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Fifty years ago the “autism spectrum of diseases” was practically unheard of in India. We lived in large joint families where one child or another may have been “difficult”, “hyperactive” (read: naughty), refused to study but eventually did assimilate into society. The rest of the family looked after the physical and financial needs of the person. He was just the uncle who was “weird” and perhaps did no work.
The advent of the nuclear family changed this. Today, one in 85 children is diagnosed with autism spectrum disorder. Four out of five such children are boys.
Most autistic children are only diagnosed by the age of three. This is when many of them start some sort of structured education and need to interact with their peers and the autistic behaviour becomes evident. There may still be a delay in diagnosis as the severity of the symptoms and the manifestations vary from child to child.
The symptoms may be subtle but appear in infancy. The child may not smile, make eye contact, or babble happily. They may resist cuddling and withdraw into themselves. They may show little or no interest in surroundings. The reaction to toys may be bizarre. They may be focused on just a portion of the toy, like the wheel of a toy car, with no desire to see how it works. Some actually lose speech and other milestones they had already developed. The ability to interact with other people may be defective or absent. Their behaviour may be inexplicably disruptive and aggressive.
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Children need to be evaluated if
• They do not smile by the time they are six months old
• Do not mimic sounds or facial expressions by nine months
• Do not babble by one year
• Do speak at all by 16 months
• Do not speak two word phrases by 24 months |
These symptoms are suspicious but not diagnostic. The diagnosis of autism is based on the presence of at least six specific symptoms from the DSM (Diagnostic and Statistical Manual of Mental Disorders). A qualified professional must make the diagnosis as it has major implications for the future of the child.
Autism may exist alone or may be part of a wider spectrum of diseases. The child may also have genetic abnormalities, seizure disorders or tuberous sclerosis (multiple tumours in the brain).
Once enrolled in school, they have learning difficulties. Though they might repeat what they learn and appear to grasp it quickly, they cannot understand the logic or concept; so they are unable to apply what they learn in daily life. They may be unable to understand certain concepts altogether. Some may be savants with exceptional musical, mathematical or artistic talents. This is easier for parents to accept as they would rather have a child who is a genius and not one with learning disabilities.
Families are understandably upset with the diagnosis of autism. Unfortunately the exact reason for autism is not known though there appear to be several contributory genetic and environmental factors.
If the families of autistic children are carefully studied, there may be several members with one or another symptom in a mild form. They may lack social skills, be abrupt or rude or have learning disabilities. There may be just a small defect in the genes of each individual and they may be compounded in the child.
Modern day additives, pesticides and other pollutants in the environment and in the food eaten during pregnancy are suspected but not proven to play a role.
There was a great deal of hype in the media postulating a link between autism and vaccines particularly MMR (measles mumps rubella). This is a disproved hypothesis. Failure to immunise the child places it at risk of contracting serious preventable infectious diseases.
Older parents are more likely to have autistic children.
There is no miracle drug to cure autism, but coexistent medical conditions should be treated. Careful nurturing and education can integrate many autistic persons into mainstream society.
Many children with mild forms when helped do seem to “outgrow” it during their teenage years.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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