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What is Autism?

Just what does it mean to be diagnosed with autism? Firstly, autism is a lifelong neurodevelopmental disability that affects one’s communicative abilities and behaviour. It is also known as a “spectrum” disorder and includes a range of people with various degrees of difficulty, hence the term Autism Spectrum Disorder (ASD). In general, people with autism may find it difficult to interact and understand how others think or feel. They typically dislike bright lights or loud noises and may find them overwhelming, and for the most part, they take a longer period of time to take in information and understand them.

However, an important point to take note is that ASD is not an illness or a disease; being diagnosed with autism basically means that your brain functions differently from others. Although ASD is not a condition that can be treated or cured, some individuals with ASD require support and guidance to help them with certain things. However as mentioned before, autism is a spectrum, and this means every individual diagnosed with ASD is different from one another. Some autistic individuals require minimal or no support whereas some may need constant care throughout their lifetime.

As for myself, I have a younger brother who is diagnosed with mild ASD. Observations regarding my brother included being lacking in demand for attention at the age of 2 years old, with comparatively little babbling, pre-speech sounds and intoned pre-speech conversations. The overall summary as described by the psychologist was that my sibling was slow in developing self-care skills and independence expected of a child of his age then. As of today, he requires minimal to no support to go about his daily activities, doing relatively well in his academics – currently completing a diploma in Information Technology, and is also adept at playing the piano. Talk about being talented.

Causes of Autism

There are several factors that give rise to ASD and each one of them may not be the only factor. It is possible to have multiple factors that come into play and these include:

  • Genetic factors
  • Parent(s) diagnosed with schizophrenia
  • Prenatal environment
  • Lack of vitamin B9 intake among pregnant women and women who want to get pregnant
  • Other risk factors include very low birth weight, certain genetic conditions, having a sibling with ASD, or the child’s sex (boys are four times more likely to develop ASD than girls are)

It has been widely known that ASD has a genetic basis, however, for more than half of the cases, the underlying genetic cause is unknown; no one gene is responsible for autism. In most autism cases, it probably relates to new genetic mutations (a permanent alteration in the DNA sequencing that makes up a gene) or microdeletions (chromosomal deletions), and by examining a child’s chromosomes, researchers can identify such occurrences as they are not present on the parents’ chromosomes. On top of that, researchers can infer whether such mutations or microdeletions was resulted from the mother or father by examining the genes that surround the mutation or deletion and comparing the results to the parents’ chromosomes.

Now before moving on to other possible causes, it is also important to know that there may be a genetic overlap between schizophrenia and autism. One study suggested that schizophrenia and autism may share underlying pathogenic mechanisms, meaning to say that both mental conditions have certain similar biological structures that are able to give rise to said conditions. As mentioned before about mutations and deletions, such occurrences are usually inherited from the father, and – as in schizophrenia – the oldest fathers have a higher probability to have children with autism than younger fathers are. In other cases, prenatal environment – the environment inside the uterus where the unborn child is developing – may also play a part in autism. Some mothers of children with autism have antibodies, a Y-shaped blood protein, that attack certain brain proteins during pregnancy. Few mothers of unaffected children have such antibodies, therefore identifying women who have these antibodies may make it possible to intervene chemically to prevent autism.

One other likely factor may lie with the inadequate intake of vitamin B9, also known as folic acid, among pregnant women and women who plan to become pregnant. Vitamin B9 has been known for its crucial role in the proper development of the nervous system.

With these likely factors laid out in consideration of other possible factors, there is no one single cause of autism. Additionally, the various conditions that affect brain development, with regards to autism, may occur before, during or after birth. What we currently know is that autism may develop from a combination of several causes and is found in many individuals globally in families of every racial, ethnic and social background; no association has been found between socioeconomic status (SES) and diagnosis of autism.

Signs and Symptoms

Some individuals may display signs of ASD during early infancy, such as inconsistent or reduced eye contact, lack of response when being called by their name. Other children may develop normally for the first few months or years of life, but suddenly become withdrawn or aggressive or lose language skills that they have acquired. Not all individuals with ASD will show all behavioural symptoms, but most will show several.

In the case of my younger sibling, he was described as a quiet baby who seldom shared objects or events he was interested in with anyone. Additionally, proto-declarative pointing, which is the typical use of the index finger to indicate an item of interest among toddlers, was markedly absent. To understand this better, his use of gestures was also very limited, and he would pull his mother’s hand to get something. Proto-declarative pointing is one crucial indicator of a later diagnosis of autism.

Although ASD can be diagnosed at any age, it is a developmental disorder because symptoms typically present themselves during the first two years of life. The following are some common signs observed among people who are diagnosed with this condition:

  • Social communication and interaction behaviours include any of these:
    • reduced, inconsistent, or no eye contact
    • failure to respond to his/her name or appears not to hear you at times
    • facial expressions, movements, and gestures that do not match what is being said
    • having trouble understanding another person’s perspective
    • does not point at or bring objects to share interest
    • does not appear to understand simple questions or directions
    • repeats words or phrases, but does not know how to use them
    • speaks with an unusual tone or rhythm and may use a singsong voice or robot-like speech
    • unable to start a conversation or keep one going, or only knows how to make requests or label items
  • Restrictive/repetitive behaviours may include:
    • repeating certain behaviours or having unusual behaviours
      • g. echolalia – the act of repeating noises and phrases that they hear; people with echolalia may not be able to communicate effectively because they struggle to express their own thoughts, therefore, they might only be able to repeat a question rather than answer it.
    • fixates on a certain object or topic with abnormal intensity or focus
    • develops specific routines or rituals and becomes upset over the slightest interruptions
    • unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
      • my brother has been described in his diagnosis as an individual who “hardly seeks comfort and this is in part due to his high threshold of pain”.

As children with ASD age, some may gradually become more involved with others and show fewer disruptions in their behaviour. As observed in my younger brother, he is able to strike up a conversation and keep it going, even though it is only with select individuals of whom he may find comfortable talking to. Additionally, some, usually with the least severe problems, may eventually lead normal or near-normal lives.

Treatments and Therapies

Redefining Life Values after 40

There is currently no known cure for ASD and as mentioned before, it is possible for symptoms to lessen especially with the appropriate intervention; people do not outgrow autism.

Structured intervention and relevant training will help these individuals acquire the necessary life skills. According to the Singapore Autism Resource Centre (ARC), there has been extensive research carried out to evidence that young children with autism experience substantial improvements when intervention is started at the earliest possible age. Parents and caregivers should note that the learning curve for pre-schoolers with ASD is different from that of his/her peers. They often require clear instructions and practice of the core skills such as social interaction, communication, self-regulation and organisational skills in order to be more self-reliant as they grow older. Given the proper education and guidance, many individuals with autism will grow up to successful contributors to the society. One famous example would be Satoshi Tajiri, the brains behind the globally renowned video game Pokémon.

Always remember the famous words of Dr. Stephen Shore – If you’ve met one person with autism, you’ve met one person with autism. Although there are similarities when it comes to certain issues experienced by individuals with ASD such as social interaction, communication and repetitive behaviour, they merge together differently for each individual. It is why some may excel at science or math while others excel in sports or arts, and this could be said the same for the rest of the human population.