Umbrella of Autism Spectrum Disorders (ASD)

Autism Spectrum Disorders also known as Pervasive Developmental Disorders, is an umbrella term for a range of neuro-developmental conditions that usually begin in infancy (the first or second years of life) and affect the growth and development of the brain. This causes severe impairments in functioning in many areas of development and also hamper the adaptive skills of the child.

One-third of children exhibiting ASD also have Intellectual Disability(ID) which makes it very difficult to distinguish between the two. But there are important differences to note. Children with ID score poorly on all parts of an intelligence test, but children with ASD may score poorly on the subtest related to language, such as tasks requiring abstract thought, symbolism. Children with ID are much more delayed in gross motor development but children with ASD quiet adept with swinging, or balancing. Children with ASD have a loss of social interests unlike in children with ID.

TYPICAL CHARACTERISTICS OF ASD:

• Communication deficits
  • Babbling (ba ba, da da) is less frequent than the infants of the same age group.
  • BY age 2, lag behind others in constructing one or two words sentences like “mommy go”
  • Echolalia is prominent and most often observed. The child repeats what is heard other person saying with remarkable fidelity. They may do it immediately or several hours later.
  • Pronoun reversal occurs. The child refers to themselves as “he”, “she”, or “you”.
  • Unable to express what they feel.
• Repetitive and ritualistic acts
  • Obsessional qualities in play are observed often from first year of life. lining of things e.g. Toy cars instead of expected manipulation of them).
  • Stereotypical behaviors (hand flapping, body rocking, twiddle their fingers in front of their eyes, stare at moving objects like fan) are self-stimulatory activities.
  • Self-injurious behaviors are also evident in ASD children with severe ID.
  • They find transitions and changes intimidating e.g. rearrangement of furniture, moving to a new house and may evoke fear and temper tantrums.

• Social and emotional disturbances
  • Play and social interactions
    • Lack peer interaction. Very rarely approach others to initiate play.
    • May be compliant and engage in play for short period when someone else initiate play. Few children may themselves initiate play.
    • Physical play such as tickling, wrestling not be enjoyable as it causes over stimulation for children with ASD.
    • Less engage in symbolic play (using a matchbox as telephone).
  • Attachments
    • Attachment is atypical and not absent. They rarely show attachment to friends, peers. Instead they form strong attachments to inanimate objects (keys, light switches).
    • Rarely approach others.
    • Rarely offer spontaneous greeting or farewell to the person greeting or passing by.
    • Lack social smile by first year
    • Poor eye contact. Even if made it is not of quality.

 CAUSES:

• Genetic: ASD have a significant heritable contribution. Chances in twins are higher. Also gene mutation can be a cause of ASD.
• Immunological factors: Maternal antibodies directed at the foetus can cause the neural tissue damage in gestation period. Though chances are very few.
• Perinatal and prenatal Factors: Maternal and paternal age at birth, gestational diabetes, complications during birth, low birth weight, birth trauma can be some of the causes

DISORDERS UNDER ASD:

• Autistic Disorder: is the most well-known of the disorders in ASD, often referred as Autism, has an onset before the age of 2.5 years. Children with Autism score usually score below 70 on standard intelligent tests, but often score better on visual spatial skills (putting together disassembled objects). Not only the downside many of them have isolated skills like multiplying two four digit numbers rapidly in their heads. Along with ID, deficits in communication, social interaction along with repetitive, stereotyped behaviors is observed, all of them that are typical of ASD.
• Rett’s Syndrome: is a very rare disorder only occur in girls, where a deceleration in child’s head growth is found after a period of 2 years of normal development, followed by the loss of ability of purposive use of and speech occurs. Hand wringing stereotypies, walking in uncoordinated manner, profound MR are typical characteristics, but may improve later in life.
• Asperger’s Syndrome: Child (more often boys) appears to be markedly clumsy, lack social interactions or peer relations, exhibit repetitive, stereotyped behaviors but there is no delay in language or cognition observed.
• Childhood Dis-integrative disorders: after at least 2 years of normal development a marked regression in several areas of functioning is observed. Significant loss of skills (language, play, social skills, motor skills, bladder or bowel control). Abnormal social functioning (reciprocal social interaction, communication, restricted repetitive stereotyped behavior pattern) is evident.

TREATMENTS FOR AUTISTIC DISORDERS

1. Parent Training: It focuses on facilitating social and communication development within home and during the activities by targeting important social skills for mastery. Other training focus on language acquisition.
2. Social Skills Training: These are provided by therapeutic leaders wherein the children are given guided practice in initiating social conversations, greetings, initiating games in group setting with peers. Emotional identification and regulation include practicing of how to recognize and labeling the emotions.
3. Psychotherapies: Behavioral Interventions help reduce repetitive actions, recommended specially if are self-injurious and for insomnia problems in children with ASD done by changing the parents behavior towards the child during the bedtime and throughout the night. Also Cognitive Behavioral Therapy can be helpful reducing any anxiety or depressions symptoms if evident.
4. Drugs: Treatment with drugs(medicines) are mainly focused on controlling the behavioral symptoms of irritability, repetitive and stereotypic behaviors.
5. Educational Remedies: The educational plan may include a variety of teaching strategies like virtual teaching that may be appealing for the child with ASD. Also behavioral analysis and language remediation is considered.