WhatIsAutismSpectrumDisorder?Autism Spectrum Disorder (ASD) is a lifelong developmental and neurological disorder that is estimated to affect nearly 2 million individuals in India (T C Daley and Sigman, 2002). It is found in every country and region of the world, and in families of all racial, ethnic, religious, and economic backgrounds. The incidence of ASD is said to be 2 to 6 in 1000 (CDC – USA), making it the third most prevalent developmental disorder in the world. The incidence of Autism is higher than disabilities like Cerebral Palsy or Down’s syndrome. Autism Spectrum Disorder impairs an individual’s understanding of what he or she sees, hears or otherwise senses. It is a disorder that is characterized by impaired development in communication, social interaction, and behavior.

DiagonasticCriteriaAutism Spectrum Disorders comes under the category of Pervasive Developmental Disorder along with Asperger’s Syndrome, Pervasive Developmental Disorder – Not Otherwise Specified, Childhood Disintegrative Disorder and Rett’s Syndrome. To diagnose autism the main criteria used is the triad of impairment (Lorna Wing & Judith Gould, 1979) Impaired ability to communicate Impaired ability to socialize Impaired imagination This diagnosis is made on the basis of the child’s behaviour. 

To further assess the child IQ Tests are done which helps determine the degree of impairment from mild to severe. Some of the individuals are relatively high functioning with speech and intelligence intact. Others have mental retardation, maybe mute, or have serious language delay. About half of the people with autism score below 50 on IQ Tests, 20% score between 50 and 70 and 30% score higher than 70. However many children with autism are described as being “functionally retardedâas they may not be co-operative to formal testing. Generally speaking, individuals with autism don’t look different, what sets them apart is the apparent lack of connection to the environment around them. They may also appear indifferent and remote and may be unable to form emotional bonds with others. Ongoing research around the world has still not unearthed a definitive conclusion on the causes of Autism. What is evident though is that Autism is neurological in origin and the genetic component factors in its occurrence.

DiagonasticInstrumentsThe symptoms of autism are often measurable by 18 months of age. One of the published screening instruments used to detect autism at 18 months is the Checklist for Autism in Toddlers (CHAT - Baron-Cohen et al., 1992; 1996). The diagnostic instruments used are Childhood Autism Rating Scale (CARS – Schopler et al 1988) and The Autism Diagnostic Schedule (ADOS, Lord et al 1989). The CARS is widely used in India and can be used with children over the age of 24 months. It involves an interview with the child’s caretakers and observation of the child. ADOS uses observation in a semi-structured environment. It requires training and certification to use and is currently not available in India

Causes Of AustimCauses of Autism It is generally accepted that autism is not a single entity but a series of behaviours with multiple causes and neurological mechanisms.

Genetic: Of the known causes, one of the most important is genetic with several possible transmissions. Twin studies have shown a concordance rate for autism of greater than 50%. Other studies have demonstrated an increased risk of related language, speech and developmental problems in families with an autistic child. Autism is one of a number of possible outcomes for children with this genetic predisposition for communication, social or learning problems. Fragile x is another genetically transmitted form of autism. Although all children with this chromosomal abnormality do not have autism, 10-15% probably do, but Fragile X only accounts for 2 to 3% of cases of autism.

Infectious Diseases: Rubella is one prenatal infection that is a proven cause of autism and others are thought to exist as well.

MetabolicDisorders: Metabolic disorders causing autism are PKU and celiac disease and it is suspected that high uric acid levels and difficulties in metabolizing purines could also be implicated.

StructuralAbnormalities:Structural abnormalities such as hydrocephalus can also cause autism; the developing technology in brain scanning equipment makes it likely that other specific structural deficits will be identified in the near futureOne such deficit might relate to an under-development of the cerebellum. Though preliminary, this idea is based on the first study to suggest the specific neurological structure underlying autism. 

Data on the under-developed cerebellum are limited to higher functioning individuals with autism at present. Other Causes: New studies also suggest that vaccinations such as the MMR may be a triggering agent. 

CurrentIndianScenarioA majority of the public, including many professionals in the educational and vocational fields are still unaware of how to work effectively with individuals with autism. The fight to have Autism recognized as a disorder requiring intervention services different from that of mental retardation is still ongoing and receiving government grants is thereby difficult.

As a result most services available to individuals with Autism are housed within schools meant for individuals with mental retardation or other disabilities. Such services often lack the special focus and appropriate approach, leading to ineffective intervention in most cases of individuals with Autism. 

Autism is currently included in the National Trust Act (1999) but has not been included in the Persons with Disability Act (1995). This results in a large number of benefits not being available for individuals diagnosed with autism.

InterventionThere is currently no known 'cure' for autism. There are however intervention approaches that may reduce some of the challenges associated with the disability. Intervention may help to lessen disruptive behaviors, and education can teach self-help skills that allow for greater independence.

Children can learn to function within the confines of their challenges, but intervention must be tailored to the child's individual behaviors and needs. The best-studied interventions include educational/behavioural medical interventions. 
Educational/behvioural interventions: There are many schools of thought regarding the best ways to teach a child with autism. Some of the more popular methodology have been briefly outlined below. In India it is a common practice to inculcate principles of different methodology and these are combined to form an eclectic approach.

TECHH of Autistic and related Communication handicapped Children was developed by Eric Schopler for the State of North Carolina in the US. The primary focus of this methodology is Structure. TEACCH believes that mosat individuals with autism having difficulties dealing with unexpected occurrences and they tend to have high levels of anxiety. The approach helps reduce this anxiety byœstructuring the physical environment, providing visual schedules (timetables that make the routine clear) and making the work process explicit and clear. Alongside the environmental adaptations, TEACCH believes in developing the individual’s skills and cultivating thier interests

AppliedBehaviouralAnalysis(ABA)This is an intensive, structured teaching programme that uses the principle of learning given by BF Skinner to teach skills or behaviours. The focus of ABA is increasing behavioural deficits such as lack of communication and decreasing behavioural excesses such as hyperactivity through a systematic use of rewards or rewards and punishment.
The major teaching methodology that is an inherent part of the ABA Approach is the DTT (Discrete Trial Training), which was given by I Lovaas. DTT involves breaking a skill into smaller components and teaching a skill intensely until mastery. Prompts are used alongside to facilitate learning

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