Michael Abrahams | Understanding autism

Autism spectrum disorder (ASD) is a neurodevelopmental condition that impacts how a person perceives and learns, and socialises, interacts and communicates with others. The word ‘spectrum’ relates to the fact that the disorder encompasses a wide range of symptoms, signs and levels of severity, from those with what we might consider to be harmless quirks to others who are non-verbal and unable to communicate with others and require constant monitoring. It is described as a ‘developmental disorder’ because symptoms generally appear in the first two years of life, although many persons with the condition are diagnosed late.

ASD is not classified as an illness or disease. It is not a mental disorder either, although persons on the spectrum may also have psychiatric conditions such as attention deficit hyperactivity disorder, anxiety, depression and obsessive compulsive disorder. They may also have learning disorders such as dyslexia, or other neurological conditions such as epilepsy.

We do not know what causes autism. The claim that the disorder can be caused by certain vaccines has not been validated by research. However, some risk factors have been identified, such as genetics. For example, a child has an increased risk of being on the spectrum if they have a sibling who has ASD. Research has found that up to 80 per cent of a child’s risk of developing ASD is determined by DNA. Additionally, certain genetic conditions, such as fragile X syndrome or tuberous sclerosis, increase the risk. Having older parents is another risk factor. Air pollution has also been found to be a risk factor, as children of mothers living near a freeway and exposed to traffic-related pollution during the third trimester of pregnancy were twice as likely to be afflicted. Folic acid and vitamin B12 are essential for our bodies to function correctly, and robust levels of folic acid in women reduce the risk of giving birth to babies with neural tube defects should they conceive. However, research has found that if women have excessive levels of these vitamins, it increases the risk of giving birth to babies with ASD.

DIAGNOSED IN INFANCY

Being a developmental disorder, ASD is often diagnosed in infancy. One of the most common signs is avoiding or not keeping eye contact with other people. It is also likely if an infant does not respond to their name or show facial expressions indicating a range of emotionsm such as happiness, sadness, anger or surprise by nine months of age, or does not talk by 18 to 24 months of age. Other signs are restrictive or repetitive behaviours, such as lining up toys or other objects and getting upset when the order is changed or when there are even minor changes in routines they are accustomed to. Delayed movement and cognitive or learning skills are also common.

Autism is not necessarily associated with decreased intelligence. In fact, it has been estimated that about 60 per cent of autistic people have average or above-average intelligent quotients, and many people on the spectrum are very successful in their jobs and professions, including several public figures. For instance, well-known people on the spectrum include Academy award-winning actor Anthony Hopkins, popular footballer Lionel Messi, and environmental activist Greta Thunberg.

Thanks to research and groups dedicated to autism awareness, we hear much more about the condition than we used to decades ago. In 2023, the Centers for Disease Control and Prevention (CDC) announced an increase in the prevalence of autism among children, stating that one out of every 36 children has autism, an increase from the estimate of one in 44 in 2021 and one in 110 in 2006.

DISCOVERING MORE

This increase may sound alarming and may lead one to believe that more children are being born with the disorder, or are developing it at a higher rate. But that does not appear to be the case. Instead, it is thought that we are just discovering more of what has always been present. There is no simple test that is used to diagnose autism. However, thanks to research and increased awareness, physicians and others who manage developmental disorders have become more skilled in diagnosing the condition. Routine screening of infants is recommended, and new techniques and tools are being developed to enhance diagnosis.

For example, last year, in a study supported in part by the National Institute of Mental Health, a tablet-based screening tool that analyses children’s behaviour in response to specific video clips was found to be of value in screening for autism in young children.

The male-to-female ratio is often quoted as 1:4, but many experts are sceptical of that statistic. Many females are believed to be missed because their signs and symptoms can differ from those of males, leading to missed or late diagnoses.

There is no cure for autism. However, interventions such as speech and behaviour therapy are vital in giving persons on the spectrum the best chance of integrating into society. In severe cases, continuous care and monitoring will be required.

It is essential for us to understand the condition, as due to its relatively high prevalence, we are surrounded by persons on the autism spectrum. Some of the children we see making loud noises or throwing tantrums are not spoiled brats but kids on the spectrum. Some of the adults we know who do not make eye contact with us or make blunt statements may not mean to be rude but may have ASD.

As for parents of young children, if you realise that they are not communicating the way they ought to, and appear to be disconnected, get them assessed as soon as you can. Early detection and intervention have the potential, depending on the severity of the disorder, to positively affect their quality of life.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams.