Sameeran had not begun to speak by the age of two. He was restless and had to be called multiple times before he responded to his name. He would gaze at the moving fan for long periods and get upset if it was switched off. Sameeran’s mother was worried, but her husband brushed aside her concerns. Sameeran’s mother, however, decided to get him assessed. Sameeran’s diagnosis turned out to be autism. Speech and occupational therapy were initiated immediately, along with supportive education. Today, Sameeran is seven and has few traces of the autistic features. He has integrated into a mainstream school and while challenges still arise, he has been making steady progress. The early intervention provided Sameeran the skills necessary to cope with his challenges.
What is early intervention?
The set of services towards identification, assessment and a multi-pronged therapeutic approach to disabling conditions in the 0-3 age group is referred to as early intervention. While physical disabilities are evident from birth, intellectual disabilities take time to manifest. Autism Spectrum Disorder leads the list. Autism is a condition related to brain development that impacts how a person perceives others and socialises with them, causing problems in social interaction and communication. It also includes limited and repetitive patterns of behavior. The term ‘spectrum’ in Autism Spectrum Disorder refers to the range of symptoms and severity.
Early intervention programmes take advantage of neural plasticity or the ability of the brain to mould itself to stimuli. The greatest changes as a result of intervention are observed in the ages 0-3. This is not to say that programmes beyond this age are not effective, but they take more effort and time.
There are many signs that parents can look out for. The child may exhibit some or many of them: The child does not smile at the parent or return their smile. She avoids eye contact. She neither uses gestures nor imitates actions. She does not look at the parent when her name is called even though she can hear her name being called. She shows no interest in playing with other children. She lines up her toys instead of playing with them. She does not share any of her interests with the parent, nor follows when the parent points out something. She seems attached to objects rather than people. She loves gazing at moving objects, lost in thought for long periods. She hates anything sticky, but may love to play with water and pour it over herself. She resists eating certain foods, does not like to touch rice with her fingers and takes a long time to finish her meal. She gets upset if her routine is changed and wants things in the same place/order every time. She repeats words or phrases she hears on TV or in videos instead of ‘real communication’. She does not communicate her needs or respond when asked a question; she repeats the question instead of answering. She finds it hard to fall asleep or has a disturbed pattern of sleep.
The three big challenges to early intervention are parental ignorance; an unwillingness to accept facts; and social stigma attached to seeking specialised services. The following are the comments we often encounter. One: “Speech delays run in our family; she will catch up.” The fact is that this is a myth and the parent will only be losing time. Two: “She has no siblings and our apartment has no children she can play with.” The fact is that even if she had siblings, she would need some help. Three: “She loves gadgets; she eats better when she has the phone.” The fact is that gadgets affect sleep and exacerbate the uneven skill acquisition seen in children on the spectrum. Four: “Put her in playschool, she will be fine.” The child may not have the skills to initiate social interactions. Five: “What will people think?” What your child needs is more important than what others think.
An integrated approach
Paediatricians are the first point of contact. A vigilant practitioner can pick up the red flags as early as 18 months. The child should be assessed by a team comprising an occupational therapist, special educator, speech therapist and physiotherapist. A plan of action should be put in place. Communication within the team is of critical importance in helping the child. The child should receive a combination of therapy and special education for one to two hours every day. Parents need to be educated on home plans and in dealing with the condition and behaviour of the child. Sometimes, the extended family also needs to be counselled on how to provide the right environment to nurture the child. Children who have been part of early intervention programmes have shown remarkable progress, and the process of their integration with the mainstream has been faster. A programme that prevents disabling conditions is better than one that tries to mitigate the effects once disability has set in.
Rema Menon is Founder-Director, Rainbow Bridge
