The Philippine Online Chronicles

Welcoming a child into the world is probably one of the most exciting and eagerly anticipated moments in a family’s life. Even while the child is still in the womb, parents already dream up of the future their child will have and imagine what this child will be like. However, for some parents, these dreams end up taking very different directions when they begin to observe that their child is not like other children.

For some, they share that they initially did not notice anything different. In fact, just like in the story of Justin, everything seemed at par in the beginning and then one day something changed. On the other hand, some parents notice early on that their child has poor eye contact, stares off to space, or does not develop speech patterns as would be expected.  For others, they notice that their children repeat everything they hear or have repetitive behaviors such as hand flapping, spinning, or inappropriate play behaviors such as lining up or stacking objects.

These are the many faces of Autism. Media, too, has shown the world many different faces of autism with movies such as Rain Man, I Am Sam, Mercury Rising, Little Man Tate, and Forrest Gump. Television shows have also featured characters with conditions that fall within the Autism Spectrum Disorders or ASD.

Today we observe the 3^rd World Autism Awareness Day . First adapted by the United Nations (UN) General Assembly in 2007, World Autism Awareness Day aims to encourage member states to take steps in raising autism awareness, recognizing that early diagnosis and intervention is essential in maximizing a person with autism’s development. Through this resolution, the UN emphasizes the Rights of Persons with Disabilities, autism included.

What is autism?

Autism falls within the range of Autism Spectrum Disorders or ASDs. ASD  is defined by the National Institute of Neurological Disorders and Stroke (NINDS) as a “a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior”.  It is a lifelong developmental disorder that affects three different aspects of a person with autism’s life:  communication, social interaction and social imagination or patterns of interests. Most commonly, impaired social interaction is the first indicator noticed by parents and caregivers.

The disorder is termed as a “spectrum” because, as the word implies, the effects of the disorder to the quality of range from case to case.  Symptoms and experiences of autism can range from severe to mild. Autism, also known as autistic disorder or classical ASD, is the most severe form while milder conditions within the spectrum are known as Asperger Syndrome, Rett Syndrome and Pervasive Developmental Disorder not otherwise specified (PDD-NOS).

Furthermore, the areas of functioning that are affected may vary. For example, some people with autism may be very intelligent and highly verbal, but have difficulty with social communication and interaction. Because of these variations, treatment strategies, diagnostic procedures and interventions depend on the individual characteristics and features present in the person with autism.

Approximately 1 in 150 children have autism. In the Philippines, rough estimates indicate that about 570,000 out of 80 million people are affected with the disorder. ASD can affect anyone regardless of ethnicity, socioeconomic status, and age. While both males and females may be diagnosed with ASD, males are four to five times more likely to have the disorder.

Although there is no one identified cause of autism, it is now generally accepted that ASDs are biological in origin. Links to abnormal biology and brain chemistry are identified as main contributors to the disorder. Genetic factors also predispose an individual to ASDs. Other theories point to diet, digestive tract changes, mercury poisoning, and food allergies. Once blamed for many cases of autism, the MMR vaccine has been disproven as a cause. However, there is still a lot of controversy surrounding vaccinations and autism which leads many parents to opt not to immunize their children.

Diagnosing autism

Diagnosing autism can be tricky, especially if the individual is high-functioning and adaptive. Unlike disorders such as Down Syndrome which has characteristic physical features, people with autism do not appear disabled or different. Some of them may even come across as advanced for their age, particularly those who have preoccupations for certain topics or things, such as dinosaurs or anatomy.

A common description given by parents of children with Asperger Disorder or those diagnosed as high-functioning is that they enjoyed reading the Almanac and encyclopedia as young children. Some even say they memorized all the flags and capitals of different countries and can name all the bones in the human body.

The diagnosis of ASD is often done by a Developmental and Behavioral Pediatrician, usually after parents, caregivers, or teachers notice different patterns of behaviors in children. Those who are undiagnosed until adolescence or adulthood recall that they were always coined as “loners,” “eccentric” or “weird” while growing up.

There are no specific medical tests to diagnose autism. Formal evaluations usually consist of behavioral observations by professionals and caregivers. Part of the diagnostic procedure can include speech, language and psychological evaluations. Other medical tests that may be helpful in reaching a diagnosis and laying out the foundations of treatment include hearing tests, EEGs to measure brain waves and rule out seizure disorders, metabolic screenings, and various brain scans such as MRI and CAT scans. Genetic testing can also be done.

Autism red flags

Although diagnosing ASD can be difficult to pin down, the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Text Revised (DSM – IV – TR) outlines behaviors and patterns of development to observe for the diagnosis of Autism.

Early signs of ASD, however, include the following:

• No babbling, pointing, or making of meaningful gestures by age one
• No smiling or joyful facial expressions by six months
• No response to being called by name despite no indications of hearing loss or disability
• Speech and communication delays
• Poor to no eye contact
• Loss of previously observed language or social skills
• Excessive attachment to a particular object or toy
• Lining up or stacking of toys or objects
• Rocking back and forth, hand flapping or preoccupation with spinning

These are just a few of the red flags that could suggest ASD in children below the age of two. According to psychologist Cristina H. Enriquez, MA, other signs and symptoms of ASD include the following:

• Poor understanding and use of verbal cues, such as modulating volume of speech, managing conversations and cadence of speech patterns.
• Poor understanding and use of non-verbal cues. For example, he or she may exhibit flat facial expressions or may misread body language and misunderstand social cues such as gestures or expressions given by others.
• Difficulty managing conversations, such as intruding in conversations or off-tangent responses to questions
• Use of jargon or “own language”
• Exhibit echolalia, or repeating of what they hear from television, radioor others around them
• Lack of expressive language skills
• Poor social interaction such as failure to develop peer relationships
• Little to no desire to seek out others to share activities or interests
• Little or no emotional reciprocity
• Preoccupation with objects or  topics
• Difficulty adjusting to changes in routines
• Repetitive and unusual motor movements, such as hand flapping

A collaborative effort

There is no known cure for autism. However, this does not mean that there is no treatment. Living with and empowering individuals with autism is a collaborative effort in the part of parents and specialists with the aim to give them the skills, competencies, and resources to manage themselves and live life to the fullest. Among these specialists are developmental paediatricians, psychologists, psychiatrists, speech pathologists, occupational therapists, and education specialists.

The treatment of autism can be physically, mentally, emotionally, and financially taxing to any family that has to go through it. Unfortunately, in the Philippines, not only do these services cost a lot, it often is hard to come across. Diagnosing autism can initially cost from anywhere around P 5,000- P10,000, sometimes even more. Therapies, interventions and treatments can run over P116,000 in the first year alone, which makes it even more difficult for families to cope with the diagnosis of autism.

In the Philippines, efforts to support Persons With Disabilities (PWDs), including those with autism, are strongly being lobbied for. In 2007, Republic Act (RA) 9442 was signed into law. This act amended the Magna Carta for Disabled Persons which entitles PWDs to avail of privileges in the form of discounts on transportation, services, commodities, and medicines. Other activities to raise autism awareness are also often being undertaken, such as Angels Walks in various malls all over the country.

Piecing together the pieces of the autism puzzle takes a lot of time, effort and understanding. In order to bring out the best in every person within the spectrum of disorders, their families, therapists, and communities must sort through the symptoms to find the pieces that fit together. Through these efforts, the world can see who the person really is beyond autism.

Photos: “Autism Awareness Ribbon Banner” by Kendra Kellogg, c/o Flickr. Some Rights Reserved / “016 (B&W)>>>” by Dave, c/o Flickr. Some Rights Reserved / “wordle” by stephanie vacher, c/o Flickr. Some Rights Reserved.

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Maria Andrea (Ria) S. Tirazona, M.S. (cand.), popularly known as Yapatoots in the online blogging and social community, is a preschool teacher at Playschool International and part-time lecturer at the Psychology Department of De La Salle University. She is also an Associate Psychologist at PsychConsult, Inc, where she specializes in Psychological Asssessment. She holds a Bachelor's Degree in Family Life and Child Development from the University of the Philippines and is currently working on her thesis for her Master's Degree in Clinical Psychology at the De La Salle University. In her spare time she maintains several blogs, including www.theaccidentalteacher.com and www.yapatoots.com.

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