When you smile, does your child smile back?
“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.
