U MAR is a six-year-old boy whose mother is a civil servant and father, a successful businessman. He is yet to speak in a meaningful way. He is often pre-occupied with his own world, playing alone and does not seem to show any emotional attachment to the parents or his older siblings. He is very rigid about the order of doing his things and will become terribly upset whenever his routine is changed. He would start banging his head against the wall or biting his hand while screaming continuously. He also loves to watch things that are rotating such as the ceiling fan, and can spend hours, just watching the ceiling fan or any object that is turning or spinning without getting tired. Some of the family friends think he is just a spoilt child who likes to get his way, but the parents are becoming more worried, especially due to his poor speech and emotional detachment. Otherwise, Umar’s physical growth and appearance have been normal. This article is in commemoration of the World Autism day (April 2).
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 Umar 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 Umar in the example 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, Umar may not understand the difference between a sad face, a happy face and an angry face. He 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 every child with autism is uniquely different. 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 etc.
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 minimise the impact of their difficulties while identifying and maximising 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 behavioural therapies provide assistance with difficult behaviours. Hypersensitivity to sounds for example can also be minimised by use of headphones. Additional medical problems may be treated with medications. In summary, a multi-disciplinary approach involving different specialists is often required.
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