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29 March 2023: Screening for Autism and severity assessment

Context: 

Autism spectrum disorder (ASD) is a complicated developmental condition that interferes with social communication, interactions, and behaviours. It is still frequently misunderstood and underdiagnosed in India. Early detection and intervention are critical for improved results and support for families.

Autism:

  • Autism is a neurological disorder, not a disease. This indicates that autistic children’s brains are wired differently, which becomes apparent as the child grows.
  • Autism is frequently diagnosed by a paediatrician or psychiatrist who has expertise working with autistic children.
  • Autism is not uncommon: current U.S. figures estimate an incidence of 1 in 44, whereas Indian data shows 1 in 100.
  • Cause: 
    • No clear understanding of cause, but there is obviously a genetic component. If there is one autistic child in the family, there is a greater probability that the sibling will be autistic as well.
  • Autism is distinguished by differences in major categories: 
    • Communication and social interaction, which frequently go hand in hand. Children with autism may find it difficult to communicate with those who are not like them.
    • Another distinguishing aspect of autistic children is that they have a specific area of interest or a repeated activity that they like.

Autism diagnosis:

  • It takes two steps to diagnose a child with autism:
    • First, at roughly 18 and 24 months of age, the child has developmental check-ups during standard healthcare appointments. During these check-ups, a doctor discusses the child’s behavior, development, and family history with the parent or caregiver, and searches for signs of autism.
    • If the doctor suspects autism, the child will proceed to the second stage of examination, which will involve a team of healthcare experts doing more exams to establish if the child has autism and what type of support they may require.
    • The road to a diagnosis will include various professionals, including:
      • Child psychiatrists, 
      • Psychologists, 
      • Speech-language pathologists, and
      • Occupational therapists.

Screening tools:

  • Modified Checklist for Autism in Toddlers (M-CHAT) Revised: This is a 20-question test for children between the ages of 16 and 30 months.
  • Ages and Stages Questionnaire (ASQ): A general developmental screen that evaluates developmental problems at distinct ages
  • The Indian Scale for Assessment of Autism is designed to assess the severity of autism.
  • The Childhood Autism Rating Scale: It assesses individuals on a range from ‘normal’ to severe,’ yielding a composite score reflecting autism severity.
  • Individuals can cope with the difficulties that ASD presents with the help of support and therapy.
    • Educational and behavioral treatments, which can target particular areas of difficulty such as speech and social skills, are especially beneficial for younger children.
    • Individuals can also benefit from supportive therapy to become less irritable, aggressive, obsessive, hyperactive, and/or impulsive.

Levels of support:

  • ASD is classified as a single disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The former system of identifying autism levels is no longer in use. Instead of several levels of autism, the severity is described by three “levels of support.”
  • Level 1: 
    • A person with autism may face social difficulties that require assistance. Without the proper support, they may struggle to initiate conversations, respond to others, or make new connections. They may also require routine and structure.
  • Level 2:
    • The person needs greater assistance at this level than at Level 1. Communication difficulties can make it difficult to have clear discussions or grasp nonverbal clues. Daily routines and modifications may be quite stressful.
  • Level 3:
    • The individual needs the highest level of assistance. They may avoid connecting with others, struggle to make friends or engage in imaginative play, and find it difficult to shift their focus or routines. Repetitive habits may impair their capacity to function, and communication difficulties will be severe.

To summarize, ASD is a complicated and multidimensional illness that necessitates a comprehensive treatment strategy. Early detection and intervention are crucial to improving outcomes for autistic children and their families. Individuals with autism can receive the necessary assistance and therapies if they are identified and treated early enough.