Though autism spectrum disorders (ASDs) are a set of developmental disorders affecting a person’s social skills; it was a terra incognita for even most doctors till the eighties of the twentieth century. In fact, many well informed people learned the word ‘autism’ when the film Rain Man released. It is a range of neurodevelopmental disorders which primarily impact an individual’s ability to communicate leading to a host of difficulties in everyday life. You should be aware that this set of disorders is not limited to any racial group or religious sect, and does not reflect economic or social status. In the previous century, autistic people were thought to be touched in the top story, or just plain dumb.
ICD-10 and DSM-IV direct doctors to list as many disorders as are required to clearly indicate the patient’s health status. Therefore, it is vital to understand the difference between disorder and disease. Put into simple layman’s language, DSM-IV clearly indicates that while disorder is non-communicable, i.e. it cannot be transmitted from one person to another; many diseases are contagious and can be transmitted from one person to another. Perhaps the biggest differential between them is that usually what might cause or have caused a disease —the underlying factors —are known. With disorders, the etiology is normally clouded. They present with a bunch of symptoms which cannot be rationalized by any prevalent condition in every patient afflicted by it. It is this latter aspect which makes the identification of ASD so challenging, especially in adults.
Some childhood ailments like Asperger’s Syndrome and childhood disintegrative disorder have been merged into the autism spectrum disorders in the ICD-10 CM and DSM5, since symptoms like difficulty, or significant delay, in acquiring verbal communication skills as in Asperger’s Syndrome are common. Asperger’s is thought to be a mild form of autism. The more alarming disorder in children is the childhood disintegrative disorder (CDD), also known as Heller syndrome. In such cases, children grow, and develop motor control and social skills like speech, understanding what is being said to them, etc. till the age of three or four. Then, they lose all these learned skills over a period of a few months. The root cause of this sudden loss has still not been fully understood. Research seems to indicate that such loss could be rooted in the neurobiology of the afflicted child’s brain.
Unlike Down’s Syndrome, there seems little chance of ASD being a hereditary disorder. Another disorder which is now clubbed in ASD is the pervasive developmental disorder not otherwise specified (PDD-NOS) in which most noticeable are delayed motor and language skills, and an absence of imaginative activity such as pretend play with toys, or having imaginary friends. Rett’s Syndrome is similar to CDD, but affects only girls. Unfortunately, since girls are expected to be quieter, and contented even if left to their own devices; this disorder does not get identified till the child is ready to go to school, when lack of hand movement and gait impairment becomes noticeable. Since they are unable to communicate verbally, or through expressive hand movements; such girls’ intellectual abilities are often underestimated, or not realized.
Autism is not a single disorder. The sheer diversity of symptoms, their severity, and variety make autism a spectrum of disorders. Further, with autistic children displaying such a variety of symptoms, it can become challenging to estimate the disorder’s severity, especially in a high performing adult.
The probability of finding two ASD patients who display identical symptoms is very slim. This is one major reason why the etiology, and progression of the ailment is so challenging to trace. Since it is a developmental disorder, the degree to which any child is affected becomes difficult to identify till two years of age, especially since children grow and develop at their own pace, and some are late bloomers. Few people will find it strange if their baby does not make eye contact, or does not respond to silly baby talk. Yet, quite often those are the very symptoms — unwillingness to interact with others —which indicate that baby might have ASD. You should consult a doctor when your baby does not appear to listen or hear what is being said, or even respond to her/his name when called. It could be deafness, or a sign of ASD. An older patient might speak at great length on a topic without any concern whether or not the audience is interested.
Quite often it is difficult for parents to realize that baby might not have learned to speak due to some developmental issue. This usually shows up as baby not babbling when learning to speak. Rather, such a baby might keep repeating the same word ad nauseum after learning a new word. Even when language skills begin to be acquired, they don’t quite match their peers. This results in their inability to express their thoughts or feelings, or reliably respond to questions. They might speak in a monotone or a singsong manner. The degree of early brain development will impact how people learn to communicate with each other as well as their intellectual ability. It might emerge as over reacting to certain stimuli due to an inability to shut out those which are irrelevant, while completely ignoring others. Though shiny objects might catch their attention, they may not have properly developed sense perception. Therefore, such children might need to taste or smell things to identify them.
Some people don’t like to be touched or cuddled. If your child seems to get irritated when given a hug, and tries to wriggle out, then you should worry. The most common symptom of such children seems to be the inability to grasp new information, or correlate it to everyday life. Another common symptom is fear or distrust of strangers, and difficulty in making friends. If your child gets upset —screams, shouts or cries inconsolably —when the routine is disrupted; has difficulty in persisting with any activity; has either difficulty in memorizing anything, or has a photographic memory; performs daily activities desultorily, or is a perfectionist, and refuses to do anything which she/he can’t perfect —you need to consult a doctor. Limited focus, or excessive focus on a topic; dissonance between speech and facial expressions; failure to pick up non-verbal cues like tone of voice, excellence in maths, science, music (genius syndrome); flap hands, or rock their body; and very marked food preferences —these are all signs that your child might suffer from some form of autism. The one sign which is the most worrisome is the tendency to cause self-harm like banging their head against a wall, or biting, if her/his schedule is disrupted, or something happens which contrary to expectation. When allied to temper tantrums, aggression, sleep disturbances, and impulsive actions, then you know you need expert guidance.
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