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Autism Spectrum Disorders

Oct 11 | 12:00 PM

There is often nothing about how people with Autism Spectrum Disorder (ASD) look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less. A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder. Lets understand in detail about the condition and some interesting management aspects.

[Music] so good evening everyone who's watching my name is dr divanshi and i'm a clinical ops intern with netflix and it is my honor to be hosting uh dr manchi deshpande noir today uh i will just quickly quickly introduce you to our viewers um dr manjuri is a consultant psychiatrist and uh the head at inland child guidance clinic and my clinic center and she's an added supporter of normalizing mental health illnesses and treating them so today she will be talking about autism spectrum disorders and some interesting ways to manage them uh we're excited to have you here ma'am and i'm sure all of our viewers uh hope to learn a lot from you yeah thank you for the introduction and thank you for team netflix and you've been coordinating i think you guys are doing a great job and trying to enhance all our clinical skills and i think these kind of presentations are much needed right so yes before without wasting much time i'll go straight into my topic which is autism spectrum disorders so yes i know autism is something that we must have heard in our mbbs right from our mbbs days even during our pg of course we study autism in great detail but even as uh established psychiatrist yes autism is something that can confuse anybody it's not a disorder that can be very easily diagnosed and more importantly managed also ah because every child with autism presents very differently so there's a very nice quote that says if you've seen one child with autism you've seen one child with autism that means you can't really generalize the symptoms you know so we i i rather child kind of clinic and of course we deal with a lot of autism kids but trust me every child that comes to us is very very different so we cannot generalize the therapies nor is it that easy to diagnose also so today i go more into just the diagnosing part because i think for that's the first step we need to learn how to diagnose autism what kind of questions can you ask in your busy opd practice and how do you diagnose even if you don't have a team say or clinical psychologist or special educator everybody uh treatment i'll just touch upon because that's too much in detail and i won't be able to give it justice so like i said some teachers about autism i think most of the times we've heard autism or the word autism or we've seen some movies in which they try to depict depict autism most of us uh have always heard that you know savage is that means an extraordinary skill so most of us think that if it's a autism case the child will have some kind of extraordinary talent or skill it's not so salmon skills are very very rare uh many people still think that it's similar to schizophrenia it's a form of childhood schizophrenia etc and most clinical most practicing psychiatrists or even pediatrician keep thinking oh why did i get this case i wish we went somewhere else this is not so easy to treat but then this i've heard from my own colleagues and my friends also because yes autism is not that easy to diagnose so again uh what do we need i think we you know it's uh basically an abstract mind set we to decipher a concrete one so there are like i said in the beginning if you've seen one child with autism you've seen only one child so there can be a range and that's why it's called as autism spectrum disorder it's the whole spectrum so i may see a child with having only one symptom and i may see a child having all the possible symptoms of autism you know so that can be a range right from their social behavioral communication motor skills sensory skills and the iq it can drain so a child can most children will be self-absorbed of course some can be quirky some children may show a lot of aggressive destructive behavior there may be a child with autism who doesn't show any behavioral problems also a child we know that one of the basic things is that in in autism is a child has poor communication skills so we have absolutely non verbal children so they may come at five six years also and be absolutely non-verbal there may be some kids who are highly verbal so there's a difference in being highly verbal but they may not be communicative so they may be able to say a lot of words but they may not be able to communicate what they want then of course we check their sensory issues that's what we do in occupational therapy some of them may be hyposensitive to certain stimuli some may be hyper sensitive a lot of them some of them may have profound intellectual disability to the point where their iq may be absolutely very very low and some may be on the higher side they may be actually gifted so we do see kids with autism who have a superior or an above average iq as well so as i said this is basically a spectrum and uh you know just because we have mentioned autism spectrum disorder does not mean the child will have all the symptoms of autism so what am i going to do over the next half an hour is uh what is the prevalence like what is the diagnostic criteria how do you compare dsm i'm sure most of all of you know dsm and we know that the dsm 5 has been you know the one that we follow so what was the difference between dsm-4 and dsm-5 some clinical pulse that means these are my observations or my learnings in the last couple of years in child psychiatry some case with nets and how do you diagnose in an opd differential diagnosis and investigations and a little bit on treatment so this is the prevalence this was i think pre-pandemic of course i think the last two three years the prevalence has gone up even more so the dsm-5 the last dsm said that the prevalence is one percent that means 100 where cdc said it was 1 in 68 but i think if we look at it today yes i think it's going to be much more uh there has been a 75 percent increase in the past decade that means in the last 10 years has been 75 increase and that's a lot if you compare the sex ratio four girls to one girl four boys to one girl so the number of boys that we see with autism are much more in my clinic also you know what used to happen to all these kids before say 10 years 20 years 30 years so of course i think the public awareness has increased today i think most parents and most of us most common public general public has at least heard the word autism so there is a lot of public awareness the diagnostic criteria has definitely broadened and even among clinicians among psychiatrists among pediatricians among general doctors also i think there is a slightly better understanding of autism so if they can't read they at least know where to rep for such children and of course diagnostic substitution so exactly what is autism spectrum disorder so in simple words it's when you look at the the person looks at the world from a different perspective you know that's the way an autism child sees the world he or she sees the world from a different perspective it's basically a neurodevelopmental disorder characterized in varying degrees by two three things difficulties in social interaction difficulties in verbal and non-verbal communication and some form of repetitive behaviors this is the very basic definition of course i'll go into dsm five so yeah it would be nice if any of you can just make it up yes also i mean how many symptom domains are there i don't know if uh yes i mean those who are practicing uh you know or studying psychiatry especially post graduates should have an idea of this this comes very frequently as a viva question how many symptom domains are there how many symptoms in each and how many are needed to make a diagnosis and which is the new symptom added in dsm 5 which was not there in dsm 4 any guesses would anybody like to uh give a question i can't see the comments so i don't know if anybody so there is one comment saying positive and negative symptoms uh okay but uh that that's yes we are saying says two domains that's right exactly very good congratulations yes that's the right answer there are two symptom domains very good i can see people interacting that's nice uh the second question how many symptoms in each and how many needed to make a diagnosis [Music] divya singh is on a roll yes this symptom added is sensory issues that's nice uh parveen kumar is also right how many symptoms in each there are three and four yes in the first domain there are three symptoms and the second domain there are four symptoms excellent i mean these guys are well read i don't think i need to explain anything so uh yes uh so let's look at the first domain which is basically persistent deficits in social communication and social interaction and all three are needed to make a diagnosis so your all the three will be needed to make a diagnosis that means deficits in social emotional reciprocity that means a two-way communication uh deficits in non-verbal communicative behavior used for social interaction so many times when i ask can he communicate it doesn't mean only verbally so if he wants water he doesn't only have to say it with some kind of non-verbal communicative behavior at least the child should be able to express some things and the third symptom being deficits in developing and maintaining relationship according to their developmental level so basically play mixing with others etc so in this domain all the three symptoms should be elicited to make a diagnosis and this is the second domain which is restricted repetitive pattern of behavior interests or activities in this you need two out of these four symptoms so that's an important fiber question i think this is asked extreme very frequently uh how many symptoms are needed so two out of these four symptoms are needed to make a diagnosis so stereotyped or repetitive speech motor movement or use of objects so you know the child typically shows a repeated motor movement so they show flapping or they show some kind of movement near their eyes or they go on rotating in a circle or they keep jumping in one place that's those are some examples of repetitive motor movements excessive adherence to routines ritualized patterns of verbal or non-verbal behavior or excessive resistance to change so the mother typically will tell you that he can't bear any change in his routine so if he's used to like getting up brushing his teeth and bathing and if you change the routine a little the child gets extremely irritated so they show a lot of resistance to any kind of change in their life they have highly restricted fixated interest so if you ask you know normally if you ask what kind of toys does he like to play a childhood like one or two toys you know generally when they come to the clinic they'll be carrying that toy with them and if i try to take it away they show a lot of resistance and get into uh get very aggressive etc so that means they're very fixated interest they may like very few things and uh you know very restricted interest basically and hypo or hyper reactivity to sensory input or unusual interest and sensory aspects of environment this also you know they'll keep looking at the ceiling fan or when they're playing with a toy they'll keep looking at the at the wheel of the toy or if they're like they love to be swing some of them like to be swing some of them don't like some children want to be rocked all the time so that means their sensory input is a little disturbed these are some things that we evaluate in great detail when we do occupational therapy so uh some more questions which i'll quickly rush through which disorders come under asd now what are the severity specifiers what are the other specifiers what is the age criteria so these are some things that you all can definitely read up dsm-5 has given very nice severity specifiers uh there are other specifiers like requires help requires moderate till requires help in everything and what is the age criteria so what after what age can we start diagnosing then also the big change to dsm 5 was the allowed dual diagnosis so now if a child has both this is a question if a child has both adhd and autism which diagnosis is giving to the child so the answer is now we can give both the diagnosis what other comorbid diagnosis are allowed absolutely any comorbid diagnosis can be allowed so you can say autism spectrum disorder with so and so with adhd earlier you know the higher diagnosis would be only like the higher condition would be diagnosed but now dsm 5 has changed that that's why maybe we're catching more of autism also uh then so just summarizing the changes from dsm-4 to dsm-5 there are no diagnostic sub-categories so earlier it was autism disorder autism disorder asperger's disorder disorder rat has been taken over by the pediatricians and the others have all been classified into autism spectrum disorder so even asperger's such comes under autism spectrum disorder uh then the category which dsm-4 followed was they allowed social communication and social interaction were different categories now it's been combined into one category language impairment not included in diagnostic criteria so you do not have to have a language impairment but it can come as a specifier then another big change is the sensory issues which have been included as a behavioral symptom another big change is the symptoms do not have to be apparent before the age of three that means at a developmental age they have just called it as at a euro developmental age you can see some of the symptoms but yes we do believe that earlier it is like the earlier the autism is diagnosed the better is the treatment then they have allowed comorbidities with other conditions and specifiers are used to describe the symptom methodology which also helps us in treating that condition so now i'm coming to the clinical pulse path so what are some of the things as a clinician that you can look at in your busy practice also how do you quickly pick up autism so what is such social referencing these are some of the normal milestones that children show as they start growing but however in autism some of these may not be seen so social referencing is a very common uh social milestone that children generally achieve between 8 to ten months of age so what does a typically child between eight to ten months and age do the child looks at the adult who say look at me i'm doing something great so you know you typically see an eight month old when he's trying to walk or when he's trying to hold something and get support he look at his mother or father or look at around him and you know just try to elicit a smile and that's when we say you know yes baby well done well done and the child gets that kind of encouragement from you i have a two and a half year old and i remember when he was uh between six to one i used to keep blue i mean he used to try to get grab my attention very frequently by this way you know they can't speak but every time they do something they look look around and you know just check with you if you're doing fine and when you encourage them yes and that's also when psychologically we say that's why the self-esteem starts developing at this age because they're looking at us for reinforcement or validation so basically this begins at eight to ten months to see whether what they're doing and are they safe this is called a social referencing this is not elicited in kids with autism joint attention generally uh this is very important and make sure that we ask all our parents who come to us in the clinic for joint attention so this emerges by around nine months and between by 18 months that is one and a half year it's generally well established so when two people can share an interest so the common way to ask a parent this question is suppose your child is busy engaged in something or is doing something and you call out your child you know look here and you show him something so say look this is a bottle okay and look this is a tv does the child grab your attention and look in that same direction so that means are you able to grab your child's attention onto something this is called as joint attention it basically means can your child join your attention so it's important to elicit this so you ask the parent if the parent still doesn't understand you try to do it yourself you call out that child and show him interesting you know colorful things or whatever that you have in your room like a toy or a ball and you show him you know can look here this is a ball and typically the child should leave what he's doing and at least look at the ball or look at you that's called as joint attention this is a very important milestone to be elicited then stimming behavior right so a lot of you must have heard this term as autism uh stimming behavior does the child show stimming behavior or stealth stimulatory behavior this refers to specific behaviors that include hand flapping rocking spinning or repetition of words or phrases so does your child do something repeatedly like rock in one place flap these hands make some movements near their eyes this is something that we need to ask parents an autism meltdown is different from a tantrum so most kids normal kids also will show tantrum tantrum is typically if you take away something that the child is playing with or you don't give something when the child asks her a child will throw a tantrum this is very common in children between two to four years old age where we say the terrible tools the child throws himself on the floor starts beating his hands and legs because he wants that tantrum to be fulfilled an autism meltdown is because of a sensory overload so typically you take a child with autism to say a party and there is a lot of noise lot of people etc the child will just start you know shouting screaming typically so it's not because something was not fulfilled it was because this body is not able to tolerate that kind of sensory overload that is an autism meltdown that's why it's different from a tanker uh i don't think i'll go into the case because it takes too much time basically so um yeah so when can autism be diagnosed this is a lot of parents come and ask us is this the right so even if i might have a three-year-old and i diagnose or i say that the child has science the parents often ask this question am i too late or am i too early so research has shown that autism can be diagnosed as early as one year of age of course when i started off practice say seven years ago mostly we used to see four-year-olds five-year-olds i think because of the increased awareness we have kids as babies i mean literally one year or 1.2 years coming in now for an evaluation referred by a very astute pediatrician or you know the child has a typical elder sibling and the mother is able to notice something is missing in this chat so a lot of parents say but should i look out for stimming should i look out for a tantrum should i look out for a meltdown so the earliest this is a very important point to keep in mind that the earliest sign of autism involves the absence of a normal behavior not the presence of an abnormal one so don't look at meltdowns don't ask for spinning behavior first just check whether the child is doing what is normal right so there are normal milestones we have to see whether the child has achieved that or not and then look for abnormal things like flapping and the sensory meltdowns etc uh i don't know if y'all can take a snapshot but i think this is a very common uh table but this is a very important table for us as a child psychiatrist for anybody who wants to do anything in child psychiatry we must know all the milestones these are the common milestones that have milestones means at that particular age this has to be achieved we need to keep up some of them in mind because if it's grossly delayed then we know that uh you know there is a development or it points towards this so i'll just tell some basic things some of the important things that we uh look out for in this is you know between one and two years of age they start understanding their name generally they start initiating play with other children they start recognizing themselves they respond to their name call or when you ask where is uh you know say john he can look at himself or he will point out or where is mama he will be able to look at mama around 18 months of age pointing generally begins so 18 months you ask a child who comes to your clinic and say where is the fan where is the light where is the tv or where is the screen the child should be able to point to us where is mum so generally being able to point to common objects and common people comes by about 18 months of age so these are some milestones that you keep in mind what are the red flags so this is another important line these are red flags that means if you don't see any of these by that particular age you just have to be a little more watchful of course every child develops differently so a child may have these milestones two months earlier or two months later so it's not very very strict but a gross delay in this is definitely a red flag so a big smile not using big smiles or other warm joyful expression by around six months no back and forth sharing of sound so when you make a sound the child makes the sound or you smile the child smiles back by nine months of age babbling which is just baba kaka data it begins generally by 9 to 10 months if it is not achieved by 12 months it is a red flag because by 12 months there should generally be at least one single meaningful word no back and forth gestures such as pointing what i just tried to elicit so is the child able to point is the child showing or you try to give him an object does he reach out for that object so no back and forth gestures like pointing showing reaching or waving by 12 months no words this is meaningful word especially by 16 months of age no meaningful two word phrases by two years so two word phrase is give me take me mujito mala de in whatever language the child should be able to join two words and make it meaningful most important red flag is any loss of speech babbling or social skills which is called as regression so many times the parent will come and tell you that the doctor my child was doing everything till one and a half year of age he was responding to his name call he was giving eye contact he could point now suddenly he has stopped doing that that's that's when your antennas have to go really that's a big big red flag that means there is regression and regression is one of the commonest things that we see in autism that means the loss of speech babbling or any kind of social skill is something we need to be careful about so finally how do you diagnose in an opinion of course we take the history from the parents so you let the parents speak as to what your observation was etcetera if the child is going to free school or play school we ask them if the teacher has given any observations because many times the teacher can notice one child not doing something compared to 20 odd in her class what are the pediatricians concerned what are your own observations as your doctor of course after that if you work in a team like we do at our cgc you can get certain tests done by the psychologist then we do an evaluation by an occupational therapist special educator or speech therapist at whichever age the child is and then we do a final diagnosis so again what are the important things in history when you are taking the history of course you ask for all the developmental thing birth history and the developmental history you ask if there is any kind of regression if there is absence of declarative pointing you these are things you will elicit also you ask the parent if there is abnormal reaction to an environment stimuli so you put on the fan and sometimes you know you make a small sound on the table and the child goes like closes as yours and starts howling so that means this he's hyper reactive to that abnormal social interactions you're trying to make that child mix with one or two kids and he just shines away he starts screaming the moment another kid enters his room absence of symbolic place you know you give an empty cup generally above 18 months the child will pretend to drink from that child is not able to pretend to play and any kind of repetitive and stereotype behavior then of course past and present medical history you check for genetic disorders we check for seizure disorders any other neurological disorders gastrointestinal disturbances are quite common in children they also are aversive to certain oral textures parent will tell you he doesn't like slimy food he doesn't like mashed food he likes only say very hard food or only liquidy food he doesn't wear clothes of a particular texture he doesn't like his hair being combed etc this is aversions to sensory stimulant and any particular food allergies that you can watch what will you look for you will try to do you know the typical peekaboo you hide under the table and see if the child or hide a toy under the table and see if the child tries to reach out for that ideally above nine months of age the child should show interest in looking for that toy then gaze monitoring or you know you just try to see so like i said the pro uh you know the joint attention you would show him a ball and say oh baby look at the boy ball you try to see if the child looks at that then you will ask where is where is god where is your mama where is your dad so you will try to elicit prototype declarative pointing then you see how is his communication is he using words is he using non-verbal communication is he making eye contact if you ask does he at least nod yes or no if you ask him do you want a biscuit do you want to play uh of course is he using imitation so you keep certain small toys in your clinic if you are going to see children very often to see how they use that toy as well and of course you ask parents does he have restrictive interest does he play with all kinds of toys uh does he have any preoccupation and does he have any unusual sexy interests or abortions so to summarize how do you observe the child you know very naturally even if you have a small cabin or if you have a small room just have two three toys many parents are holding their child very tight and just leave the child in the room just leave the child down on the floor so that you can observe what is he going towards is he coming to you is he going to his parents is he reaching out for a toy or is he just lost in himself you observe what toys he picks up keep three four toys with you simple blocks on ball and uh you know a doll etc see what kind of toy he picks up and how he plays if there is a car typically i have an auto so you know many times the child will pick up that auto and keep looking at only the wheel he will not be interested in the whole object he'll just be rotating that wheel then you check of course you check you try to observe his reaction when separated from his parents typically the child is between one to two and a half years he should show separation anxiety so if i ask the parents to leave a typical neurodevelopmental child should start crying or should get anxious because his parents are leaving a child with autism may not show that he may be happy sitting on your lap even if his parents have left the room he lacks social uh even separation anxiety you check for imitation you make funny faces or you make sounds and you ask the child to imitate you give high five give me you know a handshake see if he does that you call out his name and see if he responds you try to talk to him and see if he is giving you eye contact give him simple commands like you know give me high five or give this bottle to your mama to see if he responds to these commands try to strike a conversation of course if the child is verbal and check for equality if he's repeating the sounds etc uh so some of the investigations that we do ask for it not in all cases in needed cases is a hearing and a vision evaluation so it's a very small child it's a baby like a typical 12 month 14 month old child and you ask the parents does he respond to music sometimes they may not even know many times the parents come and say or they've gone to an ent before because they feel that the child is deaf so in such cases yes you do need a hearing and a vision evaluation pediatricians or ent doctors may sometimes ask for a beara which is a test done to check the patency of both his ears then you do a speech language and a psychological evaluation that means of certain psychological tests that we use uh of course these are not necessary in all these cbc tft depending on the case fragile x testing chromosome testing only if there is another genetic disorder eeg brain mri only if there are neurological conditions and a genetic and a neuro consultation again i'm repeating not necessary in every test most of the times it's all clinical there are very good screening tools that help us to diagnose autism so if my clinical evaluation also shows that the child has autism but i want to be sure and if i have a psychologist or if i can refer to a clinical psychologist yes we can ask for an autism evaluation which is there is a very good scale called as the isa which is the indian scale for autism there are questions that are asked to the parents in all the six domains of autism the parent answers those questions we get a score from that like less than 17 no autism it's also severity ratings we get no autism moderate severe autism so generally at our clinic we do it when we are just starting therapies and we repeat it sometimes after a year to see the progress also because it's a severity rating scale if the uh isa can be done after 30 after 30 months of course if the child is younger if it's a baby two months two years old then we do the m chat which is basically a modified uh checklist for autism in toddlers this is also available online but it is recommended to be done by a clinical psychologist in that if they get that there is a risk for autism then there is a follow-up questionnaire that can be done cars is another rating scale that is used in some clinics it is the childhood autism rating scale sometimes of course in most cases we also do an iq or a dq test to understand the intellectual capacity of the child and sometimes behavioral checklists like corners rating scale and the child behavior checklist these are checklists to understand the overall behavior of the child some time ago when i was uh it's obviously reading about about autism so you just randomly put you know treatment for autism that's the number of results that you will get you know because there's so many things so many things that people do to treat autism but however of course i i'm sure most of us know that autism is not something that can be treated you know we do work with children with autism but i completely never refrain from using the word treat autism i because that's uh you know obviously every child will develop differently and i outright tell the parents at the beginning there is no medicine so it cannot be cured as such therapies can help him to a great extent and help him to live a normal life but let's not let's refrain from using the word cure autism you know uh so there is medical management there are some biomedical intervention and what i firmly believe in even being a child psychiatrist is therapies is the cornerstone for treatment for autism so a lot of parents come and say that you know my child can't do this my child can't do that temple grandin is uh you know somebody who has written a lot of books on autism and very interesting things on autism so she says there needs to be a lot more emphasis on what a child can do instead of what the child cannot do so there are a lot of things maybe your child cannot do but there are a lot of things that even a child with autism can do and i keep telling parents that is what we need to find out that is what we need to know what your child can do so let's start focusing on those things so what are the goals of treatment parents often ask what are going to be the goals i often ask my team what are the goals for this child so we divide them into speech and language goals communication goals behavioral goals social skills educational of course when we are looking at the educational goals and in general life space so i think if we divide that we need to work on all these domains then it's very helpful we also know that we need to split so the speech and language communication will be taken over by the speech therapist the behavioral will be taken over by the clinical psychologist maybe a therapist or the occupational therapist social skills also and educational of course if you have a special educator or a media trainer who work on their educational skills and life skills in general biochemical psychologists uh one very important thing is parent psycho education you won't know how many sessions it will take to educate the parent that their child has autism you know of course nowadays things are much more different they've read up they have gone to a pediatrician they've done their own research so they most likely know that their child has a problem when they come to us but still the moment you use the term autism spectrum disorder or risk for autism their facial expression their body language just changes you know and they can be parents who can be outright disappointed to the point they'll never come to you back also so it's a very very sensitive topic and you need to spend a lot of time with parents and trust me this is very good investment you need to spend time with the parent explain the parent because so much happens after they leave your clinic with the diagnosis that my child may have have autism spectrum disorder so it's not only about treating the child it's about treating the entire family taking care of the psychological needs especially of the parents there so what do you do in psycho education you explain autism what are the symptoms what is the cost like what is the outcome of course we can't give the whole lifelong picture many times parents come and say how is the life going to be you know the first thing when i tell them you know will he complete his body example you become a doctor and so on i keep telling them we have to take one step at a time not me nor any doctor in this world can tell you how your child will develop and grow because it depends a lot of other factors as well a very important thing is to remove the guilt the blame and the shame so a lot of parents will go through guilt something that i did or did not do during my pregnancy caused this a lot of blame the mother blaming the father of the father blaming the mother the in-laws blaming the mother etc and a lot of shame oh my god my childhood is a child with special needs trust me this is this is something that will you know hamper the treatment of the child to a great extent so helping them accept the child unconditionally so that's what yeah so don't expect the parents to be immediately cooperative and you know immediately uh you know come on board etc it's going to take them time so even if they are angry even if they are upset even if they are a little aggressive it's fine give them time tell them that you know we will be there for them at each step so set therapy goals what will happen in three months in six months in one year giving them a home program is something we always do that means uh even if the child is coming twice a week four times a week for therapy there is something that they need to do at home and of course stress on the importance for a regular up with doctor and keep checking for medical commodities so these are uh some of the commonly used treatments and therapies uh you won't believe what all i've heard even as a psychiatrist people parents have come and told me they've given their child camel milk they have taken their child to you know some baba who has cured uh some a lot of children with autism so a lot happens a lot happens you need to be uh obviously a little practical when it comes to this a lot of therapies can be done a lot of people claim to treat or cure autism some of the common therapies or some of the time and tested therapies have been sensory integration aba applied behavior and analysis facilitated communication the ones highlighted in red are most commonly obviously worked upon a lot of other things like pharmacotherapy of course i am a psychiatrist so yes i do prescribe medication but again what are the medicines that we use we use medicines to treat the behavioral symptoms so if there's a lot of aggression if there's a lot of head dragging if there's a lot of sleep issues if there's just too much hyperactivity so the sim the treatment or the medical management is for the behavioral symptoms not for autism per se a lot of people go in for gfcf diet but personally my views are it's very difficult to follow in india we eat a lot of gluten food and casein of course is part of our diet multivitamins can have been used in mega doses omega 3 fatty acids stem cell therapy has been researched upon but yes uh indian psychiatric society and everybody has outright declared that stem cell therapy is not a treatment for autism so you know let's not go by all this let's go by the standardized therapies a lot of people have done hyperbolic oxygenation therapy chelation therapies uh etc but again these are not tried and tested i'm just mentioning what all can be done this is something you need to be aware of and also keep telling parents uh basically that's my clinic so this is our center so in the end yes uh again again at the end i'd like to say if you've seen one child with autism you've just seen one child with autism autism is something that's of course not very easy to diagnose more important not easy to treat also but trust me i work very closely with children with autism and it's it's it's a delight to work with these kids i keep telling these parents that you know in fact they they live uh i mean you know they notice very small things in their child so sometimes you know that child has just responded to name call and that child has given a high five after months of therapy and you see the expression of these parents you see the pure joy on their faces and even us and it's like you know sometimes we just let go of these things no i mean when you uh you know sometimes you don't you just completely ignore these things but when you work with a child with autism or any special needs these things become so important and so vital so just seeing that child smile i think makes our entire day so of course it's a long haul for parents who have children with special needs but i think yes that's why it's important that we understand this condition and start diagnosing and treating at younger ages because then definitely their lives can be enhanced for great extent thank you so much fam that was very informative and i learned a lot i'm sure everybody did there were some questions in the comment section i'll just read them out so one question was uh is there any genetic uh prenatal screening or any diagnotic diagnostic test to detect autism unfortunately there is no prenatal screening at all you know unlike down syndrome etc which can be of course detected uh you know on cleanit screening there is nothing like that you like i said uh mostly we see these symptoms after we see some of the signs when the child is eight ten months of age etc so it cannot be diagnosed or it cannot be as of now at least no prenatal screening will help us to understand uh autism okay uh there was one more question uh could you please tell me if essa can be done at the gp level or does it require a psychologist to be president no ideally a trait uh the psychologist has to be a clinical psychologist to diagnose but i think in places in uh smaller places in india of course i think others are also doing it but yes i uh it requires a clinical psychologist to do the test they have to undergo some kind of training in order to be able to uh perform lisa okay uh there was one more question early on in your presentation that's uh red syndrome is included or not in autism spectrum no red x has been taken over by pediatricians in their diagnostic subcategory because that has a genetic reason to it so it's now not included under asd anymore okay uh and okay we have questions pouring in um all right there was one question uh saying can you elaborate a little bit on the occupational therapy part yes so occupational therapy is basically uh it's occupational therapy is done by occupational therapists they work basically on these domains like i said the life the goals that we said so the social interaction the social skills basically so when a child is not able to respond to name call not pointing etc so ah you know there are we use a lot of equipment occupational therapy requires a setup it requires you to have certain things in your clinic in your in a room and these are they are trained in occupational therapy they will help us to achieve these goals so they work on sitting tolerance they work on eye contact they work on imitation they work on response to name call etc they also sensory integration therapy is a part of occupational therapy so the other will take a sensory evaluation to see out of our five systems how is the child is the child hypo or hyper responsive and then make like what we call as a sensory diet for each child and yes i mean they use things like a swing i don't know if you can uh can i flip my camera yes so this this is our clinic i mean that's the cctv of course but that's our occupational therapy room so that's my the room in rot uh so this what the child is going through now is motor play so this is basically part of occupational therapy okay all right uh someone has asked what about autistic smile i have not heard that word before so all right and uh another person is asked which uh how is aspers asperger's diagnosed as per just like i said now comes under the diagnosis of autism spectrum disorder only of course they don't have uh you know it's of a minor level in terms of they have awkwardness in their uh in their speech and in their ability to communicate with people so the conversations that they make with people will be a little more tedious will be circumstantial etc but they may not have all the typical symptoms of autism but now it is diagnosed under asd only under autism spectrum disorder uh all right i think we'll just take one or two final questions um okay so there's an interesting question by divya singh asking can genetic tests predict the probability of asd in the second child yes so they do genetic testing of course and b generally if a parent has we have one child with autism and they are planning for another child we do ask them to go for genetic testing we'll just know the risk in that condition because they'll study the genes etc but they will not be able to confirm or give an exact percentage but generally we do ask them to go for a genetic testing if it is but in my clinical observation many times i have seen that you know when they have one child with special needs the second child may not have autism they may have one or two say mild symptoms or you know some kind of deficit or developmental delay but not necessary autism spectrum disorder so the it's not a very very highly genetic condition all right uh okay so uh one final question i'll take uh from [Music] okay so there's this question about whether uh should the sugar parents ask of autistic children be asked to follow the principles of probiotics uses which are in asd so probiotics are something that we can advise it's again not a treatment they're not enough studies to tell us that probiotics treat but because a lot of children with autism have gastrointestinal disturbances sometimes their pediatrician or when they go to gastroenterologist may prescribe probiotics to them to help them with their gastrointestinal issues but not to every child with autism i think that's more specifically reserved for children who have a lot of gastrointestinal disturbances as such all right now uh thank you so much for this interactive session uh we still have questions pouring in and i'm sure we can have another session for you so specifically answer these questions and maybe start a club because you obviously loved your session very much thank you we look forward to working with you yes thank you so much thank you so much for the session yeah okay thank you bye

BEING ATTENDED BY

Dr. Murugan M & 668 others

SPEAKERS

dr. Manjiri Deshpande

Dr. Manjiri Deshpande

Consultant Psychiatrist and Head at Indlas Child Guidance Clinic and Indlas Mind Clinic

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dr. Manjiri Deshpande

Dr. Manjiri Deshpande

Consultant Psychiatrist and Head at Indlas Ch...

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