Experts offer advice on autism spectrum disorder

Autism spectrum disorder does not present in the same way in everyone.

In fact, it looks very different for different people.

It is a neuro-developmental condition that affects the way a person communicates, socialises, and behaves. It does not develop in adulthood but starts in childhood. It is an issue with the sequence of developmental milestones children are expected to meet.

Therefore, doctors and psychiatrists look at the way the child behaves to diagnose them.

Speaking at UWI’s Psychoeducational Diagnostic and Intervention Clinic webinar titled An Introduction to Autism Spectrum Disorder on February 14, developmental-behavioural paediatrician Dr Liesl Windsor explained that established criteria for a diagnosis of autism fell into two main categories.

“The reason I’m mentioning these two parts is that you have to have both parts for the diagnosis of autism to be met…No one thing says, 'That is or isn’t autism.' It’s a combination of pieces that we put together that make up the diagnosis.”

The first category, social communication, deals with how people interact with each other, having back-and-forth communication, non-verbal communication, and developing and maintaining relationships.

The second category is repetitive or restrictive interests or activities.

She stressed that repetitive behaviour was not necessarily a bad thing.

“That child may know why they do it. It’s just something they enjoy and we don’t get it at face value. So it requires some digging on our part to figure out why.”

This behaviour could include flapping their arms, spinning, close adherence to routines or rituals, wanting things to be a particular way, unusual use of vision or gaze, or sensitivity to sensory input like lights, sounds, textures or tastes.

“None of these should be considered as ‘bad.’

"What we are looking for are traits or signs that this child might have this diagnosis. We are thinking about what might this behaviour mean for this child and does this child need more support.”

Windsor stressed that having some of these signs does not prove a diagnosis. And if a child is diagnosed with autism, it is important to remember it’s not about fixing, stopping or changing the child’s personality, but to be aware they may need further support in learning, communication and socialisation, and get them that support as soon as possible.

She said scientists do not know the causes of autism. but it is most likely a combination of biological, environmental and genetic factors that lead to the behaviours seen in those with autism spectrum disorder.

And while there are no medications to treat autism, there are medications to treat some of the co-occurring conditions such as seizures, hyperactivity or impulsivity, anxiety, and gastrointestinal disorders.

Instead, different types of therapy geared towards the needs of each child are the gold standard for treatment.

Khadine Ali, a board-certified behaviour analyst, said some of the common approaches for autism involve applied behaviour analysis (ABA), as well as speech, physical, behaviour, and occupational therapy, according to the child’s needs.

“We always try to, as best as possible, utilise early intervention, because we see a lot of gains and it reduces a lot of frustration and barriers for our children. It really increases the likelihood that they would catch up to what they should be at developmentally.

“The goal is not to fix the child, but to maximise their strengths and adjust any behaviour that may be interfering with their daily functioning.”

She said when their child is diagnosed, some parents react strongly to the news. They may feel grief, a sense of loss, depression, guilt, denial, anger towards the professionals involved with the child, and other negative emotions.

“These things are normal. That does not make you a bad person, because you do love your kids. You have to grieve. It is part of the process. You have to speak to someone if you’re really struggling and have not been fully able to process it because that could be a barrier to your child’s success and their access to intervention.”

She encouraged parents to join autism support groups such as Support Autism Trinidad and Tobago, the Autistic Society of TT, or Autism Tobago, or contact a therapist or psychologist.

Windsor added that some outward physical and behavioural signs of autism could diminish over time through therapy, observing others, or growing up, but those on the spectrum may still have other challenges. such as relationship-building and social interactions.

“My approach is to focus less on the diagnosis, and more on the skills and challenges. What are we good at? Let’s make a career out of that. I focus on what is the main concern now, and how do we address that issue.”