What is the current prevalence?
Estimated prevalence 1.12 (0.74-1.68) [INCLEN study, unpublished data]. Incidence of Autis spectrum disorder in males 1:42 whereas in females it about 1:189. This makes that every 1 in 68 children are diagnosed with autism spectrum disorder
Can you pick Autism at an early age?
One can think of Autism when there is absence of:
- Response to own name by 8 months
- Babbling by 12 months
- Gesturing (e.g., pointing, waving bye-bye) by 12 months
- Single words by 16 months
- Two-word spontaneous (not just echolalic) phrases by 24 months
- Loss of any language or social skills at any age
What are the symptoms required to diagnose Autism?
- Persistent deficiencies in social communication and interaction across settings
- Restricted and repetitive behaviors, interests, or activities
- Symptoms must be present early in childhood
- Symptoms limit and impair daily functioning
What are the salient diagnostic features in the social communication domain?
- Delayed social smile
- Impairment in eye-to-eye contact, facial expressions, body postures and gestures
- Lack of spontaneous sharing of enjoyment and interests with other people
- Poor social interaction
What are the salient diagnostic features in behavioral domain?
- Body rocking, finger twirling, hand flapping, spinning and tiptoe walking
- Fascination with certain numbers, letters, schedules, animate or inanimate objects, especially parts of a toy
- Inflexible adherence to nonfunctional routines or rituals
What are the other clues on history and observation?
- Visual: Seeing things from a particular angle
- Auditory: pretends to be deaf, clapping hand over their ears
- Olfactory: Sniffing objects
- Perceptual: Refusing to eat food with certain textures or tastes, mouthing of objects, compulsive touching of certain objects or textures, diminished response to pain, increased sensitivity to touch like the feel of running water, adversity to bathing
- Mood may be inappropriate to the situation or circumstances
- Uncontrollable crying or laughing
- May be oblivious to hazards or may have excessive fear of harmless objects
What are the co-morbidities?
Obsessive compulsive behavior, intellectual disability, epilepsy, vision & hearing problems, behavioral disorders, feeding disturbances, pica, sleep disturbances, abnormalities of mood, sensory deviance and hyperactivity (ADHD).
What are the sleep problems seen in autistic children?
40 to 80% of children with autism spectrum disorder have sleep problems like difficulty going off to sleep, frequent awakenings and decrease in total sleep time.
What is the cause for Autism?
The proposed mechanisms (still a mystery) include:
- Abnormal connectivity amongst the brain cells called neurons
- Defect in brain formation in a fetus at the microscopic level
- Neurotransmitter imbalance
- Abnormal mirror neurons
- Environmental factors like exposure to toxins , radiations etc.
How is Autism diagnosed?
Autism is entirely a clinical diagnosis. Initially DSM criteria (INCLEN: INAC-ASD) followed by CARS (Childhood Autism Severity Scale) to ascertain the severity.
What is the role of genetic evaluation in Autism?
Autistic children with abnormal head size (small/large), positive family history or dysmorphic features should have genetic consultation.
Whom should you consult?
Pediatrician or preferably a pediatric neurologist
Who are involved in management?
Family, Pediatric Neurologist, Clinical Psychologist, Geneticist, Special educator, physical, occupational and speech therapist
What is the role of genetic counseling?
It is known to have multi factorial inheritance. Risk in siblings is around 7% if the affected child is a girl and 4% if the affected child is a boy. If a second child has Autism, risk increases to 25–35%. Almost 2–3% of families have more than one affected children.
What are the key points in training a child with Autism?
- Use visuals, avoid long strings of verbal instruction
- Encourage development of child’s special talents
- Use child’s fixations to motivate school work
- Use concrete, visual methods to teach number concepts
- Protect child from sounds that hurt his/her ears
- Place child near a window and avoid using fluorescent lights
- Interact with the child while he/she is swinging or rolled in a mat
- Don’t ask children to look and listen at the same time, Teach with tactile learning materials (e.g., sandpaper alphabet), Use printed words and pictures on a flash card.
Source: Information Booklet on Autism