AUTISM

Autism is a neurodevelopmental disordercharacterized by impaired social interaction, verbal and non-verbal communication, and restricted and repetitive behavior. Parents usually notice signs in the first two years of their child’s life. These signs often develop gradually, though some children with autism reach their developmental milestones at a normal pace and then regress.

Autism is a life-affecting disorder characterized by a profound withdrawal from contact with people, repetitive behaviour, and fear of change in the environment. The emotional disorder affects the brain’s ability to receive and process information. People who have autism find it difficult to act in a way that other people think is “normal”. They find it difficult to talk to other people, to look at other people and often do not like being touched by other people. They may talk only to themselves, rock themselves backwards and forwards, and laugh at their own thoughts. They do not like any type of change and may find it very difficult to learn a new behaviour.People with autism may be severely impaired in some respects but normal, or even superior, in others.

Characteristics –

  • Stereotypy is repetitive movement, such as hand flapping, head rolling, or body rocking.
  • Compulsive behavior is intended and appears to follow rules, such as arranging objects in stacks or lines.
  • Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
  • Ritualistic behavior involves an unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual.
  • Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program, toy or game.
  • Self-injury includes movements that injure the person, such as eye-poking, skin-picking, hand-biting and head-banging.

Age of Onset

First concern happens by 15 months
Early onset – within 1st yr
Later onset – within 2nd yr

Symptoms

  • Limited response to name
  • Limited eye contact
  • Delays in language
  • A typical behaviors – Spinning and intense visual examination of objects
  • Limited interest in people and social interaction
  • Limited affective range
  • Limited joint attention skills
  • Poor observational / imitative learning
  • Low frequency of communication and poor non-verbal communication
  • Stereotypical/idiosyncratic use of language (e.g., echolalia, scripting, body rocking, hand flapping)
  • Use of other’s body to communicate
  • Abnormalities in Play and Imagination Development
  • Restricted Interests and Repetitive Behaviors
  • Seeking/avoiding specific visual stimuli (lights, motion, touch)
  • Seeking sensory input (jumping, rocking, spinning)
  • Interest in details of objects (e.g., wheels)
  • Hand and finger mannerisms
  • Exceptional Abilities – Exceptional memory, computational skills, artistic abilities, musical skills
  • Failure to establish friendships with children of the same age
  • Lack of empathy
  • A need for sameness and routines

If you identify the following signs and symptoms please consult the Doctor !!

If a formal evaluation is needed for diagnosis, it will be done by a comprehensive medical, developmental, educational and psychosocial programme to help you to deal with your child and help him / her in overall development.

Biological Causes

It is generally accepted that autism is caused by abnormalities in brain structure or function. It too has a genetic basis. It also appears that some children are born with a susceptibility to autism. Other investigations portray problems during pregnancy or delivery as well as environmental factors such as viral infections, metabolic imbalances and exposure to chemicals leading to autism.

Genetic Vulnerability – Autism tends to occur more frequently than expected among individuals who have certain medical conditions, including fragile X syndrome, tuberous sclerosis, congenital rubella syndrome and untreated phenylketonuria (PKU). Some harmful substances ingested during pregnancy also have been associated with an increased risk of autism.

Treatment approaches

Treatment for autism is usually a very intensive, comprehensive undertaking that involves the child’s entire family and a team of professionals.

  • Pharmacotherapy continues to be an important component of a comprehensive treatment program for autism spectrum disorders.
    Five major drug categories which are regularly used for symptomatic treatment are as follows –

    • Selective serotonin reuptake inhibitors (SSRIs)
    • Anti-psychotic drugs help in the treatment of behavioral disorders by controlling the intensity of the neurotransmitter dopamine in the brain
    • Recent studies have developed newer anti-psychotic drugs which have proven effective in the treatment of aggression and self-injury among autistic children with fewer side effects
    • Anti-convulsants are drugs that control seizures. Since one in every four autistic patients has seizures, the use of anti-convulsants sometimes becomes imperative in managing symptoms
    • Stimulants are drugs that are used for the treatment of autism symptoms to control and treat the autistic tendencies of inattention and hyperactivity
    • Lithium is used for children who are occasionally aggressive and may become more stable when using these medicines, although monitoring the level of the drug in the body through regularly scheduled blood tests is required.

The effectiveness of these medicines varies by individual. Side effects are possible and should be discussed with your doctor.

  • ABA (Applied Behaviour Analysis) is effective for improving children’s outcomes, especially their cognitive and language abilities. ABA methods use the following three step process to teach :-
    • An antecedent, which is a verbal or physical stimulus such as a command or request. This may come from the environment or from another person, or be internal to the subject
    • A resulting behavior, which is the child’s response or lack of response to the antecedent
    • A consequence, which depends on the behavior. The consequence can include positive reinforcement of the desired behavior or no reaction for incorrect responses

ABA targets the learning of skills and the reduction of challenging behaviors. Most ABA programs are highly-structured. Each skill is broken down into small steps, and taught using prompts, which are gradually eliminated as the steps are mastered. The child is given repeated opportunities to learn and practice each step in a variety of settings. Each time the child achieves the desired result, he receives positive reinforcement, such as verbal praise, or something else that the child finds to be highly motivating. Facilitated play with peers is often part of the intervention.

  • Social Skill Development – Improving social skills like eye contact, using appropriate greetings, developing listening, increasing understanding of social cues, etc.
  • Occupational Therapy– The OT strategies include:
    • Physical activities, such as stringing beads or doing puzzles, to help a child develop coordination and body awareness
    • Play activities to help with social skills, interaction and communication
    • Developmental activities, such as brushing teeth and combing hair
    • Adaptive strategies, including coping with transitions
    • Fine motor skills required for holding objects while handwriting or cutting with scissors
    • Gross motor skills used for walking, climbing stairs
    • Perceptual skills, such as telling the differences between colors, shapes, and sizes
    • Awareness of his or her body and its relation to others
    • Visual skills for reading and writing

Tips for parents

  • Learn about autism – If you understand what affects your child, you’ll be better at preventing situations that cause difficulties.
  • Accept your child – Feeling unconditionally loved and accepted will help your child more than anything else.
  • Provide structure and safety
  • Be consistent – It is the best way to reinforce learning.
  • Stick to a schedule – Children with autism tends to do best when they have a highly-structured schedule or routine.
  • Reward good behavior. Positive reinforcement can go a long way with children with autism, so make an effort to “catch them doing something good.” Praise them when they act appropriately or learn a new skill, being very specific about what behavior they’re being praised for.
  • Find nonverbal ways to connect – You communicate by the way you look at your child, the way you touch him or her, and by the tone of your voice and your body language. Your child is also communicating with you, even if he or she never speaks. You just need to learn the language.
  • Look for nonverbal cues –Pay attention to the kinds of sounds they make, their facial expressions, and the gestures they use when they’re tired, hungry, or want something.
  • Figure out the need behind the tantrum -Throwing a tantrum is their way of communicating their frustration and getting your attention.
  • Make time for fun.
  • Pay attention to your child’s sensory sensitivities.

Autism Treatment Plan :-

  1. Build on your child’s interests
  2. Offer a predictable schedule
  3. Teach tasks as a series of simple steps
  4. Actively engage your child’s attention in highly structured activities and provide regular reinforcements

Strategies for Teachers to handle children with Autism in Classroom

  • Get the child’s attention before giving instructions
  • Use simple language with visual prompts
  • Use activities and pictures
  • Have consistent classroom rules
  • Work on understanding emotions
  • Teach from concrete to abstract
  • Introduce new experiences gradually

Risk Factors for Autism

  • According to the Autism Society, if a person has a brother, sister, twin, or parent with an ASD, that person is more likely to also have an ASD
  • Genetic disorders such as fragile X syndromeand tuberous sclerosis
  • Families who have one child with ASD have an increased risk of having another child with the disorder
  • Extremely preterm babies – Babies born before 26 weeks of pregnancy may have a greater risk of ASD
  • Children born to older parents and ASD
  • Exposure to Certain Drugs
  • Environmental Factors – Exposure to heavy metals and other toxins in the environment is also suspected of increasing the risk of ASDs

Protective factors for preventing Autism

  • Reduce or eliminate alcohol and caffeine, and eliminate tobacco
  • Begin or continue an exercise routine
  • Taking a good comprehensive multivitamin/mineral supplement
  • Adding a source of animal-based Omega-3s is essential
  • Improve indoor air quality by opening the windows when you can, and creating cross ventilation
  • Check vitamin D levels and add additional Vitamin D3 if necessary
  • Eating a diet rich in colorful, organically grown vegetables will provide an adequate intake of antioxidants to fight off the damaging effects of free radicals
  • Computers, TVs and cell phones emit Electro Magnetic Radiation, so you should not sleep with these in the bedroom
  • Do what is reasonable to green your home and to minimize exposure to toxins in your food
  • Continue a high-quality organic diet that eliminates or greatly reduces sugar and other processed foods
  • Continue to take a good comprehensive, natural, and easily absorbed multivitamin
  • Exercise regularly
  • Eat at least 80 gms of protein per day
  • Bond with your baby as much as Wear your baby as often as possible, utilizing various baby carriers
  • Having your baby held close gives them comfort, emotional ease, and very importantly, constant motion. These factors all contribute to strengthen and enhance neurological development in your baby.
  • Avoid cigarette smoke and alcohol. Both can have adverse effects on fetal development as well as long-term health of both mother and child.

Therefore, when putting together an autism treatment plan for your child, keep in mind that there is no single treatment that will work for everyone. Each person on the autism spectrum is unique, with different strengths and weaknesses.

Your child’s treatment should be tailored according to his or her individual needs. You know your child best, so it’s up to you to make sure those needs are being met. You can do that by asking yourself the following questions:

  • What are my child’s strengths?
  • What are my child’s weaknesses?
  • What behaviors are causing the most problems?
  • What important skills is my child lacking?
  • How does my child learn best (through seeing, listening, or doing)?
  • What does my child enjoy and how can those activities be used in treatment?

We at Mumbai Psychiatry Clinics have a dedicated team of counsellors and clinical psychologists who will help you with your problems, cite interventions and assess the progress on regular intervals. There are experienced psychiatrists who will be guiding you throughout your journey and our Multidisciplinary team will try to assure you with the best help possible.

References

  • Autism Risk Factors – Mayo Clinic
  • Autism Risk Factors – Healthline
  • Medicines and Can Autism Be Prevented – Web Med
  • Treatment & Therapies – Autism Speaks
  • Helping Children With Autism – Help Guide.Org