Autism is a familiar term in today’s world due to the increase in the number of kids with this condition. Leo Kanner coined the term ‘autism’ in the year in 1944. Kanner termed it as ‘infantile autism’ at the beginning.He noticed this condition becoming evident in kids during their early years of life, predominantly within the first 5 years. The term ‘AUTISM’ is rooted in the words ‘auto, meaning ‘self’ or ‘locked within themselves. Thus, we can get the sense that these individuals try to keep things to themselves. They are not very good at expressing their thoughts verbally. Yes, autism is all about that.
Firstly, autism does not have a proper definition. It is condition that is heterogeneous in nature (having multiple reasons), neuro-developmental, with early difficulties in social communication and unusually restricted and having repetitive behavior and interests. Autism known as, ‘Autism Spectrum Disorders’, meaning there is a range of other conditions that can overlap with autism, hence making it difficult to arrive at a proper and singular form of diagnosis. Autism is a developmental disorder and therefore areas of the brain responsible for social interaction and communication skills are impaired or not properly developed. It also affects them in many ways like having difficulties making sense of the world around them.
AUTISM SPECTRUM DISORDER (ASM):
The autism spectrum of disorders includes three main conditions namely pervasive developmental disorder (PDD), autism by itself, and Asperger’s syndrome while all three of them share certain common symptoms, they vary in the sense of how they present in the patient.
The major symptoms include of the three disorders include,
- Impaired social interaction
- Impaired communication
- Restricted repetitive, stereotyped patterns of behavior or interest and activities.
Presentation of autism,
The only difference detected so far is the variation of the combinations in which they present.
- Pervasive developmental disorder (PDD-NOS) mostly presents as any one of the above said 3 main symptoms.
- Whereas autism and Asperger’s syndrome present as a combination of all the 3 symptoms.
People tend to fall on a continuum from mild to severe deficits in all these conditions.Therefore autism cannot be given as the perfect diagnosis and proper tests are done before ruling out the other conditions.
PREVALENCE OF AUTISM:
- Autism affects almost 2-6 per 1000 individuals in the world, which makes it a pretty common condition.
- This condition affects more than one and a half million people worldwide. It is 4 times more prevalent in men than women.
- Autism doesn’t have any racial, ethnic, or social boundaries.
- 70% of people with autism have associated co-morbidities.
- The mortality risk of autism is 2.8% higher than unaffected individuals of the same age and sex. Other co-occurring conditions also play an important role
ETIOLOGY AND CAUSES OF AUTISM:
- Genetics plays a very important role in autism followed by certain early environmental factors. Autism is a condition that is on the rise in today’s world. Children born to parents (especially fathers) who work in the IT (Information Technology) sector are found to be affected more commonly than others, according to a study published in 2014.
- Generally, autism is more common in monozygotic individuals than in dizygotic twins (monozygotic- twins who develop from the same egg, share the genetic material, are identical and always resemble one another; dizygotic (fraternal twins)- twins who develop from two different eggs, are of different sexes, share half of the genetic material). Apart from this, siblings of autistic children show a 2% prevalence of autism.
- The causes of autism includes, post-natal or post-birth neurological infections like Fragile X syndrome ( a particular form of the genetic disorder with certain intellectual disabilities)
- Peri-natally or factors that revolve around the periods of pregnancy include maternal bleeding due to any reason at the period of 1st trimester and the presence of meconium in the amniotic fluid during pregnancy.
- Low birth weight and pre-term delivery increase the overall risk of neurodevelopmental injury.
- About one-third of the individuals have elevated plasma serotonin levels in their blood
- Psychological and emotional factors include parental rejection, issues in the family, stress from the family, a breakup of the parents, communication issues with the parents, fixation issues in the pre-symbiotic phase that creates a form of barrier between self and others.
- Advanced paternal or maternal age
Other factors responsible include,
- Certain conditions of the mother during pregnancy like diabetes mellitus, thyroid issues, hypertension, obesity, etc.
- In-utero risks like exposure to anti-epileptic or anti-psychotic drugs, certain infections of the mother
- Issues like residing in an area with high air pollution or exposure to pesticide
Apart from these,
- ‘Theory of mind’ which explains that the individual might be ‘mind blind’ in the sense that they lack the ability to put themselves in the place of others, they cannot look at things from other’s perspective which proves as a major issue and causes all the communication problems they face.
- An enlargement of the lateral ventricles and some cerebellar degeneration is seen. (cerebellum is the part of the brain responsible for most of the motor activities)
SIGNS AND SYMPTOMS:
Early detection is very important for early intervention. Autism can be easily detected in the childhood years. Certain symptoms include,
- Being non-responsive to verbal cues, even to his or her own name
- Difficulties in expressing one’s needs and emotions instead, they just kind of point out things they need
- Atypical visuomotor exploration and extremely attached to objects (non-living things) than humans
- Children with autism often have tantrum throws. Stress and distress is very common in people with autism.
- They make very little or almost no eye contact while trying to establish a communication
- Most of the time, they prefer to be aloof
- People with autism have difficulties expressing affection. They prefer not to be hugged or act cuddly
- They either prefer to be physically over-active or almost does nothing
- Very resistant to changes and almost never like them. Have a difficult time adapting to changes if any.
- Usually indifferent to normal methods of teaching
- Repetitive in nature. Either they keep on saying the same words over and over or keeps on doing the same thing.
- Inappropriate laughing or giggling might be present
- They have problems in communication therefore making friends with others is a tedious task for these people
- Most importantly, they express no fear of obvious danger.
- Echolalia (repetition of other’s phrases or words) may be present
- They have an excellent memory. The theoretical part of knowledge is good but they face trouble applying what they learned when it comes to facing general issues
- Some of them might enjoy any form of art, music, paintings, etc. For instance as in Savant’s syndrome (might occur in combination with autism or individually)
Effective and timely diagnosis plays an important role in helping the physician manage autism.
Several tools are used to arrive at a proper diagnosis. We have to rule out other conditions and arrive at the diagnosis.
Some of them include,
- The modified checklist for autism in toddlers
- Pre-linguistic autism diagnosis observation schedule
- Positive screening
- Revised autism diagnostic interview
- Childhood autism rating scale
Autism is divided as follows,
GRADE 1- Autistics who require minimal support
These people are a group that might have difficulties in initiating social communication. They might appear less interested in social interactions and might not communicate in complete sentences.
GRADE 2-Autistics who require substantial support
These are people who have marked deficits in verbal and non-verbal communication skills. They might need support in place and speak in very small and simple sentences and they might have a very narrow range of interests. Their way of communication exposes the underlying autism.
GRADE 3- Autistics who require very substantial amount of support
Severe deficits in verbal and non-verbal communication skills cause severe impairments in functioning, very limited initiation of social interactions.
It is important to know that there is no established way of treating autism. Autism is a condition which the individual has to carry for a period of a lifetime. All that can be done is early diagnosis and managing them properly and effectively since this can improve the quality of lifestyle in these people. According to studies, almost 58%-78% of autistic individuals have very poor outcomes in terms of independent living, employment, education, and peer relationship.
Drugs are only effective in managing the co-morbid conditions in these patients.
Certain forms of intervention include,
- Applied behavioral analysis
- Treatment and education of autistic and related communication handicapped children
- Music therapy
- Developing child-directed modules
- Sensory integration therapy
- Picture exchange communication system
- Prompts for re-structuring oro-muscular phonetic targets
- SCERTS (Social Communication Emotional Regulation Transactional Support) model
- Auditory integration therapy.
Let’s take a look at some of the forms of therapy in detail.
Music therapy is one of the treatment modalities commonly used to treat Autism spectrum disorder. It is used as a tool to express the autistic person’s physical, emotional, cognitive, and social needs.
This usually uses simple words, repetitive phrases and sometimes even uses non-sense terms in a repeated manner. This way the language is very much improved in these individuals
Usually done in a very protective setting. The music therapist is a trained individual in both kinds of music (vocal and instruments) and handling autistic individuals.
They carry out the therapy by means of singing, dancing, playing music, and making the individual listen, and sometimes even use creative music. The session usually starts with a greeting song with words like hello, hi, good day, etc. followed by mentioning each person’s name individually.
This trains the person to introduce him/herself on their own in the long run. In addition certain forms of musical instruments can . Initially, it would be difficult to make the individual sustain even for 30 minutes.
They might not remain focused and keeps on going from one instrument to another but as days progress they might sustain for a longer time like about 45 minutes to about an hour without changing instruments and throwing any form of trouble.
Therefore music therapy,
Helps the individual finds a way to express him/herself. They usually start expressing them by means of humming, shrieking, and even shouting at times. Using visual and tactile cues might further facilitate the process and this provides a platform and the freedom to discover and express their selves. The ultimate aim is to provide the pleasure of emotional satisfaction. This therapy should try its best to tend to the needs of every individual. Since this does not depend on speech it is better for individuals with autism to express themselves well.
- A study done and published in the year 2017 by MÖSSLER ET AL concludes that ‘Music therapy can go a long way in improving the social communication of children with autism’
- In conclusion this beautiful form of art can even cure conditions like autism
Pre-planning the therapies among the physicians take place. After planning the various forms of treatment they draw a final treatment plan that has to be carried out. Finally, a lot of patience and perseverance needs to go into executing the treatment plan in order.
It is important to understand that a few of these forms of intervention is still under research. Meanwhile, trials await approval to be used in patients.
To sum up, there is no evident way of preventing autism. All that could be done are proper and early diagnosis and managing autism effectively. Autism needs a lot of support and effort for these patients, to provide them a better quality of life.