What is Autism? Explained

In the previous post we learned about learning disabilities This blog post provides an overview of the fundamentals of comprehending those on the autism spectrum in India. Module content includes explanation of concept, explanation of reasons, explanation of diagnosis, and explanation of treatment.

At the end of this blog, the reader will:

Acquire an in-depth understanding of autism and ASD by learning about their characteristics and causes.
Find out what triggers autism and
Learn the management of autism.

Introduction
Meaning and Definition:
Causes of Autistic Spectrum Disorders
Early Signs and Symptoms
Diagnosis
Intervention:

Introduction

A collection of neuropsychiatric illnesses known as autistic spectrum disorders (ASD) cause distinct delays and deviations in social, linguistic, and cognitive development. Asperger's syndrome, autism, and pervasive developmental disorder-not otherwise defined (PDD-NOS) are all included under ASD (Vijay Sagar, 2011). One of the five developmental illnesses covered by the term "pervasive developmental disorders" is autism. Other disorders in this family include Asperger's Syndrome, Rett's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified, which is frequently abbreviated as PDD-NOS. These disorders are in addition to autism (Merry Barua and Daley, 2012). Deficits in social interaction, communication, and odd, repetitive behaviour are hallmarks of autism. People with autism range in cognitive ability from those with ordinary to above average intelligence to those who are borderline and mildly mentally retarded to others who operate in the moderate to profoundly mentally retarded range. Autism typically appears at birth or within the first two and a half years of life and is a severe disability (Merry Barua and Daley, 2012).

Human rights, inclusion, communication, and access to fundamental services including healthcare, education, and employment are socially denied to those with autism spectrum disorders in general. It is crucial that individuals with autism spectrum disorder receive more socioeconomic and political attention given the severity of the issue. Social workers who are working to affect change in society are obliged to ensure that people are aware of the appropriate services that are available to people with autism spectrum disorders so that they can be included. As a result, social work education in India now places a strong emphasis on the topic of disability.

Meaning and Definition:

Symptoms of autism spectrum disorder (ASD) include:

Persistent deficiencies in social interaction and communication in a variety of circumstances;
Restricted, recurring interests, behaviours, or pursuits;
Early developmental symptoms, which are commonly noticed in the first two years of life, must be present; and
Clinically substantial symptoms hinder essential aspects of current functioning in the social, occupational, or other domains.

The term "spectrum" describes the wide range of signs, abilities, and degrees of disability or impairment that children with ASD may experience. While some kids are only minimally affected by their symptoms, others are profoundly affected. Asperger's syndrome is no longer listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM5); instead, the traits of Asperger's syndrome are categorised under the more general term of ASD (NIMH, 2015).

The autism spectrum or pervasive developmental disorders (PDD)

The phrase "autism spectrum" is used to describe a wide range of diagnoses with comparable symptoms. The complete syndrome within the autism spectrum is known as autistic disorder. Autism is a common abbreviation for it. The majority of those who have autism also struggle with learning. However, autism can affect even those with ordinary intelligence. It is more accurate to refer to this as high functioning autism or a high functioning individual with autism (Eric Zander, 2005).

Autism in people with normal or above average intellect without the significant linguistic impairments seen in autism is known as Asperger's syndrome (or Asperger's condition) (Eric Zander, 2005).

Atypical autism or pervasive developmental disorder NOS (NOS = not else specified) are frequently used interchangeably. These diagnoses indicate that the individual has severe difficulties of a comparable sort but does not fully meet the criteria for autism or Asperger's syndrome (Eric Zander, 2005).

Childhood disintegrative disorder is very rare and means that a child develops autism after the age of 2 or 3 years of age. The child has a normal development up until this (Eric Zander, 2005)

Causes of Autistic Spectrum Disorders

Scientists do not know the exact causes of autism spectrum disorder (ASD), but research suggests that both genes and environment play important roles (NIMH, 2015).

Genetic factors

Nearly 9 out of 10 times, if one of identical twins with the same genetic code has ASD, the other twin also has ASD. If one sibling has ASD, the remaining siblings are 35 times more likely to also be diagnosed with the condition. Researchers are beginning to pinpoint specific genes that could raise the chance of ASD.

To date, researchers have only had sporadic success in identifying the precise genes at play. See the information on Tuberous sclerosis and Fragile X syndrome below for further details on such cases.

The majority of persons who have ASD have no known family history of the condition, indicating that sporadic, uncommon, and perhaps numerous gene changes are more likely to have an impact on risk. A mutation is any alteration to the genetic code that is normally present. While certain mutations can be inherited, others happen randomly. Mutations may be advantageous, detrimental, or ineffective.

Having increased genetic risk does not mean a child will definitely develop ASD. Many researchers are focusing on how various genes interact with each other and environmental factors to better understand how they increase the risk of this disorder (NIMH, 2015).

Environmental factors

The term "environment" in medicine refers to everything outside the body that may have an impact on health. This includes the things that our bodies may come into contact with, including as the air we breathe, the water we drink and bathe in, the food we consume, the medications we take, and a variety of other items. In the womb, where our mother's health directly influences our growth and early development, environment also refers to the conditions we are in. Numerous environmental factors are being researched, including toxicity exposure, problems during childbirth or pregnancy, parental age and other demographic issues, and family medical conditions.

Similar to genes, it's likely that a number of environmental factors contribute to an increased risk of ASD. Like genes, each of these risk variables only slightly increases the risk. ASD does not typically occur in most persons who have been exposed to environmental risk factors. Additionally, this field of study is being pursued by the National Institute of Environmental Health Sciences.

Scientists are studying how certain environmental factors may affect certain genes turning them on or off, or increasing or decreasing their normal activity. This process is called epi-genetics and is providing researchers with many new ways to study how disorders like ASD develop and possibly change over time (NIMH, 2015).

ASD and vaccines

To prevent against harmful, contagious diseases like measles, health professionals advise that children receive a number of immunizations early in life. Since paediatricians began administering these vaccines during routine visits in the United States, the proportion of kids getting sick, becoming crippled, or passing away from these illnesses has nearly completely disappeared (NIMH, 2015).

Around the same time that ASD symptoms frequently manifest themselves or become apparent, children in the United States receive a number of vaccinations throughout their first two years of life. A small percentage of parents think their child's problem has something to do with the immunizations. Due to the unverified idea that thimerosal may contribute to ASD, some people may have reservations regarding these immunizations. Some vaccines, although not all, used to contain the chemical thimerosal, which is based on mercury, to help increase their shelf life. However, since 2001, thimerosal has not been a component of any vaccination routinely administered to preschool-aged children in the United States, with the exception of a few flu shots. The number of children with ASD has increased despite this adjustment (NIMH, 2015).

Other parents believe their child's illness might be linked to vaccines designed to protect against more than one disease, such as the measles-mumps-rubella (MMR) vaccine, which never contained thimerosal (NIMH, 2015). Many studies have been conducted to try to determine if vaccines are a possible cause of autism. As of 2010, none of the studies has linked autism and vaccines. Following extensive hearings, a special court of Federal judges ruled against several test cases that tried to prove that vaccines containing thimerosal, either by themselves or combined with the MMR vaccine, caused autism (NIMH, 2015).

Early Signs and Symptoms

Autism spectrum disorder (ASD) symptoms can vary from child to child, but they typically fall into two categories: social impairment, which includes issues with social communication, and repetitive and stereotyped behaviours.

When learning social and communication skills, children with ASD do not develop them in the conventional ways. The first people to notice strange actions in a youngster are typically the parents. When comparing kids of the same age, certain habits frequently stand out more.

In some cases, babies with ASD may seem different very early in their development. Even before their first birthday, some babies become overly focused on certain objects, rarely make eye contact, and fail to engage in typical back-and-forth play and babbling with their parents. Other children may develop normally until the second or even third year of life, but then start to lose interest in others and become silent, withdrawn, or indifferent to social signals. Loss or reversal of normal development is called regression and occurs in some children with ASD (NIMH, 2015)

Social impairment.

The majority of kids with ASD struggle with regular social contacts. For instance, some kids with ASD might:

Make little eye contact
Tend to look and listen less to people in their environment or fail to respond to other people
Rarely seek to share their enjoyment of toys or activities by pointing or showing things to others
Respond unusually when others show anger, distress, or affection.

According to recent research, children with ASD may not be aware of the social cues that other people usually take notice of, which may explain why they do not react to emotional cues in human social interactions. Children with ASD, for instance, tend to focus on the mouth of the person speaking to them rather than the eyes, which is where children with average development tend to focus. According to a recent study, children with ASD seem to be driven to repetitive actions that are associated with sounds, such as hand clapping while playing pat-a-cake. These studies imply that children with ASD may misread or not perceive minor social cues like a grin, a wink, or a grimace that could assist them grasp social relationships and interactions. However, further study is needed to corroborate these findings. Children with ASD might not respond appropriately if they are unable to comprehend the tone of another person's speech as well as their gestures, facial expressions, and other nonverbal cues.

Similarly, it may be challenging for others to interpret a child with ASD's body language. Their body language, gestures, and facial expressions frequently contradict or are unclear in relation to what they are saying. Their vocal tone could not accurately convey how they are feeling. Many elderly ASD sufferers talk with a strange tone of voice, sometimes sounding robotic or sing-song. Another potential difficulty for children with ASD is comprehending another person's perspective. For instance, most kids comprehend that other people have different knowledge, emotions, and aspirations than they do by the time they are in school.

Children with ASD may lack this understanding, leaving them unable to predict or understand other people's actions (NIMH, 2015).

Communication issues

By the time they are one year old, normal toddlers can typically pronounce one or two words, turn when their name is called, and point when they desire a toy, according to the American Academy of Pediatrics' developmental milestones. Toddlers express their "no" when given something they do not want by using words, gestures, or their faces. Achieving these milestones could not be easy for kids with ASD. For instance, some autistic kids might:

Fail or be slow to respond to their name or other verbal attempts to gain their attention
Fail or be slow to develop gestures, such as pointing and showing things to others
Coo and babble in the first year of life, but then stop doing so
Develop language at a delayed pace
Learn to communicate using pictures or their own sign language
Speak only in single words or repeat certain phrases over and over, seeming unable to combine words into meaningful sentences
Repeat words or phrases that they hear, a condition called echolalia
Use words that seem odd, out of place, or have a special meaning known only to those familiar with the child's way of communicating.

Even ASD patients with rather strong language abilities frequently struggle with the back and forth of conversations. For instance, some highly vocal children with ASD frequently chat at length about a favourite subject but won't give others an opportunity to respond or notice when others react indifferently because they find it difficult to interpret and react to social cues.

Children with ASD who have not yet developed meaningful gestures or language may simply scream or grab or otherwise act out until they are taught better ways to express their needs. As these children grow up, they can become aware of their difficulty in understanding others and in being understood. This awareness may cause them to become anxious or depressed (NIMH, 2015).

Repetitive and stereotyped behaviors

Children with ASD often have repetitive motions or unusual behaviors. These behaviors may be extreme and very noticeable, or they can be mild and discreet. For example, some children may repeatedly flap their arms or walk in specific patterns, while others may subtly move their fingers by their eyes in what looks to be a gesture. These repetitive actions are sometimes called "stereotypy" or "stereotyped behaviors." (NIMH, 2015).

Children with ASD also tend to have overly focused interests. Children with ASD may become fascinated with moving objects or parts of objects, like the wheels on a moving car. They might spend a long time lining up toys in a certain way, rather than playing with them. They may also become very upset if someone accidentally moves one of the toys. Repetitive behavior can also take the form of a persistent, intense preoccupation. For example, they might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Children with ASD often have great interest in numbers, symbols, or science topics (NIMH, 2015).

While children with ASD often do best with routine in their daily activities and surroundings, inflexibility may often be extreme and cause serious difficulties. They may insist on eating the same exact meals every day or taking the same exact route to school. A slight change in a specific routine can be extremely upsetting. Some children may even have emotional outbursts, especially when feeling angry or frustrated or when placed in a new or stimulating environment. No two children express exactly the same types and severity of symptoms. In fact, many typically developing children occasionally display some of the behaviors common to children with ASD. However, if you notice your child has several ASD-related symptoms, have your child screened and evaluated by a health professional experienced with ASD (NIMH, 2015).

Diagnosis

Most of the health care professionals are unaware of the diagnostic criteria of autism. If health care professionals are aware of the diagnostic criteria of autism, diagnosis can occur as early as 18 months. The diagnostic tools most commonly used in India at present are the Diagnostic and Statistical Manual, Fourth Edition (DSM IV) and the International Classification of Diseases, 10 Edition (ICD 10), which have aligned their criteria for the pervasive developmental disorders. The CARS, though not strictly a diagnostic tool, is often used as one. The most important information one can gather to assist in formulating a diagnosis of autism relates to the child’s development in the areas most impacted by the disorder: communication, socialization, and restrictive and repetitive behaviors. There are no absolute markers of the disorder and no single behavior or characteristic that is absolutely required in order to apply one of the PDD diagnoses. However, there are certain common behaviors and features that tend to be more common and they are given below. The child with autism may (Merry Barua and Daley, 2012):

Prefer to be alone
Appear unaware of other people’s existence.
Not respond to name and may on occasion appear to be deaf.
Appear to avoid gaze or show unusual eye contact.
Not reach out in anticipation of being picked up
Not seek comforting even when hurt or ill.
Not smile in response to parents’ face or smile.
Have difficulty in mixing and playing with other children.
Not point to share or indicate interest, or not share in others interests.
Not point to ask for something.
Not try to attract attention to his/her own activity.
Not look at a toy across room when adult points at it.
Not look at things an adult looking at.
Have difficulty taking turns in turn taking games or activities.
Not imitate adults’ actions.
Not pretend to play house, talk on phone.
Have unusual or repetitive play, lack or have limited pretend play.
Have extreme unusual fears or have poor awareness of danger or not show fear.
Show delay or lack of language development or loss of early acquired language.
Rarely or not use gestures to communicat
Lead adult by the arm to have needs met, or use adult hand as an object.
Reverse pronouns.
Echo words or phrases.
Have difficulty in initiating and sustaining conversation.
Enjoy rotating or spinning object, or lining up objects, twirl twigs, flap paper.
Be occupied with parts of objects like knobs, switches, wheels.
Show apparent insensitivity to pain.
Like sameness in everyday routines; may show resistance to change in routines or surroundings.
Display repetitive actions and ask repetitive questions.
Not cuddle or stiffen when hugged or cuddled.
Display unusual behaviour or body movement such as spinning, hand flapping, head banging, or rocking.
Show extreme distress for no apparent reason.
Appear unaware of distress in others.
Display good rote memory for nursery rhymes, commercial jingles, irrelevant facts.

Traditionally, a diagnosis of autism is to be made by a team comprising a psychiatrist, psychologist, special educator, and so on. In many of the larger facilities this is true. But by and large, diagnosis in India is made by a single individual. This can be a paediatrician, clinical or developmental psychologist, special educator or speech therapist with extensive experience working with autistic children, psychiatrist, or a professional involved in providing medical or rehabilitative care or training. Since the purpose of diagnosis is to ensure the child receives the treatment that will address its needs, it is considered appropriate that the child receives diagnosis from any source that ensures that appropriate intervention is provided without loss of time (Merry Barua and Daley, 2012).

Intervention:

Children with autism can make significant gains through educational intervention, and particularly when the intervention is early. Early intervention has been shown to result in the child needing fewer special education and other allied services later in life and some children being indistinguishable from their typically developing peers in their later years.

In India, the idea of early intervention is still relatively new. Such an intervention requires a series of circumstances that are not present right now. Specifically, a parent must notice some atypical behaviour in their child and bring it to the attention of a paediatrician or their health worker; that paediatrician must identify the behaviours as potentially indicative of autism rather than just delayed development, typical development, or another disorder; that paediatrician must also be aware of a referral to provide to the parent; and the parent must follow up on the referral with the organisation or person to whom the child has been referred.

Pharmacological treatment continues to have a foothold in India. A study by Daley (2002) reported that among a group of 95 children, over 50 different medications had been prescribed for their ‘autism’. Seventy five percent of the sample had taken medication in the past, and 42% were taking medication at the time of the interview. Families in this study also reported an extremely wide range of treatments/‘experts’ for their children. These included: acupuncture, acupressure, Auditory Integrated Therapy, ayurvedic medicine, behavior therapy, magneto therapy, Dimethylglycine facilitated communication, etc., ‘Expertise’ of astrologers, faith healers, Fakirs, family counseling, family guru, and such others were also sought (Daley, 2002).