Defining Autism 6

How Socio Economic Status Affects Children with Autism Spectrum Disorders.

The prevalence of Autism Spectrum Disorders has increased almost 10-fold* in the past 40 years and even faster in the last decade, with some studies conducted in the United Kingdom putting it nearly at 1 in 48* children.

In India, which has such wide socio, economic divides with individual and community resources not being distributed equally the likelihood of an Autism Spectrum Disorder diagnosis is probably much higher and may have increased even more over time*. The Dyslexia Association of India™ believes that to some extent community-level resources can drive increased prevalence.

The level of impairment in communication, social interaction, and certain behaviors that we are observing are leading us to use multimodal and a wide selection of tests to understand some of the factors associated with increased risk and rising prevalence.

Individual risk factors such as exposure to toxicants, prenatal complications, or parental education are no longer sufficient to explain why autism prevalence rates have increased so stunningly.

We believe that the socio economic status of the family and the parents can also impact upon the incidences and occurrence of Symptoms of Autism. The characteristics of a place or places could drive the rate of a diagnosis of Autism. Diagnoses. Which means that it is quite possible that otherwise similar children living in different geographical areas could be at significantly different risk for autism, not because of their own characteristics, but because of the characteristics of the communities in which they reside.

We do observe from the children who come to the Dyslexia Association of India™ a strong temporal patterning of risk based on where and which community level they belong to along with certain demographics and we notice that an increase or a decrease in risk associated with community characteristics map onto changing prevalence rates. What this means is that there are certain critical social factors that map onto changes in prevalence rates for Autism Spectrum Disorders in India, and over time we can help parents who come to us understand the way in which individual and neighborhood characteristics interact over a time period to shape health outcomes for children.

Indian Parents – incorrectly assume that communities and institutions do not exert any influence over time; and that neighborhood where they elect to stay and where they have their children is a static platform of life.

However, the socioeconomic gradient for Autism Spectrum Disorders has undergone a change as we observe over the course of the last decade, with changing socioeconomic health gradients.

Health inequalities can provide important insight into factors that may mitigate or exacerbate the prospects of bearing a child who might be born with the prospect of an Autism Spectrum Disorder to a couple today.

Reality states that social status can have a significant affect on health. The more resources young couples have, the less likely they are to experience a child being born with a Neurodevelopmental Disorder. The negative socioeconomic health gradient, we have observed from the couples coming in to the association indicate that socioeconomic status itself is a fundamental cause of the prognosis of a childs mental health where issues like Autism Spectrum Disorders are concerned.

Technological and medical advances are available and can create opportunities for better health, for the educated and economically better off who are able to exploit these opportunities for their children’s mental and overall health.

A lot of parents do not understand how health disparities can manifest despite the reality that where they live has an important effect on their health and this includes the neighborhood context.

The physical environment can affect health directly and indirectly. Directly, it can expose young couples about to have a baby to toxicants, and in our country a lack of social cohesion and disorganization increases stress and isolation, thereby adversely impacting a expectant mothers health and well-being.

India yet does not have an efficient network, which can influence health outcomes by shaping how parents and expectant mothers identify and treat health issues during the expectation period that can cause Neurodevelopmental Disorders.

The DAI™ does try to structure opportunities for social interaction through the architecture of putting parents in touch with each other but this is limited as we as a culture can be quite conservative.

While the cause of Autism remains unknown - and highly uncertain. At the biological level, we know that parental, prenatal, perinatal, and obstetric risk factors have identified a host of conditions associated with an increased risk of Autism.

Parents need to keep in mind their own age when they decide to have a baby, the birth weight of the child, the Apgar score, multiple births – and a host of factors, which we can share with you when you come to the Association to meet us.

Are there genetic factors where Autism Spectrum Disorders are concerned and how important are they or what is the concordance rate and is there indirect evidence of substantial heritability are issues that parents must begin to think on.

Parents who come for an initial appointment are taught how environmental toxicants including chemicals where they live and stay can have an effect and which are these chemicals which are known to cause neuro-developmental disorders, including autism and also have neuro-toxic effect upon exposure, and might be implicated in Autism Spectrum Disorders.

Autism Spectrum Disorders can be difficult to diagnose because there are no known biological markers and the symptoms are hard to assess, especially among children with cognitive impairments. The Dyslexia Association of India™ is probably the singular body (in South Asia and SE Asia and the Middle East)* where diagnoses are based on scientific foundations. This prevents diagnostic substitution and diagnostic accretion and substitution together.

Parental social characteristics, such as socioeconomic status, education, and occupation or income, or wealth and it correlation with Autism Spectrum Disorders are very precise issues that we discuss and ascertain when checking a child, and using area-based measures of socioeconomic status, the data for which has been complied by the DAI™ that prevalence of Autism Spectrum Disorders and how and where they show an increase with socioeconomic status in a dose-response manner is used to help parents.

Resources do matter in India because obtaining an autism diagnosis can be extremely difficult. In India obtaining a diagnosis and services for their children, parents confront a dizzying private and highly confusing maze and spend considerable resources navigating through it.

The Dyslexia Association of India™ has cut down the maze and converted the entire process into a single point analytic arena with screening resources, service availability, and clarity being made transparent for parents.

With virtually nil parental and community resources for an Autism Spectrum Disorders diagnoses our personal and equivocal opinion is that Autism Spectrum Disorders have a socioeconomic gradient. The DAI™ has probably alone infused resources into the community to diagnose and remediate Autism which coincides with changes in the Autism gradient.

It may come as a surprise to parents, but if their child is a first-born child, a boy, or having older or more educated parents – we have found* that there is an increased the risk for Autism Spectrum Disorders. De novo mutations, age as an indirect proxy for elements of socioeconomic status or being born a male can be associated with an increased and greater risk of an Autism diagnosis.

How birth weight is linked to the likelihood of an Autism Spectrum diagnosis, as is birth-order is something we can advise the parents who are planning a baby or have a baby or child showing differences and who may be at greater risk for Autism Spectrum Disorders.

Evaluation of concentration of certain fat-soluble chemicals slower development of immune characteristics and temporal variability are all aspects of how we approach the diagnoses at the DAI™.

Cross-level interactions show us that as India progresses we are viewing children from neighborhoods in the bottom versus children residing in a wealthier neighborhood showing variances and the variance is tilted negatively towards the lower socioeconomic neighbourhood and urban as well as rural areas, but this may come as a surprise to educated and well settled parents that their strata is revealing an important temporal pattern that yields insight into changes in the socioeconomic gradient for Autism Spectrum Disorders being on the rise and that too on a much faster rate.

Whereas Autism Spectrum Disorders had a strong positive socioeconomic gradient in India with children born to weaker sections less educated parents living in environmentally difficult neighborhoods who had the highest probability of obtaining an Autism diagnosis, the diagnostic rate for this group is near constant in ratio of increase but incidents and diagnoses among economically well of parents appear to have started to increase. While neighborhood resources matter tremendously for Autism prevalence rates and they matter much more for children born to parents with fewer economic resources, the trend have began to equalize and the socioeconomic gradient for autism has begun to reverse with well to do communities, now showing a different picture.

The only difference is that when we take the cases of Autism Spectrum Disorders we see in children coming to the DAI™, and split them by severity, a striking pattern is revealed. Less severe cases are disproportionately found in well to do and socioeconomically strong and educated neighborhoods.

For those parents who are what is known as ‘double income single kid’ or ‘DINK’ please be cautioned that severity is not independent of the neighborhood context, and the ratio is not one to one. We are observing that the most diagnostically ambiguous cases, those that are the hardest to identify and diagnose because the symptoms that provide a basis for diagnosis are less pronounced, and are disproportionately found in educated and well to do neighborhoods with the observed socioeconomic status gradient for Autism Spectrum Disorders at least partially driven by identification and ascertainment.

As prevalence rates are beginning to increase at a faster pace and diagnoses became less more common among parents with high socioeconomic status, the community gradient is becoming stronger for India*.

Parents reading this must appreciate that individual and community resources matter differently at different points in the evolution of the disorder. Now in India, we feel equivocally that higher levels of parental education and parental economic resources are consistently associated with an increase in the likelihood of children with Autism Spectrum Disorder.

Autism Spectrum Disorders are going to be evident in increasing numbers and are assuming epidemic strength, if we view them in proportion to Neurodevelopmental Disorders and this is not being helped with the fact that a strong neighborhood socioeconomic gradient has weakened as prevalence rates have increased and this along with weak neighborhood gradients are unfortunately increasing and not stabilizing.

With the expression of socioeconomic status becoming strongly positive for less severe cases and the strength of socioeconomic status effects for more severe cases also staying strong, we will be faced in India with increasing levels of Autism Disorders with socioeconomic status of neighborhoods dynamically shaping health outcomes.

The Dyslexia Association of India™ would encourage parents who have been through a difficult pregnancy, or where someone in the family has a problem that has affected their day-to-day life and specially academics and social interaction – to come forward and speak to us. We would encourage parents who have planned and had their children after the age of 33 or 34 to specially educate themselves on the issue of Autism Spectrum Disorders and take the initiative to make an appointment with our professionals. Even if there are far of relatives who have suffered depression or the parents specially the mother of the child who is showing behaviours and academic deficits and differences, has passed through very stressful stages of pre pregnancy and during and after the pregnancy or suffered and is suffering from depression should as a couple make an appointment and meet with us along with their child.

Our research on the Human Brain and specially the patented T.R.A.I.N™ or the Targeted Remedial using Advanced Intensive Neuroplasticity™ programme has proven that the earlier we start with the identification process of such Neurodevelopmental Disorders, the greater the possibility for us to bring about lasting cortical* changes in the childs brain.

Probably in India, parents begin to weigh the financial impact on them if they have their child assessed and diagnosed and how it will affect their lives. We would like to advise them that a cost for an assessment for a child cannot exceed a few thousands of rupees and subsequently any supplement or a activity done at home is for a better prognosis for their own child.

So don’t let the financial consideration hold you as a parent down. The loss of the childs future for the need to save a few thousand can be heartbreaking in the long run.

To make an appointment with the DAI™ please call us on +91 – 8826022886 or e mail us for an appointment on as at the Dyslexia Association of India™ we have a strict policy to comprehensively check and diagnose only one child per day.

Any payment that is made for your appointment at the DAI™ qualifies for exemption from Income Tax (IT) and parents are provided a Section 80G receipt so that they can use it when filing their Income Tax Returns.

* Opinions and information expressed by the DAI™ are equivocal and specific to the organization.