Each year, on 2 April, the World Autism Awareness Day is celebrated across the globe to increase the understanding and acceptance of people with autism. Autism is not an illness or a disease but a diverse group of conditions related to the development of the brain. According to World Health Organisation (WHO) published data, approximately one in 100 children have autism. However, studies have shown an increasing incidence of autism in recent times and significant variations prevail across different regions. Hence, raising awareness to understand, accept and love the people with autism is of much importance worldwide.

Autism Spectrum Disorder (ASD)

People with autism differ from normal people in the way that they communicate and interact socially. Their behaviour may be repetitive or highly focused. They also have differences in their senses that affect the way that they feel and respond to their surroundings. The term “autism” is also known as “Autism Spectrum Disorder (ASD)”. As the name implies, it involves a spectrum of characteristics, skills and abilities in people with autism. Hence, two people with autism do not behave in the same way and their support system also should therefore be tailor-made or individualised. Although autism is a life-long condition, adults with autism can lead fulfilling lives with the support of specialist services that understand their needs and develop their skills.  Hence, early diagnosis and intervention is imperative. 

Diagnosing autism

Diagnosing ASD is not an easy task as it does not involve any specific blood test or a medical test. ASD has an early onset. However, the symptoms have to be apparent in the first three years of life in order to come to a diagnosis of ASD. The identification of the early appearance of certain signs and symptoms of autism is important for early detection and intervention. 

Red-flag signs of Autism Spectrum Disorder (ASD) by age

Age

Social communication and interaction

Restricted repetitive behaviours

By 6 months

Few or no big smiles or other warm, joyful and engaging expressions.

Extremely difficult to console.

Requires rocking and unusual movements in excessive amounts to console. 

Limited or no eye contact. 

By 9 months

Does not respond to name.

Unusual repetitive movements of the limbs and the body.

Does not show facial expressions such as being happy, sad, angry or surprised. 

Prefers to stare at rotating objects such as fans for prolonged periods.

Little or no back and forth sharing of sounds, smiles or other expressions.

By 12 months

Little or no babbling.

Obsessed with parts of toys or clings on to the same toy.

Little or no back and forth gestures such as pointing, showing, reaching or waving. 

Spins toys or objects frequently.

Does not play simple interactive games like ‘athuru mithuru’ or hand games involving clapping with each other by 12 months of age.

By 15 months

Does not share any interest with others. 

Very few or no words.

By 18 months

Does not point to or look at what you point to.

Lining up or stacking toys.

Unusual squealing.

Repetitive humming or repetitive use of same words or phrases.

By 24 months

Does not engage in pretend play.

Gets upset for minor changes often.

Very few or no meaningful two-word phrases.

Flapping, rocking and the unusual tensing of the body.

National event of the World Autism Awareness Day 2023

The National Programme of the World Autism Awareness Day 2023, was held on 1 April at the Ministry of Health with the participation of the Secretary to the Ministry, Janaka Sri Chandraguptha as the chief guest. The event was organised collaboratively by the Family Health Bureau (FHB) and the Sri Lanka College of Paediatricians (SLCP). In her welcome speech, FHB Director, Dr. Chithramalee de Silva spoke about the services extended by the Ministry for children with autism and highlighted the need for early diagnosis and intervention for the condition.

The President of the SLCP, Prof. Guwani Liyanage mentioned that they identify children who display symptoms of autism but are not diagnosed with autism in their day-to-day practices. She mentioned the fact that most children with autism have a family member or a relative with the same condition and that there is a significant relationship with the excessive use of screens. “Hence, increasing public awareness on this condition and directing the identified children to early management are imperative,” said Prof. Liyanage. 

Professor in Paediatric Disabilities, Prof. Samanmalee Sumanasena, addressing the gathering, emphasised the importance of understanding and giving recognition to people with autism. “The prevalence of autism is increasing rapidly. According to a study conducted in the United States this year (2023), one child among 36 children is affected with autism in the US. Whereas, in 2021, the prevalence was one in 44 in the US”, said Prof. Sumanasena. Further, she highlighted the importance of conducting a study to identify the prevalence of autism in Sri Lanka, since the last study conducted was done in 2009 and the prevalence at that time had been 1:93. Prof. Sumanasena raised the fact that children with autism get rejected at school entry and therefore emphasised the importance of embracing diversity and implementing inclusive education in schools.  

Addressing the gathering, Secretary to the Health Ministry Chandraguptha emphasised the need of public awareness about autism and to reduce the stigma towards them. He further highlighted the lack of human resources for providing services for children with autism as well as other special needs, due to the economic crisis and brain drain. Chandraguptha also emphasised the requirement of task shifting and task sharing in managing this crisis situation. 

Launching NAMASTE project

Neurodevelopment and Autism in South Asia: Treatment and Evidence (NAMASTE) is a United Kingdom funded project to facilitate the early identification of autism and for the provision of care based on evidence based practices. This incorporates the health systems of Sri Lanka, Nepal and two States in India to achieve the goal of helping children with autism. Professor in Child and Adolescent Psychiatry at the University of Manchester who is the Principal Investigator of project NAMASTE, Jonathan Green emphasised the importance of helping children with autism and their families for facilitating these children to be in the society comfortably. He further explained the feasibility of delivering services by non-specialists adopting task shifting methods. This five year project was launched at the National event of the World Autism Awareness Day 2023. 

(The author is a Medical Officer at the Ministry of Health.)

The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of this publication.