While there is no definitive cure for autism, early intervention programmes can help children lead better lives.
Nine years ago, Sathish and Kala* were thrilled when their son was born. JP* was a healthy boy but the parents noticed that he was different from his peers. At 18 months, he did not say any meaningful words. He refused to socialise with other children.
The paediatrician advised the parents to “wait and watch” for a few years.
This was unfortunate because doctors now know that the sooner autism is diagnosed, the earlier interventions can be started. It is extremely important that paediatricians are aware of the early signs of autism, so that a referral to a specialist is made. Unfortunately that was not the case with JP.
There is no single medical test that can diagnose autism. Diagnosis relies upon extensive history and behavioural observations. Evidence-based guidelines recommend that autism should not be diagnosed by a single clinician.
JP underwent an extensive evaluation by a multidisciplinary team comprising medical, developmental and social communication history, play-based observations, review of school reports, sensory profiling, behavioural checklists and stringently following internationally recognised criteria. The findings met the ICD-10 (10th revision of International Statistical Classification of Diseases and Related Health Problems) diagnostic criteria for autism.
It took nine long years to find the answer for JP’s behaviour, which left his family reeling. Sathish said, “As devastating as it is, the diagnosis is also a relief. Now we can move forward”. Sathish also wondered if the problem arose because Kala was stressed at work during pregnancy. Contrary to such beliefs, autism is not caused by an unhappy home environment, mental stress during pregnancy, poor handling by parents or other psychological factors. It is now clear that genetics play a causative role. However, the exact ‘autism genes’ are yet to be located. While we wait for science to unravel the mysteries of the cause, the need to help is pressing. While there is no definitive ‘cure’, children can live more functional lives through various interventions.
JP receives an integrated evidence-based programme comprising behavioural modifications, sensory integration, dietary advice and support to learning, communication and social interaction. An individualised approach tailored to the child’s specific needs is essential, as the treatment goal is to enhance the child’s abilities to function in school, home and community settings.
Sathish and Kala were introduced to the concept of social stories to help decrease JP’s tantrums, which seemed to be triggered by anxiety in unfamiliar surroundings. Having a few pictures and photographs of his environment helped. Simultaneously, the psychologist started behaviour modification therapy based on applied behaviour analysis.
The occupational therapist introduced sensory integration strategies. Many autistic children have difficulty processing everyday sensory information such as sound, touch and smell. This causes anxiety and manifests as challenging behaviours.
JP had received speech therapy earlier but his parents reported that he did not benefit. Although he was capable of repeating words, he was not consistent. He rarely looked at his therapist’s face and usually could not sit still long enough to focus on language skills. He was introduced to the “picture exchange system”, which involves communicating through the use and exchange of pictures. This approach is more useful because it encourages children to initiate communication. The parents also liked the idea of using pictures, since his peers also would be able to understand these pictures.
There is no medication to treat the core features of autism, although attempts have been made to use medication to treat symptoms such as behaviours and hyperactivity, as well as to improve the child’s ability to respond to behavioural interventions. However, these have side-effects and should be used with caution. Research on treatment strategies including alternative therapies is still underway. However specialists believe that as autism is a heterogeneous disorder, the research aimed at understanding treatment must address the heterogeneity.
JP goes to a special school and his parents wanted to know if that was appropriate. Determining the appropriate day-to-day educational curriculum and school placements for children with autism is a specialised process that considers every aspect of a child’s individual needs, particularly the attention levels, compliance to interventions, imitation abilities, language and social skills. Children with autism have the capacity to learn, but their learning styles are different from that of typically developing children. So the teaching strategies should be planned accordingly.
To say it has been difficult for Sathish and Kala is an understatement. As Sathish says while JP turns to give him a hug, “As parents we want to do everything for our child. No matter how different he is, he is very special to us and we love him.”
Early indicators of possible autism
Does not babble, point or gesture by 12 months
Delayed onset of social smile and speech
Does not respond to name
Loses development skills
Poor eye contact
Lack of imaginative play
Poor interaction with peers
Lack of or unusual emotional responses