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An eye on autism

LET’S FACE IT Early detection, right medication, proper rehabilitation and multi-disciplinary interventions are keys for the treatment of individuals on the autism spectrum, writes Anupama Ramakrishnan

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In a world that calls for equality, people with Autism Spectrum Disorders (ASD) continue to remain on the fringes. Efforts of parents and caregivers notwithstanding, they are often not rehabilitated as they should be.

“Individuals on the autism spectrum have a lot of difficulties with social interaction and will need the opportunity to learn from their neurotypical peers. They also need constant assistance to manage some of their difficulties for which they will need to rely on their more able, neurotypical peers. This will be possible only through inclusion. Diversity among humans needs to be embraced,” says Dr Vanitha Rao, Autism Consultant and Founder, Sunshine Autism Trust.

The right intervention is then imperative. “Early identification and intervention lie at the heart of treatment in autism. In our clinic at Nimhans, parents often get children as young as two to three years old who they feel do not make eye contact, or have not started speaking. It is possible to identify problems in development even at this early age,” explains Dr Eesha Sharma, Assistant Professor, Department of Child and Adolescent Psychiatry, Nimhans.

“Home-based and centre-based interventions that focus majorly on social and language development are then discussed with the parents and the child is closely followed up. The first five years of life are crucial for development. The brain is rapidly growing and is most sensitive to interventions,” she adds.

It is not uncommon for parents to miss out the symptoms in their toddlers.

“The disability can be recognised as early as 15 months but typically diagnosis is not offered till after the child turns three years of age,” explains Dr Vanitha. “A good professional normally recommends children, as young as 15 months, to start intervention if they see signs of ASD even if they do not give the child the label,” she says.

No cure only care

Can drugs help control the behaviour patterns associated with autism? “ASD is a neurodevelopmental disorder and cannot as such be cured,” says Dr Chittaranjan Andrade, Professor and Head, Department of Psychopharmacology, Nimhans.

“However, medicines are available to reduce the severity of some of the problematic behaviours associated with the condition. Such behavioural problems include irritability and uncontrollable anger, and repetitive behaviour. There are a lot of experimental and even fad therapies that one can identify through a simple Google search; there is no evidence that these therapies work,” he says.

Back home, not enough is being done in the healthcare sector for them. “In our country, there is a paucity of services for childhood mental health-related conditions, including ASD,” says Dr Eesha.

“Autism requires multi-disciplinary interventions including speech and language therapy, occupational therapy, parent training for home-based interventions, regular psychiatric follow-up for assessment and management of any emergent problems. Such multi-disciplinary intervention systems are a rarity.” She informs that there are questionnaires available that can be used to detect autism at a very young age. “These need to form a part of our primary healthcare systems for very young children so that autism can be detected early,” she says.

It’s heritable

Elaborating on the risk factors, Dr Andrade says, “Genetic studies show that ASD is strongly linked to heritable factors. More than a dozen studies suggest that antidepressant use during pregnancy is associated with an increased risk of ASD in the offspring.”

“However, studies with robust methodologies suggest that it is the indication for which antidepressants are prescribed
that may carry the risk for ASD, and not the antidepressants themselves. This is known in research as confounding by indication; antidepressants are blamed when they are, in fact, necessitated by depression,” he says.

“So what is the cause? It is likely that there is an overlap between the genes that cause depression and those that cause ASD. It is also likely that depression during pregnancy is associated with changes in the mother’s behaviour and physiology, and these changes may also predispose to ASD,” Dr Andrade adds.

Meanwhile, there is no dearth of misconceptions like measles mumps rubella (MMR) vaccine being an autism risk.

“The study which suggested that the MMR vaccine may predispose the children to ASD was described by a British team and published in the Lancet in 1998. This study was seriously flawed in many ways,” says Dr Andrade.

“Almost immediately afterwards, epidemiological studies were conducted; these, and all subsequent studies, robustly
refuted the link between the MME vaccine and ASD. However, many people in different parts of the world, including
supposedly educated people in developed countries such as the USA, continued to believe the medical fake news spread by the media. These people refused to
vaccinate their children, and pockets of measles began to appear and, even today, continue to appear across the world. Children suffer for the folly of their parents,’’ he explains.

For the parents, realising their child is autistic is tough, but what is tougher is the rehabilitation.

Ruby Singh’s son was diagnosed with autism in 1997. “It was a blind alley for us then,” she says.

“But I did financial planning to build up his future and when my son was six, I had another baby. I wanted him to have a future when we are not there,’’ she says.

Ruby also runs an NGO called Assisted Living For Autistic Adults (ALFAA).

“In India, we don’t have proper data or research done on autism. The government needs to put in their effort and capital. The society also needs to step in. Donate your time, if not money,” adds Ruby.

Clearly, turning your eyes away from those on the spectrum or overlooking their needs is not the way forward.

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