The American Psychiatry Association merging of four autism diagnoses into one umbrella diagnoses of Autism Spectrum Disorder (ASD) in 2013 has not gone down well with consultant psychiatrist Dr Subash Kumar Pillai.
He says, “How autism is diagnosed now is very inclusive. If you follow the book, the prevalence of ASD has just shot up because so many things are now included that are not necessarily an issue.
“Before, a child has ASD traits if he doesn’t speak or doesn’t speak much, has repetitive behaviour or doesn’t socialise. What’s the big deal? The important thing is that the child can talk.
“The ones that speak late will eventually speak. They may not be great socialisers and may have repetitive behaviour – as a layperson, we would call them nerds, but now, we label them autistic.”
The important factor, Dr Subash feels, is the environment children are brought up in.
“At a very young age, there is a lot parents can do to improve the child’s environment and skills. We have to get parents to understand that not talking below a certain age is not necessarily a problem. A quiet person will find a quiet interest and be happy.”
If a child has some ASD traits and cannot talk after five or six years, or was speaking a little before stopping, then further investigations are warranted.
“If you don’t manage the problem early, most of these kids will be bullied and taunted in regular school for being ‘different’. Oftentimes, the environment doesn’t work out because these non-sociable children like to ask non-related questions or ask at the wrong time.
“If you put six physicists in a room along with one singer, who is the odd one out? In my book, there is no normal as normal depends on the environment,” opines Dr Subash.
The psychiatrist sees a lot of undiagnosed older teenagers and adults with ASD, who were not given the nurturing environment they needed and now exhibit signs of depression and anxiety, as well as have relationship problems and anger management issues.
Those diagnosed as ASD often have high IQ (intelligence quotient), but low EQ (emotional quotient).
“There is this imbalance. A lot of them may not be geniuses, but they just look at things differently,” he says, citing a former five-year-old patient who could rattle off every brand and serial number of vacuum cleaners in the market.
He recalls, “When I was in Year Four, we used to draw aeroplanes in class, but one boy would only draw sports shoes. He was different and probably became a shoe designer. So maybe, in order to be a designer, you need to be an introvert?
“These are not abnormalities, but gifts that you don’t know how to use when young. Sadly, parents and teachers see it as a problem because the norm is for every boy to draw aeroplanes or play football. Why not chess or archery? A nerd is often an introvert, but so are most doctors!”
Famous people with ASD include scientist and mathematician Albert Einstein, actor Dan Aykroyd, musician Wolfgang Amadeus Mozart, artist Michelangelo, Microsoft co-founder Bill Gates, and creator of Nintendo’s Pokémon Satoshi Tajiri.
Naturally, if these “different” kids are not managed well in childhood, they will have plenty of problems as an adult. Persons with ASD, which is more prevalent in men, can have a normal married life, but their partner may find some issues later.
For example, the autistic man may continue collecting figurines, may not want to go out or to strictly stick to routine. The wife may come to deem him as boring, leading to marital conflict.
“So these ‘nerds’ come to me. They have enough social skills to have a relationship, but often, their partners don’t understand. Initially, the wife may have thought introverts are safe and stable as a life partner, but after a while, she realises he is too predictable.
“If you let it go, the husband ends up becoming more routinised (staying in their comfort zone) and the wife has to take care of everything. They’re very good at work, but where EQ is involved, such as looking after children, they’re not good.
“I have to teach them that routine is not important and they must change. In adults, this is difficult as it is already ingrained, hence, the relationship with the therapist is important,” explains Dr Subash.
If the problem persists and the autistic adult is pushed hard enough, he may feel trapped, burst out in anger and become psychotic if not treated with anti-depressants. Suicide is possible, but not common.
“If they have been labelled as autistic, it becomes a bigger problem as an adult because they have low self-confidence. I usually don’t tell them they are autistic as it’s not necessary. People who fall in this spectrum are ‘experts’; they want things their way.
“A layperson may think they are stubborn, but they are not,” he asserts.
Dr Subash’s advice to improve their social skills: encourage activities in solo sports (archery, chess, etc), music and art. When there is no team effort, they don’t feel overwhelmed. They will excel due to their ability to focus and be detail-oriented.