INTERVIEW WITH CHILD AND ADOLESCENT PSYCHIATRIST
CHILDREN, ADULTS WITH AUTISM HAVE DIFFICULTIES WITH EVERYDAY SOCIAL INTERACTION
Jan 14 - 20, 2008
LAHORE: Dr. Faria Khan is a child and adolescent psychiatrist. She has worked in psychiatry in Lahore and Ireland and completed her specialist registrar training in child and adolescent psychiatry from Manchester, UK.
Currently, Dr Faria is working as an NHS consultant in the Early Intervention Services in Lancashire, UK. She is also actively involved in research projects for the development of child and adolescent mental health services in Lahore and has recently helped in setting up the autism friendly group. Her other interests include Healthcare Management- Policy and planning, for which she is currently doing a Masters Degree form Manchester Business School. As she believes in a holistic approach in the management of her patients she also has a degree in Traditional Chinese Acupuncture.
During her visit to Lahore, Dr Faria Khan shared her experiences with the Pakistan and Gulf Economist (PAGE).
Talking about autism, Dr Faria Khan said it is not a mental health illness rather autism is a neuro developmental disorder meaning a lifelong developmental disability that affects the way a person communicates and relates to people around them. "Children and adults with autism have difficulties with everyday social interaction. They have limited ability to make friends and have limited capacity to understand other people's emotional expression. Most people with autism have learning disabilities placing them at the lower end of the spectrum"", she added. Asperger syndrome, which is a form of autism, describes people who are usually at the higher functioning end of the autistic spectrum. They can also have high IQ scores making them a genius in their fields e.g. Einstien, Beethoven. Aspergers disorder was first described by Hans Asperger in 1944, she added.
To a question Dr Faria Khan said the prevalence of autistic spectrum disorder (ASD) appears to be agreed at 5-6/1000 in UK. To date there are no prevalence studies carried out in Pakistan. However, in the UK a study carried out by Morten et al showed that in the ethnic minority population Pakistani families have a higher rate of children with a diagnosis of autism, she added.
Talking about characteristics of autism, Dr Faria Khan said diagnosis of autism is based on a triad of abnormalities which are present most of the time in a child's functioning in all situations. These are communication difficulties with speech and language, verbal and non-verbal communication; the child is not fully able to understand the meaning of common gestures, facial expressions or tone of voice. Abnormality in Social interaction results in difficulty with social relationships, for example appearing aloof, poor eye contact and indifferent to other people. These children also show stereotyped and repetitive patterns and resistance to change in routine. They can also have particular sensory behaviours e.g. intolerance to noise, she added.
In Aspergers disorder there is no clinical significant general delay in spoken or receptive language. However, there are impairments in social interaction and a narrow range of interests. It is also associated with motor clumsiness. A diagnosis of Aspergers is difficult as usually children present in their teen years to mental health professionals. This can result in a misdiagnosis of a psychotic (schizophrenia/bipolar affective disorder) illness due to similarity in the presentations. This diagnostic difficulty is also encountered by mental health professionals in the UK, she pointed out.
She said there can be a number of associated (co-morbid) mental health conditions presenting with autism which will require pharmacological treatment, the most common is depression (30%), epilepsy (25%), ADHD (attention deficit hyperactivity disorder)
Talking about causes of AUTISM, she said more evidence based medicine is showing a strong genetic link in the development of autism (60% in identical twins). A group of genes has been identified leading to ASD. Theory of mind hypothesis (inability of an individual to understand other people's feelings) also holds strong.
The concept of MMR vaccination causing autism though thoroughly researched and disputed still raises questions in parent's minds, she added.
She said there are number of other environmental factors e.g. mercury poisoning suspected of causing autism but there is still no conclusive evidence to back any suspicions.
In an ideal world, she said assessment should be carried out by professionals trained in child and adolescent mental health however in Pakistan due to the shortage of such professionals this role lies with adult mental health professionals.
A comprehensive Assessment of Autism involves a detailed clinical history, physical examination and investigations, speech and language assessment and neuropsychological assessment. Some specific tools for diagnosing autism are Autism Diagnostic Interview (detailed structured interview with parents regarding the Childs early and ongoing development) ñ Revised, Autism Diagnostic Observation Schedule is a Semi-structured & standardised assessment. It has four modules thus allowing different age groups to be assessed according to their developmental level. It assesses in four domains language & communication, reciprocal social interaction, play & creativity/imagination and stereotyped behaviours & restrictive interests.
Multi disciplinary team approach to management is essential. Specific interventions involving a structured environment, Improving communication skills, Appropriate Educational placement, Psychological interventions, Pharmacological interventions, Risk assessment and management, Vocational Training, Supported living and self support groups help.
The natures of interventions vary, depending on the training of the therapist. They range from communication-based approaches that build on the strengths of the person with autism, such as PECS (Pictorial Exchange Communication System) and TEACCH (Treatment of Autistic and Communication Handicapped Children) to more traditional behavioural techniques designed to teach basic learning skills, such as ABA (Applied Behavioural Analysis). Results suggest positive effects for those receiving preschool specific intervention, Dr. Faria said.
In Pakistan, she said, though there is some work being carried out on individual basis with limited training, there is the strong need to train and develop specific skills of professionals involved in managing these children. The autism friendly group is a group of parents and professionals who have joined together and are planning to develop this service. Other parents and professionals with an interest in autism are very welcome to join this group. There is also a need to conduct research in this particular group of children to understand our cultural perspective of the disorder. So far we rely on the west for this information, she concluded.