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INTRODUCTION

AUTISM SPECTRUM DISORDER


AUTISM SPECTRUM DISORDER



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Autism Spectrum Disorder (ASD) is a life long neurodevelopmental disorder which affects a person’s way of relating to the external world. Its incidence is estimated to be about 1 to 1.5% of the population. The male to female ratio is about 4 to 1. It is, therefore, a disorder that is more common among males than females.

Previously, we think about autism as a categorical disorder ie a person either has the disorder or not. The idea of autism being a spectrum disorder means that the person can have varying degree of autism which can impacts their level of functioning. So, no two persons have the same diagnosis of ASD are the same. Additionally, previous diagnosis of Asperger’s Disorder is now subsumed under ASD.

The main areas of difficulty a person with ASD experiences are:

  1. Social relationship, social communication and social interaction
  2. Repetitive behaviour
  3. Restricted interests
  4. Rigidity and adherence to sameness

In addition, the person may show:

  1. Unusual sensory interests
  2. Unusual sensory perceptions or experiences
  3. Intellectual disability
  4. Language problems

Social relationship, social communication and social interaction difficulties:

These may manifest as:

  1. Failure in initiating and maintaining social interactions
  2. Lack of interest or difficulty in maintaining conversation
  3. Speaking off the tangent
  4. Failure in maintain emotional reciprocity which others may perceive as Aloofness and coldness and a lack of empathy
  5. Reduced sharing of interests with others
  6. There may be a lack of seeking comfort in relationship
  7. Deficits in non-verbal communication such as reduced eye contact
  8. Mismatch in body language
  9. Unusual gestures
  10. A lack of facial expression
  11. A lack of interest in making friends

Repetitive Behaviour:

This may manifest as:

  1. Repetitive physical actions or behaviour that seem purposeless to others
  2. Use of objects in a idiosyncratic ways eg lining up objects, flipping objects or flapping and rocking
  3. Repeating what others say or phrases which are meaningless to the others

Restricted interests:

This may manifest as:

  1. Very narrow of hobbies
  2. Unusual preoccupations which the peers would not share eg memorizing train time table, bus time table, models of cars, spiders etc
  3. Persistence in maintain the hobbies or preoccupations despite the inappropriateness of the social situations
  4. Strong attachment to certain objects or toys

Rigidity and adherence to sameness:

This may manifest as:

  1. A rigid daily routine at all cost
  2. Eating the same type of food
  3. Ritualized way of speech and conversation
  4. Inability to vary one’s behaviour to fit in with the environment or social situation
  5. Difficulty with transitions eg from home to preschool, kindergarten to primary school and junior to high school
  6. Inability to think in a flexible way
  7. Problem with abstracting thinking

Unusual sensory interests:

These may include:

  1. Excessive smelling, tasting and touching of specific objects
  2. Fascination with visual stimuli such as light or movements

Unusual sensory perceptions or experiences:

These include:

  1. Abnormal pain sensation eg apparent indifference to pain
  2. Abnormal reaction to temperature
  3. Hyper or hyposensitivity to noise
  4. Abnormal reaction to touch eg normal pressure form touch may be perceived as painful

Functional impairment:

Depending on the severity of the ASD, the level of impairment may be classified from Level 1 to 3. Level 1 is classified as needing minimal support and Level 3 as needing very substantial support.

Co-morbid conditions:

People with ASD often suffer from other psychiatric or mental health problems such as ADHD, Anxiety Disorders and Depression. It is important that the person received treatment for these disorders. The person may also have speech and language problems and coordination problems.


What do I do if I suspect that my child has ASD?

  1. Consult a health professional such as a Child Psychiatrist or Psychologist who is knowledgeable about ASD
  2. Be ready to accept a multidisciplinary team approach to your child’s management. The team may include a Child Psychiatrist, Developmental Pediatrician, Psychologist, Speech Therapist and Occupational Therapist
  3. There is no cure for ASD. Treatment is aimed at treating co-morbid conditions such as ADHD, Anxiety Disorders, Depression, language, speech and coordination problems
  4. Adopt a the view of being the life coach for your child to equip him or her to live a world which may be difficult for your child
  5. Be ready to adopt a different way to communicate with your child with ASD.
  6. Be aware that your child will need to overlearn in order to cultivate a new behaviour.
  7. Understand that your child may find it hard to generalize what is learnt from the general to the specific.
  8. Adopt a long-term view. As your child goes through the different psychosocial stage of life from early childhood to adulthood, the challenges of life become more complex and numerous. It is important to keep up to date with the management.

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