Agnes is five years old, but is yet to speak in a meaningful way. She tends to use a limited number of words and often uses ‘you’ when she means to refer to herself and then uses ‘I’ when referencing others. Unlike the older two children of the family, Agnes is often pre-occupied with her own world, playing alone and does not seem to show any emotional attachment to the parents or her siblings.
She is however, very rigid about the order of doing her things, or the use of a regular routine. She becomes very upset whenever her way of doing things is changed, even a little bit, and would start banging her head against the wall or biting her hand while screaming continuously. She also loves to watch things that are rotating such as the ceiling fan, and can actually spend up to an hour in one position just watching the ceiling fan or any object that is turning or spinning without getting tired. Some of the family friends think she is just a spoilt child who likes to get her way but the parents are becoming more worried, especially due to her poor speech and emotional detachment. Otherwise, physical growth and appearance have been normal.
What is Autism?
Autism is a developmental disorder of childhood which is not evident at birth or early in life, but only becomes obvious as the child grows older and you begin to expect the child to attain certain skills and behaviours. So, the failure to attain these skills, as well as the evidence of certain patterns of behaviour during the development of the child is what makes it clear that the child, such as Agnes above, may have some difficulties. This is why it is called a developmental disorder – a problem that only becomes apparent over time and in the course of expected development.
What are the symptoms of autism?
Common symptoms are usually in three categories. 1). Communication and language challenges. 2). Difficulties with social behaviour and 3). Lack of flexibility and a rigid preference for the same routine. Several children with autism have challenges such as a delay in acquiring meaningful speech as we saw with Agnes above. They may also have difficulties understanding others or communicating their wishes. This often leaves them frustrated and may result in their throwing tantrums or banging their heads.
The social difficulties often derive from their inability to understand other people’s emotions and how to respond appropriately. For example, Agnes may not understand the difference between a sad face, a happy face or an angry face. She would not understand for example, that if mummy is crying, it means she is sad. Thus, the child may appear emotionally cold and detached. They may consistently avoid looking at people directly, which also appears odd.
Other common problems include love for fixed routine, such as the use of the same cup, plate or spoon; or following the same pattern of activities after returning from school every single day, without any change. Attempts to change the routine will result in a severe emotional reaction and tantrums. This aspect may explain why some people think the child is just spoilt. Some children with autism may also be highly sensitive to sounds, light or have some special dietary problems.
It is important to note that autism is a spectrum of symptoms and not every patient is exactly the same. Some may be severely affected by all the different types of problems, while some others may only have minimal problems, such as being very awkward socially. Some of these children may be particularly brilliant – almost like a genius in a narrow area of functioning, such as calculation, music, solving codes and puzzles e.t.c.
What are the causes of autism?
Many factors are thought to play a role in the development of autism, but they ultimately result in a disorder of brain development and functioning – especially the ‘wiring’ of the brain which regulates emotional behaviour and communication.
What can be done for these children?
The single most important goal of therapy for children with autism is to minimize the impact of their difficulties while identifying and maximizing the unique potential of each child. So, it is important to have a good evaluation and assessment, followed by providing education to the parents/caregivers.
It is important to carry the parents along and respond to their own emotional needs too, such as feelings of guilt, disappointment or despair which may occur. Speech and language therapy may help them to improve their communication skills while behavioral therapies provide assistance with difficult behaviours. Hypersensitivity to sounds for example, can be minimised by using headphones. Additional medical problems may be treated with medications.
In summary, a multi-disciplinary approach involving different specialists is often required.
The single most important goal of therapy for children with autism is to minimise the impact of their difficulties, while identifying and maximising the unique potential of each child.