As India aspires to become a 5 trillion dollar economy and is investing in sending its first manned mission to space, sadly we are still far behind when it comes to investing money on mental health.

By Balaji Subramanian

There was a time when mental illness was perceived as a curse,but gradually the attitude of society evolved and more humane and scientific methods were discovered in treatment.

Since then we have come a long way in understanding and identifying various mental illnesses like autism and how to help people and their families. However autism in India is still not widely known and there are many apprehensions and misapprehensions.

As India aspires to become a 5 trillion dollar economy and is investing in sending its first manned mission to space, sadly we are still far behind when it comes to investing money on mental health.

Most developed countries on average allocate at least 5 per cent of the total healthcare budget for mental health, in contrast in the 2020 budget, the allocation of funds for mental health is 0.05 per cent of the total healthcare budget.

Hans Asperger who is the namesake of Asperger syndrome (AS) was an Austrian pediatrician, eugenicist, medical theorist, and medical professor and one of the pioneers in mental disorders, specifically in children famously once said, “It seems for success in science or art a dash of autism is essential.”

So it is ironic for a nation that gives credence to mental intelligence, refuses to invest on mental health.

Autismin India and how it impacts families

Autism, or Autism Spectrum Disorder (ASD), is a neurobehavioral condition characterized by challenges people face with their social skills, repetitive behaviors, speech and nonverbal communication. When a child is diagnosed with autism it can appear in combinations that affect children in different ways. Autism does not mean when the child grows up they cannot be independent, however some children may have severe challenges and would need help but many lead a life with minimal support.

In India, children with autism are seen as mentally retarded by others, and parents with children, who have autism, endure high levels of mental stress and have even been accused of child abuse.  That is why caring for a child with autism is emotionally and physically taxing.

A child with low-functioning “autism spectrum disorder” can lead to emotional burnout for families. In a country like India, where children with autism are looked down upon and other parents may not want their children to be associated with an autistic child out of unfounded fear which leads to ‘social isolation’ for families.

That is why, according to Dr Prasanna C S, a leading child specialist with expertise in Adolescent Mental Health and Neuro-developmental disorders, “due to lack of understanding there is no inclusiveness for families with children with autism spectrum disorder and it is necessary to raise public awareness of the burdens faced by these families and access to medical providers for more support.”

So for a comprehensive understanding of autism, this authorposted a few questions to Dr Prasanna and cleared some misapprehensions.

What is chronological age and developmental age?

Chronological age is derived from the date of birth of a child and developmental age is nothing but the emotional, physical, cognitive and social development of a child. With autistic children a five year old may display behaviors that does not match his or her rate of physical growth.

However there is also a possibility a child’s intellectual age can be average for their actual age, but may display emotional intelligence not matching their physical age.

Mental age was first defined by the French psychologist Alfred Binet. He was the first researcher to introduce the intelligence test in 1905, i.e. the IQ test with the assistance of Theodore Simon.

What causes autism?

We do not know what causes Autism but Genetic factors seem to play a significant role. Environmental factors like maternal age at conception, early adverse events during pregnancy and birth; brain infections, exposure to neurotoxins, asphyxia and hyperbilirubinaemia may play a role. Poor parent management alone does not cause Autism.

Can autism be diagnosed before birth?

There are currently no tests available to detect Autism during Pregnancy.

How doctors identify and diagnose autism?

There are no medical tests such as blood tests or brain scans which can determine if someone has autism. To diagnose autism spectrum disorder (ASD) a doctor has to look into patient’s history and behaviors. Autism is primarily a domain for Psychiatrists but it can also be diagnosed by some psychologists, pediatricians and neurologists.

What are the psychological effects of autism on parents?

Parenting a child with any disability can be challenging. Some parents report increase in stress levels due to lack of appropriate support. Parents often report frustration due to lack of comprehensive services resulting in several assessments with multiple clinicians. Parents can enjoy their parenthood if good information and support is made accessible.

Are there special training for parents to help them cope with the responsibility of raising an autistic child?

Autism is a condition and not a disease. There is no cure for Autism and therefore it is important that adults around the child learn as to how best to manage difficult behaviors and promote pro-social behaviors. I am therefore of the opinion that parents should be educated on the condition so that they are empowered in managing the condition effectively. The clinician who makes the diagnoses is best placed to provide psycho-education and guide them. There are some helpful resources that parents can use for this purpose.

Do children with autism function normally as adults?

The prognosis depends on factors like intelligible speech by age 5, Intelligence Quotient and duration in early intervention. Autism can be picked up as early as age two and early intervention does help improve the prognosis. Most of the children diagnosed for autism can live independently as adults. Some do require considerable support including residential care during adulthood.

How common is Autism?

About 1 in 59 children has been identified with autism spectrum disorder (ASD) according to estimates from CDC’S (centers for Disease Control and Prevention) Autism and Developmental Disabilities Monitoring (ADDM) Network. It is 4 times more common among boys. The prevalence rate seems to be on the rise due to better detection and awareness.

Is vaccination related to the occurrence of autism?

The research into the role of vaccination and MMR in particular has clearly concluded that it has no role whatsoever in the cause of Autism. It is very important that children do receive life saving vaccines.

How physiotherapy is so closely associated with autism

While doing research on autism this authorfound that physiotherapy plays a very important role in helping a child grow into a strong responsible and independent adult. For more information this author reached out to Chennai based physiotherapist, V Raja who has experience in providing therapy to autistic children.

Raja has spent considerable amount of time with autistic children with various abilities and disabilities as he puts it, children who require Physiotherapy to improve activities of daily living. According to him physiotherapy helps autistic child with motor function, respiratory control and coordination, improving posture, addressing misalignments in the musculoskeletal system, such as chest wall deformities, and foot and ankle misalignments to develop age-appropriate motor skills.

In recent time yoga has been introduced as a therapy to deal with autism. But it is recommended on case by case bases.But in his experience he has seen changes in the behavior of some of his patients after doing yoga since it has the power to bring equanimity within and it helps regulate their breathing which helps them overcome anxiety.

But he cautioned that autism affects each child differently and what works for one may not work for the other. He said, “For example I like to play music during my session and some may like it or not like it or simply do not respond to it. Each autistic child is different and responds to differently so it is important to treat each case differently.” 

Early detection of autism is the most crucial and critical aspect in therapy

The most important thing is to detect autism at an early stage and through educational intervention it can result in the child needing fewer special education and many have grown up to lead lives were they do not have to depend on other for services and lead a indistinguishable life with their peers.

Given the complex nature in diagnosing autism and treat children with ASD, “interdisciplinary treatment” is the effective way forward with experts from various fields that include physicians, educators, speech therapists and occupational therapists and psychologists.

As there is more awareness, several interventions have been developed to treat for children with ASD like Applied behavior analysis (ABA) which uses evidence-based teaching techniques to increase helpful behaviors and reduce behaviors that are harmful or interfere with learning.

Developmental individual-difference relationship-based model (DIR) is nothing but “floor time therapy”, were parents and therapists come together to engage the child to engage in increasingly complex interactions.

TEACCH Autism Program was developed in the university of North Carolina were individuals with autism are engaged in activities that help them lead a flexible, independence and self-efficacy through strategies based on the learning strengths and difficulties of people with ASD.

However the progression of awareness and understanding of autism still has a long road in India and we seriously lack resources to accurately diagnose autism which leads to chasm in family and de attachment from society.

Psychiatrists like Dr Prasanna C S and physiotherapist like V Raja are on the forefront and working hard to correctly identify the condition and help autistic children without wasting valuable time.