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Autistic or Not!!

Autism spectrum disorders as they are now called,are characterised by early onset of a cluster of difficulties in reciprocal social interactions and communication and repetitive behaviours or interests. They are particularly striking because of the contrast between extraordinary consistency across individuals in some behaviours, and marked differences in others.

The most characteristic aspects of the autism spectrum concern difficulties in reciprocal interaction and the ability to form relationships. In the preschool years, children with autism can be differentiated from children who have mental retardation or language delay by their lack of interest in other children, a limited range of socially directed facial expressions, and unusual eye contact. Children with autism are less likely to comfort others (such as bringing a baby sister her blanket) and may not seek to share enjoyment in an event, such as the sight of a favourite animal. Most children with autism spectrum disorders do not show deficits in all these areas, and many gain some social behaviours as they grow older. These children have difficulty carrying on conversations, although they may ask questions about preoccupations or forthcoming events. Some children are talkative, often with repetitive speech that is more of a monologue than socially directed communication. Other children speak only rarely, primarily to ask for things.

An unusual and an intense preoccupation with ‘sameness’ such that no change is possible without them throwing a tantrum is seen. For example, some insist on taking only a certain route to school, entering the supermarket only by one specific door, or never stopping or turning around once the car starts moving. They also have a special liking for spinning objects like tops, washing machines and rotating fans.

An expert in the field of child psychiatry is generally in a better position to diagnose these children and give the parents and children the required guidance. A detailed interview with the caregiver regarding the history mostly helps in diagnosis. There are certain standardized assessment tests which help in assessment of autism.These tests contain a series of questions which are put forth to the caregiver and depending on the scoring, the diagnosis is made.

Early identification of ASD is now considered to be the aim, because it avoids unnecessary medical shopping for parents and provides chances for early guidance and genetic counselling and starting early interventions. If parents are observant, they can note the signs as early as 9–12 months which may include difficulties orienting to social stimuli (e.g., less looking at people or faces and less responsiveness to name) or less babbling, with a limited understanding of spoken language and limited gestures to express social interest or to draw attention to some object of interest in the environment. These difficulties may become more obvious in the second year of life.

Regarding management of these children, it is necessary to first explain the condition to the caregiver, counsel them about the longstanding nature of the disorder and emphasize on the importance of continuing therapy. Language and communication skills training and occupational and behavioural therapy are important for these children. Medicines are generally not given to these children unless it is to control their aggression and irritability.

There is no cure as such for autism but with early interventions, these children can be trained to adapt themselves to meet the social demands.