Dear Doctor,

My two-year-old son is a little laid back. He doesn’t say much, just a few words here and there. He has never been playful like other children his age and it worries me. I’m told he could be suffering from autism. How can I know for sure and what can I do to help him? 

Paula

Two yearsis too young to judge a toddler, saying he is a bit laid back. As different growth parameters vary, so does speech. In general, girls outsmart boys in their faculty of speech, that is, in a very young age group; girls speak more and have greater vocabulary than their male counterparts as toddlers.

A boy may simply be shy, hence not able to mix with other children so well. He may not speak and play with them enthusiastically.

If there is some ear problem, either since birth or due to childhood ear infections, a very small child may not hear well. This impairs his speech, as well as social skills. Though, he is not able to express it very well. Any birth defects impairing speech like a cleft lip or palate may make the child isolated, not speaking or playing.

Autism is a development disorder characterised by problems with social interaction and communication and often repetitive behaviour. Parents usually notice these signs at two to three years of age.  Exceptionally, some children may grow normally and show these signs later.

Autism occurs due to genetic and environmental factors. Risk factors include infections like Rubella during pregnancy, use of alcohol, cocaine, and etcetera. Substances during pregnancy, like use of anti-epileptic drugs like valproic acid can cause autism in a child.  Genetic factors also play a part. It affects the processing of information in the brain, by affecting the brain cells.

Some children with autism develop language and communication skills, later in life, whereas some may remain handicapped throughout their lives. The improvement may be spontaneous over time or may occur with interventions.

Autism is diagnosed by clinical features, excluding other genetic and chromosomal abnormalities.  But in addition to lack of communication and social skills, they also have chronic constipation and abdominal pain. A criterion has been set by DSM-v (diagnosis and statistical manual of mental disorders). As such there is no medical therapy. Behaviour and speech therapy can help a child to improve and he may even become near normal. It is an intensive comprehensive approach, involving the family and a team of health professionals. The intervention/interventions used, are based on educational level of the family, their language and cultural norms.  In the event that these interventions fail, certain psychotropic medicines are used.

All concerned should be sensitive towards the child. He should not be ridiculed at all or scolded in any way.

 Dr.Rachna   Pande is a specialist in internal medicine.