Persons with Autism Spectrum Disorder (ASD) continue to experience high rates of unmet healthcare and isolation due to social stigma and apathy. As such, creating ASD awareness is vital, and the Sri Lanka Association for Child Development (SLACD), the Citizens Development Business Finance PLC (CDB) have collaborated to create such a place in society. Recently, an intervention centre with an outdoor therapeutic sensory garden was opened at the Ampara National Hospital and a similar centre will be opened in Anuradhapura. Honorary consultant paediatrician and senior lecturer at University of Kelaniya, Dr. Samanmali Sumanasena further elaborated on this awareness-raising initiative. Dr. Sumanasena is a Professor in Pediatric Disabilities and serves the Department of Disability Studies, Faculty of Medicine at University of Kelaniya.
Autism Spectrum Disorder (ASD)
The Diagnostic and Statistical Manual of Mental Disorders describes ASD as the impairment of social communication and interaction with restricted and repetitive interests and behaviours. These include language, communication and behavioural impairments of varying severity. It’s a neuro-developmental disorder, which limits societal activities and participation among
children and adults.
- A study in Sri Lanka found that one in 93 children had ASD
- Occupational therapists and psychologists can also contribute
- First a doctor should diagnose the condition
- The primary clinician should be a speech and language therapist
Speaking to Daily Mirror, Dr.Sumanasena said the first signs of ASD emerge during early toddler days, and can persist into adolescence and adulthood. Despite research however, no clear cause has been identified for its development. “It is primarily a genetic disorder but other factors, such as environmental pollutants, changes in lifestyle, pregnancy-associated stress and the high survival rate of neonates which have undergone multiple complications at or after birth can also be a cause,” said Dr.Sumanasena. Autism used to be higher in developed countries, but is now increasing in developing countries. A study conducted in a small community in Sri Lanka in 2010 found that one in 93 children had ASD. But there’s a lacuna in autism-related data due to insufficient local research. Dr.Sumanasena observed that the current education system ignored the needs of autistic students. “The school system needs to be revamped. The children should be given an equal opportunity to learn. While they might need a bit more space, they should not be segregated from other children,” she said.
It is primarily a genetic disorder but other factors, such as environmental pollutants, changes in lifestyle, pregnancy-associated stress and the high survival rate of neonates which have undergone multiple complications at or after birth can also be a cause
The parents awareness of child development is crucial. But Dr.Sumanasena said this is a neglected aspect in the health and public sector. “If parents are aware, they will be able to identify the signs early and seek timely assistance. There are many websites that give this information,” she said. She stressed on the importance of interaction by the parents with their child. “Autism management is not rocket science. Although the primary problem may be autism, what adds to this is a lack of good parenting skills. It is vital that parents spend quality time with their children and engage them in activities from a young age” she said. The system must raise autism awareness and help parents interact better with their children.
If autism is detected before four years, with necessary parental intervention the child could function like others their age. “There are many children who have moved out of the spectrum, but it is through the effort of their families who spend a lot of time with them. There is scientific evidence to support this. But if you delay, be in denial and not act before four years, then you miss the bus,” Dr.Sumanasena emphasized. She added that all parents may not be able to interact with their child, as some parents may also be in the spectrum themselves.
Certain children may have serious genetic disorders, major brain injuries and severe seizure disorders that trigger ASD. Such children will have more severe forms of ASD, and respond poorly to intervention.
If parents are aware, they will be able to identify the signs early and seek timely assistance. There are many websites that give this information
First a doctor should diagnose the condition. Then a health team should work with the child and guide the parents on the child’s development and educate them on the activities to engage the child in. The primary clinician should be a speech and language therapist. “We have services and resources, but it has to be systemized. People need to be trained properly,” Dr.Sumanasena said.
There are many children who have moved out of the spectrum, but it is through the effort of their families who spend a lot of time with them. There is scientific evidence to support this
While there is no specific medical procedure to ‘cure’ autism, specialised health teams can detect and guide parents. Occupational therapists and psychologists can also contribute towards managing children through play. Child psychiatrists also play a role in the management of behavioural and emotional problems that may manifest. “Parents and the extended families have a greater responsibility to be actively involved for the child to improve,”Dr.Sumanasena said. She revealed that once parents learned the necessary skills they could manage the child on their own until further assistance is needed. Health teams must also liaise with the educational institutions the child attends.
Dr.Sumanasena emphasized that all parents should spend time with their babies from birth to childhood, interacting and engaging with them through various play activities. Parents must avoid giving screen time to children under three years, and exercise caution thereafter. And most importantly they should not hesitate to seek help at the earliest signs of autism in their child.
- Child psychiatrists also play a role in the management of behavioural and emotional problems that may manifest. “Parents and the extended families have a greater responsibility to be actively involved for the child to improve
Signs of autism
Signs of autism can occur from as young as six months. Signs can vary according to age and can be detected by one year. Autism can be conclusively diagnosed after two years. Research shows that early detection is possible in siblings of autistic children.
Dr.Sumanasena identified the following signs of early-stage autism. She said at first parents could miss these signs due to a lack of knowledge of a
- Not meeting the eyes or looking at the parents’ face.
- Not smiling spontaneously and needing prompting to elicit a smile.
- Not showing an inclination to bond with the mother and having breastfeeding issues.
- Being excessively cranky or unusually quiet.
- Unfortunately, a parent could interpret a quiet baby as being independent and leave him/ her alone without interacting with them and developing a relationship, causing the child to retreat deeper into his/her own world.
- With cranky children the parent could introduce them to repetitive practices or to a screen to comfort and manage them, thereby reinforcing the child’s autism.
- Babbling repetitively without variation in tone and quality. Parents could mistake this for speech.
- Saying ‘mama’ and ‘dada’ but not directly to the parents.
- Having a natural aversion to food. Disliking tastes, smells and textures, making them poor and fussy eaters. Parents may sit such children in front of a screen to coax them to eat. This becomes a negative pattern to an autistic child.
- Repetitive play, like lining up toys in a meaningless manner and spinning toys or performing ritualistic routines.
- Being unusually clever at repeating phrases or nursery rhymes. Knowing colours, shapes, numbers, and letters of the alphabet.
- Their tendency to be routine-based can be identified when about two years.
- Lacking joint attention. They may not focus or look when an object is pointed out and will fail to point at things themselves.
- Minimal or abnormal motor activity like delay in head control and delayed walking.