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The following article has been written by Dr. Jayashree, who has 33 years of medical practice and 16 years of hospital management experience in Malaysia, and is involved in social service, with her latest being Senior Manager Clinical Support. She has been awarded Darjah Johan Negeri (DJN) in 2017 by the Governor of Penang.

Autism: What it is and What we can do

What is Autism?

Autism is not a disease or illness but a nuerodevelopmental disability causing challenges in behaviour, social & communication skills. This is in-fact a condition that affects socio emotional reciprocity , non-verbal communication such as eye contact or body language. Children with ASD have problem in maintaining relationships with family friends and relatives which creates a lot of challenges in coping with social life, in academic institutions and also in the community.

What is Autism spectrum disorder ?

Autism not a single entity but a diverse group of conditions collectively called as Autism spectrum disorder ( ASD) It is not one symptom with which we can diagnose ASD . It is a spectrum and has diverse symptoms and signs.

When you diagnose ASD ?

American Academy of Peadiatrics recommend screening of children between. 18-24 months

What are the Causes of ASD ?

Genetics ( family history of ASD ) or different combinations or mutations in the cells , Biological and Environmental reasons ( pollutants ,pesticides etc ) might play a role in the development of ASD .Some associated factors such as having old parents , difficult birth or sepsis during pregnancy might aggravate and increase the risk of getting children with ASD . However giving vaccines or a particular diet do not cause ASD.

Who and when can be affected with ASD ?

Children are born with ASD and it continues for life. Males or boys are more prone to ASD Children with family history are more prone to ASD. One or few of the factors stated above might be associated with ASD but researches do not find a specific definitive cause.

How do we Diagnose ?

There is no specific blood test or investigation to diagnose ASD .We need to look for alarming signs such as - Aloof toddlers not responding to calls , playing alone for long hours or not responding to parents ,not pointing to shown objects , minimal or no nonverbal communication with severe deficiency in motor sensory integration are all some of the salient features of ASD. Not all symptoms have to be there but if we do see one or two symptoms it must create a suspicion and child must be assessesd by qualified clinician immediately Children cant be screened at birth or before delivery or in the first year of life. At the age of 2 ( between 18-24 months specifically ) qualified health professionals are able to assess using screening tools and clinical assessment to diagnose ASD

How parents can recognise symptoms ?

Though definite medical help is required to diagnose ASD , parents must recognise the symptoms below and take the child to the quailified clinicians to confirm the diagnosis. Following are some of the symptoms : Child not babbling by 4 months, not smiling or laughing by 6 months, or having no interest in games, not saying at-least few words or not pointing or not looking at shown objects by 12 months , playing aloof with less eye contact and imitating play and having difficulty in creating or maintaining relationships with family , friends or relatives. Some skills such as language might develop at first and yet it might be lost later.

Why and who should you refer the child with symptoms ?

Paediatricians & Doctors specialised in Developmental Paediatrics and in children with special needs or qualified Psychologists have the skillset specially to assess children by observation with clinical judgement (Autism Diagnosis Interview) to observe the behaviour and also by applying tools such as Autism Rating Scale and Gilliam Autism Rating Scale etc to diagnose ASD and the severity. There is no specific blood test or investigation to diagnose ASD

Why should we diagnose ASD early ?

Child’s brain is more malleable and if intervention is applied at this stage children can develop skills and coping mechanisms to combat ASD. If the child is diagnosed with ASD at the age of 4 and if the child is not talking early intervention of at-least 25 hours a week will improve and the child’s IQ and develop skills such as language skills. Researchers have proven that IQ of these children will improve more than 10 points by early intervention. Motor sensory integration , verbal social skills slowly develop with regular therapy and follow ups.

What are the forms of early intervention in ASD ?

Regular sessions with Speech therapy , Applied Behaviour therapy( ABS ) and occupational therapy with periodic follow up with Psychologist or Developmental paediatrician are important as hence in short a “Multidisciplinary team approach “ is applied to help the child holistically.

What are the common facts against ASD myths?

ASD is not the same in all individuals as symptoms and severity vary in every individual. ASD will continue to be there throughout life . ASD does not worsen with increasing age . Children with ASD can improve tremendously with regular supportive therapy ASD cannot spread to others and these kids might have associated medical conditions such as Epilepsy. ASD children can be trained to live a better quality of life. ASD is not a stigma and support from society and community with good parental guidance will improve the new skills and quality of life of these kids This will inturn create opportunities to face realities of life and provide methodolgies to cope with the disease as well as to lead a meaningful life.

Why early intervention is crucial ?

Early intervention is crucial as we can capitalise on the learning potential of young kids. If these kids are referred to the appropriate health professionals early they will customise and design therapy for each child. Though severe ASD kids can be trained they will improve from what they were but some might need support for life. However the other children with ASD definitely improve with promising new skills and lead a healthy long meaningful life Parents should be open ,be knowledgeable about ASD so that they can understand the symptoms early. Once it is recognised , parents without any hesitation must refer to the above medical professionals to diagnose and do early intervention. Community must be supportive to the kids and parents and the teachers in schools must be equipped with knowledge and criteria to recognise these symptoms as early as possible to recommend and refer them to the appropriate health professionals to make this life a better place.

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