CCT, FRCPCH , MRCPCH, Diploma in Child Health (DCH), MBBS
Delayed Speech: Can it be autism?
Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behaviour. Males are four times more likely to have an ASD than females. A recent study in US found 1 in 68 children suffering from autism.
What are some common signs of autism?
The hall feature of ASD is impaired social interaction. As early as infancy, a baby with ASD may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with ASD may appear to develop normally and then withdraw and become indifferent to social engagement.
Children with an ASD may fail to respond to their names and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behaviour. They lack empathy.
Many children with an ASD engage in repetitive movements such as rocking, or self-abusive behaviour such as biting or head-banging. They also tend to start speaking later than other children. Children with an ASD don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favourite topics, with little regard for the interests of the person to whom they are speaking.
Children with characteristics of an ASD may have co-occurring conditions, including Fragile X syndrome (which causes mental retardation), tuberous sclerosis, epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. About 20 to 30 percent of children with an ASD develop epilepsy by the time they reach adulthood.
How is autism diagnosed?
Very early indicators that require evaluation by an expert include:
• no babbling or pointing by age 1
• no single words by 16 months or two-word phrases by age 2
• no response to name
• loss of language or social skills
• poor eye contact
• excessive lining up of toys or objects
• No smiling or social responsiveness.
If you find any of these features in your child, please consult the local pediatrician or child neurologist if available who can assess your child in detail. There is no single blood test to diagnose autism. However, the doctor needs to look into certain disorders in which children have similar features or having features of autism in addition to other signs of that disorder. E.g. Tuber sclerosis, Landau-kleffner syndrome (a form of Epilpesy), other childhood epilepsies, some metabolic and genetic disease. So your doctor may do some blood test, hearing assessment, EEG, etc. depending upon the presenting features and assessment.
What role does inheritance play?
Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected. In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population.
Do symptoms of autism change over time?
For many children, symptoms improve with treatment and with age. Children whose language skills regress early in life (before the age of 3) appear to have a higher than normal risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with an ASD may become depressed or experience behavioural problems, and their treatment may need some modification as they transition to adulthood. People with an ASD usually continue to need services and supports as they get older, but many are able to work successfully and live independently or within a supportive environment.
How is autism managed?
There is no cure for ASDs. However, it is important to diagnose it early and look for associated conditions like ADHD (Attention deficit hyperactive disorder), Epilepsy, sleep disorders, etc. Earlier is intervention, better is the outcome. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children.
Educational/behavioural interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as Applied Behavioural Analysis. Family counselling for the parents and siblings of children with an ASD often helps families cope with the particular challenges of living with a child with an ASD.
Medications: Doctors may prescribe medications for treatment of specific autism-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioural problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.
Other therapies: There are a number of controversial therapies or interventions available, but few, if any, are supported by scientific studies. Parents should use caution before adopting any unproven treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child’s nutritional status is carefully followed.
Conclusion: Autism is seen commonly now a day. The main features are delayed speech, poor eye contact and social interaction and restricted interest with repetitive behaviour. Parents and physician should aware of its early symptoms so that early intervention can be started.