ISLAMABAD: Autism spectrum disorder (ASD), commonly known as autism, is a recognised disability in the West but has yet to be acknowledged in Pakistan, where only four categories of disability are considered – visual impairment, hearing impairment, physical disability and mental retardation (MR) – a paediatrician said in a statement on International Autism Day on Wednesday.

Dr Syed Hashim Raza, a consultant paediatrician and specialist in neurodevelopment and neurodisability at the Pakistan Institute of Medical Sciences (Pims) said in a statement issued from the hospital that “there are no further categories within this entity of MR to delineate the extent and nature of intellectual deficit, subsequently no appropriate services could be put in place to help alleviate their difficulties.”

“There is a stigma attached to the word disability predominantly mental within Pakistan, whether it is culturally or socially constructed is debatable, but it certainly prevails within the most modern realm of the elite society as well within the rural demographics of Pakistan,” he added.

Everyone should play a part in changing attitudes towards people with autism, NHS DG says

Dr Raza said many causes of autism have been suggested, but the theory of causation is still questionable.

He said research suggests that autism develops from a combination of genetic and non-genetic or environmental influences.

The number of children with autism in Pakistan is not known, he said, but added that considering the recent census and figures quoted from the United States – 1 in 59 children – a rough calculation would suggest there are 1.7 million children with the condition. He said that taking the country’s birth rate into account, thousands are added to this figure every year.

He said the vast majority of children go undiagnosed or labelled under “mental retardation as an unprecedented sum of doctors are unaware and have difficulty contemplating what this neurological condition is including sadly pediatrician.”

“Thus almost all rural based and some urban based families resort to traditional healers or religious pirs and if that doesn’t suffice then seclusion or even being chained is the only means of dealing with issue at hand,” he said.

At a seminar held to mark International Autism Day at Shifa International Hospital, speakers explained that autism refers to a broad range of conditions characterised by challenges with social skills, repetitive behaviours, speech and nonverbal communication as well as by unique strengths and differences.

According to the Centres for Disease Control and Prevention (CDC), autism affects an estimated one in 59 children in the US, and boys are four times more likely to be diagnosed with autism than girls.

Autism specialist Haleema Sadia said at the seminar that several factors may influence the development of autism and it is often accompanied by sensory sensitivities and medical issues, such as gastrointestinal disorders, seizures, sleep disorders and mental health challenges such as anxiety, depression and attention issues.

Autism’s most obvious signs tend to appear between two and three years of age, she said, but in some cases it can be diagnosed as early as 18 months.

Ministry of National Health Services (NHS) Director General Dr Asad Hafeez, who also serves as the chairman of the executive board of the World Health Organisation, said everyone should play a part in changing attitudes towards people with autism and in recognising their rights as citizens, who, like everyone else, are entitled to claim those rights and make decisions for their lives in accordance with their own will and preferences.

“We should also honour and respect each individual living with autism. We should also acknowledge efforts of parents, teachers, and caregivers, who provide support to those living on the autism spectrum,” he said.

Dr Raza said autism lies between ongoing social problems (communication and interaction difficulty) and repetitive behaviours, as well as limited interest or activities, such as intense focus on one item, unresponsiveness, lack of understanding of social cues (like tone of voice or body language), repetitive movements or self-abusive behaviour such as head-banging are some of the strong indicators of being at the risk of ASD. The severity of the symptoms varies widely among affected individuals.

Consultant psychiatrist Dr Abdul Wahab Yousafzai said early diagnosis and proper interventions result in better functioning of the individual ensuring his or her acceptance in society. He said prevalence keeps increasing because people worldwide are being enlightened with the signs and symptoms of the disorder along with the guidelines on how to manage autism.

Published in Dawn, April 4th, 2019