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Understanding ASD in Children

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that causes difficulties in three main areas – reciprocal social interaction, communication, and behaviour (1). It is referred to as a spectrum due to the wide range of differences children present within the ASD criteria – with these ranges also having great dimensions. As a result, ASD affects multiple areas of a child’s development. Its successful management relies on developing coordinated interventions that continually resolve the areas affected.

Social Communication Needs

Social interaction and communication difficulties include making little or no eye contact, having non-verbal expressions that do not match verbal speech, failing to have reciprocal conversations, and a rigid way of thinking that affects their ability to understand various situations.

Behavioural Difficulties

Behavioural difficulties include restricted, stereotyped, and repetitive activities, insistence on sameness and inability to manage change. Children with ASD may also present with disruptive behaviour - with or without violence and aggression - and display long lasting, intense focus on specific interests in ways that over-consumes the child.

What can co-exist with ASD?

It is worth noting that ASD usually co-exists with some form an anxiety disorder, with almost 92% of children with high intellectual ability experiencing two or more anxiety disorders (2). This can be due to worries connected to ASD like changes in their lives, lack of predictability, the urge to control various circumstances, high levels of expectations of themselves or others, and unresolved issues at school. ASD is distinguished from other major categories of conditions like Reactive Attachment Disorder, Childhood Schizophrenia, Developmental Aphasia, and Learning Disabilities (1).

Some researchers consider ASD to be caused by abnormal brain development, linked to genetic and environmental factors, with the impairments usually observed before the age of 3years of age (1). When impairments develop after the age of 3, they are usually milder and not the full range of difficulties - this is described as Atypical ASD (1). There is also Acquired ASD, that occurs when a child initially develops normally but then experiences a sudden onset of ASD at the age of 18 months; or develops a medical condition, brain dysfunction, or childhood trauma that causes the onset of ASD after the age of 18 months (3). Acquired ASD is known to account for 22-50% of all ASD cases (3).

Gender Differences

Though ASD occurs in all socio-demographic groups, its diagnosis is not uniform, as some groups identify it more consistently than others – this may also be due to a higher level of acceptance and awareness of the condition in those groups (4). It is more common in boys, and they are more likely to be diagnosed in early childhood, as compared to girls who are more likely to be diagnosed in their teenage years (4). In this regard, girls who meet criteria for ASD are most likely not to receive a clinical diagnosis, and can also be misdiagnosed, diagnosed much later, or completely overlooked (4). This is because girls have a tendency not to have explicit symptoms and can ‘camouflage’ their social difficulties, increasing hindrances to timely recognition of the condition (4).

Vulnerability to Exploitation

There are secondary concerns as a child with ASD grows older. As the nature of their social exposure and social difficulties increase, there is a risk of various forms of vulnerability, exploitation, and crime. For example, a child with ASD may develop a desire to ‘fit-in’ with their peer group, but due to difficulties making social judgements, feeling empathy or remorse, such children may end up being easily influenced towards perpetrating anti-social acts. Often when such children are interviewed, they are found not to understand the motives or implications of their actions. Therefore, they are prone to becoming repeat offenders, particularly if they are not offered appropriate interventions.

Interventions and Support

In matters of anti-social behaviour, interventions need to be geared towards helping children with ASD to process their actions and learn how to change them, with therapists and educators being well versed in the particular way in which children with ASD may view the world, or make choices. An analysis of each child's individual strengths and limitations is needed, so that the intervention is tailored to meet the child's particular needs.

There is no medication for ASD, but psychiatrists and paediatricians may offer treatments that address specific symptoms that co-exist, such as sleep deprivation and severe anxiety (1,2). However, it is worth noting that such treatments will have limited effect if used on their own. Suitable management of ASD usually coordinates a number of interventions designed to alleviate the diverse difficulties the children face, while also maintaining stability in environments they are a part of. These may include intensive behavioural modification that at times takes the form of mentoring to help the children to observe demonstration of appropriate behaviour.

Specific interventions could be required for schooling, speech and language development, establishing a consistent dietary routine, and learning to perform personal care.

How Parents and Carers can Help

Parents are highly recommended to undertake relevant parental education, like Non-Violent Resistance Training and ASD specific programmes, so that they are more equipped and empowered to manage the challenges that continue to transform as the child grows. They will need to use a clear and consistent boundaried approach in