Early screening, treatment and education can improve the quality of life for children and adults with Autism Spectrum Disorder (ASD), but a lack of awareness and trained professionals is limited especially lower-income communities in South Africa and the world.

Although statistics in South Africa are scarce, a study conducted in the Western Cape noted an increase of 76% in children with autism in schools.  Their findings are in line with the 2023 Centre for Disease Control and Prevention report reporting that approximately 1 in 36 children in the United States is diagnosed with ASD, higher than the previous 2018 estimate that found a prevalence of 1 in 44 (2.3%).

On World Autism Day (2 April) the South African Society of Psychiatrists (SASOP) calls for better understanding and an increase in health and education sector resources that can improve the lives of those affected by autism beyond only those that can afford to pay for services.

Dr Kedi Motingoe, a child psychiatrist and member of SASOP, says those who present with autism are unnecessarily stigmatised and isolated by their developing peers, parents and teachers.

“Autism, in affluent societies, is usually diagnosed by the time the child is 3 to 4 years old. Symptoms present early in the child’s development and behaviours such as the way they learn, speak, play and behave in a social context. In reality, though these children are more often undiagnosed and ruled as ‘difficult, dangerous, bad-mannered, uncontrollable, a savant, introverted and is the result of poor parenting’.

Autism is diagnosed three to four times more often in boys than girls and is a developmental disorder linked to early brain development. Although the causes are not clear, genetics, environmental factors and complications during birth do play a role.

“Autism is not a psychological, emotional or behavioural disorder, but rather a brain-based, neuro-psychiatric condition that requires treatment and support.  Those with autism experience difficulties in social situations, with verbal and non-verbal communication, and have an under or over sensitivity for sounds, smell and touch,” explains Dr Motingoe.

“Most parents become concerned due to difficulties fitting in at nursery school and behavioural issues such as tantrums. Over-stimulation is common in children with autism, and if they are not able to communicate how they are feeling it can result in aggressive behaviour such as biting.”

She says that later diagnosis in high functioning autism, either in school due to difficulties in learning or relationship with peers or teachers, portray as poor academic achievement compared to their actual intellectual capabilities.

“We cannot over-emphasise the role of education in assisting children to develop social and communications skills in order to cope with the world around them. Those on the mild spectrum of autism can comfortably be included in mainstream education, provided there is adequate recognition of their needs. Those with more severe autism are more responsive in specialised schools where intensive intervention is applied.”

The signs of autism

Little awareness of, or disinterest in others, difficulty in interacting socially, lack of eye contactSocial interactions predicated mainly on the child’s particular interestsDistress caused by changes in routine or environment, especially extreme distress for no apparent reasonNon-typical patterns of play, preferring to play alone, lack of imaginative play, repetitive behaviours or unusual habits such as rocking, flapping hands or constantly spinning objectsGross or fine motor skill development that doesn’t match the usual developmental milestonesRigid thinking style, that may be without humourHypo or hypersensitivities in sensory modalities such as visual stimuli and pain, a dislike of being touched or held, or a sense of touch, taste, smell, sight or hearing that seems extra-sensitive, or less sensitive than usual; may result in very rigid food preferencesDelayed or non-typical development of speech and language, or the child appears not to hearDifficulties holding the perspective of another

Treatment for autism

Early intervention is vital to maximise the child’s development and to reduce negative consequences such as depression, poor self-esteem, family breakdown or increased stress for the parents.

Parent and sibling support is crucial and treatment generally starts with interventions that coach parents and caregivers on debunking the myths of simply having an unruly child, to rather focus on how to engage with the child, knowing what to expect and how to support them.

Occupational therapy, especially for sensory integration and speech therapy interventions, improves communication, cognitive and social skills, reduces distress for the child and supports positive behaviour changes.

Specialised education depending on the severity and presence of intellectual impairment, should be considered and for those with higher functioning, a supporting mainstream environment where the parents and the teachers work holistically to support the child.

Although there is no specific medication for autism itself, medication may be prescribed for other conditions that exist alongside such as attention deficit hyperactivity disorder (ADHD), epilepsy, anxiety or other neurological conditions.

Where to find out more and get help

Autism South Africa (ASA) advocates for greater awareness of autism, to educate the public, educators and policy-makers; and offers information resources, support and training for parents, caregivers and community organisations working with autism. Their practical, easy-to-understand guide to autism is published in seven of South Africa’s official languages. Find out more at www.aut2know.co.za