It’s a routine these days that young mom’s walk into the clinic and want their children to be diagnosed with autism spectrum disorders (ASD).
It has been becoming a fancy diagnosis in recent years. Has the burden of disease really increased or the awareness regarding this problem had become better?
It has been a debate that this may be an evolutionary process and human beings would slowly and gradually become withdrawn, involved in their own selves and not interested in interactions.
More and more people would be aphetic, asexual and apolitical. Recent studies have shown that around 38% of young people in Japan have been preferring to live alone.
Core symptoms of autism spectrum disorder included impaired communication, repetitive restricted behaviours and impaired social interactions. These three core symptoms could be part of various clinical conditions ranging from being having normal intellect to profound mental retardation.
Depression, anxiety disorders, substance use disorders, personality disorders and Schizophrenia can also present with similar set of symptoms.
Then what differentiates autism from so called normal people and people with other mental health disorders. Age? But these days’ diagnosis of autism is even made even in early teens.
Any laboratory test? No, mental health problems are usually not picked up by routine laboratory or radiological methods so far.
Psychometric tools? They only support clinical diagnosis and predict severity but themselves are not usually diagnostic.
Therefore, it’s a team work which join different puzzles in form of child symptoms, parents report, school report (if any), impact on quality of life and other clinical parameters.
Children not speaking or being socially awkward or different in few situations could not be labelled as having autism spectrum disorder (ASD).
“It is screen time which is responsible for autistic features in my child”. Most parents come up with this explanation even without getting their child introduced in the clinic.
Screen time may contribute to existing symptoms but it’s surely not the cause of this clinical syndrome. Genes may play some role as in most of the mental health problems. Pregnancy or birth related complications may also be blamed to some extent.
Drifting away from nature also has its impact as pregnancies at extreme of ages have more chances of having outcome in form of babies with ASD.
Smoking, use of drugs and alcohol in pregnancy have also been associated with autism. It could also be a toll for advancement in medical science.
All those foetuses which may have been cleansed by nature otherwise when saved by modern medical science are usually born with a clear disadvantage. These premature or otherwise compromised foetuses may grow up with multiple physical or mental health problems including autism and learning disabilities.
Categorising these disorders under the label of “autism spectrum disorders” render clinicians and parents to understand the wide range of symptoms with which these children could present.
At one end is a child with severe mental retardation with epilepsy and on other end is a child with Asperger’s disease who is not considered diseased but different.
Diagnosing and labelling the child with autism is not as important as identifying the needs of individual and managing those effectively.
We need to understand that this is not a “software problem” as is the case in most mental health disorders. This is more of a “hardware problem” which could not be detected with precision so far because of limitations of exiting neuroimaging modalities.
Aim of management is to identify needs of child and make a plan to address those needs. Parents may have their own needs related to child condition but they need to be carefully assessed and only addressed if part of child individual needs.
Adjust expectations of patients early that their children may not be able to perform best in conventional education systems but may become best musicians, chefs, painters etc.
Team work is required to find those hidden talents. Explanation of concept of Savant Syndrome is important here, that if nature had deprived the child from one ability; another one may be more and that needs to be found out and worked upon. No single tablet or procedure could cure Autism.
After initial need assessment, parents should be informed that few symptoms would go away, few would become better and with few child and parents have to learn to live with. This explanation is never final or static; rather it’s a dynamic process throughout the life of an individual.
Few symptoms could be managed with certain medications. Role of transcranial magnetic stimulation (TMS) has strong evidence in recent years. Still main stay of treatment revolves around speech, behavioural, occupational and other therapies which demand hard work from whole team of which parents and child are the most important parts.
Lastly, in recent clinical practise a lot of youngsters (late teens and early twenties) are either brought by parents for not being too conventional in their approach in life causing distress to them or come by themselves for facing significant anxiety while following conventional pathways of life.
Detailed clinical evaluation does not reveal any psychopathology which could help the treating team to categorise them in any major mental disorder. Diagnosis of Asperger’s Syndrome usually serves the purpose for clinical team but not for the problems and needs of individual and family.
A lot of effort has been put in to manage children with Autism Spectrum disorder but still there is a lot of gap in management of adult individuals having Asperger’s. Increased trends in work from home and gadgets based model of occupation and life may help them achieve goals with minimum friction.
Mental health professionals these days should be equipped to manage needs of individuals even without putting labels. An effort should be made based on bio-psycho-social model to maintain quality of life of these individuals in such a way that they should be minimally distressed and also move along in life on a path closer to the path set by society.
Sources
- Rise in Diagnosis or Awareness: Myths and Realities of Autism Spectrum Disorders. (ResearchGate)
https://www.researchgate.net/publication/387335220_editorial_autism_pafmj
