Alert on Autism

Will Sri Lanka face a possible epidemic of this disease ask child psychiatrists.

By Kumudini Hettiarachchi

Is Sri Lanka sitting on an autism time-bomb? What are the causes and are we equipped to deal with it? One in every 150 or 100 children may turn out to be autistic in the near future.

This is the prediction of Prof. Hemamali Perera, Consultant Child and Adolescent Psychiatrist, Faculty of Medicine, University of Colombo, who sees “at least one or two new children with autism” at almost every child mental health clinic held at the Lady Ridgeway Hospital in Colombo.

Comparing these figures for autism, established already in countries such as the United States of America, Prof. Perera explains, “All over the world there is a trend towards an autism epidemic and Sri Lanka is no exception,” adding that about two decades ago 3-4 per 1,000 were estimated to be autistic. It is predicted that in the next one year, more cases of autism in children would be diagnosed than new cases of asthma, diabetes and cancer, all put together.

The increased numbers could be due to more doctors identifying autism in children or in fact because there is an upsurge in the condition itself, The Sunday Times learns. Comparisons of now and the last decade strongly indicate a rise, according to Prof. Perera.

Although no single cause of autism has been ascertained yet, one of the already-known causes has been established as genetic. But what of other preventable causes that could be due to foetal (while the baby is in the mother’s womb) exposure to environmental factors such as chemicals used in agriculture or air pollutants?

Quoting a study done in the San Francisco Bay area in California, US, to explore possible associations between autism spectrum disorders and environmental exposures, Prof. Perera explains that the results suggested a potential association between autism and metal (lead and mercury) concentrations, and possibly solvents (vinyl chloride) in ambient air around the birth residence. Such metal concentrations and solvents emanate mainly from industrial sources.

Guiding children with autism at the Child Development Centre in Maharagama

Prof. Perera was also concerned over the possible exposure of expectant mothers to organophosphates or pesticides. “There are serious concerns of the impact of organophosphates on the foetus and whether such children are more prone to autism than others,” she says, adding that she is in touch with Dr. Paul Shattock, the head of the Autism Research Unit at the University of Sunderland in England.

Dr. Shattock whose own son was diagnosed with autism long years ago, has many publications to his credit on the high possibility of organophosphates being responsible for autism.“If autism is caused by organophosphates, it is preventable,” says Prof. Perera explaining that Dr. Shattock has questioned whether some of these organophosphates which have been banned in the west are being dumped in developing countries such as Sri Lanka.

Of a large number of pesticides or bug-killers used across the world, the group known as organophosphates -- synthetic chemical compounds composed of variable mixtures of phosphorus, carbon and hydrogen -- kill by disrupting the brains and nervous systems of pests. However, these chemicals can also harm humans and have been linked to foetal death, hormonal changes, DNA damage, birth defects and a host of other problems, The Sunday Times learns.

As organophosphates act as chemicals that disrupt neuro-muscular transmission, they were developed as neurotoxins during World War II, while the poison gas, Sarin, released by Aum Shinrikyo cultists in 1995 onto the Tokyo underground is the most well-known organophosphate-based chemical weapon.

Prof. Perera points out that in England, organophosphate poisoning has been linked to the Gulf War Syndrome. There have been claims that troops in the Gulf War who exhibited symptoms such as fatigue, memory loss, weakness, joint and muscle pain and depression, may have been exposed to organophosphate pesticide poisoning.

Organophosphate pesticides are estimated to account for 38 per cent of all pesticides used globally. Dealing with the ground realities in Sri Lanka, Prof. Perera also poses the crucial question: Are we ready for an autism epidemic? Do we have enough resources and an organized environment to deal with such large numbers of people who have serious developmental disabilities, to ensure their social wellbeing?

The sectors of vital importance will be health, education and social services. Doctors and other primary health care personnel should be able to detect autism early, to be able to intervene early. The sooner one identifies them, the better, as interventions can help them to lead as normal a life as possible, it is understood.

The education system should also be geared to meet this challenge, for autistic children will need special teaching techniques and in some cases even be tailored to meet individual needs. Citing a positive example, Prof. Perera says the centre set up in Maharagama to train special education teachers and teach autistic children should be replicated in all districts.

Social services, through a welfare programme, should also be able to ease the burden on the family which has an autistic child, she says, explaining that in almost all such families the mother has to stay home to look after the child and that too not only until the child grows up but even as an adult. A special allowance may be necessary for these families, while vocational training facilities need to be arranged for them. “Unless the setting is organized those with autism will be marginalized.”

Prof. Perera’s most urgent plea is for more resources to be made available for the education needs of these children and for more research and studies here in Sri Lanka to find out the external factors which may be contributing to a higher prevalence of autism. “If we can find them and eliminate them, it will be an important step in the right direction,” she adds.