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THE HEALTH | MAY-JUNE , 2022
| Opinion |
Autism : Awareness , empathy and support
It is important for parents to realise that autism is not a disease like a specific bacterial infection which can be eliminated with a course of antibiotics
BY DR ROZANIZAM ZAKARIA
APRIL has globally been recognised as the month of autism awareness . With this year ’ s theme ,“ Inclusion in the Workplace ”, our attention is drawn to the long journey of raising awareness regarding this condition , which is still commonly misunderstood by many .
Autism , or in medical terms known as an autism spectrum disorder ( ASD ), refers to a condition that affects the development of the brain in the early stages of childhood . There are two main groups of symptoms of autism , namely deficits from the aspect of social development and communication ; and challenges in the part of behaviour .
From the aspect of communication , children with autism show delay or deficit in the aspect of speech and reciprocal interaction skills . As for the social aspect , these children have problems in terms of limited social interests , restricted eye contact , and seemed to be ‘ in their own world ’ compared to typically developing peers .
Behavioural symptoms , on the other hand , include stereotyped behaviour such as repeated hand-flapping , restricted interest ( such as preference for arranging objects ), obsession with rigid routines ( such as extreme picky eating ) and problems with sensory stimuli ( sensitive to touch , sound , or a specific odour ).
There has been no epidemiological study that accurately assesses the rate of autism diagnosis among Malaysians . However , the current study , based on the M-CHAT screening test , shows 1.6 cases per 1000 children in Malaysia .
The rate at the global level , as reported by the World Health Organisation ( WHO ), is higher at one case per 160 children . The chances are that this lower rate is due to a lack of awareness , screening and confirmation of the diagnosis at an early stage .
No specific cause has yet been identified in contributing to the development of autism . However , studies have identified genetic and environmental factors as potential contributing factors . In terms of genetics , for example , the risk of autism among other siblings is 10 times higher if one of the children is diagnosed with autism .
To date , no one specific gene has been identified as responsible . Other factors include the father ’ s advanced age , premature birth and history of any disease that affects the child ’ s brain at birth , such as a perinatal infection . Can autism be prevented ? Since autism is closely related to the developmental phase of the baby , it is irrefutable that the health factors of the father and mother during pregnancy and the birth process play a detrimental
role . The health of the mother during pregnancy is very important as it affects the development of the fetus .
It is generally advised that all parents plan pregnancy at an early age , avoid exposure to drugs , talk to their doctor about the risks of certain medications during pregnancy and seek early help for the baby in case of problems during pregnancy . For example , mothers with chronic diseases such as diabetes need to control blood sugar levels during pregnancy .
Children with autism have different levels of ability according to the severity of their autism . But in general , they will have challenges in terms of speech , selfexpression , understanding instructions and controlling behaviour .
Therefore , they need to seek early intervention , especially from a speech therapist and occupational therapist , to help with these issues . They also have a higher risk of other medical comorbidities such as epilepsy and gastrointestinal problems . Hence comprehensive support and treatment are required by relevant health providers .
Empowering parents to cope with the challenges Parents need to communicate effectively with the child , especially during play , using clear communication , coupled with the help of visual communication materials and lots of repetition .
For example , before speaking , the child needs to master pre-verbal skills such as being able to follow simple instructions , make meaningful eye contact , and imitate and match actions . These skills can be formed indirectly while playing with the child .
It is also important for parents to realise that autism is not a disease like a specific bacterial infection which we can eliminate with a course of antibiotics . Understanding the nature of autism as a neurodevelopmental disorder will help parents know that the concept of ‘ cure ’ does not really apply to autism .
Targets of intervention in autism are more geared towards training skills and facilitating development so that the child ’ s social , communication , and behavioural functions can be optimised within their capacity . Some of the characteristics of autism may remain until the child is older . However , if their function develops well , this means the intervention is effective .
For parents concerned about their child ’ s development , the first step is to bring the child for screening to any health clinic to assess the child ’ s level of physical , cognitive , and social development . From there , the doctor will determine if further assessment is needed .
A holistic approach to autism
THE intervention involved in autism includes a wide range of services . These include :
• Occupational therapy — occupational therapy works to help aspects of the child ’ s sensory , motor , and functional development . With evidencebased therapies such as sensory therapy and specific physical activities , occupational therapists will help stimulate this development aspect . When the sensory and motor aspects of the child develop well , it will positively affect the child ’ s social , communication , and behavioural aspects .
• Speech therapy — this area of therapy will focus on aspects of communication , including training in pre-verbal skills , communication skills , syllable formation , words , sentences , and higher social skills such as making friends and connecting with other individuals .
• Behavioural therapy — behavioural therapy is usually performed by a clinical or developmental psychologist . This includes specialised therapies such as applied behavioural analysis that help shape the child ’ s behaviour such as being able to listen to instructions , take care of themselves and interact with the stimuli around them . It also includes aspects of emotional control such as controlling anger , managing stress and handling conflict .
This includes auditory screening , and assessment of their fine , gross and speech motor skills . If further evaluation is necessary , the child will be referred to a specialist doctor for a formal evaluation . Confirmation of the autism diagnosis is usually done by a paediatrician , child psychiatrist , clinical psychologist , or developmental psychologist . These services are available either through government or private channels .
All parents need to take the developmental aspects of the child seriously , identify the early signs and not be afraid to seek medical advice and evaluation . If a child is confirmed to have autism , do not be in denial .
It is important to understand that early intervention and parental support are among the two most important factors in the prognosis of autism . Be prepared to learn more about it and apply what you learn based on your child ’ s strength and abilities .
Among the great resources that can be referred to is the Genius Kurnia website , a platform by a government agency to support children with autism . This website is a dedicated platform for parents to learn about autism and interventions .
Lastly , get the support of your peers and those with similar situations and take care of your mental health . — The Health
Dr Rozanizam Zakaria is Assistant Professor in Psychiatry , International Islamic University Malaysia ( IIUM ) and Fellow in Child and Adolescent Psychiatry , Ministry of Health ( MoH )