FAQs

According to the Centers for Disease Control, of the approximately 4 million babies born every year, 24,000 of them will eventually be identified as autistic. Also, recent studies suggest boys are more susceptible than girls to developing autism. In the United States alone, 1 out of 70 boys are suspected of being on the spectrum, with perhaps more going undiagnosed to this day. Studies have revealed that girls appear to manifest a more severe form of the disorder than their male counterparts.

No one knows for sure. Research says that there is a strong genetic base for this. Recent studies suggest a strong genetic basis for autism — up to 20 sets of genes may play a part in its development. Scientists also believe that environmental factors play a role in developing autism.

Each child with autism differs, but there are some signs that many of them share. Children on the spectrum generally have difficulty relating to others; they may hardly speak, and if they do, they may not communicate in ways that other people can easily understand (for example, they may scream loudly when they’re upset, instead of crying). They don’t usually sustain eye contact. It’s too intense and has trouble reading social cues. They’re also prone to repetitive behaviors, flapping their hands constantly or uttering the same phrase over and over again. Further, they may be more sensitive than typically developing children, or dramatically less so, to sights, sounds and touch.

The theory of Sensory Integration (SI) was developed in the 1960s by Dr. A. Jean Ayres, an occupational therapist who was a pioneer in the field of learning disabilities. She defined SI as the body’s capacity to organize sensory input, information and stimulation a person receives from his/her own body and the environment through the different sensory systems:

• tactile (touch)
• proprioceptive (joint and muscle impulses)
• vestibular (movement, visual, auditory)
• vision
• hearing and listening/auditory

This sensory information is then processed by the central nervous system and is used to help our body develop spatial awareness, muscle tone, postural stability and self-regulation. SI gives us the awareness of our body and the ability to use it as a tool to interact with others in our world. For those with Sensory Integration Dysfunction, the brain is not processing organizing the flow of sensory impulses properly. This can impact on a person’s functional, developmental and learning processes.

Signs of Sensory Integration Dysfunction include:
• Overly sensitive to touch, movement, sights or sounds
• Easily distractible
• Decreased awareness of surroundings
• Activity level that is unusually high or unusually low
• Impulsive, lacking in self-control
• Inability to unwind or calm self
• Poor self-concept
• Social and/or emotional problems
• Physical clumsiness or apparent carelessness
• Difficulty making transitions from one situation to another
• Delays in speech, language, or motor skills
• Delays in academic achievement
• Slow reaction to touch, movements, sights, or sounds

A Typical SI/OT Session A typical SI/OT session providing the right kinds of sensory stimulation helps in the normalization of sensory systems – tactile, vestibular, proprioceptive, auditory and visual as well as to provide the optimal state of alertness and attention. In addition, it helps to develop an adaptive response for daily functioning.

The goal of occupational therapy interventions is to enable individuals to participate in everyday occupations. This may be achieved through a range of therapy approaches such as modification of tasks and/or the environment to match individuals’ abilities, to develop skills such as posture and coordination, or for the development of daily routines and to facilitate adaptive behaviours (National Institute of Child Health and Development, 2005). Occupational therapists work with children in their natural settings; in the home with their families, in the school and in the community. Occupational therapy treatment has focused on two main areas: Sensory Motor Integration In the past, one of the more frequent sensory motor interventions in occupational therapy was sensory motor integration. However, there is evidence that children with autism do process sensory information differently from other developing children (National Institute of Child Health and Development, 2005).

Therefore, the focus in Occupational therapy has shifted to understanding how and when a child is reacting poorly to a sensory experience and structuring the environment to accommodate or minimize such reactions. Occupational therapists can use a mediator or consultation approach to work with parents and teachers providing strategies to prevent reactions to sensory experiences from limiting daily activities. For example, if a child with autism is upset by excess noise that may occur at end of a school day, they could get ready to go home before others leave. If a child is bothered by a specific clothing material (e.g. wool), this type of material could be avoided in their clothing. By adapting the tasks and environments as well as working with the families on how to teach new skills and build calming or alerting activities into their everyday routines, Occupational therapists can make a difference in the family’s day to day life.

In particular, occupational therapy focuses on self care issues, feeding, bathing, hygiene and sleep which are significant issues for children and enormous stressors for the family. In the school setting, a student’s occupational performance may be impaired by sensory, developmental, inattention and/or learning challenges .Occupational therapists may adapt classroom tasks and the school environment to promote a child’s participation. Occupational therapists can assist teaching caregivers and teachers with understanding the impact of sensory processing difficulties on daily functioning and how they can modify what they need do to maximize the child’s participation and reduce behavioural difficulties. There are 4 types of supports that could potentially have a positive impact on the lives of children with autism. The environmental supports suggested are: temporal supports (events over time – this would allow a child to prepare themselves in advance for a change in activity), procedural supports (including instructions for activities or relating people to events), spatial supports (allowing the child to organize themselves within the environment), and assertion support (aiding the child in social interactions).

Occupational therapists work with children with autism and their families to provide intervention that improves the child’s ability to participate in activities of daily living, play and school. In occupational therapy, the focus is on task analysis, breaking down a task into manageable steps for the child, teaching those steps to the key people in the child’s environment and structuring task and/or environment to support successful completion. For example, if a child with autism is having difficulty dressing himself, the occupational therapist could use a backward chaining behavioural approach which teaches skills by breaking the tasks down into manageable steps which are always performed in the exact same order.

There are five main components of ABA behavior sessions:

An ADHD diagnosis alone is not enough to qualify for disability benefits. If your ADHD symptoms are well controlled, you probably aren’t disabled, in the legal sense. But if distractibility, poor time management, or other symptoms make it hard for you to complete your work, you may be legally disabled. Legally, “disability” means a physical or mental condition that significantly limits a major life activity — in this case, works

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development.

Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

Often has trouble holding attention on tasks or play activities.

Often does not seem to listen when spoken to directly.

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

Often have trouble organizing tasks and activities.

Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

Is often easily distracted

Is often forgetful in daily activities.

Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

Often fidgets with or taps hands or feet, or squirms in seat.

Often leaves seat in situations when remaining seated is expected.

Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

Often unable to play or take part in leisure activities quietly.

Is often “on the go” acting as if “driven by a motor”.

Often talks excessively.

Often blurts out an answer before a question has been completed.

Often has trouble waiting their turn.

Often interrupts or intrudes on others (e.g., butts into conversations or games)

Rett syndrome is a rare genetic neurological and developmental disorder that affects the way the brain develops, causing a progressive loss of motor skills and speech.  primarily affects girls.

Most babies with Rett syndrome seem to develop normally for the first 6 to 18 months of age, and then lose skills they previously had — such as the ability to crawl, walk, communicate or use their hands.

Although there’s no cure for Rett syndrome, potential treatments are being studied. Current treatment focuses on improving movement and communication, treating seizures, and providing care and support for children and adults with Rett syndrome and their families.

Stages of Rett syndrome

Rett syndrome is commonly divided into four stages:

• Stage I: early onset. Signs and symptoms are subtle and easily overlooked during the first stage, which starts between 6 and 18 months of age and can last for a few months or a year. Babies in this stage may show less eye contact and start to lose interest in toys. They may also have delays in sitting or crawling.
• Stage II: rapid deterioration. Starting between 1 and 4 years of age, children lose the ability to perform skills they previously had. This loss can be rapid or more gradual, occurring over weeks or months. Symptoms of Rett syndrome occur, such as slowed head growth, abnormal hand movements, hyperventilating, screaming or crying for no apparent reason, problems with movement and coordination, and a loss of social interaction and communication.
• Stage III: plateau. The third stage usually begins between the ages of 2 and 10 years and can last for many years. Although problems with movement continue, behavior may have limited improvement, with less crying and irritability, and some improvement in hand use and communication. Seizures may begin in this stage and generally don’t occur before the age of 2.
• Stage IV: late motor deterioration. This stage usually begins after the age of 10 and can last for years or decades. It’s marked by reduced mobility, muscle weakness, joint contractures and scoliosis. Understanding, communication and hand skills generally remain stable or improve slightly, and seizures may occur less often.

Rett syndrome signs and symptoms include:

• Slowed growth. Brain growth slows after birth. Smaller than normal head size (microcephaly) is usually the first sign that a child has Rett syndrome. As children get older, delayed growth in other parts of the body becomes evident.
• Loss of normal movement and coordination. The first signs often include reduced hand control and a decreasing ability to crawl or walk normally. At first, this loss of abilities occurs rapidly and then it continues more gradually. Eventually muscles become weak or may become rigid or spastic with abnormal movement and positioning.
• Loss of communication abilities. Children with Rett syndrome typically begin to lose the ability to speak, to make eye contact and to communicate in other ways. They may become disinterested in other people, toys and their surroundings. Some children have rapid changes, such as a sudden loss of speech
• Abnormal hand movements. Children with Rett syndrome typically develop repetitive, purposeless hand movements that may differ for each person. Hand movements may include hand-wringing, squeezing, clapping, tapping or rubbing.
• Unusual eye movements. Children with Rett syndrome tend to have unusual eye movements, such as intense staring, blinking, crossed eyes or closing one eye at a time.
• Breathing problems. These include breath-holding, abnormally rapid breathing (hyperventilation), forceful exhalation of air or saliva, and swallowing air. These problems tend to occur during waking hours, but breathing disturbances such as shallow breathing or periodic breathing can occur during sleep.
• Irritability and crying. Children with Rett syndrome may become increasingly agitated and irritable as they get older. Periods of crying or screaming may begin suddenly, for no apparent reason, and last for hours. Some children may experience fears and anxiety.
• Other abnormal behaviors. These may include, for example, sudden, odd facial expressions and long bouts of laughter, hand licking, and grasping of hair or clothing.
• Cognitive disabilities. Loss of skills can be accompanied by a loss of intellectual functioning.
• Seizures. Most people who have Rett syndrome experience seizures at some time during their lives. Multiple seizure types may occur and are accompanied by an abnormal electroencephalogram (EEG).
• Abnormal curvature of the spine (scoliosis). Scoliosis is common with Rett syndrome. It typically begins between 8 and 11 years of age and increases with age. Surgery may be required if the curvature is severe.
• Irregular heartbeat. This is a life-threatening problem for many children and adults with Rett syndrome and can result in sudden death.
• Sleep disturbances. Abnormal sleep patterns can include irregular sleep times, falling asleep during the day and being awake at night, or waking in the night with crying or screaming.
• Other symptoms. A variety of other symptoms can occur, such as thin, fragile bones prone to factures; small hands and feet that are usually cold; problems with chewing and swallowing; problems with bowel function; and teeth grinding.

There is no way to prevent autism spectrum disorder, but there are treatment options. Early diagnosis and intervention is most helpful and can improve behaviour, skills and language development.

Have regular check-up, eat well- balanced meals, and exercise during pregnancy. Make sure you have good prenatal care . Reducing exposure to toxins. The scientific community has discovered evidence that environmental factors often play a role in developing autism. Pregnant women can limit airborne toxins by wearing masks and staying indoors when air quality is low. For the duration of pregnancy, women should eliminate alcohol, tobacco, and caffeine. Switching to green personal care products is wise to lessen exposure to potentially harmful chemicals. Some doctors also suggest avoiding canned foods, plastic water bottles, and excessive cell phone use. Maintain a nutritious diet pregnant women can lower the risk for autism by eating colourful, organic diet rich in green vegetables and fruit containing antioxidants. Increasing intake of vitamin D has been linked to better neurological development in Foetuses’.

After birth if you’re concerned about your child’s development or you suspect that your child may have autism spectrum disorder, conduct routine check-ups, discuss your concerns with your doctor followed by an expert team for further interventions. The symptoms associated with the disorder can also be linked with other developmental disorders also.

If your child hasn’t really smiled or shown any type of eye contact or happy expression by 6 months or afterwards, this might be an early warning characteristic of autism.

1. If your child hasn’t really smiled or shown any type of eye contact or happy expression by 6 months or afterwards, this might be an early warning characteristic of autism.
2. If your child is 9 months old or older, he/she should be sharing sounds, smiles or other facial expressions.
3. Once he/she has hit 12 months of age, your child should be pointing, showing, reaching or waving.
4. By 16 months of age, your child should be saying at least a couple of words.
5. By 2 years, your child should be expressing 2-word phrases by him/herself, (without imitating)
6. If you notice any loss of speech, babbling or social skills at any age, this might be an indicator of Autism.
7. If your child speaks with little variation in pitch, odd intonation, irregular rhythm or just a strange voice, this could be a sign of autism.
8. Does your child repeat movements with objects over and over or repeat certain movements with his/her arms, hands, body or fingers? This is a possible red flag.
9. If your child doesn’t want to hug or hold onto you. – but do not let this one be your sole indicator. Contrary to popular belief, some autistic children are quite affectionate.
10.  If your child is not bringing objects to you to identify and is not pointing to objects by the time the first birthday is reached.
11. If your child doesn’t want to interrelate with you and play games such as “peek-a-boo” or not exhibiting creative or imaginative play.
12. If your child shows aggressive behavior on a normal basis or bangs his or her head against an object.
13. If you notice your child  engaging in repetitive behaviors, such as opening or closing doors or drawers over and over or performing actions that are often repetitive and unchanging like twirling objects or rocking.
14. If your child takes more fascination with parts of a toy than the action for which the toy was designed (Spinning the wheels of a toy car instead of driving it ).
15. Learning difficulties i.e. he lacks in ability to learn inductively from surrounding events.
16. Communication or speech problems.
17.  Difficulty relating to people, marked by a lack of awareness of the feelings of others, indifferent to parents.
18. Lack of social interaction.
19. Short attention span.
20. Reacting extremely to changes in the immediate environment.

If you are concerned, in any way, about your child’s development; speak with your child’s pediatrician. You will likely be referred to a specialist- either a child psychologist or a developmental pediatrician where your child will undergo further testing.

Your child may receive a diagnosis of ADHD, or Sensory Processing Disorder instead of Autism or in addition to autism. Sometimes the signs of ADHD may manifest or present as autism. And many autistic children also have underlying sensory issues.

It’s important to keep in mind that the earlier your child is diagnosed with autism, the earlier they can begin therapy,there will be better chance for improvement.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsivity that interferes with functioning or development.

Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.

Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have a high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

As children with ADHD get older, they’ll oftentimes not have as much self-control as other children of  their own age. This can make kids and adolescents with ADHD seem immature compared to their peers where they  outburst of anger and lack of self control occur frequently. The child is viewed as immature, irritable, disruptive, demanding and uncooperative by teachers. These children also have difficulty in establishing and maintaining satisfactory social relationships.

Also the child with ADHD might:

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• have trouble taking turns
• have difficulty getting along with others
• forgetfulness
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptationAll children are going to exhibit some of these behaviors at some point. Daydreaming, fidgeting, and persistent interruptions are all common behaviors in children.You should start thinking about the next steps if:
• your child regularly displays signs of ADHD
• this behavior is affecting their success in school and leading to negative interactions with peersADHD is treatable. If your child is diagnosed with ADHD, review all king of treatment options.

Speech therapy is a training to help children with speech and language problems to speak more clearly. The professionals deal with disorders in communication, evaluation, diagnosis and rehabilitation Individual speech therapy sessions as well as group therapies are provided by 10 highly qualified speech therapists from various institutions.

Speech therapy is an intervention service that focuses on improving a child’s speech abilities to understand and express language, including nonverbal languages. Speech therapists or speech and language pathologists are the professionals who provide these services. Speech therapy includes two components – 1) Coordinating the mouth to produce sound, to form words and sentences. 2) Understanding and expressing language. The role of SLPs also includes swallowing disorders and all aspects of feeding.

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioural challenges. The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment that people with ASD can have.  ASD affects people in different ways and can range from mild to severe. People with ASD share some symptoms, such as difficulties with social interaction, but there are differences in when the symptoms start, how severe they are, the number of symptoms, and whether other problems are present. The symptoms and their severity can change over time. The signs of ASD begin in early childhood, usually in the first 2 years of life, although a small minority of children may show hints of future problems within the first year of life.

Some autistic children are delayed in their use of language and some autistic adults don’t use speech. In those cases, other methods of communication need to be established. The person may appear not to hear what you say to them, not respond to their name, or appear indifferent to any attempts you make to communicate.

They may use some of the following to communicate with you:

• Gestures
• Crying
• Taking your hand to the object they want
• Looking at the object they want
• Reaching
• Using pictures
• Challenging Behaviour
• Echolalia (the repetition of other people’s words).

The picture exchange system (PECS) is a form of spontaneous communication for children with autism in which an individual selects a picture indicating a request.[10] PECS can be utilized in educational settings and at the child’s home

Applied Behavior Analysis (ABA) is a therapy based on the science of learning and behavior.

Behavior analysis helps us to understand:

• How behavior works
• How behavior is affected by the environment
• How learning takes place

ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning.

ABA therapy programs can help:

• Increase language and communication skills
• Improve attention, focus, social skills, memory, and academics
• Decrease problem behaviors

The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills – from healthier lifestyles to learning a new language. Therapists have used ABA to help children with autism and related developmental disorders since the 1960s.

Applied Behavior Analysis involves many techniques for understanding and changing behavior. ABA is a flexible treatment:

• Can be adapted to meet the needs of each unique person
• Provided in many different locations – at home, at school, and in the community
• Teaches skills that are useful in everyday life
• Can involve one-to-one teaching or group instruction

Positive Reinforcement

Positive reinforcement is one of the main strategies used in ABA.

When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.

First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more.

Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.

Antecedent, Behavior, Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

Positive reinforcement is one of the main strategies used in ABA.

When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.

First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more.

Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.

Antecedent, Behavior, Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

The following three steps – the “A-B-Cs” – help us teach and understand behavior:

• • An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).
  • A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.
  • A consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.

Looking at A-B-Cs helps us understand:

1. Why a behavior may be happening
2. How different consequences could affect whether the behavior is likely to happen again

Example:

• Antecedent:The teacher says “It’s time to clean up your toys” at the end of the day.
• Behavior:The student yells “no!”
• Consequence: The teacher removes the toys and says “Okay, toys are all done.”

How could ABA help the student learn a more appropriate behavior in this situation?

• Antecedent: The teacher says “time to clean up” at the end of the day.
• Behavior:The student is reminded to ask, “Can I have 5 more minutes?”
• Consequence: The teacher says, “Of course you can have 5 more minutes!”

With continued practice, the student will be able to replace the inappropriate behavior with one that is more helpful. This is an easier way for the student to get what she needs!

There are five main components of ABA behavior sessions:

• Task analysis – Complex activities are broken down into a series of small steps and taught until the child can complete the task without assistance. Positive reinforcement enables child to use the new skills in future also. Years of conditioning has taught us as parents to use negative reinforcement as a method of disciplining but positive reinforcement has shown to be much more effective at achieving results.
• Chaining – Several forms of chaining exist and the therapists at your applied behavior center for autism will determine which method of chaining is best for your child given his or her individual differences. The goal is to teach and make child self sufficient to complete entire chain independently.
• Prompting – Different types of prompts are used by ABA therapist to help child learn new skills. Errorless teaching is an antecedent intervention style which helps in reducing the occurrence of an incorrect response. Chances of having mistakes are less as children are given (verbal, visual or physical gestural) cues.
• Fading – When the child starts mastering a skill with the help of prompts, the prompts must be removed gradually as he or she moves toward independence. Prompting and Fading are usually done slowly and continue until the child can perform new skills on his or her own.
• Shaping – Shaping reinforces attempts to complete a skill until the child can perform the action or skill independently.

ABA therapists use various techniques to help the children learn.

• Generalization – The therapist takes what the child has learned in one setting and applies it to other settings to help them complete those tasks successfully.
• Behavior Contracts – Behavior contracts are brief, three-part plans negotiated between the child and the ABA therapist. The contract starts by listing the positive behavior that the therapist wants to see. Then an outline is prepared on what ABA analyst is to do once the behavior is done. When long term rewards are set, behavior contract is finished. Putting behavioral expectations in writing in a contract and with enticing rewards can help motivate children.
• Video Modeling – Helps in learning suitable behaviors by watching others. It shows a child how to behave and complete an activity. This helps in improving social skills, communication skills and play skills. Imitations are easily done by Children with Autism.

Social Communication Impairments

All individuals with ASD exhibit social communication impairments. In the first few years of life, salient signs of autism include lack of appropriate eye contact and inability to initiate or respond to joint attention (i.e., sharing social experiences with a communication partner). Common social difficulties include:

• Demonstrating appropriate play skills, such as cooperative play with others. Some children with ASD may appear uninterested in playing with peers.
• Some may reject or ignore the social approaches of others.
• Responding to and initiating joint attention for social purposes. For example, many individuals with ASD are skilled at requesting items but are less likely to communicate for the purpose of sharing a social experience. Some individuals with ASD may lack interest in conversations that do not include topics of interests.
• Using and interpreting body language. For example, individuals with ASD may have challenges understanding tone of voice or facial expression in social situations.
• Staying on topic, turn-taking, and asking related or appropriate questions during conversations.
• Taking their communication partner’s perspective, checking for understanding, or predicting what information may already be known about a concept or situation during conversations.

Speech/Language Impairments

Persons with ASD may have specific difficulties in the areas of receptive and expressive language. Receptive language is the comprehension of language (e.g., following directions), while expressive language is the ability to express desires and thoughts to other persons. Some individuals with ASD express their thoughts verbally, while others may be nonverbal and require a communication device.

Those who are nonverbal may demonstrate the following:

• Delay in, or lack of, spoken speech/language, impacting approximately 20-30% of the population.
• Lack of an effective way to communicate may lead to the need for the use of alternative augmentative communication (AAC), such as sign language, pictures, or a voice output device.

Those who are verbal may demonstrate the following:

• Delayed or immediate echolalia as a means of conversation with others, for self-management, or for self-stimulation. For example, a dialogue from television programs or videos may be used as a means of conversation.
• Stereotyped or repetitive use of non-echolalia language routines that serve various functions such as initiating or sustaining a conversation.
• Use of idiosyncratic speech (e.g., inappropriate word use).
• Grammatical structure which may appear immature (i.e., telegraphic speech, improper tense or use of pronouns) or grammatical structure which may appear pedantic (e.g., monologue, advanced vocabulary in an area of interest).
• Abnormal use of pitch, intonation, rhythm or stress. For example, speech may be monotone or hypernasal, and declarative sentences may end with a rising tone to signal the asking of a question.

Both verbal and nonverbal individuals may demonstrate difficulties with receptive language such as:

• Delayed vocabulary development;
• Difficulty following directions;
• Difficulty understanding abstract concepts; and
• Difficulty interpreting social language, such as sarcasm and jokes.

Restricted Repetitive and Stereotyped Patterns of Behavior, Interests, and Activities

Although people with ASD may enjoy the same activities as typical same-age peers, the intensity and focus of their interests may differ. This may be due to the fact that some have a limited repertoire of alternative behaviors, or that they prefer and feel comfortable repeatedly performing certain tasks. Behavior under this category includes:

• Stereotyped or repetitive motor movements such as hand flapping or finger flicking, use of objects such as spinning coins or lining up toys, or use of speech such as echolalia (delayed or immediate parroting of heard words), use of “you” when referring to self or stereotyped use of words or phrases.
• Excessive adherences to routines and sameness such as being distressed by changes in the schedule, insisting on adherence to rules, or having inflexible thinking.
• Ritualized patterns of behavior such as repetitive questioning or pacing.
• Highly restricted, fixated interests that is abnormal in intensity or focus. A toddler may have a parent’s belt that they carry everywhere, a child may have a preoccupation with vacuums, or an adult may spend hours memorizing facts about their favorite baseball team.

In the DSM-5, sensory differences are categorized under restricted repetitive behaviors. Individuals with sensory differences will be under (hypo) or over (hyper) sensitive to a variety of sensory inputs:

• Visual input sensitivities are staring at spinning objects, being bothered by fluorescent lights, or having trouble with keeping their place when reading.
• Auditory input sensitivities are covering ears during loud noises, preferring loud music or none at all in the car, or not being able to respond to verbal prompts when in a noisy area.
• Tactile input sensitivities dislike getting hands or feet messy, avoiding/preferring certain surfaces, textures, or fabrics, or finding specific types of touch aversive (light touch on the shoulder vs. deep pressure hug).
• Taste/Smell sensitivities are not eating certain foods, licking or tasting non-food items, or finding strong perfume or cologne aversive.
• Proprioceptive Input sensitivities are difficulties interpreting sensations from muscles, joints, ligaments, and tendons (e.g., putting too much pressure on pencil when writing or falling/crashing into things).
• Vestibular input sensitivities are over or under sensitivities to balance and movement sensations, such as having trouble staying seated, constantly leaning head on hands and arms, or easily losing balance.

Executive Function Impairments

Executive functioning refers to advanced cognitive skills, such as attention, working memory, planning, reasoning, sequencing, and flexible thinking. In typically developing people, these skills benefit not only social interactions but also academics, learning, self-regulation, and activities of daily living.

• Individuals with ASD may have difficulty with a wide range of executive functioning tasks, such as sequencing the order in which to dress themselves, tie their shoes, pack for a trip, or complete a homework assignment.
• Rigid, inflexible thinking is a common characteristic of individuals with ASD, and therefore individuals may have trouble problem-solving or generating more than one solution to a problem.
• Individuals with ASD may have executive functioning difficulties at more basic levels, such as sustaining prolonged attention to an activity, or dividing their attention between two activities at once.

Asperger syndrome (AS) is a neuro developmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests. Asperger Syndrome is a neurobiological disorder characterized by abnormalities in social interaction and language acquisition. Asperger Syndrome is considered to be on the mild end of the spectrum. People with Asperger Syndrome exhibit three primary symptoms: Having difficulty with social interaction, engaging in repetitive behavior, standing firm on what they think and focusing on rules and routines. Often, individuals diagnosed with AS have normal or above normal intelligence. In addition, people with this condition are frequently able to be educated in mainstream classrooms and hold jobs. Early diagnosis and intervention can help a child make social connections, achieve their potential, and lead a productive life. Symptoms vary from person to person, but children with AS often have an obsessive focus on a narrow topic of interest. Many people with AS find it hard to recognize other people’s feelings. It’s common for people with this condition to avoid eye contact when speaking with other. Genetic factors and exposure to environmental toxins, such as chemicals or viruses, have been identified as potential contributors to the development of the disorder. Boys are more likely to develop AS than girls. There’s no single test that can tell you whether your child has AS. In many cases, parents report developmental or behavioral delays or difficulties.

A lack of demonstrated empathy affects aspects of communal living for persons with Asperger syndrome. Individuals with Asperger Syndrome experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest); a lack of social or emotional reciprocity (social “games” give-and-take mechanic); and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture. People with Asperger syndrome can display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in stereotyped and repetitive ways, preoccupy themselves with parts of objects, or engage in compulsive behaviors like lining objects up to form patterns.

The onset of Asperger syndrome commonly occurs after the age of 3. Some individuals who exhibit features of autism (a developmental brain disorder characterized by impaired social interaction and communication skills) but who have well-developed language skills may be diagnosed with Asperger syndrome. There is no specific course of treatment or cure for Asperger syndrome. Treatment, which is symptomatic and rehabilitation, may include speech therapy, occupational therapy and special education. Children with Asperger syndrome have a better outlook than those with other forms of pervasive developmental disorders and are much more likely to grow up to be independently functioning adults.

Asperger’s and autism are no longer considered separate diagnoses. People who may have previously received an Asperger’s diagnosis instead now receive an autism diagnosis. But many people who were diagnosed with Asperger’s before the diagnostic criteria changed in 2013 are still perceived as “having Asperger’s.” And many people also consider Asperger’s as part of their identity. This is especially considering the stigma that still surrounds autism diagnoses in many communities around the world. Yet the only real “difference” between the two diagnoses is that people with Asperger’s may be considered as having an easier time “passing” as neurotypical with only “mild” signs and symptoms that may resemble those of autism. Not all autistic children exhibit the same signs of autism or experience these signs to the same degree. That’s why autism is considered to be on a spectrum. There’s a wide range of behaviors and experiences that are considered to fall under the umbrella of an autism diagnosis. Here’s a brief overview of behaviors that may cause someone to be diagnosed with autism:

• Differences in processing sensory experiences, like touch or sound, from those who are considered “ neurotypical’’
• differences in learning styles and problem-solving approaches, like quickly learning complex or difficult topics but having difficulty mastering physical tasks or conversational turn-taking
• Deep, sustained special interests in specific topics
• Repetitive movements or behaviors (sometimes called “stimming”), like flapping hands or rocking back and forth
• strong desire to maintain routines or establishing order, like following the same schedule each day or organizing personal belongings a certain way
• Difficulty processing and producing verbal or nonverbal communication, like having trouble expressing thoughts in words or displaying emotions outwardly
• Difficulty processing or participating in neurotypical social interactive contexts, like by greeting someone back who’s greeted them

Asperger’s syndrome was previously considered a “mild” or “high-functioning” form of autism. This means people who received an Asperger’s diagnosis tended to experience behaviors of autism that were often considered minimally different from those of neurotypical people. Asperger’s was first introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994.  The symptoms are:

• having difficulty with verbal or nonverbal communication, such as eye contact or sarcasm having few or no long-term social relationships with peers
• Lack of interest in taking part in activities or interests with others showing little to no response to social or emotional experiences
• having a sustained interest in a single special topic or very few topics
• Strict adherence to routine or ritual behaviors
• Repetitive behaviors or movements intense interest in specific aspects of objects
• experiencing difficulty in maintaining relationships, jobs, or other aspects of daily life because of these previously listed sign
• not having any delay in language learning or cognitive development typical of other, similar neuro developmental conditions

When they were considered to be separate diagnoses, Asperger’s was differentiated from autism in two main areas:

• Severity. Those diagnosed with Asperger’s were higher functioning and typically had average to superior IQs, requiring less support than those diagnosed with autism.
• Language. Those diagnosed with Asperger’s had no speech or language impairment

Children at all levels of the spectrum may have social awkwardness and experience isolation. People with Asperger’s have better language skills but still may have difficulty conversing with others. Identifying social cues can be difficult, although kids with Asperger’s often have an easier time making eye contact, which aids in social interaction. One similarity that all people across the spectrum have is the human ability to love, and the desire to be loved in return.

Appearing to be obsessively focused on objects and sameness, the children ranged from nonverbal to [having] language abilities like that of ‘little professors.’ This divergence in language abilities led to the split between autistic and Asperger’s, or low and high functioning.  There are many theories, but no conclusions, about the exact cause of Asperger’s syndrome and autism. A new brain-tissue study indicates that people with ASD have more connections (synapses) between their brain cells than neurotypical people do. ASD has no one cause, but is brought about by a combination of genetic and environmental factors. These may include:

• Family history of autism
• Familial or parental diagnoses of conditions such as bipolar disorder or anxiety disorder
• Advanced paternal or maternal age
• Being part of a twin or triplet set
• Prematurity of less than 26 weeks
• Low birth weight
• Prenatal exposure to heavy metals and toxins

Pivotal Response Treatment (PRT) for autism spectrum disorders is derived from the principles of Applied Behavioral Analysis Therapy (ABA Therapy). Previously it was known as Natural Language Paradigm (NLP). This approach has been used since the 1970s. It is play-based and initiated by the child i.e., the child makes choices that direct the therapy. . Pivotal Response Training in ABA focuses on some pivotal behavior areas of a child’s development – motivation, responsiveness to multiple cues, self-management, and social initiations which then brings widespread, collateral improvements in other behavioral areas which are not directly covered under pivotal behavior. Both ABA and PRT can help in improving communication, social inclusion, academic skills, language learning and it also helps in decreasing certain behaviors such as self-stimulatory and self disruptive behaviors.

Goals of this approach are:

• To develop communication and language skills
• Enhancing positive social behaviors
• Relief from behaviors that are disruptive and self-stimulatory

Jewel has an applied behavior center for autism that provides pivotal response treatment training for parents based on a focused pivotal response training manual. Applied Behavioral Analysis programs emphasize the role of parents as primary intervention agents. The program is customized to meet the goals and needs of the individual child and his or her everyday routines. The behavioral areas are targeted through both structured and unstructured interactions. The focus of each session changes as the person makes progress, to accommodate more advanced goals and needs.

Autism is not a disorder that affects all individuals equally or in the same manner. While individuals with autism spectrum disorder (ASD) typically have problems with social communication, the extent of these problems range can differ vastly, i.e., from the extreme behavior (non-verbal with aggressive) to comparatively mild issues such as those with vocal intonation, social interaction and body language can occur. In order to qualify as falling under the spectrum of ASD, certain symptoms need to be present. Therefore, even when a person is said to be on the lower end of the autism spectrum, he or she may have significant developmental and sensory challenges that are capable enough to hinder a persons normal range of activities and relationships. However, when the symptoms are relatively mild or when the individual only has a few symptoms, the person is said to have mild or very mild autism.
It is harder to notice the mild autism symptoms even though the symptoms would already be present. Signs of mild autism in adults are often easier to spot. Mild autism in toddlers or children under the age of 3 often goes undetected.

Mild autism in children can be observed from the following symptoms :

• Problems with socializing and communication that may include difficulty with conversation, body language, eye contact, and/or facial expressions.
• Difficulty in developing and maintaining relationships
• Repetition of the same activities, actions, movements, or words again and again, even without having a particular reason.
• Having a hypo-or-hyper reactivity approach to sensory input where a person is either overly sensitive to senses or is not at all responding to senses.
• As with other types of autism, mild autism can be treated to help the individual to lead a better life. Applied Behavioral Analysis or ABA therapy for mild autism has proven to help the individuals to function better.

Speech and Language Therapy aims to help individuals communicate in functional and useful ways. Autism and speech disorders have an association and speech therapy for autism can help people with autism improve their verbal, nonverbal, and social communication. Specific benefits of speech therapy for autism include helping the child with autism and speech problems to articulate words well, communicate both verbally and nonverbally, comprehend verbal and nonverbal communication, understanding others’ intentions in a range of settings, initiate communication without prompting from others, to know the appropriate time and place to communicate something, develop conversational skills, exchange ideas, communicate in ways to develop relationships, enjoy communicating, playing, and interacting with peers and learn self-regulation.
There are various types of speech therapy for autism that therapists use based on the needs of the child. The methods to be employed are decided on by therapists from speech therapy and audiology after a thorough diagnosis. Based on this, verbal or nonverbal methods are adopted. Sometimes, music is used for therapy since autistic children respond better to songs. Speech therapy exercises are taught for better articulation. Nonverbal autism speech therapy activities involve using pictures or technology to communicate and is known as Alternative Augmentative Communication (AAC). The methods include the use of Sign language, Picture Exchange Communication System (PECS), iPads and Speech output devices. Infact, speech therapy for children and for adults have met with a lot of success.

Parenting is a difficult task in itself, let alone parenting a child on the autism spectrum. Parents can get stressed out when they feel helpless and this can affect the other members in the family as well as the family dynamics itself. Stress often surrounds the task of caring for the child and they remain due to the stigma around the disorder. Research has also shown that parents can feel caregiver overload, and this was seen especially among mothers. It is important to address the stress as it often interferes with the quality of life of the entire family. There are studies that show that the parents of children on the spectrum tend to have certain signs of depression and there is a link to low social support as well. Various aspects of one’s family life may be affected, including the finances, the marital relationship, physical health of the family members, limiting response required by the other children in the family, and in recreational/ leisure activities.

It is important to impart awareness to the parents regarding the condition of the child, they should feel that they are prepared to help the child. Research has also shown that addressing the marital relationship, familial support, and engaging in social activities can help in reducing
the impact on the family members.

Screening and diagnostic tools for diagnosis of autism are based on the child’s behavior and developmental history. In many cases, children don’t receive a final diagnosis until much older. This delay means children never get the help that they need early in their lifetime. Early detection, monitoring, screening, and evaluation of a child with autism enables them to make and receive the services and support they need to attain the maximal potential they can achieve. There are various sequences in this process. Recently, many pediatricians have begun screening for autism during well-baby checkups monitored in every scheduled check-up. The children who are diagnosed as autistic are advised to take treatment under specialists such as occupational therapists, speech therapists, special educators, and other support groups thus improving their quality of life and prognosis. If your child is suspected to have autism, you can request for a
qualified specialist referral.

Autism screening tools

Autism screening tools range from simple observation to formal assessment. The following are the screening tools commonly used:

• The modified checklist for autism in toddlers, revised (M -Chart) is a 20 question test
  designed for toddlers between 16 -30 months old.
• The ages and stages questionnaire (ASQ) is a general tool to examine developmental delay at specific ages.

The clinician may also perform:

• Functional Behavioural Assessment
• CARS(The child autism rating scale)
• The Autism Diagnostic Observation Schedule
• Autism Detection in Early Childhood
• The Autism Diagnostic Interview-Revised ADI-R
• The Social Communication Questionnaire
• Gilliam Autism Rating Scale
• Functional Skill Assessment to assess the current level of the child in various areas of gross motor, fine motor, communication, and self-care.

Occupational therapy and Sensory Assessment

Occupational therapist assessment is based on the child’s sensory processing issues. The sensory processing questionnaire addresses the sensory system in depth along with monitoring the child’s behavior and response.

There is a lot you can do to help children with autism overcome their difficulties. This information about childcare, treatment, and services can help. There are many treatments available to help children learn new skills and overcome various developmental challenges.
Speech therapy, AppliedBehavioral Analysis, Occupational therapy, Group therapy, Developmental education, etc will help you meet your child’s special needs and help them learn, grow, and succeed in life. Self-care is also important when caring for a child with ASD. When you are emotionally strong, you can be a better parent for a child in need. These tips can make life easier for children with autism.

It is best for parents of children with ASD or related developmental delays to start treatment immediately. Seek help as soon as you suspect a problem. Don’t wait for your child to understand or solve the problem. Don’t even wait for an official diagnosis. Young children with autism spectrum disorder are more likely to be successful with treatment earlier. Early intervention is the most effective way to accelerate your child’s development and reduce autism symptoms throughout life. Learning all about autism and participating in treatment can help your child in many ways.

The following tips will make your daily home life easier for you and your child with ASD:

Positive reinforcement can help children with ASD, so catch the kids doing something good. Praise them when they do the right thing or learn a new skill, and be very specific about the behavior they praise. Then Find other ways to reward them for good behavior by putting stickers on them or letting them play with their favorite toys. Create a private space in your home where your children can relax, be safe and enjoy. Children with ASD can learn to perceive the nonverbal cues they use to communicate. Pay attention to the sounds they make, their facial expressions, and the gestures they use when they are tired, hungry, or want to do something. They may use non-verbal cues to communicate their needs. Give attention to your child’s feelings. Many children with ASD are sensitive to light, sound, touch, taste, and smell. Some children with autism are “not sensitive enough”; to sensory stimuli. Find out which sounds, smells, movements, and touching are causing your child to behave “bad” or destructive, and which are positive. Understanding what affects your child will help you solve problems, avoid problem situations, and create successful experiences.

There is no treatment to cure ASD. But some interventions have been studied and used for young children to reduce symptoms, improve their cognitive ability and daily living skills and improve the ability of the child to function and participate appropriately in the community. In ASD each
the person is different and people with ASD have unique strength and difficulties in communication, socialization and their academic skills. The main problem area for a child with ASD is communication and social interactions. Through a multi-disciplinary treatment strategy, definite changes can be seen in a child. Most effective treatment and interventions are available now and it includes ABA (applied behavior analysis), Occupational Therapy, Speech Therapy, cognitive behavioral therapy, early intervention, school-based, and educational-based therapies.

Effort towards the early intervention for ASD has been encouraged more. Through early identification and early intervention, treatment results can be made much effective.

Children with Autism spectrum disorder need additional support to enhance their communication skills. There are no specific rules on how to communicate with a child with ASD. Children on the autism spectrum can be non-verbal, or pre-verbal, Irrespective of a particular child’s status, you can help children with autism communicate in several ways such as:

• Using Visual: Visual communication methods such as to communicate with sign language, or an augmentative and alternative communication (AAC) device or the Picture Exchange Communication System (PECS).
• Give them time to process: Be patient. If someone doesn’t respond immediately, we usually assume that they haven’t heard or understood, and we tend to repeat what we said or try to rephrase it. However, by counting to ten in our head, we give the child time to process what we said so that they involve them processing each word, whether it requires a response, and delivering into their memory banks to find the appropriate answer.
• Keep it simple: It’s always better to communicate in a simple way with autistic kids. When we try to use few words, they will be able to process quickly. For example, to convey instruction, it’s much easier to process, “first open, then car” than it is to work out “open the cupboard and then take the ball” which is probably what we’d typically say.
• Reinforcement: Children with ASD respond best to positive reinforcement. Make sure you talk about or reinforce good behavior often. Be generous with compliments for good behavior, be affectionate and respectful.
• Believe in what the child can do: Don’t define a child with a diagnosis as they are a growing person with unknown possibilities. Therefore encourage their abilities rather than labeling them with their disabilities.

The best way to help children with ASD is by choosing the easiest way to communicate which can help them to reduce their frustration and communicate their needs.

According to average estimates, for a couple with the diagnosis of Autism Spectrum
disorder which is of an unknown cause, the current chance of recurrence in a
subsequent child is approximately 10% based on the most recent and advanced
studies.
And this value is so much higher than the 1% chance for a random couple in the
population to have a child with ASD. Due to this reason, the younger sibling of the
child need to undergo screening for ASD and should also be monitored closely
during the growing years. If the parent already has two or more children with ASD,
the chance of a subsequent child to have the disorder is as high as 32-35% (
Ozonoff et al., 2011). Therefore it is preferable to get a genetic testing done to know
if there is a genetic link with autism.
Both genetic and environmental factors can contribute to younger children
developing this disorder when they also have a sibling with the same problem. Some
studies also suggest that the risk of ASD in a later born child is more if the first
affected child is a girl. Many family studies have detected numerous candidate genes
that encode proteins involved in the function of neurodevelopment. Currently we
cannot trace a single gene mutation or a single chromosome abnormality that can be
a cause for Autism. It could be due to several mutated genes or maybe a
combination of many environmental factors and mutated genes.
The younger sibling or the second child can also have symptoms of mild social
impairment or repetitive behaviors that fade away eventually. The siblings of a child
with autism who do not having the condition themselves are more likely to have more
autistic traits than other children due to the exposure and other genetic factors. So to
conclude, parents need to be made aware of the risk in having a second child
with autism and essential counselling should be provided to handover knowledge
about the possible struggles and risk factors that they may have to go through while
bringing up the child.

All the children with special needs must have right to education like their non autistic counter parts. Autistic children are supposed to be treated as normal kids. Treating them as abnormal child will only affect their confidence and they might withdraw from people.
Autistic children can be send to regular schools but it completely depends on where the student with autism is on the spectrum (severity ).
Schooling is a major transition in any child’s life and for children with disabilities this transition can be highly challenging. Since children with Autism Spectrum Disorder has unique social, communication and behavioral difficulties when compared to neurotypical children, starting regular schooling will be highly challenging for this population. Children with Autism Spectrum Disorder have a greater risk of poor school outcomes due to their challenges. Bullying can be a major factor that may result in school exclusion or peer rejection. Therefore it is critical that protective factors and barriers to positive school transition in children with Autism Spectrum Disorder are identified and understood.
The transition process begins as early as from their pre school age wherein the child will be evaluated to find whether she/ he is ready for schooling. Meanwhile it is equally important that parents , teachers and schools are prepared for the needs of children with Autism Spectrum Disorder.
Here are few strategies for regular schooling children with Autism Spectrum Disorder.
Children with Autism Spectrum Disorder will benefit from a regular based schedule. They might need extra time to switch to a new activity or subject. Many of them learn best with visual schedule or visual instructions. Classroom or teaching area must have minimal distractions, there by the students are more likely to be able to stay focused.

Autism is considered as a disorder which affects the neuro-developmental functioning that which in turn affects three main areas of development usually referred to as Triad of impairments.

1. Social interaction and understanding.
2. All aspects of communication — verbal and non-verbal.
3. Flexibility of thinking and behavior, including problems with imagination.

Many children may have several features in common, but its important to realise that Autism is a spectrum of disorders and every child with autism will be in different parts of spectrum. Similarly, development would be at different rate and severity for each child. Thus, a child may have chronological age as four but she/he may function at 2 years in language age and 1 year in social skills. It is also possible for their cognitive skills to be 4 at age which means development may not be uniform in all areas for children with Autism. Many children may have intellectual disabilities, but many others can have average to above average IQ as well. This states that ID does not play a part in diagnostic criteria for children with Autism.

INTELLECTUAL DISABILITY

Intellectual disability or ID was earlier known as Mental Retardation (MR). It is characterised by a below average level of Intelligence, lack of skills for day-to-day living and low mental ability. This does not mean that children with ID can’t do or learn new things, but they will be little slower comparing to others. They function at an age which is below their actual age. Degree of ID varies from Mild to profound.
A child with intellectual disability mainly has limitations in the following areas:

• Intellectual functioning refers to a child’s ability to learn reason, make decisions, and solve problems.
• Adaptive behaviours which include skills needed for day-to-day life such as effectively communicating, taking care of oneself, and interacting with others.

Compared with a normal child, a child with Intellectual disability takes more time to learn a language, develop skills in social interaction and develop self care skills. For them, learning will take more time and require more repetition. But they still can learn, develop and become a participating member of community.
IQ (Intelligence quotient) is measured by an IQ test. Average IQ Score is 100 The average IQ is 100, and majority will score between 85 and 115. If one scores below 70 to 75.
Mild Intellectual disability may not be identified until child begins schooling. Experts assessment is needed to confirm level of ID.
Within first years of life, Moderate intellectual disability (IQ 35-49) will become visible. Common signs here are speech delay. Considerable support is needed in school, at home and in society. Even when their academic potential is limited, they still can learn few basic skills needed for daily living.

The answer to this question is yes, a person with autism spectrum disorder can live independently as an adult. But not everyone can gain a same level of independence. Intervention service focus to help individuals in achieving their highest possible level of independence which may not look similar for everyone.
In ASD, symptoms differ in each person and therefore treatment plans should be tailor made focusing on each person’s skillset, interest and passion. There are various degrees and stages of independence. It depends on how early a person is diagnosed and began with treatment.
Autism independent living skills:

1. Self-help and determination skills: Self-help and determination as the ability of individuals with ASD to be aware of themselves emotionally, physically, and cognitively to create and attain their goals.
2. Functional communication: They must be able to express desires, feelings, and concerns to those they live or interact with.
3. Reduction of problems: They need skills to acknowledge and manage their emotions safely and consistently
4. Domestic and personal care: Individual with ASD will be able to live independently is their ability to perform personal and home-related tasks such as dressing and undressing, washing clothes
5. Personal hygiene practices: Brushing hair, shaving, applying makeup, showering, menstrual care

Play is beneficial to the development of social skills. Deviances in play behavior are seen in children with autism, and these deviances may be linked to delays in social development. Children can improve not only physical skills but also cognitive and social skills through play.
Child play has different stages; manipulative, functional, symbolic or representational play. Toys are first handled orally and manipulatively by children, who feel, lick, sniff, turn, throw, and so on. This manipulation provides opportunity to learn about many things, relationships, and methods of interacting. Next stage, Functional play develops at approximately 14 months of age example, using a spoon to feed the doll, or placing a teacup on a saucer’. Around 24 months of age, symbolic play emerges which is a higher lever of play involving pretence.
Children with autism show a core deficits in social interaction. In children with autism who have a variety of atypical characteristics, the initial phase of play development, which involves exploratory/manipulative behavior of objects, occurs. They usually limit themselves to a small number of things while they play. They prefer touch and tasting objects over visual exploration. Other studies reveals that children with autism spend significantly less time playing functionally. show lower levels of appropriate object use, less variety in their functional play, more repetition, difficulties in symbolic play, When symbolic play is performed, their play behavior may be more like ‘learned routine’ rather than spontaneous play.
It has also been found that children that had a strong attachment spent more time playing. They also displayed greater symbolic play behavior and a higher level of play. Children who had a chaotic attachment relationship spent less time playing than those who did not.

Autism Spectrum Disorder is a heterogeneous group of neurodevelopmental disorders with a complex inheritance pattern. While many variants in synaptic proteins have been identified in patients with ASD.

Many of the genes associated with Autism Spectrum Disorder are involved in the development of the brain. The proteins produced from these genes affect different aspects of brain development, growth, and organization of neurons. Some affect the number of neurons that are produced, while others affect the development or function of the connections between neurons (synapses) where cell-to-cell connection and communication takes place, or of the cell projections i.e, dendrites that carry signals received at the synapses to the neuron. Many other genes associated with Autism affect development by controlling the activity of other proteins.

For about 2 to 4 percent of people with Autism, rare gene mutations or chromosome abnormalities are thought to be the main cause of the condition, often as a feature of syndromes that also involves additional signs and symptoms which affect various parts of the body. For example, mutations in the ADNP(Activity Dependent Neuroprotector Homeobox) gene cause a disorder called ADNP syndrome. In addition to Autism and intellectual disability, this condition involves typical facial features and a wide variety of other signs and symptoms. Some of the other genes where rare mutations are associated with ASD, often with other signs and symptoms, are ARID1B, ASH1L, CHD2, POGZ, CHD8, DYRK1A, SHANK3, and SYNGAP1. In most individuals with Autism caused by rare gene mutations, the mutations occur in only one gene.

Genetic testing looks for the causes of Autism but cannot be used to diagnose Autism. The test which is most commonly done for people with Autism is called a Chromosomal Microarray (CMA). This test looks at the chromosomes and sees if there are any extra or missing parts of the chromosome that would cause ASD.

Some people with ASD have syndromic ASD, meaning that they have other features in addition to Autistic features.

The syndromes associated with autism are :

– Rett syndrome

– Fragile X syndrome

– Sex chromosome trisomies

– XYY and Klinefelter syndrome

– Tuberous sclerosis

– 22q11 deletion syndrome

– Metabolic disorders (rare conditions) like phenylketonuria, creatine deficiency syndromes, etc.

After all genetic testing and genetic counseling are very important which help us to understand the test results and what they mean for our child and family. Genetic testing results can give doctors useful information regarding how to treat the child with Autism and which family members might be more likely to have a child with ASD

Autism is a developmental disorder with persistent impairment in reciprocal social communication and interaction, restricted and repetitive patterns of behavior, interest, or activity. The impairment in communication and social interaction is pervasive and sustained.

The symptoms of autism can overlap with other disorders so it wants to be differentially diagnosed from disorders like ADHD, Selective mutism, language disorder, social and pragmatic communication disorder, intellectual disability, stereotypic movement disorder, schizophrenia, and Rett syndrome.

Treatments for Autism

No treatments can completely cure the situation but can reduce the symptoms and make them able to cope with their daily life situations.

Currently, there is no standard treatment available for autism, however, most people responded best to highly structured and specialized programs.

A multidisciplinary approach is BEST for autism therapy.

Multidisciplinary approaches for autism include:

• BEHAVIORAL
• DEVELOPMENTAL
• PSYCHOLOGICAL
• SOCIAL – RELATIONAL
• EDUCATIONAL
• PHARMACOLOGICAL
• COMPLEMENTARY AND ALTERNATIVE.

All the above-mentioned treatments together can create a huge reduction from the symptoms of autism and help to improve their daily living skills.

Among the above-mentioned therapies, one of the most used therapy for an autistic children is BEHAVIORAL THERAPY (APPLIED BEHAVIOR ANALYSIS). But the best is to select a multidisciplinary approach while coming to the management of autism

BEHAVIORAL APPROACHES

This method mainly focuses on changing the behavior of the child and making the child aware of the situation.

A notable behavior treatment for autism is Applied Behaviour Analysis (ABA).

APPLIED BEHAVIOR ANALYSIS

This is a highly structured approach that has been used for more than 50 years.

ABA is the main approach that used for children with severe autistic features.

ABA is a scientific approach that teaches communication, self-care, academic skills, and also reduces problematic behavior.

The four principles of Applied behavior analysis include:

1. Behaviors are affected by their environment.
2. Behaviors can be strengthened or weakened by their consequences.
3. Behavior changes are more effective with positive instead of negative consequences.
4. Behaviors need to be reinforced or disciplined for socially significant changes.

In ABA the therapist breakdown the skills into component parts and through repetition and reinforcement helps the child to learn that skill.

ABA encourages positive behavior and discourages negative behavior

Two ABA teaching styles are:

Discrete Trial Training (DTT)

Pivotal Response Training (PRT).

DTT uses step-by-step instructions to teach a desired behavior or response. Lessons are broken down into their simplest parts, and desired answers and behaviors are reinforced, Undesired answers and behaviors are ignored.

PRT: takes place in a natural setting, not in a clinic setting, and helps in generalization. The goal of PRT is to improve a few “pivotal skills” that will help the person learn many other skills.

Early Intensive Behavioural Intervention (EIBI) is a type of ABA  used for very young children with  Autism, usually younger than five, often younger than three.

DEVELOPMENTAL APPROACH

This approach helps in improving the child’s specific skills like language and communication skills, physical skills, etc…

The developmental Approach includes:

• speech and language therapy which improves the child’s understanding and use of speech.

In speech and language therapy we can use a clinician-based approach or a client-based approach.

In client center approach we mainly focus on the client  and the techniques used are mile teachings,  incidental teaching, etc….

In the clinician center approach, the clinician plays a major role and the techniques used are modeling, prompting, etc…..

• occupational therapy helps the child to develop self-help skills to make him as independent as possible.

Occupational therapy  also includes:

Sensory Integration Therapy: This improves the responses to sensory input that may be restrictive or overwhelming.

Physical Therapy: which improves physical skills, such as fine motor and gross motor skills.

PSYCHOLOGICAL APPROACH

This approach helps children with autism to deal the conditions like anxiety, depression, and other mental health issues.

Cognitive-behavioral therapy (CBT) can be given to the autistic children as psychological management, mainly recommended for children with mild symptoms.

In CBT, the therapist and the child work together to identify goals and then to change how the person thinks about a situation and reacts to it.

SOCIAL- RELATIONAL APPROACHES

This method focus on improving social and emotional skills.

For improving social and emotional skills we can provide Social Stories with simple descriptions of what to expect in a social situation.

We can keep the child in Social Skills Groups to provide opportunities for children with autism to practice social skills in a structured environment.

EDUCATIONAL APPROACHES

This is provided in a classroom setup.

One educational approach is the Treatment and Education of Autistic and Related Communication- Handicapped Children (TEACCH) approach.

TEACCH is based on the idea that children with autism thrive on consistency and visual learning.

Children usually learn together in classes and provide teachers with ways to adjust the classroom structure and improve academic and other outcomes.

The program also have schedules to make daily life predictable for children and help them improve their daily activities

PHARMACOLOGICAL APPROACH

There are no medications that cure autism. Some medication helps to treat the co-occurring symptoms like Medications to manage co-occurring psychological conditions, such as anxiety or depression,  medical conditions such as seizures, sleep problems, or gastrointestinal issues.

COMPLEMENTARY AND ALTERNATIVE TREATMENTS

Complementary and alternative treatments are often used to supplement more traditional approaches. This mainly includes special diets, relaxation therapies, herbal supplements, chiropractic care, animal therapy, art therapy.

Research suggests that food plays a role in the development of autism and increases ASD symptoms. Some children with ASD may be sensitive to the taste, smell, color, and texture of the food. They may limit or totally avoid such kinds of foods and even whole food groups. The food that the child may not like may include strong-flavored foods, fruits, and vegetables, or certain textures such as slippery or soft foods. Issues such as selective eating and nutritional deficiencies are often seen in individuals with Autism. For patients with autism, food selectivity can also increase other symptoms like deficiencies in multiple nutrients, including methyl B12, vitamin D, and folic acid. There is also evidence in which it’s said that consuming certain types of foods may directly increase the symptoms of Autism. Some studies say that dietary Gluten and Casein are not properly digested in patients with autism. Not only can the resulting peptides interfere with regular bowel motility, but also can directly affect brain functioning and development.

Undigested peptides from Gluten and Casein protein crosses the intestinal wall and disturb the brain neurotransmission which can increase behavioral symptoms in these individuals. The gluten-free and casein-free diet is the one that has to be consumed. Gluten is also present in the grain of wheat, and it’s how wheat gets processed. Some of the food that may contain Gluten are:

– soya sauce

– energy bars

– candy

– chips/flavored potato chips

– french fries

Oats Need to be certified gluten-free. Oats do not contain gluten but may be contaminated with wheat during processing. A lot of children have been known to have some sort of sensitivity to the presence of gluten in their diet. It doesn’t mean that the child has Celiac disease but they have some intolerance towards these diets. This is what is being found in some small studies and parents are reporting that removing gluten from the diet can make a big difference in the child’s behavior and speech and language communication and basically connecting as well. Some food that contains casein are;

1. Baked foods (bread, pastries, pies)
2. Nondairy creamer (will say “milk” in ingredients)
3. Whipped Topping
4. Soy Cheese
5. Salad dressing
6. Cereals.

The theory says that antibodies to gluten and casein actually can affect the opioid receptors and children seemed to appear to be a little bit more zoned out or as they say antibodies may also be affecting the brain functioning and development.  This is the hypothesis, but there is no backtesting for it apart from the Celiac Disease, but we are supposed to do an elimination diet. Parents have to be particularly supported by this because children are very choosy and selective with their appetite, working with a nutritionist is important so that you do not lose out on the adequate calories you need and you don’t develop other deficiencies.

Autism spectrum disorder (ASD) is a condition that is related to brain development that influences how a person perceives and socializes with others, causing problems in social interaction and communication.

The triads of ASD are;

• Poor social interaction
• Restricted or repetitive behavior
• Stereotypic behavior

Autistic children may face several health problems one of the problems that may face is the disturbance of sleep.

Inadequate sleep at night can also cause behavioral challenges, irritability, hyperactivity, and it can also interfere with learning and decrease their overall quality of life.

Sleep disorder happens more commonly in children having restricted and repetitive behaviors (rocking, hand-flapping, etc), with anxiety, or sensory problems.

Children with Autism tend to have Insomnia.

Some children may have Sleep Apnea, which is a condition that which they cannot breathe or which causes them to stop breathing several times during  the night

An autistic child takes an average of 11 minutes longer than normal children to fall asleep. Sometimes they may wake up many times while sleeping. It may take hours to go to sleep, or sometimes they may get up in the middle of the night and will start crying or playing. 

Causes

The sleep problems are caused due to;

• Bedtime habits
• Anxiety
• Nightmares
• Changes in their routine
• Bedwetting
• Snoring
• Less sleep is expected for their age
• Day time habits

Bedtime habits

Sleep problems are related to their activities doing before bed and going to bed to sleep. The time that they go to bed and where they go to sleep is also very important.  For example, Lot of noise, activity, and excitement before bed.

• When the child is used to falling asleep somewhere other than their own bed, it can be hard for them to fall asleep in their bed.
• And most importantly sleeping environment. If it is too hot, cold, light, or noisy, can make it hard for 5hese children to get to sleep. This can be a very particular issue for autistic children with sensory issues.

Anxiety

Children who experience anxiety might have difficulty falling asleep.  So avoid talking about the things that might make your child worry at bedtime.

Nightmares

These are the bad dreams that can wake children up and make it hard for them to get back to sleep – these are normal for children of all ages.

Bedwetting

Difficulties with toilet training and late toilet training are common in autistic children. If your child is not dry at night, your child might wake because they are wetting the bed. Or your child might wake and go to the toilet and then they might not go back to bed.

Less sleep or Restless sleep

 Autistic children often have more restless sleep than other children. They might be prone to rocking, rolling, and banging heads.  Restless sleep can be a sign of some less common sleep disorders.

Snoring

 Some autistic children snore.   Sometimes snoring can be a sign of sleep apnoea. So it is better to consult a physician if it is persistent.

There can also be biological causes that disturb the sleep patterns in autistic children. Which is related to their hormones. The hormones which control sleep are released differently in autistic children than in a normally developing child.

And also screen-time during bedtime can disrupt the melatonin hormone secretion leading to disturbance in sleep initiation.

HOW CAN WE MANAGE SLEEP PROBLEMS IN AUTISTIC CHILDREN??

There are many ways that can improve sleep for autistic children.

• Establish good sleep hygiene.
• Sleep environment:

The bedroom of your child should be dark, quiet, and comfortable. As children with ASD are sensitive to noises or have sensory issues, the environment should be chosen accordingly.

• Bedtime routine:

In bedtime routines, you can include relaxing activities such as reading or listening to music. Washing the feet with lukewarm water before going to bed can also relax your child. Should avoid the use of electronics at bedtime such as TV, computer, video games, etc. These can disrupt melatonin secretion which can cause a delay in sleep initiation.

• Sleep or wake schedule:

The schedule of sleeping and waking should be regular with not much of a difference between weekdays and weekends. Late-night sleep at weekends can disturb the weekday cycle of sleep causing concerns in the daytime behavior.

• Exercise:

Doing exercises in the daytime can help in managing excessive energy, thereby calming the child. Note that the exercise time should not be too close to bedtime as it can make it difficult to fall asleep.

• Avoid caffeine and carbonated drinks:

Drinks, like caffeine, carbonated sodas, etc., should be avoided. And particularly during bedtime, as they are stimulatory and can cause a delay in sleep initiation.

• Afternoon naps:

Afternoon naps are helpful for children, but should not be taken late in the afternoon so that they can interfere with their bedtime. And it should not exceed 30 to 60 minutes.

• Certain medications can also cause sleep problems that need medical attention.
• Sleep disorders such as sleep apnea, sleepwalking, sleep terrors, restless legs syndrome, should need a referral to a specialist and should be evaluated as a cause of sleep disturbance.
• Use of melatonin:

Use of medication like melatonin is recommended for initiation of sleep and if the child is still having sleep problems in spite of good sleep hygiene and ruling out of other causes of sleep delay. It should be started under medical supervision by an expert.

Before medications, it is always better to try behavioral solutions.

Differences in Visual Processing in ASD

Visual Reactivity

Many persons with ASD are actually hypersensitive to visual stimuli, despite the fact that some may have minimal sensitivity to it. Visual defensiveness is the term for this. In other words, they need to turn away from whatever it is that’s overstimulating them since the clarity of their vision can be overwhelming and perplexing.

It appears that with ASD, the brain impulses that typically allow us to muffle inputs do not function similarly. Due to the developmental nature of this illness and the defective integration of vision with other senses, it can also have an impact on other developmental domains, including cognitive function, motor abilities, and speech and language.

A Talent for Detail-Orientation

One of the more popular ideas for faulty visual processing in ASD is referred to as “poor central coherence.” It basically means that people with ASD prefer to concentrate on the small details rather than the big picture. They do not see the forest—only the trees. If you have an autistic child or know someone who does, you may have noticed that they tend to fixate on a single feature of toys, games, or photographs rather than engaging with the entire object.

Color Sensitivity

It’s common for people on the autistic spectrum to prefer only a select few colors while purposefully avoiding others. Even avoiding certain foods of a specific color or just playing with toys of a particular color could fall under this category.

Light Sensitivity

Fluorescent light may not be preferred by children or adults with ASD over conventional incandescent light, such as table lamps. According to some research, people with ASD are able to notice fluorescent light flickering, which is almost undetectable to the rest of us. It makes sense that such a visual overload could be extremely upsetting!

Visualization of Space

Knowing where we are in relation to the area around us is referred to by this phrase. They may struggle with visuo-spatial processing due to the sensory integration deficits in ASD, which may account in part for their clumsiness or tendency to bump into things.

You might see autistic children or adults acting in ways that use their other senses. This can be calming and make them more aware of how their body is situated in relation to their environment or other people. Such actions could be:

Hand-flapping

Focusing on a ceiling fan as it rotates

Seeing through their fingers or moving them in front of their eyes

Aligning things

Turning on and off lights

Repeatedly blinking

Teaching young children to ask questions is a complex activity in which you should have patience and perseverance. The initiating question should be preceded by answering of wh question. Children need to be intelligent to ask questions. Social initiation is a major problem faced by kids with an autism spectrum disorder. It will be very less or may be absent in many of these children. Many children with the diagnosis of autism spectrum disorder in comparison with typically developing kids have poor verbal and nonverbal initiation. This limitation may be evident during the initial period of life and can expand till the end of their life span. This will have a severe impact on their language development and their social skills.

As we know necessity is the mother of invention, and I will say that curiosity is the mother of initiating questions. According to some research done on some kids diagnosed with autism spectrum disorder, pivotal response treatment and motivation has helped kids initiate some target question. The method used in this study was engaging parents of these kids with age-appropriate toys with no instructions provided. Some target questions were introduced during play. The sequence of the question was “what is it”, “where is it”, “who is it” and “what happened”. This study made clear that play is the best way and this play present some highly attractive or desired object.

Initially, you should provide some verbal prompt to make your child ask. For example, hide a highly desired object in an attractive bag and prompt your child to ask “what is it” once the child asks the question show the desired object from the bag. So you are reinforcing your child indirectly by creating curiosity and presenting a highly desired object. As the intervention continues you can reduce the prompt.

Similarly, you can hide this highly desired object to make your child initiate “where is it”. If the object which was hidden is highly interesting and if the child really wants to find the object, then more the chance to ask the question.

You can use miniature characters to make your child initiate “who is it “questions during pretend play. you can present these characters during play and initially prompt the child to ask a question like “who is it” and you give a name to it. Gradually reduce the prompt.

Always remember question initiation for kids, especially those diagnosed with autism spectrum disorder takes time to practice and patience. It required progress monitored intervention and support of a clinician. Generalization is also an important part of this.

The main diagnostic feature in the social communication domain in ASD children who are in Pre-school is that their speech milestone development may be delayed or absent.  These children also lack nonverbal communication skills such as pointing and gestures. In regard to their social skills, they lack an understanding of other people’s facial expressions and feelings. They also find it difficult to engage in pretend play as they lack imagination and they do not show any interest in playing purposefully along with children of their same age.

As these children reach school-going age, there will be abnormalities in language development and may also have muteness. They will also have echolalia persisting in this age group. They may have an unusual vocabulary which is not seen among other children of the same age. During joint play activities, they may show inappropriate behaviors which may be disruptive or aggressive. These children may not be cooperative with any classroom activities which require imagination or creativity and are unable to cope with changes in routines or daily activities.

When these children reach adolescent age, they may still have difficulties with proper usage of grammar and vocabulary. They may be quiet most of the time when engaged in a conversation, but when asked regarding a topic of interest, they may bombard us with excessive information.  These children may have peculiar features in their speech, which is mostly monotonous and comprised of stereotypical sentences that are used repetitively. These children may find it difficult to make sense of metaphors and ironies when used in general conversations. They may use non-verbal communication skills like the use of facial expressions, gestures, and eye contact inappropriately when conversing with others. With respect to their social skills, they find it hard to make friends with their peer group but mostly may find a companion with an elder or a younger age group. They may not tolerate invasion into their personal space or may not be aware of personal space. These children have a strong liking for hobbies which may include numbering and collecting.

Not all children with autism can get into mainstream school, but there are children who successfully complete their education and there are mainstream schools that accept them.

The important part is the type of school you choose for your child; whether  Your child needs a special school or a mainstream school. If you think your child needs  extra support or care, You can help them by

• Speaking to the child’s teachers
• by assigning a shadow teacher
• By arranging special educators for separate teaching to improve academic skills.
• You can speak to staff at their nursery or school which is the best place to start
• You can get extra support from schools that are not providing such as (the ECH plan or ECHCP) Education Health and Care Plan.

This is given as a document from the local council, which helps you to know what education and health needs are required for your child.

You can contact the school, speak to them and know what support they can provide for the child.

As a part of the ECH plan, you have the right to choose the school for your child and if they reject, you have the complete right to know the reason for rejection by submitting a complaint to the local council.

The main support system for the child is their parents. Home is the first school where the child learns all the basic things. Parents should work together with the teachers to support and improve the child’s skills.

If necessary; continue the therapies and get suggestions from your therapists to maintain the current level of your child. Intensive stimulation is always important for children with special needs. The child should always get platforms to use their learned skills and to communicate without hesitation.

Autism spectrum disorder (ASD) is a group of lifelong neurodevelopmental disorders characterized by impaired social communication and language development, repetitive behaviors, and limited interests.

Tourette Syndrome (TS) is a neurological illness that is genetically inherited and manifests as both vocal (sound) and motor (movement) tics, and these individuals may have trouble with their well-being and learning new things.

It is believed that there may be a link between autism and Tourette Syndrome due to both genetic and neurological factors.  Studies suggest that the same genetic variations that cause autism may also cause Tourette syndrome and attention deficit hyperactivity disorder (ADHD). According to studies, one in five children with Tourette’s syndrome also has autism.  According to a different study, up to 20% of those with Tourette’s have autism and more than 50% of those with Tourette’s also have obsessive-compulsive disorder (OCD), ADHD, or both.

ASD, OCD, and ADHD are considered comorbid disorders of Tourette syndrome. This overlap of symptoms for tics, OCD, ADHD, and autism may be caused by underlying genetic traits that are similar and converge at the level of cortico-striatal-thalamocortical circuits. Some researchers have suggested that the four disorders exist on a spectrum, with ADHD on one end, OCD on the other, and autism and Tourette in the middle. This is because all four of these disorders can induce impulsive and compulsive behaviors. However, the challenges in differentiating between complex tics and symptoms of autism spectrum disorder may contribute to this significant overlap.

Speech anomalies including echolalia and palilalia, as well as indications of obsessive-compulsive disorder, are among the clinical and behavioral traits that TS and ASDs have in common. Another similarity between TS and ASD is that both disorders start in childhood and primarily affect men. However, the two circumstances differ from one another in both quality and quantity. Speech abnormalities like coprolalia are common in TS, whereas they are not typical of ASDs. Both TS and ASDs are characterized by abnormal repetitive movements, however in the former condition tics predominate, whilst in the latter, they more frequently take the shape of stereotypes. Insistence on sameness and marked resistance to change, which are characteristic of ASDs, are somewhat distinct from the classic obsessive symptoms that are frequently part of TS.

Each child is unique and different. All of them have their own communication strategies. It can be verbal, nonverbal, gesture, or sign language. The goal of communication is to convey the information and the understanding of that information. The sender can use any type of information but make sure that the receiver understands it.

Now a day’s parents are so busy with their own work schedules and have limited space and time to spend with their children. Parents are give electronic gadgets and the children are enjoying them. They don’t have any connections /interactions with their peer groups and society. They are in their own imaginary world. As a result of gadget exposure, children are susceptible to developing speech delays and autistic features.

Here are some tips for parents:

• Make the environment reassuring /positive for the child
• Spend time with them
• Maintain a calm and positive attitude when conversing with your child
• Be a good model
• Prepare yourself
• Speak to them in a short and simple phrase
• Praise/reinforce the child
• Remove the threatening atmosphere
• Avoid screen time
• Play with your child
• Engage them in any activities
• Go for a leisure trip
• Create a language-rich environment
• Give opportunities for more peer and social group interactions
• Make the child feel that communication or speech delivery is not a difficult task.
• Enhance opportunities to improve problem-solving skills.
• Use mother ease
• Stop comparing your child with other kids
• Teach moral values
• Make them independent in their daily activities
• Give opportunities to express their needs
• Make communication a priority
• Never criticize their speech articulation

For various reasons, autistic children often appear to avoid eye contact. While research is not yet conclusive, findings point to the following characteristics of autistic children:

• Fear or dislike of the person attempting to make eye contact
• Absence of customary social motivation
• Difficulty focusing on both spoken language and on another person’s eyes simultaneously
• Poor understanding that looking into the eyes is more revealing than looking at the mouth or hands
• Social anxiety or shyness
• Ignorance that they should look at someone during a conversation

Recent research suggests that this phenomenon can be explained scientifically as follows:

Our ears send auditory sensory signals to the auditory sensory processing area in our brain while our eyes give visual sensory signals to the visual sensory processing area. The neurons that those impulses travel along in autistic persons behave differently from those in neurotypical people. Synaptic pruning, a normal process that starts during pregnancy and lasts until adulthood in neurotypical persons, limits the formation of an excessive number of synapses. Autism patients experience inhibition of this process.

Visual signals in autistic persons can be up to ten times stronger than in neurotypical people, whereas auditory impulses can be up to ten times weaker. If our brain is struggling with processing what someone is saying to us, while being overwhelmed by what we’re seeing, the logical response is for it to redirect our eyes so it can focus on what we’re hearing.

It’s similar to how a neurotypical person could carry on a pleasant conversation despite having a pinched nerve; it’s simply more challenging. In comparison to neurotypicals, autistic people experience up to 400 percent more resting brain activity. They are constantly exposed to a significantly higher number of stimuli. Eye contact consequently seems awkward and uneasy. Eye contact isn’t always necessary because it can overload autistics with information.

This is known as The Intense World Theory in psychology. In short, persons with ASD can process information quickly and effortlessly and don’t require constant eye contact like other people do.

Research has shown early diagnosis and treatment interventions can lead to better long-term outcomes for autistic people. Because of this, the scientific community is working toward finding innovative diagnostic methods that can help detect this neurotype much earlier.

Researchers debate how dangerous environmental risks are in 2022, and they wonder how much ASD risk they confer. The American Speech-Language-Hearing Association says the following items merit more study: Automotive exhaust, Flame retardants, Hydrocarbons (typically from water contaminated with fossil fuels),  Insecticides, Lead, Polychlorinated biphenyls (found in coolants and heat transfer fluids)

It’s wise to avoid these contaminants during pregnancy. Tainted water and polluted air aren’t safe for growing babies, even if they don’t spark ASD.

But women who steer clear of all the items on this list may still have kids with autism. The research just isn’t clear right now.

Signs and symptoms of autism emerge at about age 2 when a child is getting core vaccines. Some parents draw a causal link between the vaccine and ASD. The child had no observable signs before; they got the vaccine; and now, symptoms are noticeable.

Timing doesn’t cause ASD. Vaccines aren’t the issue. This is one of the things we can say for certain regarding autism risks.

There’s a lot about autism that researchers don’t understand quite yet. But the science is clear on this: There is no connection between vaccines and ASD.

The siblings of children with a disability have an important role in uplifting them into the mainstream. They can help them in various ways, There are many such ways to include the siblings of children with disability with them like ;

• Make the siblings models for imitating activities.
• Give simple responsibilities to the siblings. For example, walk together while going to the mall.
• Make the conversation about the day-to-day incidents.
• Engage or include them in their plays
• Siblings are there to spend time together and help out with things like how to act in an action song, showing how to draw animals, or reading books.
• Engage them together in activities such as household folding clothes, washing dishes, arranging the table, etc…

Making eye contact is a challenge for those with an autism spectrum disorder.  There hasn’t been a clear explanation for this until now. However, it’s possible that autistic children are unable to read social cues from someone’s eyes. They are unable to comprehend that observing someone’s eye could potentially reveal information. Social cognitive deficiencies may be caused by problems making eye contact. As a result, eye contact can be extremely strong and sensory-overwhelming. They might avoid the practice if they feel overburdened and anxious. They lack the social motivation to look each other in the eyes. They find it challenging to concentrate on both another person’s gaze and spoken words. It makes them feel anxious if forced.

Medical or psychiatric conditions like ADHD ( Attention deficit hyperactivity disorder), OCD (Obsessive compulsive disorder), LD (Learning disability), ID (Intellectual disability), and Seizure disorders are common co-occurring conditions with autism. These conditions can occur at any time during the child’s development.

Parents who receive a diagnosis for their child struggle with thoughts of their child’s future with the developmental disability. Parents should feel that they are not alone, and it is normal to feel this way. The important thing to know is that, although there is no known “cure” for autism, there is hope. Your child will be able to learn, grow and gain new skills within their potential. The important first steps are educating yourself about the diagnosis, adjusting the child’s home environment to best meet their needs, and seeking professional therapeutic services.

There are no specific medications to treat autism.  Medicines are sometimes prescribed to treat related symptoms like irritability, aggression, seizures, insomnia, and self-injurious behavior. But medications seem to show better results only when given in conjunction with other therapies.

There are many challenges that are faced by children with autism in a regular classroom. That is,

In a regular classroom, the number of students is much higher and teachers not only don’t have specialized training in autism or other disabilities, but they also don’t always have the time to provide the attention each child needs.d

Lack of physical infrastructures such as seating arrangements, lighting, and decorations on the wall (may distract the child with disabilities)

Children with stereotypic behaviors like spins, rocking bodies, hand flapping, and finger fidgeting face difficulties in regular classrooms. They can’t understand and follow the general commands given by the teacher in a regular classroom setup (they need individualized attention).

The lack of trained/ specialized teachers also lacks special learning materials.

Unawareness of autism among teachers and peer groups may affect the process of learning.

Unable to follow the general curriculum

• Be consistent
• Stick to a schedule
• Reward good behavior.
• Create a home safety zone
• Look for nonverbal cues..
• Figure out the motivation behind the tantrum
• Make time for fun
• Pay attention to your child’s sensory sensitivities
• Support routines and transitions
• Use visual cues
• Support social skills practice
• Get ideas from other parents
• Ask your child’s school if they can help
• Join local small groups that are autism friendly

ASD tends to run in families, but the genetic pattern is usually unknown. People with genetic changes associated with ASD usually have an increased risk of developing the condition rather than the condition itself.

Increased awareness of autism has undoubtedly contributed to its rise in prevalence.

Until the 1980s, many people with autism were institutionalized, rendering them effectively invisible. Studies show that parents who are aware of autism’s presentation—by living near someone with the condition, for example—aremore likely to seek a diagnosis for their children than parents with no knowledge of the condition. Living close to urban centers and having access to good medical care also boost the likelihood of diagnosis

Many individuals diagnosed with autism may, in the past, have been misdiagnosed with other conditions, such as intellectual disability: As diagnoses of autism have risen, those of intellectual disability have decreased.

What’s more, a diagnosis of autism gives children greater access to specialized services and special education than do diagnoses of other conditions. This benefit makes clinicians more likely to diagnose a child with autism, even those who are on the borderline of the clinical criteria.

Awareness and changing criteria probably account for the bulk of the rise in prevalence, but biological factors might also contribute, says Durkin. For example, having older parents, particularly an older father, may boost the risk of autism. Children born prematurely also are at increased risk of autism, and more premature infants survive now than ever before.

Autism is a lifelong neurodevelopmental disorder that impairs the ability to communicate and interact, and  if it is left untreated the child might not know how to communicate and interact with others

Despite the fact that ASD symptoms can alter and evolve over time, with the right therapy, people can also lead independent lives. Autism levels or severity can change or worse over time.

The diagnosis of PDD-NOS can be made when a child does not meet the criteria for a specific diagnosis, but demonstrates a severe impairment in reciprocal social interactions in the presence of impaired communication skills or restricted repetitive and stereotyped patterns of behavior

Symptoms included:

• Atypical or inappropriate social behavior
• Uneven skill development (motor, sensory, visual-spatial organizational, cognitive, social, academic, behavioral)
• Poorly developed speech and language comprehension skills
• Difficulty with transitions
• Deficits in nonverbal and/or verbal communication
• Increased or decreased sensitivities to taste, sight, sound, smell, and/or touch
• Perseverative (repetitive or ritualistic) behaviors (i.e., opening and closing doors repeatedly or switching a light on and off )

Childhood disintegrative disorder (CDD) is a rare disorder.

In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), CDD is merged into autistic spectrum disorder.

CDD has a relatively late onset.

Causes regression of previously acquired skills in social, language, and motor functioning.

Due to the many different characteristics of autism, some conditions resemble autism spectrum disorders due to similarities in traits. There are diseases that have similar symptoms as autism such as Neurodevelopmental disorders include a group of pervasive developmental disorders that include ASD, Asperger’s syndrome, pervasive developmental disorder – not otherwise specified (PDD-NOS), childhood disintegrative disorder (CDD), Rett disorder, Fragile X syndrome, Landau-Kleffner syndrome, Prader-Willi syndrome, Angelman syndrome, Williams syndrome and Most of these conditions are genetically linked.

Autism is a neurodevelopmental disability that can be caused by many factors including heredity, brain injuries, even drug usage by the mother during pregnancy, etc.

Although research suggests that people with autism may be more likely to suffer from depression and anxiety than neurotypical, it cannot be guaranteed to be a cause of autism.

Many people with Autism Spectrum Disorder (ASD) have limited facial emotion. This may not mean they are depressed! In other words, the effects don’t necessarily match what they’re experiencing.

However, it is more difficult to identify depression in an autistic individual. In addition, many individuals with ASD have limited or no speech. So they may not be able to tell us how they feel

Signs to know if your child needs therapy

1:- Signs to know if your child needs therapy. There are several phases in a child’s life that you as a parent can deal with easily.
2:- Behavioural changes.
3:- Unusual anxiety and sadness.
4:- Trying to isolate most times.
5:-Health complaints.
Evaluation. It helps you and the school understand your child’s challenges. The testing will show exactly which skills your child is struggling with. That includes academic and cognitive skills, along with social-emotional skills. Testing will also shed light on your child’s strengths.

Occupational therapy has been described as the art and science of helping people do the day-to-day activities that are important and meaningful to their health and well-being through engagement in valued occupations. The primary goal of OT is to promote functional independence. Occupational therapy for autism treatment aims to improve a child diagnosed with autism’s ability to self-regulate emotions and participate in social interactions. It can also help children diagnosed with autism build on their areas of strength and overcome their limitations. Occupational therapy interventions for children diagnosed with autism may include the following:

•Emphasizing mental health and well-being
•Focusing on sensory-based strategies and sensory integration
•Implementing emotional development strategies and self-regulation plans
Improving self-care routines to help with daily activities such as bathing and feeding
•Organizing peer groups, play activities, and other methods of social participation
•Using cognitive-behavioral approaches to support positive behaviors
•Working on motor development
As a result, the child can reduce his sensory issues, and improve social interaction, academic skills, gross motor, and fine motor skills. So these are the changes that we can expect after undergoing occupational therapy sessions.

Some tips are:

• Be calm
• Be aware of Autistic symptoms
• Use visual schedules
• Use social stories
• Use PECS – to make communication easier between the parent and child.
• Include the child in day-to-day activities

Parent involvements make child therapy more effective. Children’s therapy works best when the therapist and parents work together. Some points include how can parents help with the therapy sessions.

• Parents can help to share the child’s information with a therapist.
• Supporting child’s mental health.
• Build parent therapist relationship.
• Improving the child’s home training program.
• Making reinforcing New skills and strategies.
• Support children in doing tasks they might not yet be developmentally ready to do.

Autism (ASD) is a developmental disorder caused by variations in the brain. Individuals with ASD may have trouble with engaging or participating in social interaction they may also show repetitive behaviors or interest. People with ASD may play, learn, move, or pay attention to their own patterns.

*Avoids or breaks off eye contact.
*Does not respond to names.
*Does not display facial expressions of joy, sadness, anger, or surprise.
*Does not engage in simple interactive
*Assembles toys or other items in a line and becomes irate when the order is changed.
*Continually uses the same words or phrases.
*Regularly engages in the same type of play with toys and concentrated on object parts (for example, wheels)
*Has an obsession with specifics.
*Flapping, rocking, or circling oneself
*Unexpected reactions to sounds, smells, tastes, sights, or feelings.

Speech and Language

The primary distinction between autism and the condition formerly known as Asperger’s is that Asperger’s is characterised by milder symptoms and the absence of language delays.The majority of kids who have had an Asperger’s diagnosis in the past have good language skills, but they might struggle to interact with their peers. 

Although they might feel awkward or uneasy, they had language abilities.On the other hand, communication and speech issues are typically present in autistic children. It’s possible that they have trouble understanding what people are saying to them or that they are unable to read nonverbal cues like hand gestures and facial expressions.

Cognitive Functioning

Cognitive functioning was another area where autism and the condition known as Asperger’s were different. While other children on the spectrum typically had major cognitive deficits, Asperger’s-diagnosed youngsters typically had intellect levels that were ordinary to above average.

Age of Onset

The age of onset, or when a child receives a diagnosis, is another distinction between autism and Asperger’s. A person with autism is typically diagnosed when they are four years old, whereas a person with Asperger’s may not be identified until they are a teen or an adult.This might be the case because kids with Asperger’s don’t have Cognitive problems or linguistic impairments. 

Many parents might not be aware that their child has a developmental delay until after they start school and interact with other people more frequently.

There is no way to pinpoint the precise origin of your child’s autism because autism spectrum disorder (ASD) has no established etiology. In actuality, it is widely believed that ASD is caused by a combination of factors. Instead, there are other variables that can raise a child’s risk.

Two elements that are thought to influence a child’s risk of having ASD are genetics and environment.

• A child’s probability of developing a pervasive developmental problem increasing by 2% to 20% if an older sibling has an autism impairment suggests that genetics may play a significant impact.

• There are several environmental factors that could raise the risk of a child developing autism. It’s important to note that these factors have been found to play a Moderate role in the risk of developing autism, but they are still present. These Include:

∆ Conceiving the child at an advanced age
∆ Very low birth weight
∆ Exposure to pollutants during pregnancy
∆ Infections during pregnancy
∆ Premature birth
∆ Alcohol and Drug Usage during the Time of Pregnancy
∆ Medication during Pregnancy

The very first step is to identify the symptoms at an early age and provide better therapy (Speech therapy, Occupational therapy, special education). This child’s language, speech, communication, attention, and sensory issues can be rectified. One-on-one therapy sessions will provide improvement in the child’s communication and focus, then create opportunities to socialize them with peer groups and adults. Make the language and communication clear and simple. Provide the child extra time to comprehend what you are speaking about. Don’t ask him/her many questions at a time and do not complicate the situation. Try to change his/her routine every day by adding new interesting activities so that it might help to prepare your child to adapt to any situation.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. Individuals with ASD will have deficits in social communications and interactions, and restricted and repetitive patterns of interests, activities, and behaviors and these symptoms become manifest during the early developmental period. There is no single known cause for ASD. Both genetic and environmental factors may play a role. Studies say that there are several different genes involved in autism spectrum disorder. For some children, ASD is associated with a genetic disorder, such as Rett syndrome or fragile X syndrome. Advanced parental age, low birth weight, fetal exposure to valproate, family history, and male gender (ASD is diagnosed 4 times more in males than females) are risk factors for ASD. Certain studies link ASD with birth defect agents acting during the period of pregnancy. Bacterial or viral infections in the mother during pregnancy have been found to slightly increase the risk of autism.

High Functioning Autism

High-functioning autism is a subtype of pervasive developmental disorder. People with high-functioning autism are characterized by near-normal behavior. It is defined as somewhat abnormal and/or slightly impaired development in social interaction and communication and the presence of restricted, repetitive behaviors. A characteristic type of dysfunction appears before the age of three.

Individuals with HFA have nearly normal intellectual and language development, although cognitive development is heterogeneous within this group.
There are some difficulties with domestic, academic, occupational, or social functioning, but some important interpersonal relationships. Individuals with HFA exhibit many different characteristics from other members of the autism population.

Individuals with HFA show fewer non-verbal communication skills such as facial expressions and gestures compared to their typical peers.
They also cannot understand complex social interactions, nor can they read facial expressions and body language to understand the emotional state of others.

Some HFA patients may improve their receptivity and expressiveness of language with time and experience.
However, in some people with this disorder, echolalia may persist into adolescence or adulthood, especially when communicating with unfamiliar people.