In a park, a group of three-year-old children are playing together, with their mothers watching. One toddler, Arun, is off to the side, looking up at the trees and squinting at the light. His mother calls several times but he does not respond. He doesn’t seem interested in the other children or their toys. He holds a little car tightly in his hand. Sometimes he says a few words, but they have no connection to what the other children are talking about. While Arun’s mother has been worried about him, her concerns were often dismissed by family and professionals who don’t know the early signs of autism. Early identification of autism is important because it leads to early intervention that could change the life of an autistic child.
Autism is a neurodevelopmental condition, not a disease. There is a difference in how the brains of autistic children are wired. Autism is not uncommon — recent statistics from the U.S. show a prevalence of 1 in 44, while Indian data suggests 1 in 100. The diagnosis is often made by a paediatrician or a psychiatrist with experience in seeing children with autism. We don’t fully understand the causes of autism but there is a strong genetic component. If one child has autism in the family, the sibling also has a higher chance of being on the autism spectrum.
Autism is characterised by three kinds of differences. The first two are communication and social interactions, which often go together. Children with autism may struggle to communicate with others who are not like them. For example, they may not use pointing, gestures or words to communicate, and instead may pull their parents towards what they need. They may use words out of context and sometimes repeat words.
That autistic children interact differently in social settings becomes evident when they play. Games that require turn taking, like hide and seek, are often not intuitive for them. While most children begin pretend play, like pretending to feed a doll, between one and two years of age, autistic children prefer blocks, puzzles or mechanical toys instead.
The other main characteristic of children with autism is that they have a focused area of interest or a repetitive activity they enjoy. A child may focus on cars, aeroplanes or dinosaurs over all other activities or topics. When playing with objects, they may choose to line them up or stack them instead of playing a pretend game with them. They may also have physically repetitive movements of the body, like hand-flapping or spinning, particularly when they are excited or anxious.
Autism occurs as a spectrum — every child is different and looks different as they grow. There have been increasing concerns that girls with autism are being underdiagnosed. Kanika, a 12-year-old girl in class VI, is doing well academically but is very quiet in class. She often does not understand the gossip her classmates share or jokes the other girls make, but pretends to laugh and be interested. Her main passion is a comic character that she draws repeatedly and skillfully. She is intensely anxious in social settings. She has the same social and communication challenges but she is unlikely to get a diagnosis. Kanika’s differences are not ‘typical’ of what is described as autism in boys. A skilled professional can identify Kanika’s autism and support her, and her family, through her challenges at school and at home.
How do we help an autistic child?
Like all of us, children with autism have strengths. They are often visual learners, good with puzzles, visual memory, and visual problem-solving (including visual games like chess). They have a strong sense of justice and honesty, which often means they have a harder time understanding certain social norms. Contrary to popular belief, three-fourths of autistic individuals have normal intelligence. Since autism is not a disease, it is not helpful to speak of a cure. Supporting children with autism involves educating them and people in their environment. There are several ways to teach children with autism; many involve coaching parents and teachers on how to connect and communicate with their child.
For example, Arun’s family can be taught to observe him, note what he is interested in (cars and puzzles), and use this as an opportunity to engage with him. Getting professional guidance to teach a child with autism is not always easy. It is important to explore who is available as a resource in each community. Some communities may have occupational therapists and speech therapists who are familiar with working with children with autism. In others, it may be a teacher, a special educator or an experienced parent. While it is important for the child to learn to connect, it is equally important for family members, teachers, doctors, and other children to understand the autistic individual. Children with autism have the same right to play, learn, and participate in the community as all children.
A lot of our understanding of autism today comes from autistic self-advocates — children and adults with autism who have spoken about their own experiences, and even researched the subject. Most of their difficult experiences have been related not to their autism but the lack of awareness, understanding, and empathy from others. If we want autistic children to fully achieve their potential, we need to understand that we have all kinds of minds in the world, and every one of them belongs here.
Vibha Krishnamurthy is a developmental paediatrician and the founder of Ummeed Child Development Centre in Mumbai.
