Autism is a neurodevelopmental condition affecting in early childhood causing challenges in a child’s social and communication, delayed speech and language, unusual behaviours and restricted interests, sensory processing issues and socio-emotional reciprocity. The current prevalence of autism is 1 in 36 as per Centre for Disease Control (CDC) in March 2023. It is alarmingly high versus 1 in 110 back in year 2012. This increase in rate is also partially because of increased awareness amongst parents, literacy rates, easy access to medical services and early detection.
The early signs of autism that parents can notice are
- Lack of eye contact
- Not responding to their name
- Difficulty pointing to show an object of their interest
- Difficulty with joint attention (following a person’s finger or gaze)
- Delayed speech and language
- Lack of communication of their needs and wants
- Upset with change in their routine
- Resistant to change
- Lack of pretend play skills
- Irritable in social situations
Every child is unique and not all signs are present in one child. In most countries abroad, autism screening has become a part of routine pediatric screening while in some countries like United Kingdom, only children termed as high risk for autism are further evaluated. In India, parents need to take their child to the pediatrician if their child shows any of the above symptoms or a delay in speech , language, communication milestones or social reciprocity or loss of skills which the child earlier had (regression) like talk, play, social skills.
The pediatrician then further evaluates the child and may ask for an in detail psychometric assessment from a psychologist. The child is then referred for Speech , Occupational and ABA therapy depending on the child’s unique needs. This Early Intervention helps to improve child’s speech, communication and social skills. This helps to reduce child’s frustration and improves his quality of life helping him to attend regular schools and have a peer group and engage in social activities. The importance of Early Intervention cannot be emphasized enough as it helps to change his life trajectory.
Input shared by :- (Dr. Isha Soni, Senior Occupational Therapist and Centre Head, Lexicon Rainbow Therapy and Child Development Centre, Pune)
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Early detection and therapy are two pillars to improve the lives of individuals with autism spectrum disorder (ASD). Recognizing its signs at a young age, helps in taking corrective measures leading to early intervention. This in turn aids in smoother integration into educational and societal institutions. Therapies, such as occupational therapy, applied behavior analysis (ABA) and speech therapy, help improve communication, behavioral, and social skills during critical developmental stages – laying the foundation for long-term success and well-being and alleviating immediate difficulties.
Speech therapy, in particular, tackles both verbal and nonverbal communication issues, developing important abilities such as eye contact and understanding gestures. Similarly, ABA utilizes positive reinforcement to cultivate positive behaviors and teach new abilities, empowering both children and caregivers. Further, occupational therapy works on daily living skills, fine and gross motor skills, sensory perception, and other areas to promote independence and confidence in multiple life domains.
By investing in early detection and therapy professionals, caregivers, and communities can ensure that individuals with autism receive the support they need to thrive.
Input shared by:- (Principal Mrs. Damyanti Bhattacharya, JML School)
Autism spectrum disorder(ASD) is a neurobiologic disorder characterised by a triad of
a) impaired social interaction
b) impaired verbal and non-verbal communication
c) rigid, repetitive or obsessive behavior
Detecting ASD is a complex process that requires the use of various diagnostic methods. No single test definitively diagnoses ASD, and thus, a comprehensive evaluation using a combination of approaches is essential.
ASD was first defined in the third edition of the Diagnostic Statistical Manual of Mental Disorders (DSM) in 1980. Since that time it has undergone several revisions, only to be redefined as one disorder with a spectrum of severities in the DSM-5. Although the DSM-5 is the ultimate diagnostic reference for ASD, it outlines a criterion for diagnosis including target symptoms but does not provide a formal test. Thus, a wide variety of instruments have been developed to assist with the diagnosis of ASD. The 2 tests that are considered the gold-standard for diagnosing ASD include the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised(ADI-R). The ADOS is essentially a structured play examination in which the examiner systematically implements various social “presses” with the individual being evaluated in order to evoke social interactions. The ADI-R is a structured interview with a caregiver in which developmental and behavioral symptoms are reviewed. However, even these gold-standard tests can be biased and rely on the memory and understanding of the individual and caregiver.
Additionally, AAP recommends screening for ASD for all children at age 18months and 24months. It can be done by parent checklist or direct assessment. The most frequently used screening tool is the Modified Checklist for Autism,Revised/Follow-Up Interview(MCHAT-R/FU), a 20-item parent report measure, with additional parent interview completed for intermediate scores. It can be used from age 16-30months. Recently, eye-tracking technology has emerged as a promising tool for studying early signs of autism. Research showed that children with ASD tend to exhibit distinct eye gaze patterns compared with typically developing (TD) children. They show reduced eye contact during social interactions and focus on different areas of interest in their visual environment.
Thus early diagnosis of autism can pave the way for early intervention, inproved social and communication skills, optimal brain development, being a support to the families by reducing their stress, better educational planning and prevention of secondary challenges.
Likewise, early treatment is equally important. The primary treatment is done outside the medical setting and includes developmental and educational programming. There are at least eight types of therapy for autism including ABA therapy, Speech therapy, Occupational therapy, Play therapy, DIR-Floortime, Cognitive Behavioral Therapy, Music therapy and Art therapy. So first thing is to consider what you want for your child to get out of and choose accordingly. Training and support are also given to families. However, pharmacotherapy can be used to target specific co-occuring conditions or symptoms and can improve learning process as well as social adaptation.
Autistic children, reared in a positive environment, show some improvement during early school years.
It is a lifelong condition but early diagnosis and early intervention, all may, in turn, improve a child’s quality of life as they get older.
Input shared by:- (Dr Venkatesh Giri, Shree childrens hospital, Uran, Navi Mumbai)
Early detection of autism spectrum disorder (ASD) remains crucial for maximizing the benefits from intervention outcomes, given the significant advantages that are associated with early intervention. For instance, the plasticity of the brain i.e., its adaptability is high during early childhood, which means that interventions such as occupational therapy and early social skills training which are initiated following early detection can enhance cognitive performance with better long-term outcomes and the overall prognosis for children. Early detection also ensures that parents are better equipped with the knowledge, resources, and support network they need to provide the most effective support and guidance throughout their child’s development.
Yet, determining the optimal age for autism screening poses challenges, considering the variability in onset and the risk of misinterpretation at too young an age. Screening carried out at too young an age might struggle to differentiate between ASD and other types of developmental delays, or even typical developmental patterns. The proposed screening age range of 16–30 months strikes a balance, allowing for reliable detection while minimizing the likelihood of false positives.
Recognizing the importance of early warning signs, such as little eye contact, lack of social gestures at 12 months, lack of use of any meaningful word at 18 months, and no interest in other children or usage of any spontaneous two-word phrase at 24 months.
Paediatricians and healthcare providers worldwide, including in India, utilize standardized screening tools. In India tools like the Indian Scale for Assessment of Autism (ISAA) and the Autism Behavior Checklist (ABC) are most commonly used to detect ASD. By incorporating these tools into routine assessments, healthcare professionals can facilitate the timely identification and intervention and improve the long-term outcomes and quality of life.
How Therapy Plays an Essential Role
Therapy plays an important role in supporting individuals with ASD by addressing a range of challenges they may face.
Such as Behavioral therapy, particularly Applied Behavior Analysis (ABA), is one of the most effective interventions that teaches and reinforces positive behaviors while minimizing problematic ones. Through consistent implementation of ABA techniques and monitoring of progress, children with ASD have been shown to develop improved social skills and become more successful in interacting with peers at school. The therapist collaborates closely with parents, teachers, and other professionals to support social development and promote positive outcomes.
Speech therapy is another invaluable resource, aiding in the improvement of communication skills across speech, language, and social realms. It targets specific areas of difficulty, such as verbal expression and understanding social cues, and helps in connecting with others, using clear and intelligible speech sounds, and expressing oneself more confidently.
Occupational therapy addresses sensory processing issues such as over-sensitivity to loud noises, bright lights, certain textures, or strong smells and enhances skills necessary for daily living and social interaction. By targeting sensory sensitivities and fine motor skills, occupational therapy enables individuals to engage more comfortably with their environment and participate in daily activities with greater independence. Occupational therapists empower individuals to advocate for their own sensory needs and preferences. By teaching self-awareness and self-regulation skills, therapists help individuals recognize signs of sensory overload or dysregulation and develop strategies to manage sensory challenges effectively.
Early intensive behavioral interventions (EIBI), as recognized by the National Institute of Mental Health (NIMH), have shown significant benefits in enhancing cognitive and language skills, as well as adaptive functioning, in children with autism. These interventions, implemented early in life, capitalize on the brain’s plasticity to maximize developmental gains.
It’s important to understand that there’s no one-size-fits-all approach for autism management and care and more often than not, a care plan that combines different therapies is often most effective. Interventions depend on each person’s needs and have to be tailored accordingly. Early intervention, a holistic approach, and support from trained professionals are essential for successful therapeutic outcomes.
Challenges in India
However, when it comes to therapy in low and middle-income countries like India, resources are limited, and the need for comprehensive and evidence-based training programs for ASD professionals is even more important. By focusing on andragogical frameworks (the art of teaching adults) that promote self-efficacy and transformative learning, these programs empower professionals to deliver effective interventions in resource-constrained settings.
Additionally, group and peer learning environments stimulate insights and foster collaboration among professionals from diverse disciplines. Colleagues from varied disciplines such as occupational therapy, psychology, special education, and social work should come together for discussion and reflection.
By innovating locally-driven training initiatives and emphasizing evidence-based, context-specific approaches, India can bridge the treatment gap for ASD. These efforts not only enhance the self-efficacy of professionals but also have a positive and sustainable impact on organizations, individuals with ASD, and their families.
Input shared by:- (Mr. Lalit Khetan, Founder of Care for Autism Foundation, Kolkata)
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