Autism is not... (Cont)

Sometime in 2012, I heard about a girl whom they claimed had autism. They described the symptoms and I didn't think it was autism. I asked them a couple of questions and by the time they answered, I knew it could not be autism. Eventually, I asked the mom what the doctor told her, and she told me the doctor said her child had “microcephaly”. Why then was she claiming autism? She said she was told by other people that it was autism. That brings us to another gist of what “autism is not”.

There are other special needs conditions that can affect a child. Autism affects the child’s social skill, communication skill and behaviour. These three domains have to be affected. And you cannot just conclude that a child has autism because everybody is talking about autism. So let’s continue by saying, Autism is not...

Microcephaly: I’ll start with this as it’s in our introduction. Microcephaly is a medical condition which the circumference of the individual’s head is smaller than normal because the brain has not developed properly or has stopped growing. It can be present at birth or it may develop in the first few years of life. It is often caused by genetic abnormalities that interfere with the growth of the cerebral cortex during the early months of foetal development. Abuse of drugs and alcohol, toxic chemicals, viral infections or untreated Phenylketonuria (PKU) are other causes of Microcephaly. Symptoms include intellectual disability and development delays.

A typical brain and the brain of a person with Microcephaly

Down syndrome (DS): DS unlike autism, shows on the face of the individual. It is also called Trisonomy 21 because it is caused by the presence of a third copy of chromosome 21. A child with Down syndrome experiences both physical and mental developmental delays. DS symptoms include smaller overall stature, flat facial profile, thick epicanthal folds in the corners of their eyes, protruding tongues, which is due to their smaller oral cavity and muscle hypotonia - low muscle tone.

Attention Deficit Hyperactivity Disorder (ADHD): Although it is possible to find some children with autism that also have ADHD, it is a completely different disorder. As the name implies, a child with ADHD is inattentive and hyperactive. The symptoms of ADHD can be seen generally in children, but it may become a source of concern when these behaviours occur too often. Because a child with ADHD often finds it difficult to sustain attention during tasks or play and does not often follow through on instructions, school work and other activities, it serves as a major challenge in academics. A parent that is concerned should seek a doctor’s diagnosis. The school too may advice the parent to see a doctor, but they should not just treat the child as naughty.

Fragile X Syndrome: Fragile X is the most common inherited form of intellectual disability. This is a genetic condition which involves changes in part of the X chromosome. I believe we remember, at least faintly, X chromosome from our high school Biology. Do you remember XX for women and XY for men? X and Y chromosomes are referred to as sex chromosomes. The mother donates the X chromosome to all her kids (that is what she has to give anyway) and the father donates the X chromosome to his daughter and Y chromosome to his son. So Fragile X is caused by a fragile site on the end of the X chromosome which appears to be breaking, although not quite separated. It is more common in males than females. As earlier said, it causes intellectual disability in the individual. An individual with Fragile X may also show symptoms of autism. Unlike the usual ASD, there are certain physical features that accompany Fragile X. These may include a long narrow face, prominent ears, high palate, flat feet, and soft velvety skin. They have low muscle tone which may make them seem cross-eyed, and with slack facial features. Some older males may have large testicles. They may also show symptoms of ADHD. For a child who is suspected to have autism, it is good to test for Fragile X, so that the right treatment can be administered.

Intellectual Disability: A person is said to have intellectual disability (ID) when the person shows limitations in intellectual functioning and adaptive behaviours. It is characterized by a below average intelligence or mental ability and a lack of skills necessary for day-to-day living. Symptoms include poor memory skill, delayed language development, inability to connect actions with consequences and may experience difficulty in mastering basic skills like toilet training, feeding, bathing or dressing. Children with different disorders like autism, Down syndrome, microcephaly, fragile X etc, may show intellectual disability, depending on the severity of the disorder. There is no known cause for ID except in a few cases (just about a third of the diagnosed people).

Finally, there are other Pervasive Developmental Disorders (PDD), Rett syndrome (RS) and Childhood Disintegrative Disorder (CDD). Although these are Pervasive Developmental Disorders, they are not classified under ASD because they present different symptoms. Rett syndrome is characterized by normal early development, followed by loss hand skills, distinctive hand movement, deceleration of head growth, gait abnormalities, seizures, and mental retardation. The child loses many skills that have been acquired initially, including speech. RS is found in girls. CDD on the other hand can be found in both boys and girls. It is characterized by a normal early development, usually between ages two and four, followed by a regression and loss of skills such as receptive and expressive language, social skills or adaptive behaviour, bowel or bladder control, ability to play and motor skills. This regression can span from age two to ten and it can be so dramatic that the child notices the changes and comments on it. The child eventually shows symptoms similar to typical autism.

There are many other possible disorders that affect people other than autism. Therefore, the purpose of this article is for people to seek diagnosis from a registered doctor in a registered hospital when they notice the difference in their children. Do not conclude that a child has a disorder because other people say so. Autism is not a name for all developmental disorders or any disorder you don’t understand. A diagnosis is important so that one can know the right treatment to administer. How can you treat what you don’t know? Children with different disorders can get help. But how can the child get the right help if you only assume the problem? Please let’s do the right thing.

Thanks for reading my gist. Till we talk next time.... muah