What Causes Autism?

There is no one cause of autism just as there is no one type of autism. Over the past few years, scientists have identified a number of rare gene changes, or mutations, associated with autism. There is no one single gene for autism but several genes in combination are involved. 

How to deal with Autism?

Autism is a complex, neurological, developmental disorder, which affects the way the brain processes information, the cause of which is still unknown. Since the cause of autism is unknown, there is no cure for it. There is no medication, no pills; no injections which can make the autism go away.  
As parent you may read or hear about many claims of cures for autism; however there is no medical cure till date...  
It is vitally important that as a parent, irrespective of whatever other treatments you may choose to follow, you do not compromise on the structured behavioural training program.  

A structured behavioural training program is a combination of a supportive classroom practices and specialised teaching strategies (both at home and in the school environment) is the best known treatment that can maximize skill development and achieve full potential.  
A combination of a good school and parent training is the best intervention strategy. 

How is ASD different from Intellectual Impairment (Mental Retardation)?

Autism is very different from intellectual impairment (mental retardation). When a person has intellectual impairment, there is more or less even impairment in skills in all areas of development. Therefore, if an eight-year-old child with intellectual impairment has a mental age of five, then all his skill areas would be roughly around five years (i.e. motor, communication, social, self-help, cognition etc.). 
A person with autism may or may not have intellectual impairment (Mental Retardation). However, because of limited understanding of the Autism Spectrum, many people are misdiagnosed as having intellectual impairment.  
Autism does not affect the intelligence of a person. It affects the learning style of a person. 
In autism, there is uneven skill development.  In some areas the child may show age-appropriate skills; in some the skills may be below the developmental level; and then there are people with autism who possess skills that may be beyond their age level.  
For example, an eight year old child with autism may possess some skills which are age appropriate at the eight year old level, in some skills he may be functioning at a three year old level, and for some children there may be one or two skill areas where they may be functioning at a ten year old level.

Do people with autism also have Intellectual Impairment (mental retardation)?

It is said, that about 50% of people with autism may also have intellectual impairment, just the way that people with cerebral palsy or Down's syndrome can have intellectual impairment. Autism can occur in association with other disabilities like Cerebral Palsy, Dyslexia, Down's syndrome, Visual Impairment, and Seizure Disorder.

If a child has autism and intellectual impairment or any other condition which needs more attention, autism or intellectual impairment (or any other condition)?

If a person with autism also has intellectual impairment (or any other condition), his training will need to primarily address his Autism. This is because autism affects the learning style of the 
person. That means the person with autism understands his environment and learns in a way that is often different from his non-autistic peer. 
Autism affects all aspects of the person’s behaviour and development. Persons with autism learn best when the teaching is modified to accommodate their unique learning style and hence it is the ‘Autism’ that one needs to keep in mind while teaching a person with autism. Our goal should be to help the person become integrated into society and so it is important to focus on the development of social, communicative and adaptive skills. 
 
However, for a child with cerebral palsy for instance, in addition to autism occupational therapy is also required. Similarly, for a child who also has a seizure disorder or any other medical condition, the appropriate medical intervention will be required. 

How do I know whether my child is autistic?

There are no medical or genetic tests that can detect autism. These can only rule out other conditions. A diagnosis of autism requires a sensitive and experienced doctor or clinical psychologist to observe the child very carefully, ask the parents about the development of the child and then objectively follow internationally recognized criteria for diagnosis.  
The beginning of autism may occur at birth or a child may have a period of seemingly normal development followed by a deterioration of verbal and social skills around one and a half to two and a half years. This disorder can be detected as early as a year. Autism may occur with other conditions such as mental retardation and hyperactivity, but the autistic traits in the person are typically what require attention.

Why is my child so hyperactive?

Having autism means that the child has an impairment in his/her social and imaginative skills. They may not be able to play appropriately with toys, or pretend play, or be able to play with other children. Hence most children with autism find it difficult to keeping them occupied. As a result they may run around, always be 'on the go', be restless and appear 'hyperactive' as they try to keep themselves busy in their own way. Some children may eat a lot to do this. This restlessness or 'hyperactivity' can be reduced as the children are taught new skills and appropriate ways to keep themselves occupied. 

Why does my child keep playing with his fingers/ rocking himself back and forth/ spinning around etc?

All of us combine our seven senses (sight, smell, sound, touch, taste, balance, body in space) in order to make sense of and learn from our environment. Many individuals with autism have different ways of 'sensing' their world and often have a condition known as sensory dysfunction. 
This means is that persons with autism often have trouble learning to integrate and process all the information coming from multiple sources in the environment. Their senses may be too acute (hypersensitivity), or working on a reduced level (hyposensitivity), or there may be a combination of both. Sometimes the sensory dysfunction results in self-stimulatory behaviours such as unusual finger or hand movements, rocking, mouthing, spinning etc. as natural responses or methods of 
coping with the sensory difficulties. When sensory information is faulty the world can be confusing and these self-stimulatory behaviours often help the child with autism relax. 

How does autism affect the play behaviour of my child? or Why does my child play with unusual things? Or Why does my child have an unusual playing behaviour?

People with autism have an impairment that can be characterized as a deficit in imagination. 
Imagination or creative thinking is easily observed in children through their drawings, comprehensions/essays, play behaviour or things they do in their free time. However individuals with autism, unless taught or told, are unable to think of or imagine things that they can do in their free time, as a result many of them spend their time doing the same activities, or simply running around or jumping about. 
Many autistic children show little or no interest in toys. Some handle toys and other objects purely for physical sensations e.g. to bang, put in the mouth, for the sound it makes, light that flickers, etc. Some enjoy concrete play such as puzzles or computer/video games.  A common activity for children with autism is lining up or stacking similar objects like pencils, blocks, toy cars, glasses, bottles etc. Some others use objects for their obvious purposes, such as toy broom for sweeping, or rolling cars back and forth. 
Some children do develop a sequence of events that appears as if they are playing, but a close observation shows that the sequence is often repetitive and not built upon or modified. A car is a car and remains a car. It does not become an aeroplane, fly in the air, or climb the walls. 
Other children with autism are able to learn basic pretend play behaviours, but, again, the stories may be repetitive and may not grow and develop. So a little girl may learn to bathe her doll but refuse to dry the doll with a small hand towel, as one would during pretend play. She may insist on using a regular towel. After the bath she may go on to dress, comb and feed the doll. But the play may not progress beyond the bath routine. For instance, she may never place the doll on a toy car pretending to take her for an ice-cream. They learn only what they are taught or told.  
Another consequence of this impairment is the narrow range of focused interests. Often all activities including play revolve around those special interests. 
For instance, some children may enjoy transportations and may look at pictures, advertisements, and collect toys or talk only on this theme and have no other variations in interests. Sometimes, these special interests can revolve around unusual objects such as strings, brooms, pebbles, wrappers, or any household objects or activities like scribbling, drawing or tearing paper and the play may remain focused on only these objects or activities. 

How autistic is my child? How is severity, degree or level of autism measured?

Autism is considered a spectrum disorder where symptoms and characteristics present themselves in a variety of combinations, from mild to severe and in any combination. A more able individual 
with autism might simply seem eccentric (with strange behaviour), a loner (a person that prefers not to associate with others).  
Severely affected individuals may hardly communicate and prefer to function primarily in 'their own world'. Most of the individuals fall in the middle category of this spectrum (Moderate). 
A detailed assessment by a competent professional is important for making the correct diagnosis which will further help in tailoring the intervention program specific for each individual. Standardized diagnostic assessment tools can be administered to assess the skill level of the child. Based on a test, professionals ask questions from parents to assess the presence and absence of behaviours. A score is then given to categorise the person with mild, moderate or severe autism. However, with the new and improved understanding of autism, professionals are beginning to understand that a person either has autism or not.  A functional assessment can also be done to understand the current strengths and needs specific to each child.  
With support ALL children with autism make progress. If intervention is not provided the person with autism faces greater difficulties. The way people with autism learn, understand, communicate and interact people is different.  
The teaching is approached with an understanding of the unique learning styles, and requisite accommodations to function to the best of her/his abilities, both at home and school. 

How do I choose the appropriate intervention for my child?

The key to ‘good’ intervention for any individual with autism to understand the condition, understand the unique ways in which individuals with autism think and learn, accept their autism as a vital and a vibrant part of their being, then approach the intervention, the teaching skills, and /or changing of behaviours, from that paradigm of understanding and acceptance.  On the basis of a functional assessment by a competent professional, intervention plans are tailored based upon the individual strengths and needs of each specific child. The intervention plan may use one or a combination of some of the proven effective techniques such as: Treatment and Education of Autistic and related Communication handicapped CHildren Method (TEACCH) Treatment and Education of Autistic and Communication related handicapped CHildren) is an evidence-based service, training, and research program for individuals of all ages and skill levels with autism spectrum disorders. Applied Behaviour Analysis (ABA) emphasizes on one-to-one sessions to develop cognitive, social, behavioural, fine motor, play, social and self-help skills. The technique involves structured presentation of tasks from most simple to more complexes, breaking them down into small sub-skills and then teaching each sub-skill, intensely, one at a time. It involves repeated practices with prompting and fading of prompts to ensure success. It uses rewards or reinforcement to help shape and maintain desired behaviours and skills. Verbal Behaviour Analysis (VBA) Applied Behaviour Analysis with an emphasis on Verbal Behaviour (ABA/VB) is a methodology, based on research, that is used to address functional skills, such as language/communication, self-help skills, play skills, social skills, and complying with instruction 
Picture Exchange Communication Systems (PECS) allows children with autism who have little or no communication abilities, a means of communicating non-verbally. Children using PECS are taught to approach another person and give them a picture of a desired item in exchange for that item. 

Will my child improve? When and will my child ever speak?

Being a spectrum disorder, there is a huge difference in the development of speech among people with autism. While some people with autism never speak, others start speaking late. Some begin to speak on time but the language does not develop by age.. It is very difficult to say when and whether the child will ever speak. There is no difficulty in their physical abilities that stops them from speaking. Some children who might have spoken as infants and then lost their speech may or may not get their speech back. Currently, it is unknown why some children develop speech and others do not. Experience with children with autism has shown that if the environment is accepting and people are aware of the kind of speech they need to use with the child, it can produce positive results. 

Can speech therapy help my child?

It is important to remember that it is not just the ‘Speech’; it is communication as a whole with which the child has a difficulty, which includes both understanding of language, as well as expressing him/her self through speech or any other mode. 
Every child with autism can benefit from an intervention that emphasizes communication and understanding a language in which he / she can communicate appropriately and express their needs and desires.  
Speech therapy can help some children. However, it is absolutely necessary for the speech therapist to understand autism and also the individual child otherwise the conventional methods of speech therapy might not be of much help for the child with autism, because the inability to speak is not a physical problem. 

Do people with autism not like other people? Can they make friends?

Due to the development of verbal and non-verbal communication, people on the autism spectrum find it hard to interact with others and make friends. Many of them want to make friends but are unable to do so because they do not understand ‘HOW’ to make friends. Even with adults, individuals with autism (both verbal and non-verbal) often find it difficult to communicate spontaneously i.e. showing the other person things of their interest e.g. a monkey, a dog, an aeroplane.  
A person with autism may come home and show a note in the dairy or a birthday gift, but may not be able to describe what happened or the feelings s/he may have experienced. Many children with autism show affection, smile and laugh, and demonstrate a variety of other emotions, although in varying degrees. Like other children, they respond to their environment in both positive and negative ways. Some with autism who seem ‘aloof’ appear to be in a world of their own, absorbed in their activities and show little interest in another person. Some people with autism may be comfortable with other children being in their vicinity but will not approach them by themselves. Some people on the spectrum actively enjoy but appear distinctly odd in their interaction. They make active approaches to other people on their own, but may do 
so in an odd, inappropriate, repetitive way such as hugging or pushing others. Then there are others who are seen as stilted and over-formal.  
They often stick to the rule which they have learnt and get disturbed in the situation where a ‘new’ rule is to be applied, or a previously learnt rule needs a modification. They avoid such situations or behave in a ridged or a strange manner. 
Children with autism enjoy watching other children and may want to be near them but may feel hesitant, unsure and even scared to join them in their activities. Some others may be comfortable and even enthusiastically approach, but may lack the spontaneity to initiate play.  
Their play behaviour may include only repeating what others are doing, e.g. running after one another, playing ring-a-ring-of-roses. As they grow older, they find it difficult to understand and follow social rules of games, such as getting ‘out’, taking turns or participate in make-belief play. As a result, individuals with autism have none or few friends of their age. They find it easier to relate to older people who can tell them what to do and or with people younger to them who will do as they are told. In both situations the expectations and responsibilities on the individual with autism is less. 
With the guidance of a supportive adult, children on the spectrum can learn ways to interact with other children appropriately.

How can I develop the talents that my autistic child has?

Some people with autism display remarkable abilities and skills, 

ï‚· At a young age, when other children scribble and draw straight lines, some children with autism are able to draw detailed realistic pictures in three-dimensional perspective.

ï‚· Some toddlers are so visually skilled that they can put complex jigsaw puzzles together.

ï‚· Some of them who have a keenly developed sense of hearing can play musical instruments they have never been taught, play a song accurately after hearing it once, or name any note they hear.

ï‚· Some individuals with autism can memorize entire television shows, phone directory, or bus/train timetables; others can calculate day of the week from a date or may have exceptional arithmetic skills.

ï‚· Some have an excellent ‘photographic’ memory for places or things 

ï‚· Some children can read beyond their developmental age and even before they can speak. Not all children diagnosed with an autistic spectrum disorder may have these savant abilities and skills.

Hence, it is incorrect to believe that all people with autism have a hidden skill that just needs to be ‘brought out’. Such skills do not always serve a person with autism well. If too much of focus is given on these skills of autistic children then the core areas of difficulties like communication and social skills, basic daily living skills are neglected.

What are the chances of my child going to a regular school?

There are a number of autistic children who have been going to regular schools. The chances depend on several factors. The most important are the individual capacity and functioning levels of the child, how early diagnosis was done, and the kind and the appropriateness of the early intervention provided to the child. Though some children with autism can learn like their other developing peers, most have different learning styles and so teaching styles also need to be different. Most children with autism require some modifications in the teaching style/ environment for them to be able to learn better and to keep the schooling a positive experience. Sometimes simple changes in existing classroom techniques and environmental adaptations make teaching autism-friendly. However, in some schools this is not understood and therefore children with autism face difficulties and many children drop out of mainstream classrooms after grade four or five.

Will it help my child if I relocate to another western country?

The Child with autism requires a early intervention with a structured behavioural training program in a combination of a supportive classroom practices and specialised teaching strategies both at home and in the school environment. A combination of a good school and parent training is the best intervention strategy. Be it any part of the world training at school and home is important.  Even though in India the number of services and resource persons would be fewer as compared to other countries, however the quality of services and professionals available are par with any other countries worldwide. The decision of relocating would have its own advantages and disadvantages, and each family should weigh them in order to make appropriate decision. Along with the resources available for the child, the resources available for the family also need to be considered in making the decision. The strong support system available to the child in India can prove to be a significant factor/aspect of improvement of child's social skills. 

Can my child ever live an independent life?

Since autism is a spectrum and people have varying skill levels, the future is not the same for all. ALL children with autism can learn and progress, if they receive early and more importantly ‘Focused Appropriate Intervention’. Depending on the child's individual ability, the appropriateness and the intensity of the intervention he or she receives some of children with autism may go on to lead relatively independent lives, whilst others may require support in varying areas and degrees. 

Can adults with autism get married and have regular children?

The essence of marriage is companionship. It is a union between two adults and it involves adjustment and carrying on day-to-day responsibilities of life. It also involves the ability to the plan for the future etc. Before deciding upon marriage, there are some factors that are needed to be considered by the person with autism and his/her family: 

• The level of functioning of the person, his/her ability to take on the responsibilities that are integral part of the marriage 
• The partner understands the needs and knows everything about the autistic spouse (if one of them is not autistic). 
• Financial status (employment, family support etc.) 

However, since marriage is an issue of social commitment and companionship, by the very nature of the condition, many able people with autism choose not to marry and their families respect and agree with that decision. 

What happens to people with autism when they grow up?

Since autism is a spectrum disorder and people have varying skill levels, the future is not the same for all people with autism. A lot of children who are able to deal with the mainstream school /college education go undiagnosed and are successful at jobs but may be considered as quiet or reserved adults by their family, friends and colleagues. Several adults on the spectrum, who have been diagnosed and been in a supportive environment in their childhood, have written books that have facilitated and enhanced the understanding of the condition. We have examples of people who are professionally very successful. Some have gone on to become famous authors and one of them has even won a Nobel Prize. Some advocate and speak for themselves and for other people with autism in the community. Some of those who are fully independent in their everyday life may find it difficult to sustain the demands of a job and work environment. Some are married and some choose not to. Some of those who are married face difficulties in forming relationships with their spouses and carry out responsibilities that come with marriage and having a family, and may continue to need support of another person in planning and carrying out the activities in running a house. As with every other condition, some people on the spectrum will always need support in life and may never be fully independent.  In India, there are only few schools which have an environment or the attitude to accommodate the special needs of people on the autism spectrum. However as the awareness about the needs of individuals with autism spectrum is increasing, so the number schools, vocational centres and employment opportunities are also increasing. With support from people around them including the family, friends, neighbours and teachers all of them can lead a happy and meaningful life. 

What will happen to my child after us? Is there any hostel for such children?

'What after me?!' is probably the greatest fear that plagues every parent of a child with a Special need.   Unlike some countries in the west, in India there are few hostels/ residential facilities for people with mental disabilities, and there are no or very few specialist hostels or residences that are currently available for people with autism in India. 
It is now increasingly accepted that during the early years of development, it is very important for an autistic child to live and grow in a home environment. As the child grows, he/she can be trained to live in a residential facility or a group home since that may be the need of the hour after the parents are no more or are ill and unable to provide the necessary support to the adult with autism. 
It is necessary that any such residence is not a place where one just 'dumps' the adult, but one that provides a structured environment, and predictable routines where individuals with autism are 
able to function independently to the best of their capacity. Such environments would foster independence while still providing the support that adult residents may require. It is also very important for autistic adults living in such residences to have ample opportunity to integrate with society in general so that they do not live isolated lives.