Perhaps by now, many know of a family with an autistic child; yet very little is said publicly about Autism and its effects on the family and society. It is estimated that six out of every 1000 children will have some form of Autism Spectrum Disorder (ASD), with males four times more likely to have an ASD than females (National institute of health, NIH). The estimate is the same across racial, cultural and socio-economic lines.
Autism is the most severe of a range of complex neuro-developmental disorders (Pervasive Developmental Disorders) characterized by social impairments, communication difficulties and restricted, repetitive patterns of behavior. Other disorders in the spectrum include Asperger's disorder, Childhood disintegrative disorder and Rett's disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the following defects must be shown by a child before the age of 3 to be diagnosed with Autism.
· Deficits in Social Interaction - Little use of non-verbal behaviors that indicate social "connection", such as eye-to-eye gazes, facial reactions to others (smiling or frowning at others' remarks as appropriate), body postures that indicate interest in others (leaning towards a person who is speaking), or gestures (waving good-bye to a parent); Failure to develop peer relationships as other children do; Little expression of pleasure when others are happy; Little reciprocity in social interactions.
· Deficits in communication - Delay in, or total absence of , spoken language; In children who do speak, significant trouble in initiating and maintaining conversations; Unusual language, including repetition of certain phrases and pronoun reversal; Lack of make-belief play or imitation of others at a level appropriate for the child's age.
· Deficits in Activities and Interests - Preoccupation with certain activities or toys and compulsive adherence to routines and rituals; Stereotyped and repetitive movements, such as hand flapping and head banging; Preoccupation with parts of objects (such as the arm of a doll instead of the whole doll) and unusual use of uses of objects (lining up toys in rows instead of playing "pretend" with them).
Researchers agree that early detection is significant in determining outcome and that in some cases, age 3 may be too late to address some deficits. For this reason, The National Institute of Child Health and Human Development (NICHD) lists five behaviors that should trigger further evaluation.
· Does not babble or coo by 12 months
· Does not gesture (point, wave, grasp) by 12 months
· Does not say single words by 16 months
· Does not say two-word phrases on his or her own by 24 months
· Has any loss of any language or social skill at any age
A child having any of these "red flags" does not indicate an Autism diagnosIs, just a call for further evaluation by a multidisciplinary team including a neurologist, psychologist, developmental pediatrician, speech therapist, learning consultant etc.
Causes
There is no known single cause for Autism. What is clear to researchers is that despite media proliferations of links with immunizations and parental practices, those claims are scientifically unsubstantiated and disproved. Discoveries are at best preliminary even though two possibilities have been clearly identified i.e. genetics and environmental influence. While no specific genes responsible for Autism have been identified, research is on-going on the possibilities of defects in genes that control brain development at the fetal stage. Environmental factors including viral infections, metabolic imbalances and exposure to heavy metals like mercury are being investigated.
Treatment
There is currently no cure for Autism. Interventions generally target specific symptoms and behavioral patterns which are known to bring about significant improvements. Symptoms vary significantly with the individual child and each has to be approached by the right team of experts in the different areas of unique defects.
Living with Autism
The primary purpose of this exercise is to raise some level of awareness and dialogue at the community level. It is clear at this level that friends, family, neighbors, churches etc. rarely understand or know what to "make of" or "do" with the autistic child or his/ her immediate family. Avoidance, hence describes the level of involvement.
Families of autistic children themselves are often understandably devastated at the diagnosis. The demands as the child grows up with increasing levels of dependency are great and often lead to high levels of stress. Many marriages unfortunately do not make it. Many families cannot just do basic things that regular families take for granted like attending church, eating out or going on vacations. Round the clock attention to the autistic child is one thing, having to deal with judgmental actions and intolerance from on-lookers is quite another. It is therefore needful as a community to become aware of the nature of and the needs of an autistic child and his/ her family. "The Autism society", "Autism Speaks" and many other organizations involved in Autism give out free information and often provide help and guidance not just for the immediate family but for community establishments like churches on how to help and accommodate.