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December 2002


Issue 7

Inside this Issue:

2 "Autism", by Dr. Vrajesh Udani, M.D.

3 "Autism - a diagnostic view", by Meghana B.W., M.A.

4 "Intervention

strategies for Autistic children", by Dr. Smita Desai, Ph.D.

Our team at Drishti: Smita Desai (Ph.D) Anand Desai (M.Sc) Meghana B.W. (M.A., Clinical) Ramani Kumar (MSc, CCD) Tanaz Mistry (DSE-MR) Sweta Vaswani (M.A., Clinical) Vibha Sharma (M.A., Clinical) Lorainne DePenha (B.Ed, Sp.Ed) Manju Chakravarty (DSE, MR) Divya Menon (BSc, HS) Namrata Doshi (BSc, HS) Smriti Bakshi (BSc, HS+) Fouzia Farooqui (BSc, HS+) Hetal Jobenputra (DipPhH) Dhvani Shah (DipPhH) Miriam Correa (DipPhH) Lalitha A. (B.A.)

Andheri (W) 206 Midas Chamber Andheri (W), Mumbai 400053 Phone: 022-26732496 Fax: 022-26732494 Bandra (W) 501 Gasper Enclave Pali Naka, Bandra (W) Mumbai 400050 Phone: 022-26441850

Dear Friends, It would I am sure come as no particular news to many of you that the subject of Autism is itself making news over the recent past. While existing statistics in western societies indicate the percentage of children diagnosed under the Autistic spectrum as relatively miniscule - compared to other prominent disabilities, such as LD for instance - there has been a steep rise in the number of cases being identified. This reflects also in the recent increase in referrals to Drishti of children with symptoms related to the Autistic spectrum. While it was earlier reported that the observed increase in cases with Autism be attributed to artificial factors (such as loosening of diagnostic criteria, mis-classification of autism cases as MR in the past, etc.), latest studies indicate the increase to infact be a real increase and not an artificial one. For this I refer to the recent report: "Epidemiology of Autism in California - A Comprehensive Pilot Study", by Dr. Robert Byrd, available at We remain indebted to our expert contributors in all our issues. We are particularly grateful to Dr. Vrajesh Udani, for agreeing to contribute to this issue and apologise for the inconvenience that we might have caused him by our persistent follow-up! We are certain that the information provided by Dr. Udani would be invaluable to all the readers. I also thank Smita and Meghana for their respective articles. We do hope you will find the contents of this newsletter of interest. As always, your comments and suggestions are most welcome and would go a long way in the evolution of this newsletter and to better our services to the community in general. Kind Regards. Editor Anand Desai (

Experts Corner Autism Dr. Vrajesh Udani, M.D., Child Neurology & Epilepsy, P.D. Hinduja Hospital & Research Center

with males than females. There is a dramatic increase in prevalence over the last 15 years and most experts believe that something in the environment may be responsible. Vaccines, allergies, mercury poisoning, vitamin deficiencies, emotional traumas etc have been blamed though there is no real evidence to support all these claims. Clearly it seems that both genetic and environmental influences are important.

Early and accurate diagnosis is very important. Parents, teachers and related professionals play equally important parts in this process. Initial assessments should focus on diagnosis and severity. Once the diagnosis is established the parents should get as much information as they can handle. Sources Children usually are first noticed to are the internet, books and medical have delayed speech development "Early and accurate and related professionals. Once they and present at about 1-3 yrs to the have accepted that something is diagnosis is very doctor. On closer questioning it wrong early intervention has a very important. Parents, becomes clear that these children good chance of helping the child. teachers and related do not use gestures either e.g. These interventions include various professionals play pointing to what they want, shaking therapies focusing on sensory equally important parts integration, language development their head to say „no‟ – quite unlike deaf children with delayed speech. in this process." and changing of particular If speech develops it lacks the behaviours. The parent has to do the normal intonations and inflections that are used for therapy under constant guidance from the therapist. expression. It tends to be used for the child‟s needs Drugs are mainly used to help unwanted behaviours and there is seldom any spontaneous conversation or like aggression, hyperactivity, anxiety, mood swings, narration. Often children have difficulty answering stereotypes, self-injurious behaviours etc., which unfamiliar questions and often repeat what is asked interfere with therapy. Pharmacotherapy is seen to be in a parrot like manner. Socially, these children tend most useful with older children to manage difficult not to participate in group activities and often play behaviours interfering with education and peculiar games by themselves. Their attachment to adolescence. Drugs useful include the atypical / parents is more to fulfill their needs and often they typical antipsychotics like risperidone, olanzapine, hand-lead the caretaker to what they want. They tend SSRIs like fluoxetine and fluovoxamine, anti-opoids to be hyperactive children but unlike the typical ADD like naltrxone, mood stabilizers like valproate, child are extremely finicky about cleanliness and oxcarbazepine and lithium and finally anti-anxiety order – they insist on this and throw tantrums if drugs like buspirone. For sleep disturbances thwarted. They play with parts of toys and objects e.g. melatonin and clonidine are useful. wheels of a car and have a fascination for odd Metrhylphenidate is useful for attentional deficits subjects e.g. logos of TV channels. These deficits in and hyperactivity in mildly affected individuals. general tend to make these children a misfit in school Other unproven therapies which sometimes help are and other environments. Often they have significant the gluten and casein free diets, vitamins / natural learning difficulties in school not only due to deficits foods like B6, Mg, natural vitamin A, L-Carnosine etc. in expression, reading and other skills but also by Therapies in use which, probably do not help are their hyperactive behaviour and odd habits. auditory integration therapy and facilitated The exact cause of most cases of autism is not known. communication. It can be understood as a brain developmental Special education as a therapy is a necessary aspect of disorder. In the normal scheme of things, so called the management of the autistic disorder. Parents „neural networks‟ develop for specific skills e.g. should be provided with an Individualized Education language, motor ability, music, memory etc. These Plan (IEP) for the child. There should be careful networks link up critical brain areas involved in a monitoring of all therapies at regular intervals. particular function. These networks are influenced by Prognosis indicates short-term improvement in most „genes‟ from the parents as well as the environment cases. Approximately 60% of cases are seen to be and need to be functional within the first 5-6years. In completely dependent on caretakers for daily children with autism it is possible that these functioning. Only 10% are seen to be completely networks are not optimally functioning and early independent and hold down (odd) jobs. About 5% intervention may help. outgrow the problem completely (with higher IQ, Research suggests a prevalence rate of 2 to 5 cases Asperger‟s syndrome), 10-30% seem to deteriorate in per 10,000 individuals. Rates are 4-5 times more Autism is a developmental disorder characterised by severe and pervasive impairments in communication and social behaviour. It also includes in varying degree stereotypic behaviour and a very narrow range of interests.


Views expressed in this newsletter belong to the individual authors.


adolescence. Studies indicate that in adult life there is a persistence of autistic symptoms. - For more information, please contact Dr. V. Udani at or at 24447251/23812251

Psychologists corner Autism - a diagnostic view By Meghana B.W. (Psychologist, Clinical), Drishti

Diagnostic procedures: To date, there are no medical tests like x-rays or blood tests that detect autism. And no two children with the disorder behave the same way. In addition, several conditions can cause symptoms that resemble those of autism. So parents and the child's pediatrician need to rule out other disorders (e.g. hearing loss, speech problems, mental retardation, and neurological problems). But once these possibilities have been eliminated, a visit to a professional is necessary (e.g., child psychologist, developmental pediatrician, or pediatric neurologist, child psychiatrist).

social interaction, communication etc.). This is done by closely observing and evaluating the child's behavior. Parental rating scales are also used. A structured interview: It is used to elicit information from parents about the child's behavior and early development. Observation: Observation of the childâ€&#x;s behaviour in the testing situation. The (Diagnostic and Statistical Manual for Mental Disorders-4th Edition) DSM-IV Criteria: The DSM is a clinicianâ€&#x;s handbook, which helps a professional to arrive at a diagnosis. It has the listing of all the required criteria essential to make a diagnosis. Other tests that are used: Various other tests are used in order to arrive at a complete picture of the disorder. This includes tests for determining the intellectual ability/mental development (I.Q), determining the social and adaptive functioning, determining the language (verbal & non-verbal) development, etc. A complete assessment is required for diagnosis and future program planning.

Tools used for diagnosis: Available tools are broadly of the following types: Standardized rating scale: Used by professionals to rate a range of behaviours in the different areas (e.g.

How are Autistic infants Different? Infants with Autism

Normal Infants

Communication -Avoid eye contact -Study mother's face -Seem deaf -Easily stimulated by sounds -Start developing language, then abruptly stop talking -Keep adding to vocabulary and expanding altogether. grammatical usage Social relationships -Act as if unaware of the coming and going of others -Cry when mother leaves the room and are anxious -Physically attack and injure others without provocation with strangers -Get upset when hungry or frustrated -Inaccessible, as if in a shell -Recognize familiar faces and smile Exploration of environment -Remain fixated on a single item or activity -Move from one engrossing object or activity to -Practice strange actions like rocking or hand-flapping another -Use body purposefully to reach or acquire objects -Sniff or lick toys -Show no sensitivity to burns or bruises, and engage in -Explore and play with toys self-mutilation, such as eye gouging -Seek pleasure and avoid pain NOTE: This list is not intended to be used to assess whether a particular child has autism. Diagnosis should only be done by a specialist using highly detailed background information and behavioral observations.


Views expressed in this newsletter belong to the individual authors.


Special Ed Corner Intervention Strategies for Autistic children Dr. Smita Desai, Ph.D. (Educational Psychologist & Special Educator), Drishti

Today, more than ever before, people with autism can be helped. A combination of early intervention, special education, family support, and in some cases, medication is helping increasing numbers of children with autism to live more normal lives. While no single cure is in sight, a combination of treatments is helping improve the daily functioning of individuals with autism.

Inclusion of the above elements in educational programs, have shown important gains over time in most areas. The TEACCH philosophy is seen to be most useful for the middle- and low- functioning individuals with autism. For the high functioning individuals within the autistic spectrum, the TEACCH guidelines have to be applied flexibly. Although higher functioning children may be able to handle academic work, they need help to organize their tasks and handle distractions. Behaviourist approaches which, involve time intensive, highly structured and repetitive sequences followed by rewards for correct responses have also been found effective. Other parallel therapies that may be required are speech, occupational, and physiotherapy.

Over the years, wide-ranging therapies have been A number of treatment approaches have evolved in suggested as being useful in the treatment of the decades since autism was individuals affected by autism. first identified. Some therapeutic These include music therapy, "Today, more than ever programs focus on developing dance therapy, art therapy, before, people with autism skills and replacing holding therapy, auditory can be helped…a dysfunctional behaviours with integration training. However, combination of treatments more appropriate ones. Others these have either never is helping improve the daily focus on creating a stimulating undergone rigorous scientific learning environment suited to functioning of individuals scrutiny, or have not shown the individual child‟s needs. specific positive value in dealing with autism." with autism. There may be A “model”- or rather philosophy positive effects, but cannot be recommended for the – for educational interventions in the autistic treatment of the basic impairments characteristic of spectrum disorders, has been developed by Schopler, autism. Lansing and Mesibov, at University of Chapel Hill, North Carolina, U.S.A. It is generally referred to as Parents are often disappointed to learn that there is TEACCH (Treatment and Education of Autistic and no single cure available. However, parents should Communication–handicapped Children), and consider their own sense of what will work for their includes several elements, that are now generally child and follow-up consistently with the involved accepted as the necessary cornerstones in most professionals. Parental involvement has emerged as a educational interventions for individuals along the major factor in treatment success. Recognising that autistic spectrum (Schopler, 1989). These include; parents are the child‟s earliest teachers, programs are increasingly beginning to train parents to continue  A high degree of structure, including a fairly therapy at home. rigorous curriculum for daily life activities, school subjects, areas that need particular training and leisure activities.  A high degree of continuity over time (with regard to training personnel, physical environment, time schedules).  A highly individualized approach (to deal with wide degree of variability in terms of intellectual Recommended sites with excellent resources level, autism impairments, level of general skills). on this subject:  An emphasis on concrete- often visual- ways of teaching subjects and skills.  A long-term perspective with regular developmental and educational “check-ups”.  Acceptance of underlying developmental disorder and a respectful attitude to the individual with autism and his/her family, who need to be informed and consulted at all stages of intervention.


Views expressed in this newsletter belong to the individual authors.



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