There are general worries that we see more children served with autism in India. Estimated Prevalence of Autism Spectrum Disorder (ASD) in India is a variable, but shows a recent trend. It takes good quality epidemiological studies to estimate the true prevalence. In the US, the disease control center estimates the increase in the prevalence of around 1 in 44 children. This has increased from 1 in 69 children in 2014.
Children with ASD usually show difficulties in communication, socializing and behavior. General red flag for ASD including children who do not speak at the expected time, do not respond to names, display recurring behavior such as flapping weapons when vibrant, sensory behavior such as blocking the ear or staring at the lights. Children with ASD can show strong and unusual interest in certain objects and games can be unusual.
At this stage, our understanding of the causes of the underlying autism is limited. Genetic factors are identified only at around 20% of children with ASD. Often, we don’t know what causes ASD but there may be several known risk factors.
Early diagnosing autism is important because the problem areas can be identified and early intervention can be provided. At present there are no biological or genetic markers known for ASD. Therefore, diagnosing ASD is carried out with clinical assessment of development and behavior and applying diagnostic criteria. Sometimes psychometric judgment like cars is used to support or clarify the ASD diagnosis.
It is very important for experienced doctors to assess autism children carefully like children often come with other problems such as hyperactivity, anxiety and attention problems. In-depth assessment of development and behavior including multi-disciplinary assessment is needed for a holistic picture of children’s strength and difficulties. ASD diagnosis is not always easy. Other conditions such as reactive attachment can imitate autism and hence the need to evaluate this.
The Indian Association of Paediatrics (IAP) recommends screening all children at 18 months for ASD. Children start coming early but there are still many children who are present late.
It is important to understand that there is no cure for ASD but there are various interventions and evidence of improvement with initial intervention.
Interventions help improve communication, learning, socialization, integration and sensory behavior skills in ASD. This is provided by speech language therapists, early childhood teachers and therapists and special educator psychologists.
Children with autism have a wider problem with speech, i.e. Communication. Also, there are many developing communication skills before speaking which includes the intention to communicate, mutual attention, eye contact, pointing and movement. Communication strategies must overcome pre-verbal communication if this has not been established.
Children’s family profile diagnosed with ASD in Rainbow Hospital has several recurring themes such as nuclear families with one or both parents who work, and children may have increased screen time and experience social isolation. With a pandemic and its lock, the last two factors may have been intensified. The first thousand days of children’s lives are very important for the overall results of development. We know that children learn to recognize their mother’s faces, develop visual discrimination and hearing in the first year. In the context of migration and larger economic drivers, neglected children from their families are wider and increasingly placed in front of the screen and tablet. This raises the question of whether replacing human interaction and warm parents with Staccato, one-sided tone and excessive and visual cartoons that disrupt children’s development. Can this be a risk factor for autism spectrum disorders?