www.indianexpress.com | April 24, 2021
With rates of autism higher than ever, it is likely that each one of us will encounter someone on the autism spectrum.
By Dr Deepa Bapat
Over the past few years, with greater awareness around the disorder, more and more people are likely to have encountered the term “autism”. However, the overall awareness remains low and misinformation abounds. Individuals commonly refer to children with intellectual disabilities as being autistic. Often, children with behavioural issues or those who are difficult to manage may be herded under the term autistic. In reality, the use of the term should be reserved for a specific group of individuals that present with difficulties in social communication and interaction, along with repetitive, stereotyped behaviour.
Understanding the symptoms of autism
Social communication and interaction are vital to our existence primarily since it serves as a way to learn from our surroundings and to establish relationships. Inability to communicate is often associated with frustration and behavioural issues as it robs a child of the ability to impact what is happening in their immediate environment (e.g. I am hungry and grumpy – I ask for food –I receive food – I am then no longer hungry – I return to being happy). Contrast this to a scenario when a child is hungry but is unable to ask for food (e.g. I am hungry and grumpy – nobody gives me food – I continue to be hungry, grumpy and frustrated).
There are a myriad of ways in which deficits of social communication and interaction may manifest in the real world. Individuals with autism may appear to have a general disinterest in other individuals – ignoring other people around them, not initiating conversation with anyone, difficulty engaging in small talk and lack of eye contact among other things. It is important to note however that just like other kids, children with autism experience hunger, feel cold and may also experience anxiety. The difficulty is primarily in communicating the same to their caregiver. Take a minute to consider what an incredibly isolating experience it must be! Moreover, in the vast majority of cases, rather than not wanting to feel connected to someone else, the child is simply unable to figure out how to do this. Think of it as a child having the same needs as others, but not being equipped with the requisite skills to have these needs met. Almost like being in a foreign land where the language in parlance is a mystery.
The second set of symptoms, which include repetitive, stereotyped behaviours, are typically the features that catch people’s attention. It might look like odd behaviour with toys or stereotyped motor movements. For instance, rather than feeding a doll with a bottle, children with autism may be more interested in twirling the doll’s hair. They may tend to line up objects such as cars and engage in the same type of play repeatedly (e.g. spinning the wheels of the car), rather than demonstrate variety or purposeful play (e.g. cars having an accident, cars going up the wall, etc). Some of the most common stereotyped motor movements in children include hand-flapping, rocking, head-banging and finger-twirling. What is commonly missed though is that these behaviour are ways for the child to self-soothe when they are upset or overwhelmed. In other words, these behaviours may serve as a coping strategy to navigate the seemingly bizarre rules in the neurotypical world.
Another way repetitive, stereotyped behaviour may manifest is through hypo- or hyper-sensitivity in any of the five senses, but is most commonly observed with regard to sounds or visual stimuli. For instance, a child with hypersensitivity might be able to hear everything happening in their environment with the same intensity. In a regular household this might mean that the child hears the typing on a keyboard, the pacing of someone in the house, the sound of the floor being swept, the vegetables being cooked, the washing machine running – all just as loud. Essentially, the individual is having difficulty filtering out irrelevant information. It is easy to imagine how this could be overwhelming, and might offer an explanation for the meltdowns commonly observed in children with autism. By the same token, they may also show reduced sensitivity to pain and not appear to cry when they fall. Children may demonstrate hypo- or reduced sensitivity in some domains, but be hyper- or overly sensitive in others, which many a times makes the disorder enigmatic, for clinicians as well as parents.
While it is common to use blood tests and neuroimaging techniques to diagnose disorders such as cancer or epilepsy, the diagnosis of autism is a behavioural one. That is, a diagnosis can only be made on observing the child interact with people and objects in their environment. This information is used in conjunction with a detailed history obtained from the child’s parents to finally arrive at a diagnosis. It then follows that autism can only be diagnosed at an age when children fail to show behaviours that are otherwise typical for children their age. Since many of these behaviours are social in nature, a lack in these skills may only be apparent after 18 months of age. It is therefore very difficult to make an accurate diagnosis of autism in the early days of life, although research is making gains in this area every day. There are however very reliable tools to identify individuals who may be at-risk for autism at an early age. By identifying at-risk individuals, children are able to commence intervention earlier, which is known to be associated with better overall outcomes for the child.
But why should this happen?
Broadly speaking, autism falls under the category of neurodevelopmental disorders, which means that it is something that individuals are born with. One does not develop autism at a later point in life. While the precise causes for autism still remain unclear, there is now sufficient evidence to suggest that it is not caused by vaccinations, mercury poisoning or poor parenting. Rather, it is a disorder caused by atypical wiring in the brain. A lot more research is needed however before we are able to understand exactly what is different in the autistic brain.
Where to from here?
If any of this sounds like someone you know, it may be a good idea to link them to a psychologist or a paediatrician. There are a number of therapies available to help teach children with autism the skills they are lacking, and research clearly indicates that children make tremendous progress with early intervention. However, as with many pediatric disorders, family involvement is key. Repetition of skills learnt in therapy in the home environment is vital for children to make progress. And each of us can help by trying to understand what this experience must be like, both for the child and for the caregiver. With rates of autism higher than ever, it is likely that each one of us will encounter someone on the autism spectrum. This Autism Acceptance Month, we encourage you to be autism aware – may your awareness of the condition be a gift to all individuals and caregivers grappling with this disorder.
(The writer is Adjunct Faculty, FLAME University. The opinions in this article are solely the views of the author.)