By Dr Shabina Ahmed, MD
On December 18, 2007, the United Nations General Assembly adopted resolution 62/139 declaring April 2 as World Autism Awareness Day (WAAD) in perpetuity. The significance of this resolution is that it is one of only three official disease-specific United Nations Days, the others being Diabetes and Mental Health. The Day aims to bring the world’s attention to autism, thereby developing world knowledge of autism, especially in its early diagnosis and intervention. It formally recognises autism as a growing global health crisis.
WAAD is being celebrated worldwide today. From Glasgow to Guwahati, Stockholm to Shillong, it is being observed with musicals, video conferences, walkathons, lectures, commitments by various world leaders and activities that would bring together organisations and people around the world to give a voice to the millions who are undiagnosed, misunderstood and seeking help.
The world has seen a25-fold increase in 30 years, in the number of children with autism. An Indian study in 4000 households under the International Clinical Epidemiology Network Trust, estimates upto 1.5% of the population, translating to a prevalence rate of 1 in 66, or 10 million children.
The United Nations 2016 WAAD theme is “Autism and the 2030 Agenda: Inclusion and Neuro-diversity” and reflect how the Agenda implicates in improvement of those with autism. Interestingly, the UN 2030 Agenda for Sustainable Development Goals targets that none should be left behind, five of these are explicitly referenced to people with disabilities (PWD). They are quality education, decent work and economic growth, reduced inequalities, sustainable cities and communities and partnerships for the Goals.
What I would like to draw attention to is the reference to sustainable cities and communities, which simply means creating the least carbon footprint and producing the lowest quality of pollution as well as creating an inclusive society. There are studies incriminating environmental factors to autism, much more than previously thought of, and the most susceptible periods are the prenatal and early infancy.
Giving the child the proper environment is paramount. On the occasion of WAAD 2016, we need to look into the social and family environment as well as pollutants, and the impact it makes to autistic persons.
The environment around us not only impacts us through chemical pollutants, but how we structure it for the autistic person is equally vital.
Why do we need to structure the environment? Autistic persons become very anxious and agitated if there are sudden changes in their daily activities, and therefore need to have a predictable routine. Within this caring and supportive environment, they need to accomplish their tasks. It gives them immense confidence and self-esteem.
Empathise with the autistic person as to how he or she views the world around them, and help them in overcoming their difficulties.
Autistic children are very sensitive to noise, light, smell and heat, and thus need a calm ambience. Even the tone of your voice can upset them. Modification of the environment is also desired.
They have no awareness of danger, and parents and caregivers should take special precautions with everyday objects, especially electrical gadgets. A not so uncommon event is when some people with autism run out of the house or school. It is important that some mechanism be developed so that the child can be brought back. It may be a good idea for them to carry some sort of identity on them. Window panes may be covered or replaced with strengthened glass.
Lighting is another important issue with people with autism. They see the various lights as flickering , and to some they emit a humming sound, which can be very distracting. Avoid using blinds, as movement of the head can create a flickering sensation. It is best to use soft, diffuse or even adjustable lighting.It is advisable that soft pastel colours, and not bright patterned wallpaper, be used for the walls. A special sensory room, or a corner, in a distraction-free area may be created for the child to retreat to when necessary.It will contain a selection of sensory items, like bean bags, mirrors, fibre optics,sound system, various types of balls, etc
Autistic children cannot filter out noises the way we do. Noises therefore can be very disturbing. Carpeting or soft flooring are recommended. Because of their increased sensitivity of the senses, subtle smells can overwhelm them. Someone’s deodorant or perfume or the smell of certain materials like fabrics can trigger a panic attack.
Coming to the pollutants that impact autism, it is known that many plastics ontain potentially harmful toxins, being manufactured from a large array of petroleum-based chemicals. Some of these are hormone-disrupting and attach themselves or leach onto food and drinks and impact our health, especially pregnant women and babies where neurodevelopmental changes take place. Leaching is more when plastic comes in contact with oily or fatty foods, more so with heating and from old, scratched plastic, the worst offenders being polycarbonate, polyvinyl chloride (PVC) and styrene.
Polycarbonate contains bisphenol-A, and is mostly used in plastic baby bottles, water bottles, “sippy” cups and clear plastic cutlery. PVC is used mostly as cling wrap, squeeze containers, detergent bottles, cooking oil containers while polystyrene is used in the soft, disposable cups.
It is therefore important that we avoid using plastic containers to heat our food in a microwave oven, as the chemicals are released and get leached onto the food; and more fatty the food, greater the attachment. It is thus advisable to use glass containers. Equally important is to note that cling wraps also should not be used for microwave use. Plastic bottled water should be avoided as much as possible, but if you do, as in travelling, take care that you use a polycarbonate water bottle. Wash the bottles regularly avoiding strong detergents, and discard them if there are scratches.
It is therefore always best to use other alternatives to plastic packaging whenever possible. Next time you go shopping, carry your bags or cardboard boxes.
As you can see, it requires a heart to understand the autistic child. Every autistic person is different, but if we remember that the environment impacts them, then small affordable changes will make a positive impact to the child.
(The author is Developmental Pediatrician Assam Autism Foundation National Awardee for Child Welfare and can be reached at [email protected])