Now Reading
Paediatric Neurologist Educates Parents On The Early Signs Of Developmental Disorder In Children And How It Can Be Managed

Paediatric Neurologist Educates Parents On The Early Signs Of Developmental Disorder In Children And How It Can Be Managed

Consultant paediatric neurologist in the Department of Paediatrics, University College Hospital, Ibadan, Dr Joy Alejo, has shared the early signs of developmental disorder in children, known as autism and how it can be managed.

What is autism? How can you describe it?

Autism is something we call a developmental disorder. That means you find it in very young children within an age group where the brain is still developing. That’s where you see it manifesting.

So, developmental disorders will happen generally under the age of five and the brain will still be undergoing a lot of growth and changes within that period. So, it is a very sensitive period. In Autism, what we now see is that there are defects or abnormalities with social communication, interactions and communication and they have repetitive movements.

For example, when you are talking or communicating with someone, there are two things happening; verbal communication and non-verbal communication. Non-verbal communication has to do with the way one uses the hands, makes eye contact with the other person, expresses emotions and reciprocates it and some level of response. For instance, when someone is angry with you, there is a posture the person should also take.

If someone is angry with you and you are smiling, it is abnormal. So, when you begin to see young children under the age of five having problems with communication, both verbal and non-verbal, you need to start getting worried. They (affected children) can have repetitive movements like having children that can stand and just be flapping their hands or they like playing with a particular toy and they can stay at it for hours. It’s odd, the behaviour is not usual.

Most children at that age may easily get distracted. They can play with a particular toy for two minutes and get distracted and get jumping up and down and can’t concentrate. It’s normal with that age but when you have a toddler who can stay with something for hours, it is not normal. Some even get to the point where they can get destructive to themselves; they can be hitting their head on the wall or keep biting themselves.

So, it can manifest in those repetitive movements, or sometimes, they could have a particular word they like to say over and over. They could have what is called echolalia as well, meaning that if you say something, they just say it back to you instead of answering you. They mirror the words you say. So, those abnormal, repetitive behaviours and abnormality in communication are two things that are the key manifestations of autism.

You may also see a child who, for example, does not want to make eye contact. You will be talking and they will be looking away, not looking at your face and things like that. When you see that in children who are between the ages of, commonly between one and a half to three years, it begins to get worse and they begin to show signs of autism.

What causes it?

Recently, autism has become very common. It used to be a disease that people felt was a disease of the white man. They had a lot of children that have the disease and we didn’t have much here but with time, we are beginning to have it very frequently and we are wondering if it’s because we are now looking out for it, you know, people are getting more aware.

So, when they noticed that their child is not talking on time, not looking at their faces or doing some funny things, they quickly come for help. We are making the diagnosis more.

The other factor is that there may be other things that children are now being exposed to that they were not exposed to in the past.

For example, you can point at what causes malaria but unfortunately, autism is not like that. The cause of autism as it is said is multi-factorial.

It’s been found out that there are some genes when they are present in some individuals, there will be autism. For example, when they check some individuals with autism, they found some abnormalities in some of their genes. So, there are genetic factors and the thing that supports that is that you can find them in families.

If the first child has autism, the likelihood that the second child will have is high. So, it tells us that there is some form of inheritance factor there. Then, we have a twin study which shows that when a twin is autistic, especially if they are identical, most likely, the other one will be autistic. So, it’s telling us that there is something in the family lineage that can also explain it from the genetic factor.

There are some environmental factors that people have, which predispose them to autism. Also, when you have children born to parents who are older, it’s been found to be more common. Even for children who were conceived by assisted reproductive technology, like IVF and all that, it’s been found that the likelihood of autism may be higher in those groups.

There were some studies at some points that suggested that some vaccines were responsible. It was a big scandal then; the MMR vaccine, which was used for measles, mumps and rubella.

So, some people started saying that shortly after their children got the vaccine, they developed autism. What we realised later after bigger studies were done was that it wasn’t the vaccine. It was just that the time they gave the vaccine was coincidental and it’s the usual time that the children will develop the features of autism; so, it was then looking as if it was the vaccine that caused it.

There is an age group when it begins to manifest and it was around that age group that they were given the vaccine and people were attributing the cause of it to the vaccine but it was just a coincidence. People have talked about that as well but that has been proven to no longer be correct.

Some people have said that the use of too many antibiotics affects some of the chemicals in the intestine and can affect some things. There are many things that people are trying to find out the possible causes.

SEE ALSO: Nigerian Mum, Rafatu Salami Narrates How Her Son Suffered Autism, Cerebral Palsy And ADHD Over Delayed Transfusion

Some have even said that the deficiency of some multivitamins like vitamin D and the like can cause it but none of these has been proven and that’s very tough because if a proper cause hasn’t been found, then it’s difficult to find out what to do to prevent it.

Other things that are preventable and have been related to autism are maternal infections during pregnancy. There are some infections we call TORCHes infection, that’s toxoplasmosis, HIV and so on. Those are things that when a woman has them during pregnancy, they may affect the unborn child and cause some injury to the brain.

So, in this regard, if a woman does her antenatal care very well, she can be quickly treated if she has some of the infections and there could be early intervention.

Also, during delivery, if a woman does not get good care and when the baby is born, the baby does not cry well at birth, it can also reduce the oxygen being available to the baby’s brain and that can also injure the brain. So, basically, anything that can cause injury or damage to the brain, even after delivery, some babies may have jaundice; they don’t have enough food.

When a baby is born, within 30 minutes, you expect the baby to breastfeed. In some babies, if the mother does not produce enough milk, they will give the baby water and glucose. Some of those little things should be well managed within the period of delivery, both before birth, at birth and shortly after birth.

As I said earlier, autism is a developmental disorder. It means that during the time the baby is developing, any injury can make or mar that child. So, one needs to be very sensitive about that. At least, from all the factors that I have mentioned, those are things that are easy for us to manage or do something about.

The World Health Organisation advocates that children under two years should not have any screen time. They should go out, play and be happy. Maybe, they have noticed some of these things and that’s why they are making such recommendations.

You mentioned that babies from parents that are aged could predispose a child to autism. Is there a particular age that is regarded as ‘aged’ and does gender suggest any dominance?

No. when you have both parents that are over 40 or you have one of such, you find out that it’s more in those kids. You also find out that it is more in boys; almost four times more in boys than girls.

What are the very early signs to watch out for in order to manage the condition well?

Indeed, I am really excited that we are talking about this because early diagnosis is very helpful. As I said, the two major areas that are affected are the social and communication aspects and the second one is the repetitive behaviour.

So, once you have a child, a child should start saying their first word by one year. Before then, the child must have been saying some vowel sounds, but by one, a child should be saying his first word. By the time a child is two, he should be able to identify things, identify people, combine words and the girl child is usually faster in talking than the boys.

Most girls at 18 months are able to express themselves. For us as neurologists, if a child has not said any word at two years, you should be worried; whether boy or girl and if at two to three years, a child is barely able to say a word that you can understand, definitely, it’s a red flag because they should be vocalising very well at three.

There are times that at such age, the children don’t talk to the parents but can sing their favourite rhymes along with what they watch or with other children, that’s also a red flag if they don’t talk.

Some people are able to come early and we are able to make a diagnosis on time, which is a good one because the earlier you make the diagnosis, the better, and then social interaction is also another issue. When a parent observes that a child likes staying on his own, is not friendly, doesn’t make eye contact or looks at the parents while talking, it is a sign.

See Also

Most children love attention, they want you to hug them and hold them while talking to them but for children who are autistic, some of them don’t even like to be touched. If you touch them, they start screaming and all that. When you see some of those signs that they are anti-social or problems with communication, you should start asking questions, they are red flags.

Another reason why it’s a red flag is that it may point to the fact that the child does not even hear because we call that in medicine a close differential. If a person comes for something, your mind won’t be in only one thing, you will be thinking of other things.

So, one of the things you worry about if a child is not talking is that maybe the child does not hear. So, whichever it is, if the child does not hear, you need to intervene on time so that the child can start learning and acquire language on time as he is developing because it may be a problem that will continue to adulthood and you don’t want that. If a child is not talking by two years, the child should be brought for assessment.

ALSO SEE: Nigerian Parents Share On Their Journey To Helping Their Children With Autism Rise Above The Spectrum

Are there complications with it?

There is something we call co-morbidity; co-morbidity is other things that can come with autism, that can accompany it and one of those things is intellectual disability, what people refer to as low Intelligence Quotient. Sometimes, it’s related to low cognitive ability.

There is also what we call Attention Deficit Hyperactivity Syndrome. So, the child is hyperactive and cannot concentrate and learn.

Long-term consequences of this may be that this will affect the child everywhere; at home, in school, in church and if a child grows like that without intervention, it will affect how he is going to settle in society because one cannot be useful if he does not communicate, cannot take oral examinations and can affect the child’s productivity in society.

You also need a caregiver for such a child. The long time consequence is that the child is not able to integrate well into the society and cannot be independent. Nobody wants such a child.

How is it diagnosed?

We have certain behavioural tests that we run on the child to make a diagnosis and that’s why once it is suspected, you should just come to a paediatric neurologist, which we have in UCH and if you can’t get a neurologist, you can get a child’s psychiatrist.

There are tests we will run to ascertain that the child fits into the autism session. Some cases are mild and then we educate the parents and tell them what to do.

Generally, the procedure is that we have to do speech therapy because speech is a problem. We also have to do behavioural therapy. We do the hearing assessment for them to ascertain that they can actually hear.

There are children who can’t hear but are regarded to be stubborn or difficult but the truth is that the child can’t hear. So, we do all of the assessments and give assistance where we can.

How is it managed?

So, the exact cause is not known, it’s something that has to be managed. It gets better with management, and it is more in boys than girls. It gets better if well managed and that’s why the emphasis is on early diagnosis.

The way it is abroad, especially in the UK, once a child is autistic, the government takes over the care of that child and do everything to manage it. Those are societies that understand that something must be done early and fast about it.

Source: PUNCH

Copyright © 2021 Motherhood In-Style Magazine. All Rights Reserved.