World Autism Day 2022: Why Is Early Treatment Crucial For A Child's Long-term Development?

Autism Spectrum Disorder (ASD) is mostly a lifelong condition characterized by social-communication impairments as well as by repetitive interests and activities. The number of cases are seen more among boys compared to girls. Causative factors of ASD is multifactorial, resulting from complex interactions  between genetic and environmental factors.

One of the most frequently asked questions by the parents of a child with autism is “what future will my child have?”. It's quite challenging to answer this question as it depends on various factors.We emphasize on early recognition of the symptoms and therapy to prevent long term complications and associated comorbidities. 

Early Recognition and Monitoring

Early interventions during preschool age, as early as 2 or 3 years of age is advised. During this period child's brain has more capability to undergo transformation because of plasticity. Which means it can be easily moulded and have good long term neurological development.

Child's family members including Parents, grandparents and other caregivers can participate in developmental monitoring.

Early red flags for ASD include 

• poor eye contact 
• poor response to name
• lack of showing and sharing 
• no gesturing by 12 months  
• loss of language or social skills

The American Academy of Pediatrics (AAP) recommends screening of developmental and behavioral patterns for all children during regular well-child visits at these ages:

• 9 months
• 18 months
• 30 months

Additionally, AAP recommends that all children must be screened, specifically for ASD during regular well-child doctor visits at the age of 18 and 24 months. Based on the results the pediatrician may recommend further tests, to check if a child is at high risk for ASD (e.g., having a sister, brother, or other family member with an ASD).

Developmental monitoring observes how your child progresses over time and whether the child is meeting the typical developmental milestones which includes playing, learning, speaking, behaving, and moving. If there is a delay in achieving the milestone, it is essential to speak to your doctor about your concerns. 

Associated comorbidities

During the transition to adulthood, people with ASD face several relevant challenges. There is an increased risk of health problems such as obesity and epilepsy. Children with ASD are prone to serious or even fatal accidents. Increase of premature mortality has been reported particularly in people with lower intellectual functioning, mainly due to neurological disorders and congenital abnormalities.

Psychiatric comorbidity is frequent, an increased risk of anxiety and depression further, possible recurrence of schizophrenia or bipolar disorder was reported. Hyperactivity Disorder (ADHD) is a very frequent psychiatric comorbidity in individuals with ASD and affects the life of children and adults over time impacting negatively on executive functions, peer relations and mood. 

In general, the (1) absence of a medical (e.g.: a rare disease such as tuberous sclerosis) or psychiatric (e.g.: ADHD) comorbidity, (2) an early treatment, (3) presence of verbal speech at around 5-6years and (4) discrete intellectual functioning are all favorable prognostic factors. 

Treatment 

• There are no medicationsthat treat the main symptoms of ASD, however, some medications can be used to treat co-occurring symptoms which helps people with ASD function better.
• Behavioral approach - A notable behavioral treatment for people with ASD is called Applied Behavior Analysis (ABA). ABA helps in acquiring desired behaviors and discourages undesired behaviors and improves variety of skills. Progress is tracked and measured accordingly.
• Developmental approach - The most common developmental therapy for people with ASD is Speech and Language Therapy. It helps to improve the person's understanding and use of speech and language. Occupational Therapy teaches children various skills that helps them to live less dependent life. Skills may include dressing, eating, bathing, and relating to people can be improved.
• Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH)- class room teaching based on the idea that people with autism have good response to consistency and visual learning.

Hence, early recognition of ASD and appropriate timely therapy is crucial for long term development. It further improves the quality of life of child and the caregivers.

Authored by Dr Kranthi Mohan - Consultant Neurologist, BGS Gleneagles Global Hospital