats its most vulnerable members”.
People with autism have treasures hidden inside them - it remains up to
us to help them discover it and to share it with the rest of us.
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