“My child never understands jokes or sarcasms. He started speaking late compared to his elder sister. He is a fussy eater and is very particular about the clothes he wears. He also suffers from chronic constipation. He does not engage in pretend plays with other kids, he does stay near them but appears to play on his own. Other kids find him boring and make fun of him. He has a special fascination for cars and particularly likes spinning the wheel of the toy car. He does not look at people when being spoken to. He is quiet smart at times but feels very different from other kids of his age”
Is this kid just odd? Is he doing it by his choice? There is a high chance this child is labelled as weird and made fun of in social gatherings. Is there any possibility of him suffering a medical condition? Or is it just a normal variation?
Autism Spectrum Disorder (ASD) is a developmental condition which was traditionally considered to have persistent challenges in social interaction, speech and nonverbal communications, and restricted/repetitive behaviours. It is now known that it is also associated with sleep problems, seizures and other medical conditions. The term "spectrum" in autism spectrum disorder refers to the wide range of symptoms and severity. More than a mental health condition, it is a neurodivergent condition. That means they have different strengths and challenges from people whose brains don’t have those differences. It is typically a life-long condition, though early diagnosis and treatment can make a tremendous difference. These individuals can usually function better in various domains if the right behavioural, social and educational interventions are done at the right time.
Some children show the symptoms in early infancy, such as reduced eye contact, lack of response to their name or indifference to caregivers. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired.
Some children may have difficulty in learning and have signs of lower levels of intelligence. Others have normal to high intelligence. They may learn quickly, but have trouble communicating and applying what they know in everyday life and adjusting to social situations. However, instead of labelling them as high or low functioning, it is important to carefully assess and optimise interventions helping them reach their full potential.
While ASD is most often diagnosed in toddlers, it’s possible for autistic adults to go undiagnosed. Those individuals with ASD who have lower support needs may simply feel like something is different about them since childhood but may not be able to pinpoint exactly why. It is common to find co-morbidities like mood disorders, anxiety, Obsessive Compulsive Disorder in ASD and the diagnosis of these may be challenging due to overlapping symptoms.
The exact cause of ASD is unknown. Research has found that certain genes do play a role in the causation. Some factors associated with an increased likelihood of developing ASD include the presence of a sibling with ASD, older age of parents, certain genetic conditions like Fragile X syndrome, tuberous sclerosis, etc. Extremely pre-term birth, low birth weight and other obstetric complications are also possible risk factors.
Treatment should begin as soon as possible since earlier treatment initiation ensures proper care and can reduce individuals’ difficulties while helping them build on their strengths and learn new skills. There is no single best treatment since the individuals with ASD have a wide range of symptoms and difficulties. Hence, the treatment plan needs to be tailor made to suit individual requirements.
Behavioural, psychological, and educational interventions: These are the mainstay of treatment. These programs are often highly structured and intensive, and they may involve caregivers. These programs may help to learn social, communication, and language skills. They usually focus on building upon strengths, learning skills to help in independent living. They also focus on reducing the problematic behaviours that interfere with functioning in various domains of life.
Medications: There are no curative medicines for ASD. The medicines are for symptomatic treatment of difficulties like irritability, aggression, repetitive behaviours, hyperactivity, attention problems, anxiety and depression. They will also be needed in the management of medical conditions frequently associated with ASD.
Treatment may not be curative but will help the individuals with ASD to function well and have a better quality of life. These individuals are just different and there should not be any discrimination related to them, they need to be understood and this can happen only when there is awareness. It is important for the society to integrate them and make the necessary accommodations to help them reach their full potential.