Lt Col Nazmul Huda Khan, MPhil, MPH :
World Autism Awareness Day is observed on April 2. The theme to celebrate the day in this year 2022 is,” Take the pledge to help create a world where all people with autism can reach their full potential”. The day recognizes and spreads awareness for the rights of people with autism. Autism is recognized as a major public health challenge in the world. The global prevalence of autism is increasing day by day; it has increased twentyfold to thirtyfold since in the late 1960s and early 1970s. The latest prevalence studies of autism indicate that 1 in 59 – the number of children diagnosed with an autism spectrum disorder in 2018. Boys are at higher risk for autism than girls. The average male-to-female ratio for autism is 4.2:1, affecting 1 in 70 males but only 1 in 315 females. Females, however, are more likely to have associated cognitive impairment. In the Southeast Asia region, it is estimated that every 1 in 160 children has autism. Recently, the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh confirmed that almost similar proportion of children have been suffering from autism in Bangladesh. Wherein, the urban prevalence is higher than the rural areas. It’s estimated that the cost of caring for the services required for autism can be $196 billion per year for adults and $66 billion per year for children.
There are a number of potential risk factors associated with autism e.g., hereditary factors, infection and immune dysfunction, neurotransmitters, peptides and growth factors, endocrine factors, obstetric factors, neurotoxin environmental or other xenobiotic exposures, alcohol, smoking and illicit drug exposure etc. Several prenatal and perinatal complications have been reported as possible risk factors for autism. These risk factors include maternal gestational diabetes, maternal and paternal age over 30, bleeding after first trimester, use of misuse of medication during pregnancy and meconium in the amniotic fluid.
There is no single specific form of autism rather various degrees of severity involved in this disorder. Symptoms of autism are always present before age three, but autism is often not diagnosed until a child is two to three years of age, or even later. Individuals with autism often remain undiagnosed or inaccurately diagnosed because many clinicians hesitate to discuss this possibility with parents of young children, even when some symptoms are present.
Autism is the most commonly characterized by three domains: social interaction, communication and repetitive or stereotypic behavior. It may involve a combination of brain enlargement in some areas and reduction in others during the early stages of prenatal and postnatal brain development.
– Social communication / interaction behaviors may include: getting upset by a slight change in a routine or being placed in a new or overly stimulating setting; making little or inconsistent eye contact; having a tendency to look at and listen to other people less often; responding in an unusual way when others show anger, distress, or affection; failing to, or being slow to, respond to someone calling their name or other verbal attempts to gain attention; repeating words or phrases that they hear; having facial expressions, movements, and gestures that do not match what is being said; having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions.
– Characteristics of autism include Restricted and Repetitive Behaviors (RRBs) which include a large range of specific gestures and acts; it can even include certain behavioral traits.
The goal of management of autism cases is to maximize child’s ability to function by supporting development and learning. The earlier children with autism spectrum disorder get help, the greater their chance of treatment success. Early intervention during the preschool years can help child learn critical social, communication, functional and behavioral skills. However, a range of specialist educational and behavioral programmes can help children. Planning for child’s future opportunities, such as employment, college, living situation, independence and the services required for support can make this process. The management team may include: a pediatrician; mental health specialists, such as a psychologist and psychiatrist; a learning disability specialist speech and language therapist; an occupational therapist; education and social care services. The parents of a child play a crucial role in supporting their child and improving their skills. If a child has autism, it’s a good idea to find out as much as parents can about the condition.
In Bangladesh, autism is basically seen through the lens of misinformation and stigma. Bangladesh, despite these complexities and challenges, has successfully taken the base steps to deal autism. The country is now trying to develop a rights-based paradigm for individuals with autism. Two important acts to protect the rights and ensure safety of the differently able persons have been promulgated in the parliament. Prime Minister Sheikh Hasina has taken a keen interest to take this issue forward both nationally and globally.
Saima Wazed Hossain, a school psychologist and global advocate for autism who is also the daughter of Prime Minister Sheikh Hasina has been actively engaged in global and domestic advocacy of autism. World Health Organization has recently honoured Saima Hossain for her outstanding contributions to the area of autism. The MoHFW has a 15-member “National Steering Committee. It has a “National Advisory Committee (NAC)” headed by Saima Wazed Hossain who serves as the Chairperson. Bangladesh has taken so many steps to contain and for an esteemed management of autism. Amongst those few are appended below:
n Autism has been incorporated in the primary education curriculum.
n It has been included in national curriculum of Text Book Board “autism” as a subject.
n Allowance of 20 minutes additional time in public examinations for all children with autism.
n Allocation of 2% reserved seats for autistic children for admission in academic institutions not run by the public sector.
n Jatiyo Protibondhi Unnayan Foundation (JPUF) has been founded to ensure that the persons with disabilities have adequate support to participate in the mainstream society
n Around 61 special needs schools are run by the NFDDP through different NGO’s.
n Disability Service Centers are functioning in district & upazila level having a special Autism Corner.
n Arranged training of four thousand doctors, nurses, physiotherapist and special educator in Center for Neurodevelopment & Autism in Children, BSMMU and in National Institute of Mental Health.
n Arranged training of health workers and social activists through batches on autism and neuro-developmental disabilities in sub-districts all districts of Bangladesh
n JPUF (Jatiyo Protibondhi Unnayan Foundation) has been developed the capacity to conduct following training programs:
n Training for the mothers of mentally challenged children;
n TK 200 million has been allocated to the trust established for people with neurodevelopment disorders and TK 50 million to the trust established for the physically disabled
n Government allocated a total of 12.01 acres of land in Savar in favor of Jatiyo Protibondhi Unnayan Foundation (JPUF) to establish a Protibondhi Sport Complex as a center of excellence
n Expansion and development of PROYASH in Dhaka Cantonment Project to provide care to children with autism and disability
Children with autism typically continue to learn and compensate for problems throughout life, but most will continue to require some level of support. Planning for child’s future opportunities, such as employment, education and the services required for support can make this process smoother. People with autism can help to make a change in the world; all they need to be successful is treatment and support from their environment.
(Lt Col Nazmul Huda Khan, MPhil, MPH is Assistant Director, Kurmitola General Hospital).
