‘In his own world’ - Sadaf Shahid Saturday, April 02, 2011

February is an unusually busy month. It is the month when parents of two- and three-year-olds prepare themselves and their toddlers for multiple trials, like screening, scanning and scrutinising, so the children get into the best of the best educational institutions. Professionals, or rather those well-versed in the tricks of the trade, work with these children and their hyper-anxious mothers, providing them with every possible proposition from what to say and how to dress for the D-day.

The children are robbed of their playtimes and naps to go to these “must attend” sessions. The positive side of all this is that children who exhibit even the slightest below-average performance, according to these self proclaimed experts, are sent for reading, writing, IQ, speech evaluations. (The yardsticks by which average and below-average performance is measured would take another thousand words to explain.)

It wasn’t very unusual when a mother told me that the tutor asked her to get her son assessed, since he seems to be “in his own world.” Other consultants had merely considered the child inattentive, hyperactive and thus unable to develop age-appropriate speech and language skills. But the phrase “in his own world” had struck her. It was a red flag, something the tutor had noticed but others hadn’t. By the time she came to me, she had already read about ASD (autism spectrum disorder). Before I could even suggest that her child might be under the ASD spectrum, she herself asked, “Is my child autistic?”

What was surprising was that a teacher, not a medical practitioner, could sense that something wasn’t right. The alarming aspect of this situation is that every child with a speech delay, different set of social skills or even superior speech and language skills is now suspected to have autism or Asperger’s syndrome. Amir Khan’s Taarey Zameen pe became the salvation of children with dyslexia. Since then, most tutors, or someone simply familiar with the term, might suggest that a child struggling with reading and writing could be dyslexic. A number of children with learning differences (not disabilities) are being sent for screening and evaluation to rule out the possibility of dyslexia only because their tutors are of the opinion that they are learning-disabled.

Similarly, My Name Is Khan came as a ray of hope for parents of children with Asperger’s syndrome. But it also created trouble for every child who performed better on academics but had the slightest difficulty in social interaction or had a particular set of interest – or, in other words, could not be stereotyped.

A number of other movies, like Rain Man, have been made on similar topics. While these movies have helped remove certain misconceptions, we must remember that, in order to add entertainment value, they present a dramatised version. The point to remember is that high functioning children or adults with autism or Asperger’s have a much lower population than children with autism who are non-verbal, low-functioning.

ASD, as its name implies, is a spectrum disorder. One could be right in the middle, with all the symptoms, or just borderline, with few symptoms. According to the DSMIV (Diagnostic and Statistic Manual of Mental Disorders), ASD has four symptoms: a. impaired communication; b. repetitive stereotypic pattern of behaviour; c. lack of pretend- or imaginative play; and d. impaired social interaction.

Symptoms vary from one individual to another, and sometimes overlap with other developmental disorders. A child obsessive with cars and not interested in other toys may not necessarily have autism. What is important is the way she/he plays with them. If the child is involved in multiple-action and multiple-play episodes – e.g., if he copies dad or mum, pretending to drive, remembering different makes, parking them in the garage – he is clearly demonstrating imagination and creativity and picking up perception and cognition from the environment.

Similarly, nor can a child who doesn’t interact with other kids be labelled as autistic. He could be shy or may have some other sensory integration issues preventing him from behaving and playing like other kids. It is always the context in which a certain behaviour takes places that needs to be measured and evaluated before a child is labelled. Such behaviour does not occur in isolation, but in tandem with other difficulties.

After years of research, Dr Eric Schopler, professor of psychology and psychiatry at the University of North Carolina, has developed a methodology called CARS (childhood autism rating scale) to assess and identify children with autism and distinguish them from those developmentally handicapped but not autistic. CARS assesses children above the age of two on five different areas: relating to people, body use, adaptation to change, listening responses and verbal communication. Physicians, psychologists, special educators, speech language pathologists and even professionals with minimal exposure to autism can be trained to use CARS. The scores help categorise children into mild to moderate to severely autistic.

Unfortunately, parents looking for help are often misguided. In the absence of standardised tools, children are sometimes misdiagnosed and, despite intervention, reap little or no benefit. Then, there is the mushroom growth of the so-called rehabilitationists doing strange things in the name of therapy. Children are evaluated, without their parents, in 30/40-minute sessions and parents are told not to do anything at home, because the child will start becoming “normal.” Most of their victims are people from the underprivileged classes although, out of desperation, educated people also fall prey to them.

I would request that even though this has become quite fashionable, please do not “label” kids with autism or any other disorder. Either suggest that parents seek professional help, or do remain silent.

The writer is a speech therapist. Email: sadafshah01@hotmail.com

Source : http://thenews.com.pk/TodaysPrintDetail.aspx?ID=39479&Cat=9

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