AUTISM SPECTRUM DISORDER

Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. It begins early in childhood and lasts throughout a person’s life. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people with ASD often have difficulty with communication and interaction with other people, restricted interests and repetitive behaviors and symptoms that affect their ability to function in school, work and other areas of life.

Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience. It varies from individual to individual. For example, some people with ASD may have advanced conversation skills whereas others may be nonverbal. Some people with ASD need a lot of help in their daily lives; others can work and live with little to no support.

People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. It’s a condition that affects both children and adults. If left untreated, ASD could worsen in severity. The American Academy of Paediatrics (AAP) recommends that all children be screened for ASD at their 18- and 24-month well-child checkups. Research shows that starting an intervention program as soon as possible can improve outcomes for many children with autism.

What causes Autism Spectrum Disorder (ASD)?

The exact cause of ASD is unknown. The most current research demonstrates there is no single cause. Some factors that are associated with an increased likelihood of developing ASD include:

1. Having a sibling with ASD
2. Having older parents
3. Having certain genetic conditions (such as Down syndrome or Fragile X syndrome)
4. Having a very low birth weight
5. Having a maternal history of viral infections
6. Metabolic imbalances

What are the signs and symptoms of Autism Spectrum Disorder (ASD)?

Symptoms of ASD typically become clearly evident during early childhood, between ages 12 and 24 months. However, symptoms may also appear earlier or later. Early symptoms may include a marked delay in language or social development. People with ASD have difficulty with social communication and interaction, restricted interests and repetitive behaviors.

Social Communication/Interaction behaviors may include:

1. Avoiding or not keeping eye contact
2. Not responding to name by 9 months of age
3. Not showing facial expressions like happy, sad, angry, and surprised by 9 months of age
4. Not playing simple interactive games like pat-a-cake by 12 months of age
5. Using fewer or no gestures by 12 months of age like not waving goodbye
6. Not sharing interests with others by 15 months of age like showing you an object that they like
7. Not pointing to show you something interesting by 18 months of age
8. Not noticing when others are hurt or upset by 24 months of age
9. Not noticing other children and join them in play by 36 months of age
10. Not having pretend play skills like pretend to be a superhero or a teacher during play by 48 months of age.

Restrictive/ repetitive behaviors may include:

1. Lining up toys or other objects and gets upset when order is changed.
2. Repeating words or phrases over and over (called echolalia)
3. Playing with toys the same way every time
4. Focusing on parts of objects (for example wheels of car)
5. Becoming upset by slight changes in a routine and having difficulty with transitions
6. Repeating movements like rocking, flapping their arms, spinning or running back and forth
7. Being more or less sensitive than other people to sensory input such as light, sound, clothing or temperature
8. Having obsessive interests

People with ASD may also experience additional symptoms:

1. Delayed movement, language or cognitive skills
2. Hyperactive, inattentive or impulsive behaviors
3. Unexpected mood or emotional reactions
4. Unusual eating habits or preferences
5. Unusual sleep patterns
6. Epilepsy or seizure disorder
7. Anxiety, stress or excessive worry
8. Lack of fear or more fear than expected
9. Gastrointestinal issues (for example, constipation or diarrhoea)

Note: Not all people with ASD will have all behaviors, but most will have several of the behaviors listed above

How common is Autism Spectrum Disorder (ASD)?

The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically in recent decades. The Centre for Disease Control announced in 2021 that the rate of autism in the U.S. during 2018 was 1 child in 44. This is a notable rise from rates given for 2016 (1 in 68), 2008 (1 in 88) and 2000 (1 in 150). Prevailing theories suggest that the rise is largely due to increased awareness and diagnosis of autism rather than a massive increase in overall occurrences of ASD.

How Autism Spectrum Disorder (ASD) can be diagnosed?

A diagnosis of ASD is ultimately made based on your description of your child’s development, plus careful observations of certain behaviors by your paediatrician, autism experts, medical tests, and your child’s history. Getting an autism diagnosis is a two-stage process, and it starts with your pediatrician.

• Well- Child Visits – Paediatricians are the first step in the autism diagnosis process. Every child gets an assessment at their 18- and 24-month checkups to make sure they’re on track, even if they don’t seem to have any symptoms.

At these visits, your child’s paediatrician will watch them and talk to them. They’ll ask you questions about family history (whether anyone in the family is on the spectrum), and about your child’s development and behavior. Your responses are very important in your child’s screening. If your child shows developmental problems or your doctor has concerns, they will refer you to a specialist for more tests.

• Other Tests – If your child needs more tests, your next appointment probably will be with a team of ASD specialists — child psychologist, speech-language pathologist, and occupational therapist. You may also meet with a developmental paediatrician and a neurologist.

This evaluation is usually to check things like your child’s cognitive level, language abilities, and other life skills like eating, dressing themselves, and going to the bathroom. Some of the evaluation tools used in diagnosing ASD are:

• Diagnostic Interview for Social and Communication Disorders (DISCO) – DISCO is an interview-style test used to enquire about a person’s developmental behaviors through their day-to-day functioning. Medical experts can use the DISCO to diagnose ASD in both children and adults.
• Autism Diagnostic Interview-Revised (ADI-R) – The ADI-R has also been used in diagnosing ASD in adults and children. Its focus is on the quality of communication, social interaction, and restricted and repetitive behaviors when trying to make a diagnosis.
• Autism Diagnostic Observation Schedule (ADOS) – ADOS is a tool used to assess social interactions and communications in people with ASD or might be at risk of developing the condition. The ADOS can be used to diagnose the condition in both children and adults. It’s also a great tool for people at any stage of ASD. People with severe ASD who might not communicate verbally at all will benefit from the ADOS assessment systems.

What is the treatment for Autism Spectrum Disorder (ASD)?

ASD is most often a life-long condition and there is no cure for it. But, both children and adults benefit from supportive therapies and other considerations. They can help them feel better or alleviate certain symptoms. Every child and adult with autism is unique. For this reason, the treatment plan is individualized to meet specific needs. Some of the therapies that can be helpful are:

• Applied Behavior Analysis (ABA) – This is a therapy based on the science of learning and behvior. ABA therapy programs can help increase language and communication skills, improve attention, focus, social skills, memory and academics and decrease problem behaviors.
• Speech and Language Therapy (SLT) – Speech- language therapy addresses challenges with language and communication. It can help people with autism improve their verbal, non verbal and social communication. The overall goal is to help the person communicate in more useful and functional ways.
• Occupational Therapy (OT) – Occupational therapy helps people work on cognitive, physical, social and motor skills. OT programs often focus on play skills, learning strategies and self-care. OT strategies can also help to manage sensory issues.
• Relationship Development Intervention (RDI) – Relationship Development Intervention is a family based behavioral treatment which addresses the core symptoms of autism. Parents are trained as the primary therapist in most RDI programs. RDI helps people with autism form personal relationships by strengthening the ability to form an emotional bond and share experiences with others.

Tips for family and carers

1. Patience is essential when caring for a person with autism. Since their social and communication skills are often underdeveloped, it can be difficult to get through to them. So, be patient.
2. Learn how to communicate with them. You have to develop creative ways to communicate with them based on their individual needs.
3. People with ASD tend to best when they have a structured schedule or routine. Set up a schedule for your child, with regular times for meals, therapy, school and bedtime. Try to keep disruptions to this routine to a minimum. Prepare your child in advance if there is any change in their schedule.
4. Reward good behavior. Praise your child when they act appropriately or they learn a new skill and be specific about what behavior is they being reinforced for.
5. Practice self-care. You can take a 10-minute walk in the morning, or soak in the bathtub for 15-minutes at the end of a long day.
6. Join a support group. Joining a support group with other parents of autistic children can help you feel less alone. Simply talking to people who understand and empathize with your struggles can feel good.
7. Ask for help when required. You can always reach out to your support system to ask for help. They can help with taking care of your child when you need some time for yourself or getting resources that can better equip you to care for your autistic child.

Myths v/s Facts about ASD

References

https://www.nhs.uk/conditions/autism/support/

https://www.cdc.gov/ncbddd/autism/facts.html

https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd

https://www.autismspeaks.org/autism-response-team-art

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)