By Dr Omobolaji Oyebanjo-Popoola ABPN, ABPM, FASAM
Autism spectrum disorders are developmental disorders that affect communication and social interaction. These disorders are caused by abnormalities in the neurological system. In the US, over 200,000 cases are diagnosed each year.
In the Black community, there is an incidence of denial (often for fear of stigmatization) amongst parents who consequently, do not seek timely help. Unfortunately, there is a disparity in diagnosis, as Black children are 2.6 times less likely to receive a diagnosis of Autism as their white counterparts; instead, they tend to be diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and conduct and oppositional defiance disorders.
The latter two, attract less sympathy while often placing them on alternative treatment paths, ranging from reform or “alternative” schools, the juvenile justice system, all the way into the criminal justice system.
The deprivation of early intervention and adequate treatment for Autism therefore, can have far reaching consequences.
Primarily affecting first-born children of mothers 35 years or older, breached babies, and mothers who experience stress during their pregnancy, the disorder also has a higher incidence in males than in females.
Studies show that autism spectrum disorder, has a causal attribution of 20% to environmental factors and 80% to the genetic pool. Hence, Autism runs in families.
For the most part, no two cases are alike, as the symptoms vary. There are varying intensities of Autism, ranging from mild symptoms to severe cases. Communication and social interaction problems are common, as well as obsessive interests and repetitive behaviour.
There are different disorders under the Autism spectrum. There are three major classifications under the Autism spectrum disorders. Autistic disorder, which is otherwise known as Classical Autism, is the most severe form of the disorder, under which language and social skills are severely impaired.
The next one is the Pervasive Developmental Disorder, which is attended by some impairment in speech and social skills. The third is the Asperger’s syndrome, which generally has normal language but impairment in areas of social skills and interaction.
Autism does not mean low IQ or mental retardation. If you are not able to communicate with someone successfully, how can you truly test their IQ? If they learn differently from neurotypical children, how reliable can a regular IQ test designed for neurotypical kids be when deployed in the testing of a child on the autism spectrum, bearing in mind that a large part of the IQ test is communication? With some reservation, it is found that the IQs of children on the spectrum vary, with some being low and some being high. It is prudent therefore, that before you lose hope or give up, you consider intervention.
Other symptoms common in Autism include rocking, hand flapping, stimming, echolalia, pacing, hyperactivity, sensitivity to touch, light, and sound; avoidance of change and new spaces, and avoidance of eye contact. Some have self-injurious behavior, as some on the spectrum beat themselves up physically. As it is a neurological disorder, some of the children might also experience epilepsy or seizures, have unusual eating or sleeping habits, and might have delayed cognition and learning. Despite these symptoms, some children on the spectrum can turn out to be geniuses and some even savants. Not every speech delay falls into the diagnosis of Autism, as some children just do not gain the power of speech early in their development, or are not properly stimulated for speech. For example, an only child that doesn’t have playmates to communicate with, a young child who has older siblings that answer questions for them, or a child who is deaf, all can experience delay in speech.
Autism begins before age 3 and can last a lifetime. Some people have been known to resolve many of the symptoms through early intervention. Autism is challenging to diagnose, as a lot of reliance is placed on the history-taking from the parents and monitoring of developmental milestones. It is quite a comprehensive assessment; upon completion, interventions are typically multifaceted involving various professionals and various mechanisms. The treatment team might include various professionals, depending on the predominant symptom. They include occupational health, counseling, therapy, education intervention, speech therapists, psychiatrists, neurologists, nutritionists, and pediatricians. In my years of practice as a psychiatrist, I see many children on the spectrum who have improved significantly.
These are my goals as a psychiatrist.
- Reassure and support the parents for the long journey ahead. Refer them to resources and encourage self-care in them as the journey is a long one, with many ending in divorce.
- Reduce the behavioral problems that sometimes occur in children on the spectrum. In my experience, the inability to have their needs met due to their inability to communicate leads to frustration, resulting in acting up and temper tantrums. In frustration, many patients act out and learn that they can get results by negative reinforcement. The goal should be for them to communicate their needs clearly and have them met to obviate any reliance on negative reinforcement. The sooner you can empower the child to communicate, whether by sign language, flashcards, communication board or acquiring certain words that can assist them in getting help for their most common and basic needs, the sooner parent/caregiver and child will arrive at a workable formula for progress.
To give you a little insight into how a child might feel in circumstances where they are unable to communicate their needs or desire, perhaps you could imagine yourself, as an adult going to a country where no you don’t speak their language and they don’t speak yours. The immediate handicap and frustration of such a situation, approximates to what I am seeking to convey about children who are similarly handicapped. In children, as many have not yet acquired coping skills, they cry, act out, or throw tantrums when frustrated. People around them will experience that as problematic, whilst to the child, they are just trying to get their needs met. Thus, if the child is taught how to communicate their needs, then the behavioral outbursts will be diminished.
- Referral to occupational health to teach them life skills, such as tying their shoes, holding their pencil properly, and buttoning their shirts.
- Referral to applied behavioral analysts or programs. One of the main things in children on the spectrum is that many are visual learners and learn differently from neurotypical children. In behavioral analysis, knowledge is broken down into bite-sized pieces and reinforced to make a whole again. Applied behavioral analysis is a scientific approach to understanding behavior. It addresses how behavior works, how to reinforce positive behavior, how to diminish negative behavior, and how learning takes place. Many skills can be acquired, such as language and life skills by using applied behavioral analysis. Often, positive reinforcement is used to encourage the behavior that is being sought. The preferred behavior is typically demonstrated to the child. When the child repeats the behavior, they are given positive reinforcement to encourage them to continue the same until it becomes a part of the child. There are professionals who actually train for extensive periods of time, to become applied behavioral analysts, but there is a severe shortage of those professionals and their time can therefore be rather expensive. In the interim, there is software and other programmes that can be used to train the parents or their assistants in applied behavioral analysis, so that the children can learn the behavior while awaiting an opening for specialist help. Things as simple as potty training to the complexities of algebra can be taught to children in this way.
- Referral to social workers, therapists or psychologists. To handle issues of anxiety and depression, some children might benefit from the services of a social worker, therapist or psychologist. Many children on the spectrum also benefit from social stories taught by these professionals that helps them prepare for socialization, so that they can blend better into the society. An example of a social story is to act out or demonstrate how a child should behave when they attend a peer’s birthday party. It will take them through many scenarios that can occur at a birthday party and teach them appropriate responses. Some social stories are in books and some are on video tape. These professionals also offer access to social skills groups from which the children could benefit. (A word of caution here is that, not every social worker, therapist or psychologist is trained to deal with autism spectrum disorders. Its important therefore, to verify that those consulted have the relevant expertise).
- Referral to psychiatrists for diagnosis and management of attention issues, behavior issues, sleep issues, anxiety, depression, ritualistic behavior, self-injurious behavior, and aggression where present.
- Referral to a nutritionist to ensure that they are getting appropriate and adequate nutrients, as many are picky eaters and affected by the texture of certain foods. Hence, children on the spectrum may only eat a limited number of foods and are at risk of malnourishment. The nutritionist will work with the child to accustom them to a variety of foods that will provide them with the adequate nutrients to thrive and prevent digestive problems like constipation. Malnutrition is also implicated in learning difficulties, so they cannot afford to be malnourished.
- Referral to education assistance such as an individualized education plan (IEP). Some children start off in a specialized classroom and join their neurotypical peers in certain classes or activities as they are able to tolerate. The goal is to get them out of the small classroom to the general classrooms as soon as they can benefit from the instruction in the general classroom. The benefits of a small, special class include the one-on-one instruction at the child’s pace, the presence of paraprofessionals to help the child work at their own pace, and to watch out for the child. Parents should endeavor to partner with teachers, be supportive of the teachers, and not leave all the education to the teachers.
- Referral to neurologist or pediatrician. Some children might have seizures or epilepsy. Hence, they will need medication management for those conditions, and the pediatrician will also monitor their developmental milestones to ensure they are not falling behind.
- Remain hopeful. Engage them in sporting activities, musical activities such as participation in a choir, piano, and art. Many of these children are gifted, but they just learn differently. Be open-minded; as a parent, your responsibility is to bring out the best version of every child that has been assigned to you and to help them uncover their gifts and purpose.
Below are some of the works of famous people on the Autism spectrum: –
*The contents of this article reflect the writer’s personal opinion. No doctor-patient relationship is assumed or intended. If you have any queries of a personal nature, please reach out to your personal physician.
