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Finding out that your child has autism will leave you entangled in a lot of emotions like rage, sadness, fear, worry and nervousness. However, there are a lot of people sailing in the same boat as you. It is crucial that you power through these emotions for the sake of your child who needs you the most. In this article, we will look at autism, its causes, symptoms, diagnosis, and treatments.
What Is the Autism Spectrum Disorder in Children?
Autism is an umbrella term that is used to categorise a range of disorders that include different syndromes and conditions diagnostically classified under DSM (Diagnostic and Statistical Manual of Mental Disorders). It covers a set of cognitive and behavioural defects which include social integration, linguistic development and communication impairment. The spectrum in the name Autism Spectrum Disorder implies that there is no fixed manner or degree limiting the symptoms. Different children show different extents of the disorder which means that they all have special abilities and challenges to face. The child could have mild, moderate or severe symptoms.
ASDs do not have a racial or socioeconomic bias. Based on data from the CDC in the United States, the probability of a child acquiring one of these conditions ranges from 0.3% to 1% of the population. Boys stand a higher risk of having an ASD, with a four times higher rate than that of girls; although girls exhibit far more severe symptoms.
Although the rates of ASD are increasing by around 15% per year, scientists are unsure if the increase is in real terms or if the diagnostic methods for identifying them have improved. Now, there are several disorders that come under the term Autism Spectrum Disorder. These are:
Also known as autistic disorder, children having it mainly show difficulty in mastering communication skills. In addition, they exhibit lower degrees of empathy, that is they find it tricky to read the emotional responses of the people around them. Autistic children find it very hard to clearly express their thoughts, feelings, and desires. It is also quite common to find children with autism having talents and skills in different areas, such as mathematics, memorisation, music, art, dance, etc.
2. Childhood Disintegrative Disorder
An extremely uncommon condition, it manifests in children who have developed without showing any symptoms for 2-3 years, and after which they begin to show lowered levels of communication ability.
3. Asperger’s Syndrome
Children with this syndrome have normal to better-than-average linguistic skills. However, they have problems socializing and communicating. Therefore, Asperger’s is also called high-functioning autism.
4. Pervasive Developmental Disorder
PDD is an umbrella term used for those children who show symptoms of an ASD but do not quite match the other conditions.
If your child shows a few symptoms of autism, it does not immediately mean that she has ASD. For example, your child might be unable to comprehend simple words, refuse to change habits, show repetitive behaviour, have difficulty getting along with other children, and so on. However, many kids are like this and it needn’t necessarily mean anything. If you feel like your child has marked differences in communication as compared to other kids of her age, you could go to a certified medical expert for a diagnosis.
Causes of Autism in Children
The causes of autism are still debated by both medical researchers and professionals. However, they all agree on one thing – that it is likely that there are several causes of autism. Research shows that autistic behaviour in some instances can be caused by getting Rubella while pregnant, phenylketonuria in the baby, and encephalitis (brain swelling). Generally, the consensus is that the following things may be responsible for autism:
Studies on identical twins show that autism appears in the other twin more than it would if they were fraternal. In addition, having an autistic child increases your chances of having a second autistic child by 5 per cent; which is significantly higher than the average rate of 1.5. Some studies have identified a set of genes linked to autism, especially in the presence of other factors like hormonal imbalance, anoxia, and exposure to toxins. A genetic condition known as Fragile X syndrome is also known to be linked to autism.
2. Environmental Factors
There are several possible environmental factors involved with autism such as premature birth, foetal alcohol syndrome, maternal obesity, pregnancy diabetes, and certain pregnancy medications for seizures. Another set of culprits could be toxic chemicals like pesticides, herbicides, mercury, and lead.
3. Parental Age
Research has connected the age of the parent to autism in the child. Interestingly, teenage mothers and women over 40 tend to have more autistic children than women between these ages. The age of the father also plays a major role, with a 50-70% jump in risk of having an autistic child for fathers over 50 years old.
4. Other Health Issues
A host of conditions have been shown to have links to autism. Some of them are neurofibromatosis, Down’s syndrome, muscular dystrophy, cerebral palsy, and infantile epilepsy.
One extremely crucial thing to remember is that there is no link between autism in your child and vaccination. In recent years, it has been a trend for people to not vaccinate their children for the fear of the vaccine causing autism. This was due to a now well-debunked study that linked a mercury-preservative, called thimerosal found in the MMR vaccine, to autism. While thimerosal is not used anymore, multiple large-scale studies have shown that there is no connection between vaccines and any ASD.
Signs of Autism in Children
The signs of autism in children can be observed from a very young age. However, here you can find signs of autism in children of different age group:
1. In Preschool Children
Autism can be observed in children from 6 months to 4 years old. Here are the signs to look out for if your baby is less than a year old.
- Your baby is uninterested in baby games or faces
- Your baby isn’t smiling, laughing, or reacting to voices and other sounds
- Your baby isn’t showing any interest in talking or making sounds and gestures
- Your baby isn’t comfortable being touched for long periods of time
For children between one and two-years-old, here are some important signs to take note of:
- Your toddler isn’t employing any body language
- Your toddler isn’t using at least two words at a time by the time she is two
- Your toddler has shown a regression in verbal ability and speaks less than before
- Your toddler prefers to live in her own zone, withdrawing from human interactions
- Your toddler doesn’t like to walk much or even if she does, it is only on her toes
Children with autism between two and four years old show the following symptoms:
- A child finds it difficult to express herself in words and may even not talk entirely
- Speech problem, a child talks, but with an uncommon rhythm, that is with stutters, high or low-pitched vocalization or in a flat tone
- A child isn’t comprehending instructions or directions given to her by her parents, family or teachers
- Expresses emotions loudly and in public for no obvious reason
- A child shows signs of hyper-focus, which means she looks at a single object or talks about one thing for hours at a time
- Prefers her own company, often shunning other children of her age
- A child repetitively does things like open and close doors, walk in circles, flap limbs, or line up toys in a specific way
- Stubborn behaviour, especially about her taste in food and habits
- Shows fear for simple things like chairs or stuffed toys but might not be afraid of vehicles or heights.
- She is unable to sleep comfortably through the night
2. In School-age Children
In many cases, autism symptoms in children do not show up early on. However, as there is still the risk of developing an ASD later in life, it is important you pay attention to the following signs in your school-going child.
Children with autism show strange reactions towards stimuli such as lights, sounds, smells, tastes, and touch. They might appear to not pay attention to those directly talking to them, but at times be annoyed by gentle sounds like papers shuffling or birds chirping. Any sudden change in sensory stimuli around them, like an appearance of bright lights, loud sounds, and rough textures can bother them greatly.
2. Emotional impairment
Children with autism cannot express their emotions in a socially acceptable way. They might begin to shout, weep, or laugh without any apparent cause. If faced with anxiety, your child might even show hysterical or aggressive behaviour like biting, scratching, hitting, breaking objects, and so on. They might show inappropriate gestures or expressions in a social context, choosing to ignore other people, thereby having few or no friends at all. These kids tend to show obsessive behaviours, especially when it comes to certain objects that preoccupy them constantly.
3. Neurological impairment
If your child has autism, she will likely be smarter at non-verbal tasks than verbal. She’ll tend to use short sentences and find it very difficult to speak with regular grammar. She will also tend to be good at visual and spatial tasks, but less efficient with questions that require abstract thought. These children tend to take things literally as they find it hard to comprehend idioms, similes, or metaphors.
How Is Diagnosis Done?
Stages of Diagnosis
Children who have autism have a unique pattern of development. While sometimes, ASD can be noticeable from birth, usually the lack of linguistic and social abilities surface after a year or two. The faster autism is diagnosed, the faster you can help your child cope with the disorder.
The doctor will first observe the unique behaviour of your child. For the diagnosis to be done, your child should have a problem in at least one of the following: social behaviour, linguistic ability, or hypersensitivity.
Medical professionals usually attempt a diagnosis in 18 months old. This is because signs of autism fluctuate. However, several children with high-functioning autism cannot be diagnosed until they go to school and exhibit unconventional social behaviour. In other cases, an autism test for the child can be made much earlier if the symptoms are obvious. The most common method of screening your child is via the M-CHAT-R or the Modified Checklist for Autism in Toddlers-Revised. It is usually performed for children between the ages of one and two. This method observes all behaviours and reviews them against a standard control for that specific age. To make the test more viable, a post-test interview is taken. However, as this test is not totally comprehensive, if you suspect or notice strong autism symptoms, you should get a developmental screening for your child, which will tell you of any developmental disabilities your child may have. If there are any problems, your doctor will suggest a comprehensive diagnostic evaluation.
2. Comprehensive Diagnostic Evaluation
This method is a significant improvement over screening. It includes observing your child’s development and behaviours, as well as performing genetic, hearing, vision, and neurological tests. For this, you might have to go to a specialist like a developmental paediatrician or a child neurologist. For this evaluation, a set of diagnostic tools are available. Some of them are the Autism Diagnostic Observation Schedule-Generic, the Childhood Autism Rating Scale and the Gilliam Autism Rating Scale-Second Edition.
Treatments for Children With Autism
Intervention should start as early as possible. A definitive diagnosis isn’t necessary for commencing intervention. Intervention should focus on the core features of autism i.e. deficits in social interaction and communication, and repetitive restricted patterns of behaviour, activities and/or interests. The Intervention should be evidence-based, specific, structured and suited to the developmental needs of the kid. The management of children should be done through interdisciplinary teams, and coordinated by the paediatrician. Note that the management of co-morbidities is very critical to the effectiveness of the treatment. Pharmacotherapy may be offered to kids when there is a specific target symptom or co-morbid condition.
1. Neurobehavioral Impairment
Therapy with a trained child psychotherapist is the first option. In cases where children with autism also show signs of depression or anxiety, this treatment is strongly recommended.
Medication may be required to relieve some of the symptoms that children with autism go through such as seizures, aggression, depression, and insomnia.
3. Treatments Not Recommended
There are a significant number of treatments recommended for autism, but must be strongly avoided as they don’t show much efficacy and can even be harmful. Some of them include gluten-free diets, oxygen therapy, monitoring brain activity, and using medication to remove mercury.
Common Health Complications
Autistic children may be susceptible to some common health conditions. These include:
These usually start in childhood or adolescence and may occur at any time.
2. Genetic Disorders
These include Angelman’s syndrome, Fragile X Syndrome, Sclerosis, and Duplication syndrome.
3. Sleep Problems
These may be caused by sleep apnea or gastrointestinal disorders.
4. Gastrointestinal Disorders
Autistic children are susceptible to diarrhoea or chronic constipation.
Children with autism may eat things that are not food, like chalk, clay, or dirt even when they are grown up.
6. Sensory Integration Dysfunction
This is caused by a difficulty in processing sensory information and may cause unusual responses to sounds, sights, and smell which may seem normal to others.
Child autism is beyond the control of parents as it is vastly determined by genetics. For those who feel that they may be at risk, here are some of the precautions:
Avoiding alcohol and eating organic food will help, as alcohol and pesticides have been linked to autism in children.
For those who have a family history of autism, studies have shown that having children between the ages of 18-40 years maximises the chances of having a non-autistic child.
1. Educate Yourself
It is important that you, as a parent, learn as much as you can about Autism so you will be able to support your child and help her with her condition. There are also several parent support programs for those parents who have a child diagnosed with autism.
As this is the one major skill your child with autism lacks, it is important to help her communicate clearly. You can do this by talking clearly and simply in a noise-free environment. You should enunciate with enough pauses, so your child can process your words in her own time.
3. Support Groups
Thankfully, there is a lot of support these days for children who have an ASD, and you must realise that you are not alone. If you can, find a group of parents either in your area or online whose children also have autism. You will learn a lot about raising children with autism, as well as be able to lend your support to those parents.
It is painful to come to terms with the fact that your child might have autism. However, the most important thing for you to do is not lose hope. The key thing to remember here is that you have to help your child live a fulfilling life.
1. The Autism Spectrum Disorder diagnosis requires the involvement of a multidisciplinary team that works together.
2. The intervention that’s administered by a clinician should be in the ratio of 1:1 or 1:2 (child to therapist ratio) and individualised for each kid and with an interdisciplinary team that documents intervention and evaluation.
3. Home interventions and Parent-education are more likely to be effective if they’re part of a multidisciplinary intervention program.
4. Interventions that are Psychopharmacologic do not treat the underlying ASD. But, they can improve the kid’s functioning and their ability to participate in behavioural interventions.
5. There’s no evidence for the effectiveness of alternative/ ‘complementary therapies and paediatricians should be able to counsel the caregivers to not opt for these therapies.
Also Read: Conduct Disorder in Children