Doreen Mercieca 

The birth of a child into a family is an event that is viewed by most expectant parents as a joyful experience. Plans are made for the new arrival and the whole family, including the extended family, are thrilled to welcome the new addition. Baby arrives and all anxiously await for the appearance of the developmental milestones. Joy begins to turn into concern when communication difficulties, demanding and peculiar behaviours and problems in emotional expression replace the typical development, that is more often than not taken for granted.

Autism Spectrum Disorders (ASD) or as more widely known, simply autism, is a range of complex neurodevelopment disorders, that are characterised by social impairments, communication difficulties and restricted, repetitive and stereotyped patterns of behaviour. It is a wide-spectrum disorder, which means that its degree and symptoms may vary from one individual to another. The onset of autism appears in infancy and early childhood and can be seen in the delays in the basic areas of development such as early words, playing and interaction with others.

The impact that autism has on the individual varies widely, as do its effects. Some affected by this condition may have only mild impairments, while others have more challenges to overcome. However, no matter the degree of severity, every individual on the autism spectrum will have difficulties, to some degree, in the following areas which are present currently or by history:

§  Social communication and social interaction across multiple contexts

§  Relating to others and the world around them

§  Thinking and behaving flexibly

Although each individual with autism is unique, Mesibov et al., (2005) have identified a significant number of common characteristics and have described them as neuropsychological deficits and strengths such as:

§   A strength and preference in the processing of visual information in comparison to the difficulties with language and auditory processing;

§   Marked variation of levels of attention, where individuals may be highly distracted at times and at other times may be so intensely focused that they may have difficulty in shifting their attention;

§   Difficulties in communication which include impairments in the social use of language;

§   Difficulty with the concept of time such as recognising the beginning or end of an activity, how long the activity will last and when the activity is finished;

§   Attachment to routines and the particular settings where they are presented, thereby hampering the transfer or generalisation of skills from the original learning environment;

§   Special interests and intense engagement in preferred favourite activities resulting in great difficulty to focus interest elsewhere; and

§  Sensory processing difficulties which may be displayed as strong preferences or aversions.

The number of possible combinations and varying degrees of how the individual with autism is affected by the above factors is a clear indicator that there is no set pattern of how each individual with autism may learn. Thereby, any approach implemented must be personalised according to the diversity of how the individual thinks, learns, communicates and perceives the world.

During the last two decades, there has been a steady increase in the demand for specialised services for children with autism. This is mirrored in the ever-increasing number of referrals that the Inspire autism specialised programmes are receiving. The reported rise in the number of children who are being diagnosed and referred for services may be attributed to a number of variables such as increased awareness, the broadening of the diagnostic criteria used or an actual increase in the incidence of autism. In collaboration with the parents, the providers of services in the areas of health, social care and education must be in a position to respond and provide for the needs of children on the autism spectrum who make up 1% of the child population (Baird et al., 2006).

There is a lot of research and different opinions among professionals, parents and experts about what causes autism and what the best approaches are to treat it. What is for sure is that everyone agrees that early intervention can improve the development of a child with autism. In fact, for children at risk and children who show early signs, it can make all the difference. Hence, the importance of early detection.

 

Early detection

The best person to spot the earliest warning signs of autism is the parent or the guardian with whom the child lives. Nobody knows the child better than the parents/guardians who certainly have the most occasions to observe behaviours that a professional might not have the opportunity to pick up during a typical visit. Professionals are valuable partners, but the importance of the parents' observations and experience must never be underestimated.

It is very important to note that the earliest signs of autism are evident through the absence of typical behaviours, rather that the presence of abnormal ones. It is very common that the early signs of autism may be misinterpreted as having a "good baby". For example, "He is such a quiet baby, he prefers to  sit all day in his buggy rather than being picked up" or "He is so good, he prefers to sit alone and watch TV rather than playing".

 

Don't accept a wait-and-see approach - Take Action!

Regression of any kind is a serious autism warning sign - Any loss of previously gained skills such as early words (that is, mummy, up, bye-bye), babbling, gesturing or social play (that is, peek a boo, clapping hands, waving) should be taken very seriously as regression is a major indicator of the possibility that autism is present.

Early detection of autism will reap several benefits for the family. First and foremost, they can finally get answers to their questions regarding their child's development, thereby allowing them to understand what autism is and how this will affect their child. Once the family receives a diagnosis, they can move forward from wasting their energy on unfocused worry to focusing on positive planning. As soon as the difficulty has been identified by professionals, specialised intervention should start straight away. In young toddlers, a straight forward diagnosis may not necessarily be made at a very early age. The child would be closely monitored and reassessed at a later age as it may be the case that the suspected difficulties that were initially displayed were not a result of being on the autism spectrum.

It is not necessary to have a diagnostic label to start to get help for the concerns regarding the child's development. Recommendations to address existing concerns can be made to target any potential difficulties from the very early days as it is never too early to start introducing strategies that tackle communication, social and sensory difficulties. In addition, parent training should also be initiated to enable and empower them to facilitate their child's learning process. If there is a concern regarding the child's development, rather than worrying and hoping that "he will grow out of it", precious time is passing by. Better to see a professional who may advise that: 1. There is nothing wrong or 2. Yes, there may be a problem, thus enabling the parents to take action and seek specialised support.

Each child is unique and will develop at his/her own pace. One must not panic if their child is a little late to talk or to walk - there is a wide range of what is considered "typical" in development. However, if the child is not within this range and the parent suspects a problem, it is highly recommended that this concern is brought to the attention of a professional.  Without a doubt, the road to diagnosis may be long and stressful and nothing can prepare a parent to hear a confirmation of their fears. Though some time may be needed to adjust to the new reality, the best step forward is to be proactive - through accessing support for the parent and services for the child. And the earlier this starts, the better.

 

Doreen Mercieca MEd Autism (Birm.) is an Autism Spectrum Disorder advisor and also forms part of the Expert Panel at Inspire. For further information, contact Doreen Mercieca on 2092 8112 or send an email on: [email protected]