DHAKA, Jan 24, 2025 (BSS) - Prasun (pseudonym), a four-year-old boy, is noticeably different from his peers. Despite his growing up, he struggles to stand steadily and cannot speak clearly. While he can utter a few words, forming complete sentences remains beyond his ability. He rarely establishes eye contact with those around him and often retreats into his own world, avoiding social interaction. His interest in playing with other children is minimal, and he displays peculiar behaviours, such as repeatedly demanding the same object or action and crying until his demands are met. These behaviours align with the characteristics of autism—a condition that affects a child’s capacity for social interaction and effective communication.

What is Autism?

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterised by difficulties in communication, social interaction, and repetitive behaviour patterns. A child’s nervous system begins to develop during the prenatal stage and continues to mature significantly during the first few years of life. However, if this development is disrupted for any reason, it can lead to autism. Autism is not a disease but a condition that reflects unique neurological wiring, with each child displaying a spectrum of traits ranging from mild to severe.

Understanding autism as a developmental difference rather than a defect is essential in fostering a supportive environment. 

The Importance of Observation 

Dr Ahmed Helal, Associate Professor at the National Institute of Mental Health, highlights the critical importance of early observation in identifying autism. He notes specific developmental milestones that children should ideally achieve. For instance, if a child does not smile or respond to social cues by six months, fails to babble by twelve months, does not point at objects of interest, or cannot say simple words by sixteen months, these could be early warning signs. 

Additionally, children who initially develop language or social skills but later lose them may also have autism. Dr Helal advises parents and carers to seek specialist advice if these signs are evident, as early intervention can significantly improve outcomes. 

Key Symptoms of Autism 

Children with autism typically exhibit two primary traits: difficulties in social communication and restricted, repetitive behaviours. They often struggle to build or maintain relationships, failing to respond to their name or engage in typical back-and-forth interactions. Their facial expressions may not match their emotions, making it hard to discern whether they are happy, frightened, or upset. They rarely share their interests, feelings, or experiences, resulting in an emotional disconnect from their surroundings. Even children who can speak may struggle to maintain conversations or adjust their speech to suit different social situations. 

Repetitive Behaviours 

Repetition is a hallmark feature of autism. Children with autism may engage in repetitive physical actions, such as flapping their hands, spinning in circles, or tapping objects in a specific rhythm. They might also show a fascination with certain objects, such as spinning the wheels of a toy car repeatedly rather than playing with it conventionally. Language repetition, or echolalia, is also common, where a child repeats the same word or phrase multiple times. These behaviours, though unusual, provide comfort and predictability to children with autism, who often thrive on routine. Any disruption to their routine can cause significant distress. 

Onset and Risk Factors 

The signs of autism typically emerge between 18 and 38 months of age, a critical period for brain development. Although the exact cause of autism remains unknown, researchers have identified several potential risk factors. A family history of autism increases the likelihood, as other factors like exposure to infections during pregnancy, low birth weight, or complications during delivery can contribute. Environmental factors, such as exposure to toxic substances like lead during pregnancy, and nutritional deficiencies in both mother and child, may also play a role. 

While these factors may heighten the risk, autism cannot be attributed to any single cause, making it a complex condition requiring further research.

Associated Challenges 

Autism often coexists with other health challenges, complicating life for affected children and their families. Seizures (epilepsy), hyperactivity, and intellectual disabilities are common comorbidities. Difficulties with motor skills, such as using their hands for precise tasks, are also prevalent. Digestive issues, dental problems, and resistance to chewing food further complicate daily life. These associated challenges necessitate specialised care, often requiring the collaboration of multiple healthcare professionals to address the child’s needs holistically.

Global Prevalence and Trends 

Globally, the prevalence of autism has risen significantly in recent decades. According to a 2018 report by the US Centers for Disease Control and Prevention (CDC), one in 59 children is diagnosed with autism, with boys being four times more likely than girls to be affected. However, the growing prevalence also highlights the urgent need for resources, support systems, and societal acceptance to enable individuals with autism to lead fulfilling lives. 

Awareness and Treatment in Bangladesh 

In Bangladesh, awareness of autism has improved significantly in recent years, thanks to targeted campaigns and government initiatives. As a result, more children are being diagnosed early and receiving appropriate care. However, misconceptions persist, such as the belief that autism results from poor parenting or a lack of discipline.

Dr Helal emphasises the importance of following expert guidance to dispel these myths. Early diagnosis, tailored education, behavioural therapy, and, if necessary, medication can make a significant difference.

Medications, when prescribed under strict medical supervision, can help manage symptoms like hyperactivity, aggression, or self-injurious behaviours, enabling children to benefit more effectively from therapy and training. The ultimate aim is to empower these children to live as independently and meaningfully as possible.