Dear Doctor, I’m desperately worried about my three-year-old son. His speech is reasonable but he doesn’t speak much and seems to live in a world of his own. He started nursery recently which I was hoping would make him more sociable, but the nursery teachers say he plays on his own and gets very upset if interrupted. I’m worried that he may be autistic. How can I find out if there’s anything wrong?Olive, 29, Kiyovu Dear Olive At three years of age, if the child likes to stay away from any interaction with others, autism is a possibility. The exact cause for autism is not yet known. But the hypothesis is that there may be inadequate development of one, two or more of the million neuro circuits in the brain which are responsible for receiving, transmitting and interpreting information. These children may not understand all that is communicated to them and may not be able to express themselves. They mostly like to remain isolated and have no interest in play things or play mates. The degree of disability can be from mild to severe. Mild cases can even reach university level and with proper support and guidance, they lead as normal a life as possible. Those with severe autism struggle to even finish preliminary classes. In between this spectrum, there are cases who may have moderate symptoms but are able to learn enough to carry on their daily work and express these basic needs. In all these cases there is no physical weakness or disability. Intellect of the child may be normal or slightly impaired. A child with chronic ear infection may have impaired hearing. As he does not hear clearly, a problem which he cannot understand or express, he keeps to himself and does not interact with others. Children with autism sometimes isolate themselves and don’t show interest in play mates. (Net photo) Fetal alcohol syndrome is a condition where the child is exposed to alcohol when in the uterus due to alcohol being consumed by the mother. Here the child is seemingly normal but has mild brain damage and may later have strange behavior and interaction for his age. Due to some genetic disorders also a child may be abnormal in his behaviour at par with his age. There is no definitive diagnostic test for autism till date. But diagnosis is made on basis of features suggesting autism and excluding conditions that can cause brain damage. A child may have one or more features. In a young child, delay in speech development for example not speaking at least 10 words by the age two, infrequent repetition of set of words and phrases, frequent repetitive movements like locking or flapping fingers, set routine and being upset if routine is disturbed using single words to communicate in spite of knowing how to construct sentences, not responding to being called in spite of normal hearing, reacting negatively if asked to do something and rejecting being cuddled or petted, are features which should alert one to the possibility of an autistic child. Treatment of autism involves team work. A team comprising of a child specialist with experience and training with autism, parents, professionals who can train the child in speaking and social interaction skills, works together regularly with the child. With good support and training, a child can become normal or almost normal. Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.
