LD4 – Autism

Autism, despite its name, is not just one type of disorder. The better term is Autism Spectrum Disorder (ASD henceforth) and that includes a number of distinct developmental deficits and perhaps also from a variety of etiologies (causes) too. DSM IV does distinguis between ‘classical’ autism and PDD NOS (pervasive developmental disorders – not otherwise specified) which does include most of what I’m here calling the autism spectrum.

ASD actually results in a failure to relate. The affected child may not make good eye contact, may find close physical contact disturbing, and will not easily speak even to express basic needs. In other words, the ASD child may not even recognise “the other” as similar to but distinct from “the self”.

Observant care givers will be able to identify the more severe forms of ASD quite early as the deficits in achieving developmental milestones and interaction may be discernible even from the 9th month onwards, but sometimes it takes much longer to detect.

Common signs include:

• not turning when the parent says the baby’s name;
• not turning to look when the parent points and says, “Look at…” and not pointing themselves to show parents an interesting object or event,
• lack of responsiveness.
• repetitive motion, rocking back and forth.
• failure to speak, babbling.
• lack of ‘pretend’ play.
• repetitive, mechanical, play.
• smiling late; and
• failure to make eye contact with people.

(The above signs may not all occur together and may not all be discoverable at the same ages)

The lack of interaction can have a devastating psychological effect on the parents. While all developmental deficits are challenging to parents, the parents of kids with ASD perhaps have the hardest time. But, if the challenge is taken up, even severely affected kids will show improvement and sometimes the improvements will be remarkable.

The challenge is really not ever to give up. The parent (or caregiver) must insist on a relational response and then must insist on the right response. It can be a lifelong struggle, but ultimately very rewarding.

Once ASD is suspected, the child psychologist or paediatrician will be able to confirm the diagnosis. Therapy involves intensive one-on-one occupational therapy, with sensory integration, and directed play involving the child. Behavioral approaches as well as cognitive ones have proved to be helpful but it is most important that the parents learn what they have to achieve at home and work to effectively reinforce whatever the therapists are doing. Some parents actually take the lead in providing therapy and we have seen this approach produce excellent results. The more the parental involvement, (in my experience) the better the child responds!

In our experience even severely affected children can show remarkable improvement, so don’t get discouraged and don’t give up hope.

While all the parents of children with developmental deficits will be under some extra pressure, especially the parents of autistic kids can find the pressure and tension very taxing. So, it is particularly important that they get support for themselves and being a part of a group with the parents of other ASD affected children can be a great help.

Asperger’s Syndrome is somewhat related to ASD and sometimes even considered to be a part of the ASD spectrum. In Asperger’s, the language deficits may not be present. These kids will have normal or even good language skills but will still be lacking relationally.

All ASDs are treatable. Sometimes, remarkable improvement is seen. With dedication and will, a lot can be done! Get help, and then stick to the task at hand. Take it one day at a time, be patient, set yourselves tough but achievable goals, and you may be surprised at what you and your child can achieve together.

Insight into your child’s personality, what he (ASD is about five times commoner in males) likes and dislikes, getting your lives into a routine, and keeping a detailed journal that covers nutrition, moods, therapies, and anything else that comes to mind – will all prove to be very valuable aids to doing the best that you can for your child.

The American Association of Pediatricians has just published two papers on Autism. For further information, this is an excellent place to start.
AND Please, please, PLEASE look at all the wonderful and up-to-date information contained in the “Yale’s Autism Seminar“!!!!