By: Dr. Isha Soni
Autism is a neurodevelopmental condition and is characterized by difficulty in speech, communication, limited interests, sensory issues, repetitive behaviour and social skills. It is identified in early childhood between age 18 months to 3 years when the child fails to meet speech and social milestones. According to the DSM -5 criteria, it is clubbed into one single umbrella of autism spectrum disorder as opposed earlier to various diagnosis like Asperger’s Syndrome, Pervasive Development Disorder etc. Now, it is further classified as mild, moderate or severe autism depending on the level of assistance required by the child for an independent functioning in day to day life.
Mild autism means requiring minimal support or assistance. These children have manageable symptoms that have less impact on their daily activities and relationships. Every child with autism is different despite the same diagnosis as the presentation varies in terms of onset of symptoms, domains affected, severity, functionality, response to therapies, any metabolic differences and support from the environment.
Mild autism may present as less eye contact, need based response to name, not talking on demand, lack of meaningful communication but may repeat rhymes and songs, use of non verbal gestures to indicate needs and wants, sensory differences like getting upset with certain sounds, touch or avoiding certain situations, preference of having predictable routines, rigidity in following certain rituals, preference to play alone, overtly interested in certain topics like cars, dinosaurs, engines etc. Sometimes the symptoms are so mild and the child is so functional in his environment that the parents don’t feel alarmed till age 3-3.5 years. Only when the kindergarten personnel may point out to the child being different from others in his play patterns or social skills, the parents realise it. Until then the parents just feel that their child has a different personality or is shy or pampered.
After going through developmental paediatric and psychological consultations, when the diagnosis is broken to the parents, they often think that it is mild and doesn’t warrant much attention. But is that so? Doesn’t that child with mild ASD need intervention? Since it is mild, wont my child outgrow it?
I believe it is the other way around. Yes, a mildly autistic child requires less support but it becomes more difficult for that child to merge with the community. Since the manifestation of a mildly autistic child isn’t obvious, it becomes more difficult for the society to understand a child’s behaviour. The child may come across as blunt, disobedient, rude, or overtly pampered. The parents are also often misinterpreted to not have “disciplined” the child.
The child struggles a lot in the school where he becomes a very easy bully- target due to certain mannerisms, not understanding sarcasm, being upfront, in-depth knowledge on a certain topic, difficulty with play skills, understanding rules of a game, get easily triggered by something.
In the family scenario too, the child may not be received well due to above mentioned reasons and not understanding social cues, body language, facial expressions, tone of the situation (birthday party vs. get well soon visit), literalness of words said. At times, the child may find a situation overwhelming due to sensory stimuli misunderstood by others as “acting out”. Or if the child is a “sensory seeker” may end up touching or smelling others at inappropriate places or things. Many people may get offended by such behaviour. The relatives may find the behaviour absurd and make fun of the child and try to avoid him.
This child surely understands the behaviour of people around him and feels “outcast” further causing low self esteem and confidence, feeling of loneliness and “nobody likes me to I am not good enough”.
The parents are also in the same boat and juggle between making the child and other people around understand him. Gradually, they start to give up on socialising and decline invitations, going out to restaurants, movies, malls leading to isolation and frustration. They find it hard to justify their child’s behaviour to prevent from being “labelled” as it is considered to be a social taboo.
What can be done?
Early intervention is really helpful as it can help improve the entire growth trajectory of the child. Sensory Integration Therapy can help to improve the child’s sensory processing, sensory regulation and help the child to gel in better with the environment. Speech and Language Therapy will help to improve communication of the child. Group sessions conducted by a SLP or an OT practitioner will help to improve social skills of the child. ‘Social Thinking Program’ is really helpful to make the child understand the ‘little’ yet very important social nuances, hold conversations, understand another’s opinion, enter and exit a group etc. ABA Therapy can help to modify behaviours.
Most importantly, familial and community support can lead a long way to mainstream the child.
There is no one size fits all protocol for a child with mild ASD despite having the same diagnosis. Each child has to be seen from ‘he’ is. It is very essential to find therapists with a ‘neurodiversity-affirming’ approach who don’t see this child as a ‘deficit’ but a ‘child with difference’. It is extremely essential that the therapy is child led and importance is given to build ‘connection’ rather than just ‘compliance’!! (The author is a Senior Occupational Therapist and Centre Head at Lexicon Rainbow Therapy & Child Development Centre, Pune, Maharashtra)