Autism: A challenge

--Maj Gen Dr. AKM Safiullah Khan (Retd)

Autism is an emerging challenge confronting today’s world. The term “autism” is derived from the Greek word “autos,” meaning ”self,” It is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. Autism is used as a short name of a large group of disabilities called Autism Spectrum Disorder (ASD). The child is born normally without any complication of self or mother and grows up well having no disease or disability. With the advancement of age shows some difference from most of the children of similar age group. ASD includes:

Autism: This is characterized by delays or abnormal functioning before the age of three years in one or more of the following domains:

a) Sociability,,//

b) Communication//, and

c) Behaviour.

Asperger’s syndrome: This can be distinguished from autism by the lack, delay or deviance in early language development. In addition, individuals with this condition do not have significant cognitive delays.

Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS): This is characterized by milder symptoms of autism or symptoms in only one domain of autism.

Most of the people with villages and quite a number in the cities have a common belief that the condition is nothing but a socialization problem and the child will overcome it and he/she grows up and plays with normal children of the same age group. Though very encouraging, the notion is wrong. Many others think that this is the ill effect of some evil spirit which can be rectified by religious intervention like ”prayer, doa, tawiz”. This assumption is also not true, rather an early detection, proper assessment and intervention may improve the condition of a number of such children.

Cause and Distribution

No specific cause of ASD has yet been identified. However, it appears to be due to co-ordination problem of some of the intricate functions of different areas of the brain. So far, reliable record of its incidence and distribution are available in the USA, UK, Canada, Australia and Singapore only. ASD is increasing at an alarming rate. At present, one in every 150 children is believed to be suffering from this problem. World Autism Day is observed on 2 April every year since 2008 and from then, awareness about this in our country is increasing. The Government of Bangladesh has been giving due importance after the Dhaka Declaration in an International Conference on Autism Spectrum Disorders and Developmental Disabilities held on 25 July 2011 in Dhaka.

Detection

To date, no definite test or procedure can detect possibility of Autism in a child before or soon after birth. Early diagnosis of ASD is important. Autism speaks at different stages of early childhood. Possibility of ASD is strong if a child.

Does not smile or express feeling of joy by 6 months.

Does not produce babbling sound by 12 months.

Does not utter single word by 16 months.

Possibility becomes stronger if such a child can not speak a sentence of two words at two years of age or loses functional speech that he/she had before. At this stage, the child should be taken for proper assessment without any delay.

Assessment

Assessment is now carried out at various places in Dhaka such as the “Beautiftil mind at Uttara, Shishu Hospital, “Shishu Bikash Kendra at Mirpur and Matuail. After proper assessment, if early intervention is arranged, chance of improvement is fair.

In ASD, there is some deficiency in one or more of the three main fields of the development of personality namely sociability, communication, and behavior.

Sociability

When the child is affected by this, he does not respond or does not even look towards the person, does not speak or speaks inconsistently, repeats words or sentences without any reason or speaks past events as present one. Other features may include- removing face if one wants to take a photograph, playing alone with the same thing in the same way time and again and not sharing joys or sorrows with others.

Communication

It is difficult to communicate with the child, draw attention and exchange ideas. The child fails to make eye contact with others. It may be noted that both for communication and sociability, eye contact between the child and others are essential.

Behavior

There are various behavioural problems. They like or dislike particular sound, special environment or work, produce flapping of fingers, hand or leg like grasshoppers, press the eyes with finger, produce squinting of eyes, run around, get annoyed without any reason, throw things here and there, break items, make aggressive movements, yell, criy or laugh aloud quite often without any apparent reason. As quite a number of autistic children concomitantly suffer from epilepsy, such unusual. activities are often erroneously thought to be epileptic movements. However, these movements are the stereo typed movement of Autism.

Management

Although there is no cure for Autism, it can be well-managed. The main goal of management is to lessen associated deficits and family distress, to improve quality of life and functional independence. Treatment has to be tailored as per child’s needs. Intensive and sustained special education program and behavior there early in life can help children acquire self-care, social/and job skills. There has been increasing attention to the development of evidence based interventions for young children with ASD. A two pronged approach can be used for management of ASD. These are.

Home based general management

Under this approach, parents are at the focal point assisted by near relations and care giver. Parents who can create enabling environment for the management of their children would get the best result. If the mother is a housewife, she may take this responsibility as a challenge by giving maximum time and effort. Allah would certainly reward her. If she is a working lady, grandparents and other close relations can help the care giver who has to be properly trained. In such case, after return from workplace, the parents have to produce a pleasant atmosphere and give time to the child. They must remember that their children are very sensitive and. can grasp the situation even though they look inattentive. Unpleasant environment in the house produce deep sorrow in their mind which hamper their improvement. Despite scuffle between the couple, they have to keep a smiling face for the improvement of their child. Now, parents can acquire myriads of information from books, journals, articles, internet, seminars & workshops on autism.

Specialized management

This may be institution based or privately arranged with the specialists. There are many specialized institutions at Uttara, Gulshan, Bashundhara, Dhaka, Cantonment, Mirpur, Dhanmondi where integrated specialized management are imparted by psychologist, speech therapist, occupational therapist and physiotherapist. Part-time service of psychiatrist and pediatric neurologist are available there. Specialized management is also imparted by the specialists at their residence or at the residence of the child.

Symptomatic & Unconventional approach

Though there is no specific medicine for ASD in some uncontrollable cases, symptomatic treatment such as Weloperidol for over aggressive patients, Atomexitin (SUEV) for attention deficit hyperactive conditions may be tried. Alternative therapies such as herbal, homeo-medicines and acupuncture have also been advised and are claimed to show some positive results.

Some rays of hope

In the backdrop of helplessness in the field of medical treatment, there are some rays of hope. In a current research, it has been found that deficiency of a particular Amino acid in some cells of the brain is responsible for ASD and good result has-been seen by applying this in the brain cells of rats. Further study will show how much this is effective in human being.

Stem cell trams plantation is also claimed to give positive result. However this is also in experimental stage.

To sum up, it may be said that a proactive attitude by the parents is pivotal in the management of autism. A little sacrifice by them may produce wonderful result. Parents must be convinced that their child is the best and most invaluable. They must be happy with whatever they have. With close and constant attention, God willing their child with certainly improve.