Dr. SHAHANA PARVEEN, Consultant Psychiatrist, NIMH, Dhaka, Bangladesh
A child with autism needs different steps of management at different stages of development. As autism is not curable, it is better to use the term management instead of treatment. Their problems are multidimensional. So the quality of life of the affected child can be improved through an integrated management.
Although not curable, early diagnosis, special education and training can facilitate the daily life of the affected child.
Any physical problem such as hearing, sight etc. should be checked to see if it is functioning. It is also important to make sure that there are no other developmental disorders such as birth defects, mental retardation, hyperactivity, inattention, epilepsy or hormonal problems. Management is basically a teamwork. This team will have members as required. Although each child has some similarities in symptoms and behavior, they need to be considered separately for management. In the integrated system, the discussion centers the child as an individual and then focuses at larger roles that can be played by society.
Treatment of a child with autism
Each child needs individualised intensive training. One trainer for one child is the best ratio. The program should include personal and social skills, behavioral, educational and psychological issues. The younger the training age, the better the results. They need to be involved in specialized schools or special arrangements in mainstream schools. It can be started in pre-schools or any specialised center.
People of different professions can make fruitful contributions to the management of autism. If we consider the overall issues of autism, we will see who can play what role. A possible list of who can be on a team (but it is best to include members according to the child’s needs)
- Parents / guardians / caregivers
- Speech therapist
- Special education instructor
- Occupational therapist
- Clinical Psychologist
- Social worker
- ENT specialist
The role of the family is paramount in the whole management. The first task is to try to accept the reality, even if it is difficult. Accept it as a disease. Create an environment to teach the child at home the behaviors learned from specialized centers.
Simply explain the matter to all members of the family (parents, siblings, other members of the household) and give an idea of what to do next.
Siblings should be given information according to their age and an idea about the special needs of their special sibling. Include them in the process. If necessary, you can arrange regular training of the child in the specialized education center according to your ability. In day-care or pre-school, they will have the opportunity to interact with other children. You need to find out how to keep your child busy. Make regular eating habits by sitting down with everyone. It would be better if the child can use the toilet, to do his own work from the beginning. If a new problem arises, discuss it with your child’s counselor. Not only behavioural trainings, the child should have access to entertainment too.They must be prepared for adolescence and puberty. We need to be careful about maintaining our own health and not depriving other children of their normal lives. It is necessary to maintain regular contact with other such parents and to acquire new knowledge and training in this regard.
If there is a special child in the family, then if the family wants to have another child later, they need to have a clear idea about the hereditary risk before pregnancy.
Speech and Language Therapists
Shaping behaviour in a way so that the child speaks, learns language, and builds meaningful linguistic and social communication with others. They can work directly with the child or advise his team on these issues.
The occupational therapist
will plan his behavior according to his needs in food, clothing, sports, drawing, school preparation, computer, etc.
They will monitor the child’s walking, proper use of every part of the body, movement and will directly treat the child or advise the team accordingly.
will help the child to deal with extreme restlessness, epilepsy, suicidal behavior or violent behavior towards others, his depression, anxiety or other mental problems.
People of some more professions such as; Psychologists, general practitioners, pediatricians do not have a direct active role in the team, but they play an important role in any physical and mental problems of children with autism.
Role of school / special school
If it is a general school, you can arrange special help / assistant for the child with autism. The family needs to be involved in the child’s behavior plan. Encourage classmates to be friendly and helpful. Notify the family & the counsellorif there is any change in his behavior at school. If it is a special school, every child must have an individual behaviour plan implemented & monitored accordingly.
Participation of the Community
The role of local society
Neighbors and society should look at their problem with a positive attitude. It is better to refrain from any kind of unusual curiosity or negative comments towards such children in the social environment. If necessary, parents can be helped with information on where to go with the child.
Religious places of worship can help to positively change people’s minds by giving a good explanation of religion to special children / disadvantaged people. Can dispel conventional superstitions. It can give a parent emotional strength by saying that it is not due to any kind of curse or someone’s mistake or sin.
What autism is, who has it, where to get advice, what are the facilities they can get at the public and private levels, if they keep broadcasting again and again, the dilemma of the general public and parents will be reduced. Other parents will be inspired to intervene quickly if the media highlights the successes of autistic children.
State Measures and Policies
To accurately assess the population of the country affected by this problem, to review their socio-economic context and to identify special needs. To create skilled manpower through training using local manpower and resources. Subject based research and planning. To arrange their employment according to their ability. Arrangements for construction of shelters for the homeless. Officially campaigning on the issue. Monitor the work of other agencies.
Government medical colleges are providing autism diagnosis and necessary assistance through child development centers and autism corners.
Non-governmental organizations can exchange knowledge gained through workshops, various conferences and research if they come forward in this regard. Donating behavioral materials to poor families will make them less likely to drop out of the training program. They can also help coordinate the work of others on the team with the family.
In this way, integrated management will be more effective if everyone comes forward from their position. We hope that today’s backward autistic children can become active partners without being burdened in the society of tomorrow.