What is Autism Spectrum Disorder (ASD)?
Autism spectrum disorder (ASD) or Autism is an umbrella term for a group of developmental disorders that are neurological in origin and cause social, communication and behavioural challenges.
ASD is the third most common developmental disorder. It is mainly characterized by impaired social interaction and communication and the presence of repetitive behaviours or restricted interests.Children with ASD may also have their sensory sensitivity affected i.e, they may be under or over sensitive to certain senses (eg. loud noises, certain fabrics etc).
What are the disorders that fall under the autism spectrum?
Here is a brief overview of disorders that fall under the autism spectrum:
Autistic disorder: A child is diagnosed with autism when he or she has all the signs of symptoms of ASD.
Asperger's Syndrome: Referred to as high functioning Autism, it is characterized by significant issues with social/emotional skills and obsessive focus on certain topics. There is no language or cognitive development delay. Click here for more details.
Pervasive Developmental DisorderNot Otherwise Specified (PDD NOS): PDD is often referred to as Atypical Autism because it is diagnosed when a child exhibits some but not all characteristics of autism. For instance,if a child exhibits speech delay and certain repetitive behaviors—he would most likely get a diagnosis of PDD (NOS)
Rett Syndrome: Rett Syndrome is a rare and severe disorder which is linked to a defect in the chromosome X, and therefore it mostly affects girls. Rett Syndrome is characterized by normal period of development followed by a slow regression in skills, often loss of communication skills and loss of purposeful hand movements.
Childhood Disintegrative Disorder: This is a very rare disorder where there is normal development in all areas initially and the onset of regression of skills happens much later than in other disorders of the spectrum. Children with Childhood Disintegrative Disorder experience loss of skills across all (language, social, behavioural and motor) development areas.
Earlier, each condition (autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome) was diagnosed separately but now, these conditions are grouped together and are called as autism spectrum disorder.
What are the signs of ASD?
Any child in the autism spectrum will have difficulties in three main areas:
Social interaction (difficulty in building relationships, etc)
Social communication (difficulty in verbal/non-verbal communication, for instance body language, gestures, etc)
Social imagination (difficulty in flexibility of thought, organizing, etc)
There may also be problems with development of motor skills and the presence of unusual repetitive behaviors such as hand flapping, rocking, etc.
How can a child be screened for ASD?
Screening is only to rule out the possible presence of a developmental delay and professionals may use screening tools such as M-CHAT-R/F to assess the risk for ASD. Screening is usually followed by a detailed evaluation and assessment. An earlier identification of the condition can facilitate earlier intervention and more favorable outcomes for the child in the long term.
Here is an age appropriate checklist (Credit: Com DEALL) to help you self-screen your child. You can use this to know if your child is meeting the right developmental milestones and then discuss it with a developmental paediatrician, child psychiatrist or a clinical psychologist. Please note that this checklist is not a substitute for a professional assessment.
How is ASD identified?
There is no single medical or genetic test to identify ASD. However professionals may carry out an evaluation or assessment using diagnostic tools such as Autism Diagnostic Observation Schedule (ADOS) or Autism Diagnostic Interview - Revised (ADI-R) to identify ASD. The child will be evaluated across a range of skill development, including communication, social, motor and cognitive development.
In some cases, the child may shows signs of autism early on. In some cases, ASD is usually marked by a period of apparent normal development upto the age of 2 to 2.5 years followed by a loss of acquired skills in certain areas. This is referred to as ‘autistic regression’.
Many children with ASD may also have another medical or psychiatric conditions and this is referred to as comorbidity. Conditions that are commonly comorbid with autism are ADHD, anxiety, depression, sensory sensitivities, Intellectual Disability (ID), Tourette’s syndrome and a differential diagnosis is done to rule them out.
What are some unique strengths of children with ASD?
Children with autism have trouble in relating and interacting with the world around them. However they may also possess unique strengths which may help them thrive in their chosen careers later on. Some areas in which children with autism commonly have average or above average skills are
Specialist knowledge in a particular area
Good visual and spatial memory
Methodical and organized
Ability to understand abstract concepts
Problem solving/ logical reasoning
What causes ASD?
Experts are still trying to find the exact cause of autism but research indicates that it may be caused by a combination of genetic, biological and environmental factors.
What are the interventions available for ASD?
Autism spectrum disorder is a lifelong condition and there is no cure, but the right therapy or intervention can help the child learn the necessary skills to improve the quality of their life. Since ASD can be detected as early as when the child is between 12-18 months old, intervention can be provided quite early for a better outcome.
The most effective intervention for ASD is interdisciplinary, structured and specialized to help the child meet their communication, social and behavioral milestones. Children with ASD can make significant progress if the intervention received is structured, intensive and consistent.
Applied Behavior Analysis (ABA): ABA works mainly on reducing problem behaviors in children with autism. It looks at behavior in a three step process: instruction, behavior and the consequence. This method uses rewards or reinforcement to help the child learn and maintain desired behaviors and skills. The child's progress is tracked and measured. ABA uses techniques such as:
Discrete Trial Training (DTT): DTT method helps the child master complex tasks by first mastering the small subcomponents of the task. Positive reinforcement and incentives are used to reward correct answers and behaviors. The desired behavior or skill is taught and repeated until the child learns.
Early Intensive Behavioral Intervention (EIBI): A type of ABA that is aimed at reducing atypical behaviors of autism in children younger than five or more commonly under three years.
Pivotal Response Training (PRT): PRT focuses on four pivotal areas of a child’s development: motivation, self management, self initiation and responsiveness to multiple cues. It is a child-directed intervention because the therapist often uses an activity or an item that interests the child to teach and help the child reach a goal.
Treatment and Education of Autistic and related Communication Handicapped Children Method (TEACCH): TEACCH is based on structured teaching. It builds on skills that children with autism already possess. The goal of TEACCH is to help children with autism function as independently as possible.
Developmental, Individual Differences, Relationship-Based approach (DIR - also called "Floortime"): Focuses on emotional and relational development (feelings, relationships with caregivers). It also focuses on how the child deals with sights, sounds, and smells.
Occupational therapy: Occupational therapy employs a variety of strategies to help a child with autism participate more effectively in everyday tasks. It helps strengthen certain areas like gross motor skills and fine motor skills.
Speech therapy: Speech therapists work with the child and help improve communication. They use alternate methods like gestures, picture boards, etc. to help the child learn how to express their thoughts and ideas to others. It is important to have speech therapy as part of a an interdisciplinary intervention programme, because children with autism have more trouble in communication.
Sensory integration therapy: Helps the child deal with sensory information such as sights, sounds and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched. When children gain better control of their senses, they are in more control of their movements, sounds, and emotions. This reduces awkwardness and improves social skills.
Music therapy: For children with ASD, music therapy employs specific musical activities to improve social and communication skills in children with autism.
Picture Exchange Communication System (PECS): This is used commonly for children with autism who have minimal or no communication abilities. Picture symbols or cards are used to facilitate communication.
Note: Research shows that early intervention treatment can greatly support a child’s development. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has autism or any other developmental problem. Also many intervention centers offer programs to help distraught parents or caregivers who need support and counseling. Please talk to your therapist to find out what training is available and what will equip you best to work along with the therapists in helping the child.
Caring for someone with ASD
Parents or guardians go through enormous stress and can be quite distraught when they know that their child is diagnosed with autism. Many parents, especially mothers quit their jobs to become full-time caregivers for their child. A lot of adjustments happen at home, siblings learn to adapt their life around their brother or sister who has been identified to have autism, family members chip in with more support, activities and plans are made keeping the child's interest in mind, and so on. In short, raising a child with autism brings with it a unique set of challenges. However, when armed with the right knowledge, parents or caregivers can make better choices for the child.
In this situation, as a parent and caregiver, you can:
Learn as much as possible about autism. Participate in training programs where you can learn about how you can use different interventions.
Plan and provide a regular routine for all the daily activities.
Seek professional help. You may also need counseling to be able to cope with the situation.
It is but natural that only parents of children with special needs can completely understand what other such parents go through. Join support groups and connect with other parents of children with autism.
Take time for yourself. Take care of your physical and emotional health.
This article has been written with inputs from Ms Deepa Bhat Nair, Affiliations Co-ordinator, Com DEALL Trust, Bangalore.