It is important for parents to realise that autism is not a disease like a specific bacterial infection which can be eliminated with a course of antibiotics
BY DR ROZANIZAM ZAKARIA
APRIL has globally been recognised as the month of autism awareness. With this year’s theme, “Inclusion in the Workplace”, our attention is drawn to the long journey of raising awareness regarding this condition, which is still commonly misunderstood by many.
Autism, or in medical terms known as an autism spectrum disorder (ASD), refers to a condition that affects the development of the brain in the early stages of childhood. There are two main groups of symptoms of autism, namely deficits from the aspect of social development and communication; and challenges in the part of behaviour.
From the aspect of communication, children with autism show delay or deficit in the aspect of speech and reciprocal interaction skills. As for the social aspect, these children have problems in terms of limited social interests, restricted eye contact, and seemed to be ‘in their own world’ compared to typically developing peers.
Behavioural symptoms, on the other hand, include stereotyped behaviour such as repeated hand-flapping, restricted interest (such as preference for arranging objects), obsession with rigid routines (such as extreme picky eating) and problems with sensory stimuli (sensitive to touch, sound, or a specific odour).
There has been no epidemiological study that accurately assesses the rate of autism diagnosis among Malaysians. However, the current study, based on the M-CHAT screening test, shows 1.6 cases per 1000 children in Malaysia.
The rate at the global level, as reported by the World Health Organisation (WHO), is higher at one case per 160 children. The chances are that this lower rate is due to a lack of awareness, screening and confirmation of the diagnosis at an early stage.
No specific cause has yet been identified in contributing to the development of autism. However, studies have identified genetic and environmental factors as potential contributing factors. In terms of genetics, for example, the risk of autism among other siblings is 10 times higher if one of the children is diagnosed with autism.
To date, no one specific gene has been identified as responsible. Other factors include the father’s advanced age, premature birth and history of any disease that affects the child’s brain at birth, such as a perinatal infection.
Can autism be prevented?
Since autism is closely related to the developmental phase of the baby, it is irrefutable that the health factors of the father and mother during pregnancy and the birth process play a detrimental role. The health of the mother during pregnancy is very important as it affects the development of the fetus.
It is generally advised that all parents plan pregnancy at an early age, avoid exposure to drugs, talk to their doctor about the risks of certain medications during pregnancy and seek early help for the baby in case of problems during pregnancy. For example, mothers with chronic diseases such as diabetes need to control blood sugar levels during pregnancy.
Children with autism have different levels of ability according to the severity of their autism. But in general, they will have challenges in terms of speech, self-expression, understanding instructions and controlling behaviour.
Therefore, they need to seek early intervention, especially from a speech therapist and occupational therapist, to help with these issues. They also have a higher risk of other medical comorbidities such as epilepsy and gastrointestinal problems. Hence comprehensive support and treatment are required by relevant health providers.
Empowering parents to cope with the challenges
Parents need to communicate effectively with the child, especially during play, using clear communication, coupled with the help of visual communication materials and lots of repetition.
For example, before speaking, the child needs to master pre-verbal skills such as being able to follow simple instructions, make meaningful eye contact, and imitate and match actions. These skills can be formed indirectly while playing with the child.
It is also important for parents to realise that autism is not a disease like a specific bacterial infection which we can eliminate with a course of antibiotics. Understanding the nature of autism as a neurodevelopmental disorder will help parents know that the concept of ‘cure’ does not really apply to autism.
Targets of intervention in autism are more geared towards training skills and facilitating development so that the child’s social, communication, and behavioural functions can be optimised within their capacity. Some of the characteristics of autism may remain until the child is older. However, if their function develops well, this means the intervention is effective.
For parents concerned about their child’s development, the first step is to bring the child for screening to any health clinic to assess the child’s level of physical, cognitive, and social development. From there, the doctor will determine if further assessment is needed.
This includes auditory screening, and assessment of their fine, gross and speech motor skills. If further evaluation is necessary, the child will be referred to a specialist doctor for a formal evaluation. Confirmation of the autism diagnosis is usually done by a paediatrician, child psychiatrist, clinical psychologist, or developmental psychologist. These services are available either through government or private channels.
All parents need to take the developmental aspects of the child seriously, identify the early signs and not be afraid to seek medical advice and evaluation. If a child is confirmed to have autism, do not be in denial.
It is important to understand that early intervention and parental support are among the two most important factors in the prognosis of autism. Be prepared to learn more about it and apply what you learn based on your child’s strength and abilities.
Among the great resources that can be referred to is the Genius Kurnia website, a platform by a government agency to support children with autism. This website is a dedicated platform for parents to learn about autism and interventions.
Lastly, get the support of your peers and those with similar situations and take care of your mental health. — The Health
A holistic approach to autism
THE intervention involved in autism includes a wide range of services. These include:
• Occupational therapy — occupational therapy works to help aspects of the child’s sensory, motor, and functional development. With evidence-based therapies such as sensory therapy and specific physical activities, occupational therapists will help stimulate this development aspect. When the sensory and motor aspects of the child develop well, it will positively affect the child’s social, communication, and behavioural aspects.
• Speech therapy — this area of therapy will focus on aspects of communication, including training in pre-verbal skills, communication skills, syllable formation, words, sentences, and higher social skills such as making friends and connecting with other individuals.
• Behavioural therapy — behavioural therapy is usually performed by a clinical or developmental psychologist. This includes specialised therapies such as applied behavioural analysis that help shape the child’s behaviour such as being able to listen to instructions, take care of themselves and interact with the stimuli around them. It also includes aspects of emotional control such as controlling anger, managing stress and handling conflict.
Dr Rozanizam Zakaria is Assistant Professor in Psychiatry, International Islamic University Malaysia (IIUM) and Fellow in Child and Adolescent Psychiatry, Ministry of Health (MoH)