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 Psychological & Emotional Health

April 2012
Understanding The Autistic World
Dr Maitry Pandya
The brain interprets for you the sights, sounds, smells, and other sensations, bringing you the bunch of experiences that you live through every moment of your life. If your brain couldn’t help you understand these things, you would have trouble functioning – communicating with people, feeding yourself, going to school, taking yourself to work and every other function.

Kids with Asperger’s syndrome or Autism face this very challenge.A lack of understanding of the world around them is life for them, and obviously, they react to what’s going on around them in unusual ways.

  • Autistic children do not relate to their environment in the same way as children normally do.
  • They have difficulty in understanding words and conveying their response.
  • They may be emotionally detached since their perception of feelings is different and they don’t understand its implications.
  • Human touch too is repulsive to them and they shy away from it.
  • Loud noises or noisy surroundings disturb them and they react by covering their ears - an attempt to muffle the noise.
  • They have difficulty expressing themselves and are frustrated by their loss for words. They flap their Understanding The Autistic World Dr Maitry Pandya hands, repeat certain words over and over again, resort to temper tantrums and even confine themselves to playing with one particular toy only.
  • They also may insist that their toys and other objects be arranged in a certain way and get upset if the arrangement is moved or disturbed. t Autistic children don’t like changes in their routine. They prefer a schedule that remains the same always.
  • The degree to which autism affects a child differs. Some children are affected mildly whereas others may have a severe case of autism and require intensive professional help.
Causes Or Issues Behind Autism
Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but it is a very active area of research. There are probably several combinations of factors that lead to autism. The genetic factor seems to be an important one while chromosomal abnormalities and neurological disorders too seem to play a big role

Warning Signs Of Autism
Most parents will notice that something is not right with their child when the affected child is aged two or three. In some cases, parents may pick up the signs even earlier. Some possible early signs of autism that a child displays are:
  • Does not babble, point, or make meaningful gestures by the age of one
  • Does not speak any words by the sixteenth month
  • Does not combine words by the age of two
  • Does not respond to his or her name
  • Loses language or social skills
  • Avoids eye contact
  • Doesn’t seem to know how to play with toys
  • Is obsessive about arranging toys or other objects in a particular fashion.
  • Is attached to one particular toy or object
  • Doesn’t smile
  • At times seems to be hearing impaired.
Watch Out Signs In Developmental Years

Suspect Signs - First Year:
There are certain milestones of development that the average child reaches within the first year of development. Some of these include standing with support by parents/ guardians crawling around, uttering single words, waving goodbye and other simple gestures. If these signs are not displayed within the normal time frame, parents need to be alert to the
possibility of autism

Suspect Signs - Second Year:
  • A lack of interest in other children and people
  • Lack of eye contact
  • Not pointing at objects that are wanted
  • Does not progress to use or framing of sentences of two words
  • Losing words or language skills that were already acquired
  • Repetitive behaviours such as hand flapping or rocking
  • Does not look at objects you are pointing to
  • Does not play pretend games
  • Walking on tip toes
Suspect Signs – Second To Fifth Year:
  • A lack of interest in other children and people
  • Lack of eye contact
  • Not pointing at objects that are wanted
  • Lack of or strange reaction to the distress of other children
  • Obsessed with certain objects, toys and games
  • Focus on order, routine and arrangement of objects
  • Distress when these orders, routines or arrangements are disturbed
  • Repetitive movements such as rocking, hand flapping, or spinning around
  • Sensitivity to loud sounds that normally don’t disturb other children
  • Sensitivity to touch i.e. disliking hugs or fabrics of certain clothes t Sensitivity to smell and taste
Suspect Signs – Pre-teen Years
In some cases, a child may be at the milder end of the autism spectrum and developmental delays may only become obvious in the pre-teen years. Some signs could include:
  • Lack of eye contact
  • Few if any close friends
  • Does not share or take turns
  • Lack of communication skills, or unusual ways of talking
  • Little use of non-verbal communication and gestures
  • Repetitive phrases and focus on limited range of topics
  • Does not show empathy toward others
  • Difficulties with the ‘give and take’ of conversation
  • Unusual gestures made when excited or distressed
Suspect Signs – Teen Years
In mild cases of autism or Asperger’s syndrome, developmental delays may become evident as late as in the teenage years too. Some signs of mild Asperger’s syndrome could include
  • Lack of eye contact
  • Apparent lack of emotion
  • Difficulty in establishing close friendships
  • Literal thinking and trouble with sarcasm, irony and subtle humour
  • Tendency towards obsessive and compulsive behaviours
  • Inappropriate comments or behaviour in social situations
  • Difficulty in understanding the views, emotions and needs of others
Manifestation Or Progression With Age
Autistic children display the progression of their condition in several ways.
  • Some children learn speech and/ writing, social skills and self-care on their own.
  • There have been instances where some children experience a miraculous recovery and behave normally either for no apparent reason or as a result of early intervention.
  • Autistic children become mainstreamed after years of hard work and intensive training.
  • Some children develop slowly.
  • There are a few who never move beyond a level of functioning that society perceives as ‘low’, yet others are fairly typical during childhood and report becoming ‘more autistic’ in adulthood.

Early Intervention
Early intervention applies to children of school going age or younger, who are diagnosed to have or be at risk of developing a handicap or other special need that may affect their development. Early intervention can either be remedial or preventive in nature and even the focus can be on either the child or on the parents. Early interventions seek to minimise delays towards achieving as normal a life as possible for the affected child.It is important to prevent a child from lagging in reaching normal developmental milestones.

Management Of Autism& Sensory Integration Therapy
An early, intensive and appropriate treatment programme will greatly improve the outlook for most children with autism. Treatment is most successful when it is geared towards the child’s particular needs. An experienced specialist or team should design the programme for the individual child. Autistic children may need to be institutionalized if the condition is severe. In severe cases they can be admitted to special schools, rehabilitation centres and pre-vocational centres.

Sensory integration therapy is very helpful for autistic children. SIT is a type of occupational therapy that places a child in a room specifically designed to stimulate and challenge all of the senses. The aim is to improve the ability of the brain to process sensory information so that the child will function better in his daily activities. During SIT the child interacts one-on-one with the occupational therapist and performs an activity that combines sensory inputs with motions. Examples of such activities include:
  • Swinging in a hammock (movement through space)
  • Dancing to music (dance)
  • Playing in boxes filled with beans (touch)
  • Crawling through tunnels (touch and movements through space)
  • Hitting swinging balls (eye-hand coordination)
  • Spinning on a chair (balance and vision) and
  • Balancing on a beam (balance)
A parent can integrate sensory integration into the home by providing many opportunities for a child to move in different ways and feel different things. For example, a swing set can be a form of sensory integration therapy as can a ball pit or a lambskin rug.

What Is Normal Life Like For An Autistic Person?
When parents find out that their child has autism, they often want to know if their child will be able to lead a “normal” life. Though it’s natural to want this for your child, it’s important that you feel proud of your child no matter what, and that you don’t place expectations on him or her. There are just so many differences in each case of autism that it’s impossible to predict how “normal” a person’s life will be. The good news is that no matter how “low-functioning” or “high-functioning” a child with autism is, there is help and hope for their future. The sooner a child begins to receive help, the more they are able to learn. Even so, no matter when your child is diagnosed, it’s never too late to start treatment.

Know Autism
  • Autism is an organic disorder affecting several areas of a child’s development.
  • Autism is present from birth, or very soon after, but the nature of the disorder can mean that diagnosis is delayed for months or years.
  • Early intervention can improve long-term function and help the families.
  • Infants with autism may display characteristic features of gaze, hearing, social development and play.
  • People working with infants and young children are in a prime position to recognize these characteristics and refer the family for specialized assessment.
  • Learning disabilities may or may not be present in children with autism.
  • Always listen to the parents. They often suspect something is wrong
    even though they may not be able to pinpoint.
Dr Maitry Pandya is Head, Dept of Occupational Therapy Apollo Hospitals Ahmedabad

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