A nuanced approach to autism

In 2013, the pre-eminent psychiatry handbook, Diagnostic and Statistical Manual of Mental Disorder, redefined how healthcare professionals should approach autism.

The different autism-related disorders, such as Asperger’s syndrome — where children suffer from social interaction deficit but no language impairment — were dismissed in favour of the term autism spectrum disorder (ASD). Children are now diagnosed as either mild, moderate or severe.

Critics of the new definition were concerned it would mean that children suffering from certain mild autism-related disorders would fail to meet the diagnosis criteria. Adversely, the supporters of the new diagnosis guidelines argue that they are based on a deeper and more evolved understanding of autism.

Dr Reyad Abu Sharaf, Senior Psychology Practitioner at Dubai Health Authority (DHA), agrees that autism shouldn’t be viewed as a brain disability and that instead, it should be viewed as a disorder where the brain simply works differently. He describes autism as a neurodevelopmental disorder, that affects communication and behaviour.

As people’s understanding of the disorder has deepened, the perception of the autism has also changed. Now, famous autistics include teenage climate activist Greta Thunberg — an individual who has made a significant contribution to society.

Dr Sharaf works at DHA’s Early Intervention Centre, helping children aged between six months and six years old. He says that six to 18 months old is the earliest that autism can be diagnosed but that later diagnoses tend to be more accurate.

“If the child is showing issues with non-verbal communication, such as a lack of eye contact or listening responses, for example, at 18 months we can start to observe the child and compare them to existing scales,” he says.

“There are 15 symptoms and we will assess all of these symptoms before making a diagnosis. We will assess language and verbal communication. We will also assess things such as visual and hearing responses.”

Dr Sharaf says that there are three main symptoms for ASD — impairment in social interaction, a communication and language deficit and repetitive behaviours.

He also says that motor impairment [issues with balance, sport and coordination] and fine motor impairment [anything that relies on using fine movement in the hands] can be signs, although they are not the primary symptoms.

In the case of repetitive behaviour, he says that movements can be random and devoid of purpose. “If the child is playing with a car, for example, he might continuously move the wheel without enjoying it within the context of a game or with any reason.

“Once you’ve seen a child over a number of sessions, you will discover their repetitive behaviours and when you speak to their parents, they will talk about the behaviour.

“There is also echolalia repetition. So, for example, if you ask the child, ‘What’s your name?’ they will reply, ‘What’s your name?’ — they will not understand it and they will continue to keep repeating the question.”

A case-by-case approach

Children with autism can vary when it comes to their behaviour depending on a number of factors, including the severity of their condition. “If a child is diagnosed with mild ASD, they can experience good relationships with their parents, teachers or specialist.

“If the child has severe or moderate ASD, there will be more impairment with social interaction but it varies on a case-by-case basis and depends on other factors such as how early they were diagnosed and their reaction to behavioural therapy and the family.”

Focusing on strengths

Dr Sharaf agrees that while autism can be a disadvantage in some situations, children can possess exceptional abilities in other areas of life, which is why he says it is important to diagnose the child as early as possible, so that behavioural therapy can commence and parents are provided with the opportunity to learn how to deal with the disorder most effectively. Although there is currently no cure and the fact that autism is a lifelong condition, Dr Sharaf says that children’s strengths can be nurtured and developed with the right approach.

“With early diagnosis, we don’t have anything to lose. If there is any impairment, such as a language deficit, with early intervention services, the results are much better at two years old than three or four years old.

“We can also focus and strengthen certain points in the child and train the parents on how to do this. Some children can be very brilliant with maths and numbers or perhaps drawing and painting.”