Raghav, a bubbly three-year-old boy who had achieved all his major milestones on time like sitting, turning, crawling, walking, and speaking his first words suddenly lost his ability to talk, seemed to have forgotten everything he had learned, and got lost in his own world. He no longer maintained eye contact and slowly stopped responding to his name. His parents, Ravi and Priya, were quite taken aback. Their first child, with so many dreams and aspirations, had transformed from a bubbly kid into one who seemed trapped in himself, leaving them deeply disturbed. Their visit to the paediatrician, was nothing but a life-changer – your son is on the spectrum (In simple terms, he has been diagnosed with Autism Spectrum Disorder). 

The big questions – What?  Why? How? - lingered in the parents’ minds. The child seemed normal but exhibited typical behavioural changes witnessed in ASD. Post all the evaluations, doctors recommended therapies but there was no answer. 

This is the reality of Autism Spectrum Disorder (ASD) or also known as Spectrum Disorders. Many times and on several occasions, based on the severity of the condition, it is often misunderstood as mental retardation. 

Statistics state that in India, ASD affects 1 in 65 children aged 2-9 (up to 1.8-2 million), per studies like the Indian Journal of Paediatrics. Further research suggests that ASD is over 3 times more common among boys than among girls.

The Understanding 

In simple terms, Autism Spectrum Disorder is a complex developmental condition involving persistent challenges with social communication, restricted interests and repetitive behaviour. It has been recorded that many individuals on the spectrum even excel at cognitive tasks such as pattern recognition and memory; others are more challenged by their sensory processing or their ability to show and respond to emotions.

For people on the spectrum, they are normally good at the 3 Ms – Maths, Memory and Music. 

However, it is now that doctors and families are becoming more aware of the issue. However, despite increased awareness and passage of a variety of policies supporting individuals with disabilities in India, there remain gaps in the number of individuals needing early identification of ASD, appropriate evidence-based interventions, and culturally relevant care.

Delving Deeper 

Despite several research and medical explorations, there is still no answer to the cause of Autism in children. However, several factors are considered such as genetic and environmental.

Research of the brain suggests that neuroimaging shows differences in the structure and function of the brains of individuals with ASD, including areas that are important for social processing, language, and executive functioning. Thus, early identification of children with ASD and the provision of timely intervention can help improve their outcome.

The Early Signs

In India, cultural paradigms exist which may hide or mask traits typical of ASD, by attributing them to ‘shyness’, ‘boys doing things late’ , etc. There are many families that do not want to face the truth and delay addressing the condition. Despite all developments, families / individuals should be aware of potential early indicators. 

• No eye contact 
• Zero social interactions 
• Not responding to their names at 6-9 months 
• Use of very few or no non-verbal communication methods (gestures, facial expressions, etc.)
• Exhibiting repetitive behaviour (flapping of hands)
• Toe walking 

Importance of Early Intervention

Early diagnosis of Autism Spectrum Disorder (ASD) is a transformational milestone that brings about increased growth in communication and socialization skill development as well as improvement in behaviours within the earlier window of maximum brain plasticity, when the brain has the greatest opportunity to develop multiple new connections to facilitate cognitive development. 

Awareness and Action

The landscape of Autism Spectrum Disorder (ASD) in India requires a dual strategy: redefining therapeutic priorities through a developmental lens (i.e., focusing on interaction and meaningfulness rather than just on surface behaviours) and expanding access to services to those living in rural areas.  Early intervention centres are being established in metropolitan regions of India. There are many dedicated schools for children with autism in major metropolitan regions such as Delhi, Bengaluru, Chennai, Pune, Hyderabad and Mumbai. In addition to these school systems, many NGOs have developed vocational training programs to assist individuals with ASD.

This is a feature authored by Dr Naeem Sadiq, Medical Director, Plexus Neuro Center.