FREQUENTLY ASKED QUESTIONS

Given the nature of deficits in development of verbal and non-verbal communication, people on the autism spectrum find it hard to interact with others and make friends. Many want to make friends but are unable to do so because they do not understand ‘how’ to make friends. Even with adults, individuals with autism (both verbal and non-verbal) often find it difficult to spontaneously show another person things of their interest e.g. a monkey, a dog, an airplane. Verbal children may not come home and excitedly narrate some extraordinary incident at school without being questioned about it. A person with autism may come home and show a note in the dairy or a birthday gift, but not be able to describe what happened or the feelings s/he may have experienced. Many children with autism may show affection, smile and laugh, and demonstrate a variety of other emotions, although in varying degrees. Like other children, they respond to their environment in both positive and negative ways. The way people on the spectrum interact with others range from being perceived as aloof to being perceived as stilted and overformal. Those with autism who seem ‘aloof’ appear to be in a world of their own, absorbed in their activities and show little interest in another person. There are others who are not aloof, but rather passive in their interaction. These are people with autism who may be comfortable with other children being in their vicinity, who may not move away from others, but will not approach others themselves. Some people on the spectrum actively enjoy but appear distinctly odd in their interaction. They make active approaches to other people on their own, but may do so in an odd, inappropriate, repetitive way such as hugging or pushing others. Then there are others who are seen as stilted and over-formal. They have fluent language in adolescence and adult life. They may be excessively polite and formal in their behaviour and try to behave well and cope by sticking rigidly to the rules of social interaction. They may often be disturbed by a situation, where a ‘new’ rule may need to be applied, or a previously learnt rule may need modification to keep the interaction going, and avoid such situations. Often, children with autism enjoy watching other children and may want to be near them but may feel hesitant, unsure and even scared to join them in their activities. Some others may be comfortable and even enthusiastically approach, but may lack the spontaneity to initiate play. Their play behavior may include only repeating what others are doing, e.g. running after one another, playing ring-a-ring-of-roses. As they grow older, they find it difficult to understand and follow social rules of games, such as getting ‘out’, taking turns or participate in make-belief play. As a result, individuals with autism have none or few friends their age. They find it easier to relate to older people who can tell them what to do and or with people younger to them who will do as they are told. In both situations the expectations from and responsibilities on the individual with autism is less. However, with the guidance of a supportive adult, children on the spectrum can learn ways to interact with other children appropriately.

The key to ‘good’ intervention for any individual with autism to understand the condition, understand the unique ways in which individuals with autism think and learn, accept their autism as a vital, vibrant part of their being, and then approach the intervention, the teaching of skills, and /or changing of behaviours, from that paradigm of understanding and acceptance. What most people with autism need are interventions that spring from a rock solid understanding of autism, which provide them with structure and predictability, and incorporate good behavioural principles in the teaching. 

On the basis of a functional assessment by a competent professional, intervention plans are tailored based upon the individual strengths and needs of each specific child.

The intervention plan may use one or a combination of some of the scientifically proven effective techniques such as:

Treatment and Education of Autistic and related Communication handicapped CHildren Method (TEACCH) emphasizes on using skills that children already possess to enable them to become independent. Organizing the physical environment, developing schedules and work systems, making expectations clear and explicit, and visual materials are effective in developing skills and allowing people with autism to be independent of direct adult prompting.

Applied Behaviour Analysis (ABA) emphasizes on one-to-one sessions in discrete trial training (DTT) to develop cognitive, social, behavioral, fine motor, play, social and self-help skills. The technique involves structured presentation of tasks from most simple to more complex, breaking them down into small sub-skills, and then teaching each sub-skill, intensely, one at a time. It involves repeated practices with prompting and fading of prompts to ensure success. It uses rewards or reinforcement to help shape and maintain desired behaviours and skills.

Verbal Behavior Analysis (VBA) is an addition to ABA and is also based on breaking down and teaching language in functional units unlike the teaching of language based on grammar. In addition to teaching at the table, teaching in (and with) the natural environment (NET) is important.

Picture Exchange Communication Systems (PECS) is built on the fact that non-verbal children with autism may attempt to spontaneously use objects to communicate. People with autism tend to be visual learners, and a visual means of communication can help them to understand and use the process of communication. PECS aims to teach spontaneous social-communication skills by means of symbols or pictures and the teaching relies on behavioural principles, particularly reinforcement techniques. Behavioural strategies are employed to teach the person to use functional communicative behaviours to request desired objects. The requesting behaviour is reinforced by the receipt of the desired item.

Some people with autism display remarkable abilities and skills far out of the ordinary.

*At a young age, when other children are drawing straight lines and scribbling, some children with autism are able to draw detailed, realistic pictures in three-dimensional perspective.

*Some toddlers who are autistic are so visually skilled that they can put complex jigsaw puzzles together.

*Some who have a keenly developed sense of hearing can play musical instruments they have never been taught, play a song accurately after hearing it once, or name any note they hear.

*Some people with autism can memorize entire television shows, phone directory, or bus/train timetables; others can calculate day of the week from a date or may have exceptional arithmetic skills.

*An excellent ‘photographic’ memory for places or things is often described in children with autism and is not too uncommon.

*Some show Hyperlexia - characterized by a preoccupation with print noted before the age of three years. In some cases hyperlexic children can read beyond their developmental age and even before they can speak.

*While a majority of such children are usually diagnosed with an autistic spectrum disorder, contrary to what is usually perceived, all children with autism do not have these savant skills. Hence, it is incorrect to believe that all people with autism have a hidden skill that just needs to be ‘brought out’.

Additionally, such skills do not always serve a person with autism well, if there is too much focus on these areas and neglect of the core areas of difficulties like communication and social skills, as well as basic daily living skills. 

If a person with autism also has intellectual impairment (or any other condition), his training will need to primarily address his Autism.
This is because autism affects the learning style of the person. What that means is the person with autism perceives his environment and learns in a way that is often different from his non-autistic peer (whether neurotypical or with any other developmental condition).
Autism affects all aspects of the person’s behavior and development. Persons with autism learn best when the teaching is modified to accommodate their unique learning style and hence it is the ‘autism’ that one needs to keep in mind whilst teaching a person with autism. Our goal is to help the person become integrated into society and so it is important to focus on the development of social, communicative and adaptive skills.
However, for a child with cerebral palsy for instance, in addition to autism occupational therapy may also have to be provided. Similarly, for a child who also has a seizure disorder or any other medical condition, the appropriate medical intervention will be required.

A. Most of the IQ tests that are currently developed are not suitable or appropriate for people on the spectrum and do not accurately measure the intelligence of a person with autism. It is very difficult for people with autism to take an IQ test because they may have certain skills but are not able to use them or exhibit them in a test and hence the score that they may get in the test may be skewed.

It is said, that about 50% of people with autism may also have intellectual impairment, just the way that people with cerebral palsy or Down's syndrome can have intellectual impairment. Autism can occur in association with other difficulties like Cerebral Palsy, Dyslexia, Down's syndrome, Visual Impairment, and Seizure Disorder.

A. Early intervention is especially crucial to the child's progress. This is why an early and accurate diagnosis is so important. Even though in India the number of services and resource persons would be fewer as compared to other countries, the quality of services and professionals available is at par with any other country worldwide.

However, the decision of relocating would have its own advantages and disadvantages, and each family should weigh them in order to make appropriate decision. Along with the resources available for the child, the resources available for the family also need to be considered in making the decision. The strong support system available to the child in India can prove to be a significant factor/aspect of improvement of child's social skills. Additionally, even though the numbers of professionals in the U.S are far greater in number compared to India, accessing the special education services for the child can be very expensive.

Therefore, the question of relocation has many issuesthat are important to be assessed by the family. And hence, the decision has to be specific to each family.

A. The essence of marriage is companionship. It is a union between two consenting adults and it involves adjustment and carrying on day-to-day responsibilities of life. It also involves the ability to the plan for the future etc. Before deciding upon marriage, there are some factors that may need to be considered by the person with autism and his/her family:

  • The level of functioning of the person, his/her ability to take on the responsibilities that are integral to marriage
  • That the partner understands the needs of, and that he or she knows everything about the autistic spouse (if one of them is not autistic).
  • Financial status (employment, family support etc.) 

However, since marriage is an issue of social commitment and companionship, by the very nature of the condition, many able people with autism choose not to marry and their families respect and agree with that decision.

A. 'What after us?!' is probably the greatest fear that plagues every parent of a child with autism. Unlike some countries in the west, in India there are few hostels/ residential facilities for people with mental disabilities, and there are no specialist hostels or residences that are currently available for people with autism in India.

It is now increasingly accepted that during the early years of development, it is important for an autistic child to live and grow in a home environment. As the child grows, s/he can be trained to live in a residential facility or a group home since that may be the need of the hour after the parents are no more or are ill and unable to provide the necessary support to the adult with autism.

It is necessary that any such residence is not a place where one just 'dumps' the adult, but one that provides a structured environment, and predictable routines where individuals with autism are able to function independently to the best of their capacity. Such environments would foster independence while still providing the support that adult residents may require. It is also very important for autistic adults living in such residences to have ample opportunity to integrate with society in general so that they do not live isolated lives.

A. Current estimates suggest that up to 25% of ASD is caused by known genetic abnormalities (Miles, 2011). If there is one child with autism in the family, the risks of having another child with autism is much higher than in the general population. So far, there is no genetic counseling that is available to tell families if their second child will have autism or not, nor is there a reliable test to detect autism in the foetus.

A. It is important for us to remember that when a child has autism, it is not just 'speech' with which the child has a difficulty, but with communication as a whole, which includes both understanding of language, as well as expressing themselves through speech or any other mode.

Every child with autism can benefit from interventions that emphasize communication, and can learn to understand language, communicate and appropriately express their needs and desires. To reiterate, some people with autism can learn to speak to communicate; others can learn to use signs, objects, pictures, or written means of communication.

Speech therapy can help some children. However, it is absolutely essential for the speech therapist to understand autism and also the individual child. Otherwise, the conventional methods of speech therapy help children with autism very little, because the inability to speak is not a physical problem.

A. Being a spectrum disorder, there is a huge variation in the development of speech among people with autism. While some people with autism never speak, others start speaking late. Some begin to speak on time but the language does not develop age appropriately.

It is very difficult to say when and whether the child will ever speak. It is confirmed that there is no difficulty in their physical abilities that stops them from speaking. Some children who might have spoken as infants and then lost their speech may or may not get their speech back. Currently, it is unknown why some children develop speech and others do not. Experience with children with autism has shown that if the environment is accepting, and people are aware of the kind of speech they themselves need to use with the child, it can produce positive results.

A. There are a number of autistic children who have been integrated into regular schools. The chances depend on several factors. The most important are the individual capacity and functioning levels of the child, how early diagnosis was received, and thereafter the kind and the appropriateness of the early intervention provided to the child.

Though some children with autism can learn like their typically developing peers, most have different learning styles and the therefore teaching styles also need to be different. Most children with autism may require some accommodations in the teaching style/ environment for them to be able to learn better and to keep the schooling a positive experience. Sometimes simple changes in existing classroom techniques and environmental adaptations make teaching autism-friendly. However, in some schools this may not be understood and therefore children with autism face difficulties and many may have to drop out of mainstream classrooms after grades four or five.

A. Since autism is a spectrum and people have varying skill levels, the future is not the same for all people with autism. ALL children with autism can learn and progress, if they receive early and more importantly focused, appropriate intervention. Depending on the child's individual ability levels and the appropriateness and intensity of the intervention he or she receives, some children with autism may go on to lead relatively independent lives, whilst others may require support in varying areas and degrees.

A. People with autism have an impairment that can be characterized as a deficit in imagination.

Individuals with autism, unless taught or told, are unable to think of or imagine things that they can do in their free time. Consequently many of them spend their time doing the same activities, or simply running around or jumping about. Amongst children, imagination or creative thinking is most easily observed through the variety in drawings, comprehensions/ essays, play behavior or things they do in their free time.

Many children with autism show little or no interest in toys. Some may handle toys and other objects purely for physical sensations e.g. to bang, put in the mouth, for the sound it makes or a light that flickers. Some enjoy concrete play such as puzzles or computer/video games. A common activity for children with autism is lining up or stacking similar objects like pencils, blocks, toy cars, glasses, bottles etc. Some others use objects for their obvious purposes, such as toy broom for sweeping, or rolling cars back and forth.

Some children do develop a sequence of events that appear to be play, but close observation shows the sequence is often repetitive and not built upon or modified. The impairment is in the age-appropriate pretend play. A car is a car and remains a car.It does not become an airplane, fly in the air, or climb the walls.

Other children with autism are able to learn basic pretend play behaviours, but, again, the stories may be repetitive and may not grow and develop. So a little girl may learn to bathe her doll but refuse to dry the doll with a small hand towel, as one would during pretend play. She may insist on using a regular towel. After the bath she may go on to dress, comb and feed the doll. But the play may not progress beyond the bath routine. For instance, she may never place the doll on a toy car pretending to take her for an ice-cream.

Another consequence of this impairment is the narrow range of focused interests. Often all activities including play revolve around those special interests. For instance, some children may enjoy transportations and may look at pictures, advertisements, and collect toys or talk only on this theme and have no other variations in interests. Sometimes, these special interests can revolve around unusual objects such as strings, brooms, pebbles, wrappers, or any household objects or activities like scribbling, drawing or tearing paper and the play may remain focused on only these objects or activities.

A. Autism is very different from intellectual impairment (mental retardation). When a person has intellectual impairment, there is more or less even impairment in skills in all areas of development. Therefore, if an eight-year-old child with intellectual impairment has a mental age of five, then all his skill areas would be roughly around five years (i.e. motor, communication, social, self-help, cognition etc.).

In autism, there is uneven skill development- in fact this is the hallmark of autism. In some areas the child may show age-appropriate skills; in some the skills may be below the developmental level; and then there are people with autism who possess skills that may be beyond their age level. For example, an eight year old child with autism may possess some skills which are age appropriate at the eight year old level, in some skills he may be functioning at a three year old level, and for some children there may be one or two skill areas where they may be functioning at a ten year old level.

While some people with autism also have intellectual impairment, many of them do not. However, because of limited understanding of the spectrum, many people are misdiagnosed as having intellectual impairment. Autism does not affect the intelligence of a person. It affects the learning style of a person.

A. Hyperactivity can have a medical reason and may be a co-morbid condition in some children with autism. However, in most people with autism this is not the case. Having autism means that the child has an impairment in his/her social and imaginative skills. They may not be able to play appropriately with toys, or pretend play, or be able to play with other children. Hence most children with autism find it difficult to keep themselves occupied. As a result they may run around, always be 'on the go', be restless and appear 'hyperactive' as they try to keep themselves busy in their own way. Some children may eat a lot to do this. This restlessness or 'hyperactivity' can be reduced as the children are taught new skills and appropriate ways to keep themselves occupied.

A. All of us combine our seven senses (sight, smell, sound, touch, taste, balance, body in space) in order to make sense of and learn from our environment. Many individuals with autism have different ways of 'sensing' their world and often have a condition known as sensory dysfunction.

What this means is that persons with autism often have trouble learning to integrate and process all the information coming from multiple sources in the environment. Their senses may be too acute (hypersensitivity), or working on a reduced level (hyposensitivity), or there may be a combination of both. Sometimes the sensory dysfunction results in self-stimulatory behaviorssuch as unusual finger or hand movements, rocking, mouthing, spinning etc. as natural responses or methods of coping with the sensory difficulties. When sensory information is faulty the world can be confusing and these self-stimulatory behaviours often help the child with autism relax.

A. Autism is not an illness that can be treated or 'fixed'. Instead, as mentioned earlier, it is a neurological condition, wherein one needs to teach the individual to reach his/her maximum potential using intervention and management strategies thatwould work most effectively with their unique learning style.

The most effective and well-documented intervention or management option for individuals with autism is a structured behavioural training programme. This intervention is based on understanding the unique learning styles of individuals with autism, making accommodations for the same, and using and adapting behavioural principles to teach.

The focus needs to remain at all times on the core areas of difficulty, i.e. communication and social understanding. Teaching appropriate play and leisure skills, and self-help skills, are equally important. Autistic children can make significant progress if the intervention is appropriate and consistent and hence, a combination of a good school and parent training is the best intervention strategy.

Early intervention, before the child is five, is especially crucial to the child's progress. This is why an early and accurate diagnosis is so important. Autistic children grow to become autistic adults, and there is a particular need for focus on teaching every skill to independence, and to provide meaningful outlets for social interaction and employment where possible.

Some of the scientifically proven effective intervention techniques include:

Treatment and Education of Autistic and related Communication handicapped CHildren Method (TEACCH) emphasizes on using skills that children already possess to enable them to become independent. Organizing the physical environment, developing schedules and work systems, making expectations clear and explicit, and visual materials are effective in developing skills and allowing people with autism to be independent of direct adult prompting.

Applied Behaviour Analysis (ABA) emphasizes on one-to-one sessions in discrete trial training (DTT) to develop cognitive, social, behavioral, fine motor, play, social and self-help skills. The technique involves structured presentation of tasks from most simple to more complex, breaking them down into small sub-skills, and then teaching each sub-skill intensely, one at a time. It involves repeated practices with prompting and fading of prompts to ensure success. It uses rewards or reinforcement to help shape and maintain desired behaviours and skills.

Verbal Behavior Analysis (VBA) is an addition to ABA and is also based on breaking down and teaching language in functional units unlike the teaching of language based on grammar. In addition to teaching at the table, teaching in (and with) the natural environment (NET) is important.

Picture Exchange Communication Systems (PECS) is built on the fact that non-verbal children with autism may attempt to spontaneously use objects to communicate. People with autism tend to be visual learners, and a visual means of communication can help them to understand and use the process of communication. PECS aims to teach spontaneous social-communication skills by means of symbols or pictures and the teaching relies on behavioural principles, particularly reinforcement techniques. Behavioural strategies are employed to teach the person to use functional communicative behaviours to request desired objects. The requesting behaviour is reinforced by the receipt of the desired item.

All people with autism can and do make significant progress. They become more responsive to others as they learn to understand the world around them if the intervention that they receive is appropriate, consistent and autism friendly.

A. We know that autism is a complex, neurological, developmental disorder, which affects the way the brain processes information, the cause of which is still unknown. Since we do not know what causes autism, we do not have a way to fix (cure) it.

At present, there is no cure for autism: there is no medication, no pills, no injections which can make the autism go away. Of course, as a parent you may read or hear about many claims of cures for autism. This may be more so in the last few years with the emergence of the internet as a 'bazaar' spreading some truly bizarre promises of cure. Being an invisible condition, it is easy for parents to be swayed to the 'right treatment' that would make their child's autism somehow 'go away'. We do understand the overwhelming urge to find the magic pill, tonic, therapy or treatment to make your child non autistic but caution in choosing an intervention is most crucial.

As a parent, of course, you would want to be informed of whatever is available, but it is also extremely important to have a clear-headed and rational approach and take well-considered decisions. And alongside it is vitally important that as a parent, irrespective of whatever other treatments you may choose to follow, you do not compromise on the only consistently effective treatment for autism. This is a structured behavioural training program; therefore, a combination of a supportive classroom practices and specialised teaching strategies (both at home and in the school environment) is the best known treatment that can maximize skill development and achieve full potential. Therefore, a combination of a good school and parent training is the best intervention strategy.

A. We still do not know what causes autism. There is a lot of research looking into what may cause the condition, and the indications are that autism may result from a combination of factors including genetic and environmental influences.

Current research indicates that anything that can produce structural or functional damage to the central nervous system can produce the condition of autism. We also know that certain viruses and known genetic conditions like Fragile X syndrome are associated with Autism. Statistics show that there are families that have more than one child with autism (a twin or a sibling) or wherein a parent or a grandparent may also have autism, and that reinforces the genetic component to the causes. Current estimates suggest that up to 25% of ASD is caused by known genetic abnormalities (Miles, 2011). We know that there is no one single gene for autism but several genes in combination are involved.

It is important to remember that autism is a spectrum disorder and the manifestation may vary widely across individuals. Hence it is believed that the factors that may have caused autism in a particular individual may entirely separate from those in a different individual. Given all these considerations, is difficult to tell parents why their child has autism and in most cases, the cause may not ever be known.

An important point to keep in mind is that autism is not caused by an unhappy home environment, both parents working, mental stress during the pregnancy, poor handling by the mother, an emotional trauma, or other psychological factors. A parent or home environment cannot cause a person to have autism.

References:
CDC. Prevalence of Autism Spectrum Disorders Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. MMWR 2014 ;63 (No SS 2):1-21. Miles, J. H. (2011). Autism spectrum disorders—a genetics review. Genetics in Medicine, 13(4), 278-294.

A. One of the most significant changes that has been brought about by the fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) is that the separate diagnostic labels of Autistic Disorder, Asperger's Disorder (Syndrome) and PDD-NOS, have been replaced by one umbrella term "Autism Spectrum Disorder." The diagnosis of Asperger's is now combined within the category Autism Spectrum Disorders under DSM-5, and will no longer be an individual diagnoses.

In the earlier version of the DSM, i.e. the DSM-IV, one of the main differences between Asperger's Syndrome and autism is that there is 'No Qualitative impairment in communication' in the person diagnosed with Asperger's Syndrome. What distinguished Asperger's Syndrome from Autism was also the severity of the symptoms and the absence of language delays. Children with Asperger's Syndrome were thought to be only mildly affected and frequently had good language and cognitive skills.

The DSM-5 has made changes into how autism is defined. Now, there is no longer a separate diagnosis category for Asperger's Syndrome and other sub parts of autism. There is now just one single diagnosis definition for autism.

A. The term 'PDD' is widely used by professionals to refer to children with autism and related disorders; however, there has been great deal of disagreement and confusion among professionals concerning the PDD label.

Diagnosis of any developmental disability, including autism is based upon the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) (American Psychiatric Association, Washington DC, 2013), and is the main diagnostic reference of mental health professionals in the United States. DSM-5 is the revision of DSM-IV TR by the American Psychiatric association and was launched in May 2013. DSM-5 presents a new and more accurate way of diagnosing individuals with autism.

In earlier version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the term "PDD" was not a specific diagnosis, but an umbrella term under which the specific diagnoses are defined. In the DSM-IV, there are five disorders (Autism, Asperger syndrome, Rett syndrome, fragile X syndrome, and PDD-NOS) that fall under the category of 'Pervasive Developmental Disorders' (PDDs).

The diagnostic criteria in DSM-5 combines these five as Autism Spectrum Disorder (ASD), and therefore according to the current understanding, Autism Spectrum Disorder is the most accurate diagnosis

A. Autism is not a rare or uncommon disorder. It is the third most common developmental disorder, more common than Down's syndrome. With an increase in understanding and awareness levels, professionals are beginning to understand that some people who were diagnosed with mental retardation, hyperactivity, or labeled badly behaved children may actually have autism.

Recent international studies show that about 1 in 68 people have autism and the overall incidence of autism is believed to be consistent around the globe (CDC, 2014). This means that there are over 18 million people with autism in India. This also means that we have all come across at least one person with autism in our lives – but we never realized s/he had autism.

Autism is four times more commonly diagnosed in boys than girls. It knows no racial, ethnic, geographical or social boundaries. Family income, lifestyle, and educational levels do not affect the chance of autism's occurrence. Doctors, politicians, and rickshaw drivers alike may all have children with autism.

Reference: CDC. Prevalence of Autism Spectrum Disorders Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. MMWR 2014 ;63 (No SS 2):1-21.

A. Autism is considered a spectrum disorder where symptoms and characteristics present themselves in a variety of combinations, from mild to severe and in any combination. A more able individual with autism might simply seem eccentric, a loner. More severely affected individuals may hardly communicate and prefer to function primarily in 'their own world'. Most individuals fall in the middle of the spectrum.

A detailed assessment by a competent professional is important for making the correct diagnosis which will further help in tailoring the intervention program specific for each individual. Standardized diagnostic assessment tools can be administered to assess the skill level of the child. Based on a test, professionals ask questions from parents to assess the presence and absence of behaviours. A score may also be given to categorise the person into mild, moderate or severe autism. However, with the new and improved understanding of autism, professionals are beginning to understand that a person either has autism or not. This is the reason that all separate diagnosis including Autism, high-functioning autism, and Asperger's are becoming meaningless now and being grouped together in one category.

A functional assessment can also be done to understand the current strengths and needs, specific to each child.

With support ALL children with autism make progress. Likewise, if intervention is not provided the person with autism faces greater difficulties. If a person has autism, then the way s/he learns, understands, communicates and interacts with people is different. But, when the teaching is approached with an understanding of the unique learning styles, and requisite accommodations are made support the same, the child with autism can learn to function to the best of her/his abilities, both at home and school.

A. There are no medical or genetic tests that can detect autism. These can only rule out other conditions. A diagnosis of autism requires a sensitive and experienced doctor/clinician to observe the child very carefully, ask the parents about the development of the child, and then objectively follow internationally recognized criteria for diagnosis. Onset may occur at birth, or a child may have a period of seemingly normal development followed by a deterioration of verbal and social skills around 1 1/2-2 1/2 years. Where onset is at birth, the disorder can be detected as early as a year. Autism may occur alongside conditions such as mental retardation and hyperactivity, but the autistic traits in the person are typically what require attention. For more information on a diagnosis of autism click here.

A. For parents who want to speak to their children about their autism there is often the question of 'when'. When do we tell our children? This is a decision that needs to be made depending on the individual child, his environment, and the personal family circumstances. In some cases we may want to tell the child about his autism, the moment we feel that he is beginning to realize that he is different. Speaking from personal experience, one of the writers, Indrani Basu, started speaking to her son about his autism when he was around seven years old. This was the fallout of a particular incident.

"We had gone to the park one day. He was playing on the swings whilst I was talking to some friends. I noticed a few children pointing out at my son, laughing at him and making jokes about him. He got down from the swings and came to me crying. Was it because he realized that he was different and the other children were ridiculing him? I have no idea. But, I decided, whatever be the cause of his crying, it was time to tell him about his autism and his being different."

So the answer to "When do we tell our children that they have autism?" Is ideally "Now!" But at a more practical level the discussion on autism can be introduced as soon as the parent or carer herself or himself has come to some level of comfort about the diagnosis, since that will determine how the child will perceive his autism.

Disability Certificate for Autism

The Department Of Empowerment Of Persons With Disabilities through a Notification dated 25 April 2016 issued Guidelines for Evaluation and Assessment of Autism and Procedure for Certification.

Before this one could not get a certification for Autism, you had to make do with a Disability Certificate of Mental Retardation that also mentioned Autism.

Currently, in Delhi, the Autism disability certification based on these guidelines is being carried out at the Psychiatry Wing of Ram Manohar Lohia Hospital (RML). The process typically requires three visits. There is no fee. Each visit requires registration. The registration counter, which incidentally is open to sun and rain, opens at 9 am. Be prepared for a long queue which starts at 8am. The days for certification visits are Mondays, Wednesdays and Fridays. Remember to have your child accompany you, and carry two photos of your child.

A. Since autism is a spectrum disorder and people have varying skill levels, the future is not the same for all people with autism. A lot of children who are able to cope with mainstream school /college education go undiagnosed and are successful at jobs but may be considered quiet or reserved adults by their family, friends and colleagues.

Several adults on the spectrum who have been diagnosed, and been in a supportive environment in their childhood, have written books that have facilitated and enhanced the understanding of the condition. We have examples of people who are professionally very successful. Some have gone on to become famous authors and at least one has won a Nobel Prize. Some advocate and speak for themselves and for other people with autism in the community.

Some of those who are fully independent in their everyday life may find it difficult to sustain the demands of a job and work environment. Some are married and some choose not to.

Some of those who are married face difficulties in forming relationships with their spouses and carry out responsibilities that come with marriage and having a family, and may continue to need support of another person in planning and carrying out the activities in running a house.

As with every other condition, some people on the spectrum will always need support in life and may never be fully independent. In India, there are few schools which have an environment or the attitude to accommodate the special needs of people on the autism spectrum. Vocational centers and employment opportunities are even fewer.

For most parents struggling with getting services for their child with autism, one of the biggest worry is 'what after us?' As yet, there are not enough and appropriate lifespan services for people with autism where they can lead a life of dignity and respect.

However, with support from people around them including the family, friends, neighbours and teachers all of them can lead a happy and meaningful life.