Symptoms: Problems with social communication and interaction and restricted or repetitive behaviours or interests.

Causes: The exact cause of Autism is not known. Genetic and environmental factors could be the cause of autism.

Risk Factors: Family history, certain genetic conditions (like Down syndrome or Fragile X syndrome), low birth weight.

Prevalence: About 1 in 100 children has autism.

Severity: Mild to severe

Which doctor to consult: Paediatric neurologist, child psychiatrist, child psychologist, developmental-behavioral paediatrician.

OVERVIEW:

Autism or Autism Spectrum Disorder (ASD) is a neurological and developmental disorder that begins early in childhood and lasts throughout a person's life. It affects how a person acts and interacts with others, communicates, and learns. It includes what used to be known as Asperger syndrome and pervasive developmental disorders. It is called a "spectrum" disorder because people with ASD can have a range of symptoms, including difficulty with social interaction and communication, as well as an atypical pattern of activities and behaviours. 

The capabilities and requirements of individuals with autism vary and can change over time. While some may live independently, others may require life-long care and support due to severe disabilities. Autism could significantly impact education and employment opportunities, and caring for and providing support to individuals with autism can place significant demands on families. The quality of life of individuals with autism is influenced by societal attitudes and the level of support.

Although autism can be detected in early childhood, it is often not diagnosed until later. People with autism often have co-occurring conditions, such as epilepsy, depression, anxiety, attention deficit hyperactivity disorder, and challenging behaviours, such as difficulty sleeping and self-injury. The level of intellectual functioning among individuals with autism varies widely, extending from profound impairment to superior levels.

SYMPTOMS:

People with autism generally have problems with social communication and interaction and restricted/repetitive behaviours or interests. They may also have different ways of learning, moving, or paying attention.

Social communication and interaction skills: Examples include:

• Not maintaining eye contact.

• Not responding to their name by 9 months of age.

• Not showing any facial expressions.

• Using few/no gestures by 12 months of age.

• Not sharing interests with others by 15 months of age.

Restricted or Repetitive Behaviors or Interests: People with ASD have behaviours or interests that may seem unusual. Examples include:

• Lining up toys/other objects and getting upset when the order is changed.

• Playing with toys the same way each time.

• Echolalia (repeating words or phrases over and over).

• Getting upset by minor changes.

• Having obsessive interests.

• Following certain routes.

• Unusual reaction to sound, smell, or taste.

Other characteristics: These include:

• Delayed movement and language skills.

• Delayed learning and cognitive skills.

• Inattentive, impulsive, or hyperactive behaviour.

• Unusual sleeping and eating habits.

• Excessive worry, stress or anxiety.

• Unusual emotional reactions or mood.

CAUSES:

Studies have shown an increase in the prevalence of autism, but the causes of this condition are not yet well understood. Researchers have identified rare gene mutations and small genetic variations in individuals with autism, suggesting a genetic component. However, scientists are also exploring the role of environmental factors in the development of this disorder. Exposure to harmful substances during pregnancy might trigger a genetic mutation that leads to autism in her child. Notably, there is no evidence to support a link between autism and vaccines, including those that contain thimerosal, a mercury-based compound. 

RISK FACTORS:

The factors that increase the likelihood of developing Autism Spectrum Disorder include: 

• Advanced parental age at the time of conception.

• Having a sibling with ASD.

• Genetic conditions.

• A very low birth weight.

• Prenatal exposure to air pollution or certain pesticides.

• Any birth difficulty that may lead to oxygen deprivation in the baby’s brain.

• Maternal obesity, diabetes, or immune system disorders.

POSSIBLE COMPLICATIONS:

Some complications related to Autism are as follows:

• Gastrointestinal (GI) problems: Children diagnosed with autism tend to suffer from a higher incidence of gastrointestinal symptoms such as stomach ache,  constipation, and diarrhoea in comparison to their non-autistic peers.

• Epilepsy: Seizures are more likely to occur as one grows older, with the greatest number of seizures happening during adolescence.

• Malnutrition: It has been found through studies that people with autism tend to have restricted choices in food, which can result in inadequate intake of nutrients.

PREVENTION:

Currently, there is no known way to prevent Autism. Early detection and screening may help lower the impact of autism. These include:

• Genetic testing.

• Testing for congenital hypothyroidism.

• Avoiding smoking during pregnancy.

• Protecting yourself from air pollutants.

• Eating healthy and nutritious food.

• Avoiding high thermal-intensity ultrasound.

WHEN TO SEE A DOCTOR:

It is advised to consult a doctor as soon as you notice any signs or symptoms of autism in the child.

DIAGNOSIS:

Diagnosis in young children:

• Developmental monitoring: Developmental monitoring is a crucial process that involves actively observing a child's growth and facilitating discussions between parents and providers. The primary objective is to determine whether the child is meeting the standard developmental milestones such as playing, learning, speaking, behaving, and moving, which most children attain by a specific age. This process is continuous and requires consistent attention to ensure that the child is developing normally.

• Developmental screening: Developmental screening is a process that assesses the progress of your child's growth and learning. It is a regular part of some doctor visits, regardless of any existing concerns. The American Academy of Paediatrics (AAP) recommends that all children undergo developmental and behavioural screening during regular doctor visits at 9, 18, and 30 months of age. Additionally, it also recommends that all children be screened specifically for ASD (autism spectrum disorder) during regular doctor visits at 18 and 24 months of age. The screening questionnaires and checklists are based on research that compares your child's development to that of other children of the same age. During the screening, the doctor will evaluate your child's language, movement, and thinking skills, as well as their behaviours and emotions.

• Developmental diagnosis: A brief screening test is not sufficient to diagnose developmental problems in children, but it can indicate if they need further evaluation from a specialist. If the screening test identifies any areas of concern, a formal developmental evaluation may be required. This evaluation is a more comprehensive assessment of a child's development, and it is usually conducted by a trained specialist such as a developmental paediatrician, child psychologist, speech-language pathologist, occupational therapist, or other expert. The specialist may observe the child, conduct structured tests, ask questions to parents and caregivers, and have them fill out questionnaires. The evaluation results will determine the child's strengths and weaknesses and help identify whether they meet the criteria for a developmental diagnosis.

Diagnosis in older children and adolescents: In school-going older children and adolescents, caregivers and teachers are usually the first to identify symptoms of Autism Spectrum Disorder (ASD). These caregivers may consult healthcare providers regarding their child's social issues, which may include difficulties with subtle communication. For instance, a few children may have trouble interpreting tone of voice, facial expressions, or body language; older children and adolescents may find it hard to comprehend figures of speech, humour, or sarcasm, which may also hinder their ability to form friendships with peers.

Diagnosis in adults: Identifying ASD in adults is often more challenging than in children. This is because some of the symptoms of ASD in adults can overlap with those of other mental health disorders like anxiety disorder or ADHD (attention deficit hyperactivity disorder). To diagnose ASD, the doctor will examine the individual's social interaction and communication challenges, sensory issues, repetitive behaviour and restricted interests. Additionally, the doctor may speak with caregivers or other family members to gain knowledge about the person's early developmental history, which can help ensure a precise diagnosis.

TREATMENT:

The following are the types of treatments available for Autism Spectrum Disorder (ASD), which aim to reduce the impact of the symptoms that hinder daily activities and negatively affect one's quality of life.

Medications: An expert in child psychiatry can examine a child to determine if they have any other mental health issues and decide if medication is required. For instance, medications such as aripiprazole and risperidone can be used to reduce irritability associated with autism. These medications have been approved by the Food and Drug Administration for treating irritability associated with autism. Medications may help a person with ASD have lesser irritability, aggression, repetitive behaviour, hyperactivity, attention problems, anxiety, and depression.

Other approaches:

• Behavioural approach: This involves a structured approach to studying a child's functional challenges and creating a behavioural plan to improve adaptive skills and decrease inappropriate behaviour.

• Developmental approach: Developmental therapy is focused on improving language and physical skills. The most common form of developmental therapy for individuals with ASD is speech and language therapy, which helps to enhance the person's understanding and use of speech and language. While some individuals with ASD communicate verbally, others may use signs, gestures, pictures, or electronic communication devices to communicate. Additionally, physical therapy can be beneficial in improving physical skills, such as fine movements of the fingers and larger movements of the trunk and body.

• Educational approach: In most cases, these therapies take place in classrooms. The instructors can suggest modifications to the classroom environment to enhance academic and other achievements. For example, visual reminders of daily routines can be created and displayed prominently. Learning areas can be defined with boundaries, and teachers can use visual aids or demonstrate procedures to supplement verbal instructions.

• Social-Relations approach: This intervention helps children with autism improve their ability to navigate social situations. It focuses on improving social skills and building emotional bonds.

• Occupational therapy: This involves addressing adaptive skills deficits with activities of daily living, as well as problems with handwriting.

• Parent management training: Parent support groups help parents learn effective ways of responding to problematic behaviour and encouraging appropriate behaviour in their child to cope with the stress of raising a child with autism.

• Treating co-occurring conditions: Children who have autism are more prone to experiencing insomnia, ADHD, intellectual disability, anxiety, and depression than children without autism. It is imperative to address these issues as they can have a significant impact on the child's overall well-being. Proper treatments such as psychotherapy or medication can help alleviate the effects of these conditions. The treatment usually involves coordination with a paediatrician or primary care clinician.

LIVING WITH:

Many people who have Autism and their families face daily challenges. However, improving their overall quality of life can be achieved through finding resources and planning for the future. It is essential to maintain proper health by eating healthily, exercising, getting optimum rest, drinking enough water and having doctor consultations, including regular physical and dental check-ups.

To discover local resources or special programs, you can contact your healthcare provider, local healthcare department, school or autism advocacy group. Additionally, participating in an autism support group and sharing information and experiences can be beneficial for individuals with ASD and their caregivers to learn about treatment options and ASD-related programs.

It is recommended to keep a record of conversations and meetings with healthcare providers and teachers. This information may help decide which programs and services are appropriate for the individual with ASD. Keeping copies of healthcare reports and evaluations is also recommended, as this information may help individuals with ASD qualify for special programs.