AUTISM AWARENESS - Autism spectrum disorders - What everyone should know

 How common is ASD?

The autism spectrum disorders (ASD) are now the most common group of developmental disorders of childhood. Though we do not yet have accurate figures for Jamaica, the Centers for Disease Control and Prevention in the United States reported in March 2014 that one in every 68 children will have a diagnosis of ASD, based on information collected in 2010.

This has increased from one in 88 children reported in 2012, from information collected in 2008. The prevalence of autism has increased 20 to 30 times since the first studies were done in the 1960s to 1970s, when the rate was one in every 2,500 children. By 2000, the rate was one in every 100 to 200 children.

In Jamaica, where we have almost 40,000 births per year, this means that approximately 600 children per year will later be diagnosed with ASD. Because boys are affected four to five times more than girls, this 600 will be made up of 500 girls and 100 boys.

What causes ASD?

Though we have done very well in tracking the prevalence of ASD, we have not been very successful in identifying the cause or causes. Our current understanding is that ASD is caused by a combination of genetic and environmental factors. This means that a new diagnosis of ASD is more common if there was a previous diagnosis in a family (genetic factor).

For environmental factors, heavy metals and pollutants have been studied but no definitive environmental factor has been identified. What is known is that mothers and fathers who have children when they are 35 years and over are at greater risk of having a child with ASD.

How can I know if my child has ASD?

Children with ASD have delayed language, including delayed speaking (late talking or normal talking first followed by loss of words), delayed understanding (for example, not responding when their name is called), and delayed use of gesturing (for example, not pointing to indicate their needs).

They also do not socialise as well with others; they may not play with other children as expected; and may avoid looking persons in the eyes. They may also have unusual behaviours, including repeating the same activity over and over very frequently and intensely (for example, spinning objects, turning light switches on and off), repeating words often, becoming very upset at small changes (for example, refusing new foods, taking only certain foods, wearing only certain clothes) and being extra sensitive to sound, touch, taste or smell.

Each child is different and may not have all the signs to the same degree.

Parents often notice language development problems first but are often told children will "soon talk". As a result, many children do not get diagnosed until they are three to four years old, when a diagnosis can be made as early as 18 months. Children who are identified and get services earlier do better than those who do not.

To ensure early diagnosis in Jamaica, the Child Health and Development Passport has five questions that parents should answer about their child at 18 months.

These questions are:

1. Does your child take an interest in other children?

2. Does your child use his finger to point to show an interest in something?

3. Does your child imitate you (for example, making a face)?

4. Does your child respond to his/her name when you call?

5. If you point at a toy across the room, does your child look at it?

If a parent has any concern about these questions, he/she should bring this to the attention of his/her child's doctor or nurse.

How is a diagnosis of ASD made?

Your child can be referred to a specialist developmental paediatrician at the University Hospital of the West Indies (UHWI) Child and Family Clinic for a diagnosis to be made. Diagnosis usually involves two types of tests - tests for autism and tests of your child's development. Developmental tests are done as just over a half of children with autism may have developmental delay. For both autism and developmental testing, your child will be given toys to play with and observed very closely. Sometimes blood tests are necessary.

There are no tests for prenatal diagnosis at this time.

What is the treatment for ASD?

Children with ASD often require behaviour therapy, speech therapy, occupational therapy and early intervention or special educational services. Some children may require medication.

Is there any help for parents?

Jamaica is fortunate to have a strong parent support group, the Jamaica Autism Support Association (JASA). JASA parents meet on the last Saturday of every month at the YMCA at 4 p.m. (www.jamaicaautism.org)

Maureen Samms-Vaughan is a consultant developmental and behavioural paediatrician, UHWI; professor of child health, child development and behaviour, UWI; email: yourhealth@gleanerjm.com.