 Do you know one in hundred children has got autism? I'm Dr. Pallavi Joshi, I'm a consultant psychiatrist with Manipal Vathur. Let us discuss about autism today. Autism, what we typically say is the group of disorders, autism spectrum disorder basically developmental disorders where the brain develops little differently than what we consider normal. And what we see typically the three areas. One, where difficulty in communication in some form exist, difficulty in social interaction exist. And third, there are repetitive and restricted patterns of interest as well as behavior. So what we typically say when we talk about early signs of autism, commonest is when the baby is, you know, three months old, the eye contact is something which is really strong. Okay, it gets established around two to two and a half months and it gets stronger, particularly with attachment figures. So eye contact is a very important sign when it comes to autism. It is poor, it could be absent. One, second thing, you know, when the baby is small, you must have noticed if you have handled the baby, you know, they have the anticipatory posture, please hold me, please take me. So that is absent in autism. Third thing, what we definitely say, you know, the science of affection. Okay, so when the parent comes in, usually the child smiles, okay? Or they have the ways of showing affection, they cuddle, they just rub their cheek against you. So they have their methods of expressing love and affection that could be absent. Now these are very early signs, what we typically say. As the baby grows, as the child grows, what typically we see the language development is delayed in most of the cases. Okay, so speech development is delayed. There is a difficulty in normal communication or there is a difference in the communication, what we typically say, you know, they try to communicate in different way, not in so normal ways, what we typically understand. So, and what else happens in addition to speech delay? There could be pronomial reversal. So if you ask, what are you doing? You is doing this. So you know, they are not able to change the pronomial reversal in that case. Now when it comes to interactions, what we say autism in other language, so what is that? They are just engulfed in themselves. So interaction with others is quite less. What else happens to these children? They engage in self-stimulatory behaviors. Most of the parents who have seen autism kids who are dealing with autism kids, they see, they will do some self-stimulatory behaviors, repetitive same action, repetitively doing the same thing. Now these children, they are very prone for anxiety. So what happens? Little disruption in their routine. There could be temperamental issue. They may throw a very bad temper tantrum. What else happens? Irritation, getting irritated for petty reasons that could be there. And what else happens in addition to these features? Okay. There is a heightened stimulation, heightened sensitivity to certain stimuli. So for sound, for something, they might get irritated very easily. Whereas to pain, we have seen cases. We know where ruptured appendicitis are happened and the child didn't complain of pain in autism. So what happens? There could be less sensitivity to some stimuli. Okay. So these are few features. Now in addition to that, many autistic children have comorbid issue. Almost 70% of them have comorbid mental retardation. They also have learning disability. They might have depression and anxiety issues which are also unaddressed sometimes. And many have, as you know, the development of brain, as we told in definition, is little different. They might have even seizures, defeats. So these are some early signs of autism. But what we typically say, you know, in few cases, what I would like to add, a child may develop normally till 18 months. Okay. Or 9 months. And there could be loss of milestones. So we have cases where the child was having eye contact earlier, with the child was talking earlier. But after 18 months, after 20 months, there could be reversal. So the milestone may get reverted to whatever we say, regression. They might not be able to do the activities what they were doing earlier. Most important is genetics. So there are some 4 to 5 chromosomes which are identified, which have some genetic loci, which may cause autism. Also, Fragilex syndrome, tuberous sclerosis, these are some genetic conditions where the child is more prone for autism. So one, genetics. Genetics are important when we talk about causation of autism. So there are some 4 to 5 genes which are implicated, where some genetic loci are there, which are implicated in autism. One point. There also, you know, Fragilex and tuberous sclerosis. These are known medical conditions, which make a child more prone for autism. One point. Second, what we say, advanced maternal and paternal age. That is also one of the independent risk factor for autism. Most of these autistic children, when they were taken for some studies, they found to have high plasma levels of serotonin. So that's also one of the cause indicated, which may lead to autism. Some of the factors, you know, which are less known, what we have still not understood. Maternal infections. If the mother has some infection like rubella, cytomegalovirus, that increases the risk of having autism in the kid. Perinatal complications. Having bleeding while a mother is pregnant. Or a child is having birth trauma, asphyxia, that can also increase the risk of having autism. Having a sibling. If you have a sibling who has autism, it is multi-fold risk again for the second child to have autism. Treatment is mainly supportive. We don't have curative treatment for many illnesses in medicine. Autism is one of that. But definitely the supportive treatment can be offered and should be offered to each and every kid. The mainstay of the treatment is not medicine. Medicines we give, although we are doctors, only for supportive management. So if the kid is having aggression, we have medicines for it, for controlling the aggression. Kid is having ADHD, attention deficit hyperactivity. We have medicines for it. Anxiety, we have wonderful medicines for self-stimulatory behavior. We have effective medicines. We also have medicines for seizures. But when you talk about the mainstay treatment for autism, we don't have medicines for curing it. But therapy is highly recommended for each and every autism kid. And how it helps? We say typically each and every autistic kid, no matter what the severity of autism is, has the potential to improve. No doubt about that. So therapy helps each and every autism kid. So it should be initiated as early as possible. Once the diagnosis is done, it has to be started. So we have role of different specialists in managing, psychiatrist, developmental neurologist, psychologist for taking therapy sessions, OT, occupational therapist for development of some social skills which are really required for integration in society, as well as role of shadow teacher, special educators. Now what is the aim of the therapy? One is the speech development should happen. So speech therapy should also be there in all these things. Secondly, social interaction should get better because for every parent, what is the goal? They want a child should lead an independent and happy life. So for that also social interaction needs to be better. Also with special educator, many children are able to complete their education in structured classroom coaching, in normal coaching. So that is also something what we look forward. And a child should develop meaningful relationships in future and should lead an independent life. This is the goal of therapy. What else? Nutritional help we take. Most of these children have leaky gut syndrome. So what is that? They have constipation. They have a lot of digestion issues. So help of nutritionist is really recommended. And simple, simple changes they sometimes just tell you like introducing ghee or having casein-free or gluten-free diet and it could be helpful for many people. What I would like to really talk about is parents. And we typically say each child, each autistic child if has got something special is a parent who is refusing to give up on that kid. So this is very important. When being parents, you know, sometimes it's very exhausting for most of the parents. When they are taking the charge of the kid and they are investing lot of time in development of the kid. So what we typically say, please have support group. And how it's helpful when you want to take, you know, break the support group can support the kid look after the kid for some period of time. They go for holidays together. They discuss the recent developments of treatment together. Okay, so which is very useful. The socialization which, you know, the similar concept, the similar pain, the similar agenda is very useful for most of the parents.