Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by specific symptoms, including two main impairments: deficits in social skills and communication, along with abnormal behaviors. The severity of these symptoms can vary. For example, a child with mild symptoms might briefly make eye contact and respond when called, whereas a child with more severe symptoms may avoid eye contact, show no effort to engage others in their interests, and display a flat affect. Common behaviors include repetitive actions, such as hand-flapping when excited, spinning, walking on tiptoes, or repeating meaningless sounds or phrases from adults or media sources, unrelated to the current situation. Children with ASD may also have intense, narrow interests and show resistance to changes in routines. Sensory integration issues are frequent, such as extreme fear of certain sounds or indifference to pain or injury. These symptoms significantly impact the child’s development, learning ability, and daily life, as well as that of their family.

                       
                       Currently, the incidence of autism diagnoses is increasing globally. Although the exact cause is unknown and there is no cure, early diagnosis and ongoing integrated therapy can significantly help. With appropriate care from family members, children with autism can improve their symptoms and increase their chances of social integration. Since caring for a child with autism requires considerable dedication and time, family members play a crucial role in supporting and assisting each other. Caregivers should be well-informed about the disorder, treatment options, common developmental issues, and co-occurring conditions. Information can be obtained from healthcare professionals and reputable sources. Early acceptance and intervention are beneficial for developmental progress and social integration. Joining parent support groups can also be very helpful.
 

Holistic Care for Children with Autism

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1. Promoting Social-Emotional Skills

Social-emotional skills are fundamental for interaction and communication, involving the ability to understand oneself and others' needs, emotions, and feelings, and to regulate emotional expression appropriately. These skills are crucial for future social success. Examples of promoting social-emotional skills include:

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                 1.1 Social and Communication Skills through Play (DIR/Floortime):  This method involves interacting with the child through play, which is child-centered and interests-based. Parents should engage actively with their child, avoiding passive activities like screen time. Frequent and prolonged interactions help the child step out of their world and develop relationships, leading to improved social and language skills.

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               1.2 Social Skills Training: When a child interacts with others but still struggles with social skills, such as inappropriate behavior, difficulty asking to play, or resolving conflicts, ongoing social skills training is essential. This training might include role-playing, practicing dialogue patterns, or using social stories.

 

                1.3 Social Stories: These are narratives designed to help children understand social situations, emotions, and appropriate behaviors. They feature the child as the protagonist and include illustrations and simple descriptions of desired behaviors in specific situations.

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        2. Stimulating Language and Communication Development To bring a child's language development closer to their peers, enabling effective communication of needs and emotions, and reducing undesirable behaviors:

 
               2.1 Speech therapy can be practiced both at home and with professionals. The principles of promoting spoken language include:
 

      2.1.1 Avoid having the child be alone or with inanimate objects such as tablets, computers, mobile phones, or televisions. This is because screen-based media provide one-way communication and reduce the opportunities for the child to practice interacting with humans.
 

      2.1.2 Expand your child's vocabulary by describing activities as you do them, including describing emotions and feelings. Engage in language-related activities such as reading storybooks and singing songs with your child.
 

      2.1.3 Encourage the child to communicate their needs, for example, by making confused expressions to prompt the child to use gestures or words to express their needs. Stimulate speech through play by creating situations that encourage communication. For instance, when playing with a puzzle, you might hide a piece to prompt the child to ask for it, or give the child someone else’s shoes and encourage them to say “not mine” or ask for their own shoes.
 

      2.1.4 When the child begins to communicate using single words or short sentences, model complete sentences for them. For example, if the child says “water,” you might expand the sentence to “You are thirsty and want to drink water.”

 

                 2.2 Alternative Communication: For children with severe speech limitations, alternative communication methods, such as Picture Exchange Communication System (PECS) or communication apps, can be used.

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        3. Encouraging Self-Help Skills Children should be encouraged to develop self-help skills for daily activities, promoting independence, fine motor skills, planning, task management, and self-esteem. Visual aids, such as step-by-step guides, can help children complete tasks independently.

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        4. Occupational Therapy Occupational therapy addresses difficulties with fine motor skills required for daily activities or writing. Parents can support muscle development through activities that enhance fine motor skills, such as drawing, cutting, or assembling.

 

        5. Sensory Integration Therapy

               Children with autism often have sensory processing issues, including hypersensitivity, hyposensitivity, or sensory-seeking behaviors. Sensory integration therapy helps adjust these responses to improve calmness and learning readiness.

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        6. Behavioral Intervention

               Parents should observe their child’s behavior in various situations and stimuli. Behavioral interventions involve reinforcing appropriate behaviors with praise or rewards and addressing undesirable behaviors by ignoring or redirecting attention. Consistent responses and family-wide adherence to strategies can improve behavior and developmental outcomes.

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        7. Educational Intervention

               Educational interventions aim to enhance social, communication, and cognitive skills. Children should participate in educational programs suited to their abilities, whether integrated in regular schools or specialized settings, focusing on life skills and social interaction.
 

        8. Pharmacotherapy

               While medication cannot cure autism, it can alleviate co-occurring symptoms such as irritability or aggression. Medication should be used cautiously and adjusted based on the child's response and overall needs.

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        9. Ongoing Monitoring Autism is a chronic condition requiring regular follow-up as children may have persistent issues affecting social integration. Monitoring for co-occurring conditions like ADHD, learning disabilities, and mental health issues is important.
 

        10. Complementary and Alternative Medicine (CAM)

               Various CAM approaches, such as hyperbaric oxygen therapy or dietary changes, are used, though their efficacy lacks robust evidence.

Although there is no cure for autism, appropriate treatment and family support can significantly improve a child’s development and ability to interact happily with others.

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  Dr. Prakasit Wannaphasaiyong

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  Dr. Sureeluk Sujaritpong

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  Associate Professor Department of Developmental and Behavioral Pediatrics Department of Pediatrics, Faculty of Medicine Siriraj Hospital

 

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2. Hyman SL, Levy SE, Myers SM, AAP COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020; 145(1):e20193447

3. Long M, Brown KR. Autism Spectrum Disorder. Pediatr Rev. 2021; 42(7): 360-374