Understanding autism: More than 1,000 cases reported in Bagmati Province

KATHMANDU: Bagmati Province is witnessing a surge in autism cases, with more than 1,000 reported cases, according to the Ministry of Health and Population of the Province. The lack of a comprehensive system to record these cases has led to challenges in accurately assessing the extent of the issue. Dr. Shakar Khanal from the ministry emphasized that the actual number could be significantly higher than the reported 1,253 cases.

Of the 13 districts in the province, Kathmandu has the highest number of reported cases with 495, followed by Lalitpur with 83, Bhaktapur with 78, Chitwan with 113, Makwanpur with 77, Nuwakot with 65, Sindhupalchok with 54, Dhulikhel with 33, Sindhuli with 65, Ramechap with 28, Kavre with 75, and Rasuwa with 17 cases. Notably, the majority of cases involve children aged between 5 to 7 years old.

Globally, autism affects 1 in 100 children, and while estimates suggest around 300,000 people in Nepal are affected by autism, there is a pressing need for more accurate data. The government is urged to establish a proper system and infrastructure for recording cases, ensuring a more precise understanding of the prevalence of autism and facilitating targeted support for affected individuals and their families.

What is autism?

Autism spectrum disorders (ASD) are a diverse group of conditions. They are characterized by some degree of difficulty with social interaction and communication. Other characteristics are atypical patterns of activities and behaviors, such as difficulty with transition from one activity to another, a focus on details and unusual reactions to sensations.

The abilities and needs of autistic people vary and can evolve over time. While some people with autism can live independently, others have severe disabilities and require life-long care and support. Autism often has an impact on education and employment opportunities. In addition, the demands on families providing care and support can be significant. Societal attitudes and the level of support provided by local and national authorities are important factors determining the quality of life of people with autism.

Characteristics of autism may be detected in early childhood, but autism is often not diagnosed until much later.

People with autism often have co-occurring conditions, including epilepsy, depression, anxiety and attention deficit hyperactivity disorder as well as challenging behaviors such as difficulty sleeping and self-injury. The level of intellectual functioning among autistic people varies widely, extending from profound impairment to superior levels.

Key facts

Autism – also referred to as autism spectrum disorder ̶ constitutes a diverse group of conditions related to development of the brain.

About 1 in 100 children has autism.

Characteristics may be detected in early childhood, but autism is often not diagnosed until much later.

The abilities and needs of autistic people vary and can evolve over time. While some people with autism can live independently, others have severe disabilities and require life-long care and support.

Evidence-based psychosocial interventions can improve communication and social skills, with a positive impact on the well-being and quality of life of both autistic people and their caregivers.

Care for people with autism needs to be accompanied by actions at community and societal levels for greater accessibility, inclusivity and support.

Epidemiology

It is estimated that worldwide about 1 in 100 children has autism. This estimate represents an average figure, and reported prevalence varies substantially across studies. Some well-controlled studies have, however, reported figures that are substantially higher. The prevalence of autism in many low- and middle-income countries is unknown.

Causes

Available scientific evidence suggests that there are probably many factors that make a child more likely to have autism, including environmental and genetic factors.

Extensive research using a variety of different methods and conducted over many years has demonstrated that the measles, mumps and rubella vaccine does not cause autism. Studies that were interpreted as indicating any such link were flawed, and some of the authors had undeclared biases that influenced what they reported about their research. 

Evidence also shows that other childhood vaccines do not increase the risk of autism. Extensive research into the preservative thiomersal and the additive aluminium that are contained in some inactivated vaccines strongly concluded that these constituents in childhood vaccines do not increase the risk of autism.

Assessment and care

A broad range of interventions, from early childhood and across the life span, can optimize the development, health, well-being and quality of life of autistic people. Timely access to early evidence-based psychosocial interventions can improve the ability of autistic children to communicate effectively and interact socially. The monitoring of child development as part of routine maternal and child health care is recommended.

It is important that, once autism has been diagnosed, children, adolescents and adults with autism and their carers are offered relevant information, services, referrals, and practical support, in accordance with their individual and evolving needs and preferences.

The health-care needs of people with autism are complex and require a range of integrated services, that include health promotion, care and rehabilitation. Collaboration between the health sector and other sectors, particularly education, employment and social care, is important.

Interventions for people with autism and other developmental disabilities need to be designed and delivered with the participation of people living with these conditions. Care needs to be accompanied by actions at community and societal levels for greater accessibility, inclusivity and support.

Human rights

All people, including people with autism, have the right to the enjoyment of the highest attainable standard of physical and mental health.

And yet, autistic people are often subject to stigma and discrimination, including unjust deprivation of health care, education and opportunities to engage and participate in their communities.

People with autism have the same health problems as the general population. However, they may, in addition, have specific health-care needs related to autism or other co-occurring conditions. They may be more vulnerable to developing chronic noncommunicable conditions because of behavioural risk factors such as physical inactivity and poor dietary preferences, and are at greater risk of violence, injury and abuse.

People with autism require accessible health services for general health-care needs like the rest of the population, including promotive and preventive services and treatment of acute and chronic illness. Nevertheless, autistic people have higher rates of unmet health-care needs compared with the general population. They are also more vulnerable during humanitarian emergencies. A common barrier is created by health-care providers’ inadequate knowledge and understanding of autism.