Dustin Hoffman made the life of a babbling autistic savant appear almost enviable in the ’80s classic, Rain Man. He played Raymond, an autistic man with super recall and math skills that his brother uses to count cards and make a fortune at Las Vegas. I was a teen when I saw the movie, and from where I was, it seemed a very good life to have: unsmiling, boundless brilliance in social and emotional isolation. The obsessive-compulsive adherence to routine was a bit of a bother, but not walking on cracks seemed a small price to pay for a highly functioning sociopathic savant with a legacy and a crooked brother to keep the money coming.
I soon discovered that geniuses among people with autistic-spectrum disorders (ASD) are few and far between. In almost all cases, ASD show up in the form of impaired social skills, communication difficulties, and restricted and repetitive behaviour patterns. Apart from autism, other conditions along the spectrum include the milder Asperger syndrome, and childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD-NOS).
This week, the US Center for Disease Control and Prevention sparked off a storm by announcing that ASD affects one in 88 children in the US, up 23% from the previous estimate of one in 110 just two years ago. While CDC is silent on whether the rise is because of over diagnosis, better diagnosis or an actual increases in the prevalence, it is conclusive about the fact that children are being diagnosed earlier, by age 3, with the median age at diagnosis being age 4. And that boys are four times more likely to have ASD than girls.
Children are getting diagnosed with ASD almost as early even in public hospitals in India, shows data from the Child and Adolescent Psychiatric Clinic run each Friday at the All India Institute of Medical Sciences. Babies who do not make eye contact, don't respond to people by smiling or gesticulating, and focus intently on something to the exclusion of others for long periods could be showing early signs of ASD. Many also make repetitive movements such as rocking and twirling, and start speaking later than other children. Since children with ASD lack empathy, they have trouble interpreting social cues such as tone of voice or facial expressions, which makes it difficult for them to understand what the other person is thinking or feeling.
Though general awareness about autism is still low in India, children who end up in the Friday clinic run by Dr Rajesh Sagar, additional professor of psychiatry at AIIMS, are usually under 3 years old and brought there by their mothers who can tell there's "something wrong" with their baby, though they cannot put their finger on what exactly is the problem.
Children with ASD may have or develop co-occurring conditions, such as Fragile X syndrome that causes mental retardation (present in 70% cases), tuberous sclerosis that promps non-malignant tumours to grow, epileptic seizures (20-30% children develop epilepsy by adulthood), Tourette syndrome that causes uncontrolled repetitive movements or sounds, learning disabilities and attention-deficit disorder.
Since there's no cure, treatment designed to improve specific symptoms, including anxiety, depression, obsessive-compulsive disorder, behavioural problems and seizures.
No one knows what causes autism, but it's likely to be a result of multiple genetic mutations and/or environmental factors. Childhood vaccination and parental behaviour have long been disproved as possible causes of ASD. Whatever the cause, the way ahead is diagnosing and managing the condition. That done, it just becomes another manageable disorder, like diabetes and hypertension.