When you smile, does your child smile back?

As autism di­ag­noses ap­pear to have risen steadily over the last 10 years, ex­perts point out the ben­e­fits of early in­ter­ven­tion

Kathimerini English - - Focus - BY LINA GIANNAROU

“Does he like to play peek­a­boo?” “Does he use his in­dex fin­ger to point and ask for some­thing?” “Does he look you in the eye for more than a cou­ple of sec­onds?” “Does he smile when you smile?” “If you show him a toy on the other side of the room, will he look?” “If you make a face, will your child copy you?”

The screen­ing test for signs of autis­tic spec­trum dis­or­ders, which in­cludes ques­tions like those above, is a painful process for par­ents. The ques­tions re­quire hon­est and ob­jec­tive yes/no an­swers, but the par­ents of­ten take their time. The urge to con­ceal some in­for­ma­tion, to jus­tify a child’s be­hav­ior in or­der to avoid adding what may be a de­ci­sive no to the list, is in­tense. Lately, how­ever, many doc­tors have ob­served that par­ents who ar­rive in their of­fices with the ques­tion “Is my child on the spec­trum?” are more savvy. They are more anx­ious, but also more fo­cused.

Ed­u­cat­ing par­ents

“[BBC tele­vi­sion se­ries ‘The A Word’], which ad­dresses the is­sue of autism, has mo­bi­lized many par­ents,” says spe­cial­ist pe­di­a­tri­cian Chris Tzoulakis. “I have no­ticed lately the in­tense an­guish in fam­i­lies look­ing for signs of autism spec­trum be­hav­ior in their chil­dren. They have started ask­ing more spe­cific ques­tions.” Re­cently, a 2-year-old who wasn’t talk­ing, not point­ing and not do­ing well so­cially was brought to his of­fice. The par­ents had de­cided it was time to get an ex­pert opin­ion. As Dr Tzoulakis says, the suc­cess of the TV se­ries, which con­cerns a boy with high-func­tion­ing autism (pos­si­bly Asperger’s syn­drome), has even led par­ents of in­fants to ap­proach their pe­di­a­tri­cians for in­for­ma­tion early on.

M-CHAT is the first key test for as­sess­ing the like­li­hood of autism spec­trum dis­or­ders. “I do it for all par­ents. If they ob­serve that there are a lot of missed tar­gets, I re­fer the child to a child devel­op­ment spe­cial­ist.” It is im­por­tant to note that if a child does not pass this test, this does not nec­es­sar­ily mean they are on the spec­trum. How­ever, it could rep­re­sent the like­li­hood of an in­creased risk for other de­vel­op­men­tal dis­or­ders. A gen­eral as­sess­ment is re­quired for each child who fails the screen­ing test. “In all cases, autism is not one thing. The spec­trum is wide. But it is im­por­tant that par­ents show an in­ter­est and are open to lis­ten­ing. I saw one mother who, when asked if her child made eye con­tact, didn’t know how to an­swer. A child man­ages good eye con­tact from six months.” Par­ents also should be aware that some­times a child re­gresses and loses skills they have gained.

Steady in­crease

At the Cen­ter for De­vel­op­men­tal and Be­hav­ioral Pe­di­atrics at the Univer­sity of Athens’s Pe­di­atrics Depart­ment, how­ever, they have not no­ticed an in­crease in traf­fic af­ter the se­ries aired. They couldn’t have de­tected it any­way. The wait­ing list is so long that ap­point­ments are booked a year in ad­vance. “In gen­eral, I think that par­ents are in­formed, but al­though I have no per­sonal opin­ion, if a tele­vi­sion se­ries han­dles the sub­ject cor­rectly, that can only be a pos­i­tive thing,” says Dr Nenita Per­vanidou, the de­vel­op­men­tal spe­cial­ist/pe­di­a­tri­cian re­spon­si­ble for the unit. As men­tioned, the di­ag­noses have been ris­ing steadily over the last 10 years: From 1 in 150 chil­dren, the ra­tio is now 1 in 68 (1.5 per­cent). “Of course one rea­son is that there are far bet­ter ser­vices which pro­vide more ac­cu­rate di­ag­noses. Be­fore, doc­tors gave other di­ag­noses, such as the child be­ing a bad stu­dent or de­vel­op­men­tally de­layed. But there may be a gen­uine in­crease. One rea­son is that the vi­a­bil­ity of pre­ma­ture in­fants, which has been linked to autism, has in­creased.”

Ex­perts are call­ing for ther­apy for par­ents as well as chil­dren. “Most ex­hibit de­nial. For a child, for ex­am­ple, who does not turn when you call their name, they will say the child is busy do­ing some­thing that he loves, or if he does not speak, it is be­cause he’s a lit­tle slow. Oth­ers come with gen­uine con­cerns, and some­times, in rare cases, there is noth­ing wrong with the child in the end. When par­ents sense some­thing, how­ever, it is usu­ally true.”

Early in­ter­ven­tion

Early in­ter­ven­tion is crit­i­cal. Re­cent re­search pub­lished in the med­i­cal jour­nal The Lancet (Oc­to­ber 2016) showed that the proper ed­u­ca­tion of par­ents and the devel­op­ment of ap­pro­pri­ate skills by them can lead to sig­nif­i­cant im­prove­ments over time. Six years ago, re­searchers from the uni­ver­si­ties of Manch­ester, New­cas­tle and King’s Col­lege stud­ied a to­tal of 152 chil­dren on the autism spec­trum aged be­tween 2 and 4 years, along with their par­ents, for a pe­riod of six months.

The fam­i­lies were di­vided into two groups: One fol­lowed the con­ven­tional treat­ment and the other more in­ten­sive. The lat­ter, in col­lab­o­ra­tion with spe­cific ther­a­pists, ex­am­ined ways to im­prove com­mu­ni­ca­tion skills and in­ter­ac­tion with their chil­dren. The method was named the Preschool Autism Com­mu­ni­ca­tion Trial and con­cerned child-par­ent com­mu­ni­ca­tion in the preschool pe­riod, when 80 per­cent of in­ter­ac­tion takes place at home. Six years later, they found that chil­dren in the in­ten­sive in­ter­ven­tion group had im­proved sub­stan­tially when it came to the cen­tral symp­toms of autism. Specif­i­cally, the per­cent­age of chil­dren who were clas­si­fied with “se­vere autism” had fallen from 55 per­cent to 46 per­cent.

Early in­ter­ven­tion is crit­i­cal in the treat­ment of autism. Re­cent re­search sug­gested that the proper ed­u­ca­tion of par­ents and the devel­op­ment of ap­pro­pri­ate skills by them can lead to sig­nif­i­cant im­prove­ments over time. At the same time ex­perts warn that par­ents also should be aware that some­times a child may regress and lose some of the skills they have gained.

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