Autistic Spectrum Disorder (ASD)

Introduction

Nowadays, many parents are well aware of this disorder and take their child for evaluation at an early age. Some parents are too anxious and unnecessarily worry about their child’s introverted nature or sad feelings at times. In this article, we shall discuss about common presenting features, various myths about ASD with reality facts, and early warning signs for ASD.

What Is ASD?

Autistic spectrum disorder is a pervasive neuro-developmental disorder characterised by:

1. Persistent deficits in starting and maintaining socialization. In simple words – they prefer to play alone and don’t mingle with others.
2. Difficulties in initiating and sustaining social communication. In simple words – they have problems in talking and delay in language development.
3. A range of limited, repeated and unbending behaviour and interests. That means they have stereotyped repetitive behaviour like watching rotating objects, talking repeated phrases, playing particular games, etc. They don’t prefer to change their routine.

The onset usually occurs in early childhood, but symptoms fully manifest later in life, when they can’t cope with the rising social demands.

Deficits are severe enough to cause impairments in personal, social, educational and occupational domains of life.

According to the recent  ICD-11 classification system, autistic spectrum disorders are classified based on the presence of associated problems in intellectual development and impairment in functional language.

According to the previous ICD 10 classification system, a few of the named disorders which were included under ASD are discussed here for better understanding.

1. Childhood Autism

The disorder manifests before the age of three years. It includes problems in all the  above-described three areas of psychopathology. The child may present with a range of other nonspecific problems like phobias, sleep-wake disorders, eating disorders, anger outbursts and aggression towards themselves like biting themselves, banging their head, etc.

2. Atypical Autism

Autism is called atypical since it presents only after the age of three years, and it doesn’t have all the three characteristics of autism.

Atypical autism is usually noted in extremely retarded people and people with receptive language disorder.

3. Asperger Syndrome

This disorder was named after Hans Asperger, a doctor in Vienna during the reign of the Nazi party, who was the first person to note down this pattern among children. It is also called by doctors as “high functioning type” of ASD, since symptoms are less severe.

Asperger’s syndrome differs from autism in having normal language development/ communication, but it has two other characteristics of autism. This disorder is frequently associated with marked clumsiness. The abnormalities may persist throughout their lifetime.

4. Rett Syndrome

In this type, there is a period of normal development before the onset of the disorder.  There will be loss of previously acquired skills over a period of few months. The child will be dull, withdrawn and have stereotyped, repetitive behaviour, problems in social interaction and communication. In some cases, the disorder was found to have associated encephalopathy.

In recent international classifications DSM V (2013) and ICD 11 (2018), it is not included as an autism spectrum disorder and is classified as a developmental anomaly.

When to Suspect Autistic Spectrum Disorder?

• When the child is not responding with a smile by 6 months
• When the child doesn’t make sounds or face expressions by 9 months
• When the child doesn’t speak a single word by 16 months
• When the child doesn’t speak two-word phrases by 24 months
• When the child loses language, communication or social skills at any age

What Needs to Be Done?

When you suspect autistic features in your child, kindly take the child to your paediatrician at an early age, between 18 to 24 months and evaluate. Based on the child’s condition, you can consult a psychiatrist/clinical psychologist for further evaluation. There are several treatment approaches that will help you manage the disorder.

Behavioural Approaches:

Applied Behaviour Analysis (ABA)

It is a behaviour therapy that encourages desired behaviours and discourages unwanted behaviours of a child. ABA includes 2 teaching styles as follows:

Discrete Trial Training: DTT uses stepwise instructions to teach a desired behaviour.

Pivotal Response Training or PRT: It helps a child improve a pivotal skill, like initiating communication with others in  real-life situations.

Developmental Approaches:

• Speech and language therapy
• Occupational therapy
• Sensory integration therapy

Educational Approaches:

It is given in the classroom setting. One model is described below:

TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children): Verbal instructions are provided along with visual instructions (pictures, drawings and images) or live demonstrations.

Social Approaches:

Social stories which give descriptions of how to behave in social situations.

Social skills groups which give an environment to practice the social skills.

DIR Model: Floor time – developmental, individual differences and relationship-based model.

This model will help parents and therapists explore the individual interests of a child and create opportunities for communication.

RDI Model: Relationship development intervention (RDI) includes activities that motivate and give an opportunity to participate in social interactions.

Pharmacological Approaches:

There are no medicines for autism. But there are medicines for associated conditions like anxiety, depression, hyperactivity, aggression and self-harming behaviours which will improve the quality of life in individuals with autistic spectrum disorders.

Autism Myths and Facts:

1. Myth: The autism disorder is a relatively new condition.

Fact: Autism was described in 1943 by scientist Leo Kanner and  has been diagnosed since then.

2. Myth: Autism is a mental illness.

Fact: Autism is a neurological disorder.

3. Myth: Autism is caused by vaccines.

Fact: There is no direct evidence for it.

4. Myth: Autism is due to poor parenting or “refrigerator mothers”, mothers who are emotionally cold and distant.

Fact: The development of autism is not related to parenting style.

5. Myth: Individuals with autism do not feel love. They are unable to form meaningful relationships.

Fact: Though they have difficulty in social interaction, they can fall in love and have close social relationships and even raise a child. Their way of expressing love is different.

6. Myth: Autism is rare.

Fact: According to recent statistics, 1 in 36 children are identified with ASD.

7. Myth: Autism is seen only in boys.

Fact: It can be present even in girls, though it is four times more common among boys than girls.

8. Myth: All individuals with autism will have intellectual disabilities.

Fact: Some of the individuals may have  above-average intelligence and excel in particular domains. Autism is a spectrum; individuals will have varying levels of cognitive abilities.

9. Myth: Autism can be cured.

Fact: There is no cure for autism and it is not a disease to be cured. Children with autism are neurodivergent and the way they perceive the world is different, which makes their social interactions difficult. They just need to be understood.

Let us try to understand them and support them wholeheartedly.