Parents’ guide to managing and caring for autistic children

World Autism Day 2022: Autism can be diagnosed in children aged 15-24 months. The greatest progress is made by children who have started making progress in language and non-verbal skills at the age of 3.

World Autism Day: Parents have an essential role to play in helping their children with autism

Autism Spectrum Disorder (ASD) is a term used to describe a condition that presents a combination of deficits in social communication skills and repetitive sensory or motor behaviors. There is an increased gender preference for ASD in male children. If parents have concerns about delayed speech, lack of eye contact, or repetitive behavior such as spinning a toy car wheel, they need to seek professional help to screen the child for possible ASD. The screening can be offered from the age of 18 months. The Modified Autism Checklist (M-CHAT) is the most commonly used screening tool for this purpose. Children who are regularly seen by a pediatrician, those who have close contact with grandparents, and those who have a normal older sibling have a better chance of an early diagnosis.

Standard practice for diagnosis is to obtain an assessment using a Childhood Autism Rating Scale (CARS), a language and motor skills assessment, and an intelligence quotient (IQ) score. Attention Deficit Hyperactivity Disorder (ADHD) is the most common association with ASD. Social anxiety, separation anxiety, or phobias also affect many children with ASD. Irritability and aggression are two other common characteristics of ASD in children. Epilepsy is an association in approximately 8% of children with ASD.

The diagnosis of ASD can be made in children 15-24 months of age. The greatest improvements are seen in children who have started making progress in language and non-verbal skills by the age of 3, and this reiterates the need for early detection so that corrective action can be taken at the earliest.

Parental participation in early intervention between the ages of 2 and 3 predicted a more positive outcome for adults. The WHO estimates the worldwide prevalence of ASA to be around 1%. Advanced maternal (≥ 40 years) and paternal (≥ 50 years) age has been observed as an association for autism. Maternal medication (exposure to valproic acid) has been shown to be an increased risk factor for ASD. Studies have shown that there is no link between autism and vaccination. Folic acid supplementation before pregnancy has been shown to provide some protection against ASA. Fragile X syndrome and tuberous sclerosis are two genetic disorders known to be associated with autism.

Fragile X syndrome and chromosome microarray testing are the two basic genetic tests offered for these children and once a definitive diagnosis has been made using either of these tests, this not only aids the couple in future prenatal diagnosis but carries also essential for prognosis for the affected child and for helping the family to get in touch with specific family support groups.

Emphasis should be placed on teaching parents and caregivers to build shared engagement and balanced play with the child so that this strategy helps autistic children to be more proactive. The proven treatment strategy is applied behavior analysis (ABA), which focuses on play therapy, social interaction, and initiation of communication, and is performed by a therapist trained in dealing with children with ASD. At least 15-20 hours of exercise per week is required to see significant improvement. Group therapy programs are extremely useful in reducing anxiety symptoms in children with ASD. Medications are given to control irritability and restlessness. ADHD requires medical treatment to improve attention span.

With early diagnosis and remedial action, particularly through parent-mediated interventions, more children with ASD are able to speak, read, and live in community and be independent at varying levels.

(Dr. Sheela Nampoothiri, Clinical Professor, Department of Pediatric Genetics, Amrita Hospital, Kochi)

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