<i>Common facts about autism</i>
A two -year- old boy Shamim, had no notable problem since birth up to 12 months of his life. After his first birth anniversary, his mother noticed that he was not perfectly responding to the stimuli and he liked to stay alone. Gradually he became quiet. He did not show any interest to the surrounding toys and objects. His language development seemed to be slow and did not show any reaction to the presence of neighbor child of his age. When his mother told her observational findings to his father who is a very busy businessman, he did not give much importance, as his son was apparently fine. However, they consulted a paediatrician lately at the age of 18 months who diagnosed the condition as Autism, a brain development disorder. Autism impairs social interaction and communication, and causes restricted and repetitive behaviour. It develops before 36 months of age and is typically diagnosable at the age of 18 months. The hallmark of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement. Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they cannot understand social cues, such as tone of voice or facial expressions, and do not watch other people's faces for clues about appropriate behavior. The cause of Autism is multifactorial. Genetic factors play a significant role, but what is actually inherited is not clear. Language and cognitive abnormalities are more common in autistic children then in general population. Problems in chromosome number 15 play a vital role in causing Autism. Brain injury during birth and following birth may also be a causative factor. Occasionally brain volume of Autistic children may be increased. Abnormal neurochemical findings have also been associated with Autism. Previously it was thought that MMR vaccine may be an association but it proved false. Symptoms are poor eye contact, poor social relationship, delay in use of words, language problem, reliance on non verbal communication, stereotyped body movements, less interested to surrounding objects, introverted, echolalia may present. Accurate measurement of intelligence is not possible because of non-cooperation and communication problem. Occasionally an Autistic child may have an isolated remarkable talent. There is no specific diagnostic test for Autism. Physician diagnoses it clinically. Management needs multidisciplinary approach. Parent-education, patience and compliance are very important to have better management. Considerable advances have been made in the treatment of Autism. Special education, intensive behavioral therapy beginning before three years, targeted towards speech and language development, is very much important. Parent-education, training and support are mandatory for better outcome. Medicine does not improve the situation. But if there is seizure problem aniticonvulsive drugs are needed. Prognosis is variable depending upon the time of diagnosis, severity, parent's education and attitude. A better outcome is associated with higher intelligence, functional speech and less bizarre symptoms. Some may grow up to live a self-sufficient and others may remain dependent on family. Early diagnosis and intensive management starting earlier helps in better out come. In our country we are also having many children suffering from Autism, we all should show very caring and sympathetic attitude for them. Our love and affection may help them a lot. The writer is an Associate Professor of Department of Pediatrics, Community Based Medical College, Mymensingh.
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