Ep. 194: Autism in children and adults: different or the same?

00:00:00: Welcome to EANcast, your weekly source for education research and updates from the European Academy of Neurology.

00:00:26: kids, small adults organized by the scientific panel of child neurology on European Academy of Neurology.

00:00:35: The main item we will discuss today is autism spectrum disorder patients having ASD and a transition from their early childhood into adolescence.

00:00:53: My name is Taras Voloshin.

00:00:56: I'm a Ukrainian doctor specialized in autistic disorders, and have my PhD thesis done on ASD patients.

00:01:07: We've got two guests along with me.

00:01:10: That's Dr Lavanya Damodaran.

00:01:14: She's a consultant pediatric liaison neuropsychiatrist at the Birmingham Children's Hospital from Birmingham in Burmese game UK and Dr.

00:01:25: Malik, Dr.

00:01:26: Osman Malik is a consultant child and adolescent Europe psychiatrist from Avalina London Children's Hospital also from the UK.

00:01:38: so we are glad to congratulate you here And I hope that will have fruitful discussion.

00:01:44: Welcome both of you.

00:01:47: Thank You for joining us today and making such great company.

00:01:52: We may start from Lavania, Damodaran.

00:01:55: Yes and you will be the first one to introduce us that topic of ASD criteria diagnostic criteria And let's say these core features of the disease.

00:02:10: Thank You very much for EAN and terrorist.

00:02:13: for this in mind I am pleased to be here along with a colleague Dr Malik To talk about autism spectrum disorder, it is a neurodevelopmental condition characterized by persistent deficits in social communication and interaction.

00:02:30: In multiple contexts as well.

00:02:42: Symptoms must be present in the early developmental period, but there is also a caveat that I will explain in the next question.

00:02:51: Symptomes tend to cause significant impairment and social occupational and important areas of functioning.

00:03:00: These are captured with semi-structured assessments such as autism diagnostic observations scheduled to Autism Diagnostic Interview revised within a multidisciplinary setting in children and there are use of questionnaires like autism spectrum quotient in adult settings.

00:03:18: So what's your opinion, Dr.

00:03:20: Damodaran?

00:03:21: Is it a fundamentally same disease in small kids and adults?

00:03:30: how do you think... What is your personal opinion on that?

00:03:34: Personally having looked after the children as well as young adults has they transitioned into their adulthood?

00:03:42: We would say that we tend to see the core features, the core diagnostic features of autism present throughout The Life's Fan.

00:03:51: They might manifest slightly differently based on their skills and experiences life experiences however but you know...we'd still say they are similar.

00:04:04: also looking at the diagnostic features the requirement is that they persist through out life, regardless of when the diagnosis is made.

00:04:14: So important features of DSM-FI definition that supports diagnosis in adulthood are their diagnostic behavior descriptions applied to all ages.

00:04:24: Behavior contributing to a diagnosis can be current or historical and the criterion for specific early age onset is no longer required must be present in early developmental period, but may not fully manifest until social demands exceed limited capacities that individuals might have or maybe must by learning strategies and their later life.

00:04:54: So based on the stressors of life experience for those social demand academic demands work demands they make presents a little later where the core features are been present before might have not manifested in a way that leads to diagnostic process.

00:05:15: Thank you Dr Damodaran, Dr Malik could please briefly explain to us about these early signs we may look at and let's say take care of the early stages let's say, distinguish in between.

00:05:39: this was a normal limit.

00:05:42: Was it within the normal limits?

00:05:44: Let us take it.

00:05:45: and that is in-between the pathology itself

00:05:48: Sure Yes.

00:05:51: so there are number of features That we look for In children And we might call them early signs or childhood features will indicate or give us a clue that the child may be on the autism spectrum.

00:06:10: And one of the most common ones is speech delay, The important thing about speech delays.

00:06:17: it's not necessary.

00:06:18: if your child has a speech delay then they must have Autism because They could have a Speech Delay and just go to have a speech and language Disorder without Autism but It Is very Common.

00:06:29: On the other hand there are also young people with Autism who never had a speech Delay.

00:06:34: And in the past we would make a distinction that if you had a speech delay and other features of autism, We'd call that typical autism or childhood autism.

00:06:43: Then If You Didn't then we have to use different labels like aspergers Or atypical Autism.

00:06:51: Now it's all merged into one.

00:06:53: so this is an important sign.

00:06:55: speech delay but not essential.

00:06:58: The other thing is that we look for an early childhood response to name.

00:07:03: And again, this isn't essential feature.

00:07:04: but some children when you call out their names may not respond.

00:07:08: It could be they're busy But if there's a consistent pattern then sometimes don't automatically recognize the dating address.

00:07:16: Another thing is eye contact Again This variable because now the autism spectrums widen so We do have people who make some.

00:07:23: but If we notice Early Lack of Eye Contact We also look for sensory issues.

00:07:31: And even though, again, sensory issue you can see sensory issues in people who don't have autism like ADHD or no diagnoses but they are common and more extreme.

00:07:42: so the child might react excessively to sounds and parents will think that the fireworks of hand dryers extremely triggers my child.

00:07:51: Then there is the rigidity that if there's a change in a pattern or they're refusing to put socks on extreme behaviors, extreme dysregulation.

00:08:01: If plans are changed.

00:08:03: and one other important thing is patterns of playing.

00:08:07: sometimes when children particularly when their own social environment like nursery or kindergarten A parent observes a child or at the birthday party and they notice that my child was playing with their truck, not necessarily part of group play.

00:08:23: Or even in group play there were on-the-side lines.

00:08:26: So these are important features.

00:08:28: how they're playing?

00:08:30: How do you manage little changes?

00:08:32: Sensory issues eye contact The speech language delay.

00:08:37: But if we don't have delays We look at patterns.

00:08:39: like some children autism will have echolalia where it repeats alot copy somebody and they might go through a phase where they are not referring to themselves as I in the first person.

00:08:52: They might say if there's a boy, he wants to go out... He wants a sandwich instead of saying their name.

00:08:59: We also look for other signs like stimming so hand movements and flapping And we look for tiptoe walking.

00:09:07: So those are sort of early signs.

00:09:09: but one important thing just add here As Lavanya said that within the autumn spectrum, now we're recognizing that it is not essential to pick up all signs before a certain age like age two or three.

00:09:23: Because there are children who may have some subtle features and they only become really prominent a little bit later on when the demands increase at school, social demand expectations.

00:09:32: So I think that's been slow evolution of those symptoms whilst in the past it was always language delay or we pick up before age three.

00:09:40: now while early signs aren't their important because earlier you identify You can offer interventions.

00:09:47: The intervention is not to change autism but to improve quality of life, yes?

00:09:51: So those I would say are important signs to look out for.

00:09:55: And even in clinics if you're a clinician who is not necessarily running an autism clinic, a pediatrician, cardiac or neurologist and you see a child whose tiptoe walking, who's stimming, who has got sensory issues eye contact it may give you the clue as a clinician then you might not diagnose your child.

00:10:15: because What do

00:10:27: you think about the early recognition of this disease?

00:10:49: sees his early signs and puts out the diagnosis.

00:10:55: That is a first one to state that this is autistic case?

00:11:00: Yes, I think it varies quite a lot depending on people's experience of seeing neurodiverse young children.

00:11:09: The more experienced they are They're most likely to detect them for an assessment.

00:11:15: And sometimes these children don't get identified till much later on when they have problems in the school environment.

00:11:21: So that's a common reason for referral, even though these signs were there but their child had a lot of problem with school refusal or problems.

00:11:27: where this started secondary schools and it is only then did become prominent.

00:11:32: so often they are missed particularly females.

00:11:34: I won't go into detail because i know that Lavanya will talk about female presentation But thats one example.

00:11:42: often these early features are missed or they're subtle and so the diagnosis a bit later on.

00:11:49: Now, is there an advantage of picking up early?

00:11:51: There's some studies more from the speech-and language side about early interventions again not necessarily to change autism but to improve communication.

00:12:02: uh end language.

00:12:05: yeah Thank you and maybe Dr.

00:12:08: Lavagna will tell us more about this adulthood stage, yes?

00:12:15: About the presentation of ASD and clinical science in adulthood that so-called camouflaging problems with relations or social behavior The problems of higher rates, of comorbidities and under diagnosing the disease as it is.

00:12:41: So may you tell us more about how does autism and ASD cases reveal themselves, manifest themselves clinically throughout adulthood?

00:12:52: And why do these adult patients still need care or they need psychiatric care... from their families, they need social interaction.

00:13:05: So can you just briefly explain us about this adulthood stage and why do we speak overall not only of the kids having ASD but also adults who have an ASD as well?

00:13:19: Thank you very much!

00:13:20: As Osman pointed out something really... unique features that we pick up in children, such as you know they are not... They don't respond to their name being called or they might not smile back in a social setting and they might actually exhibit it in the form of a meltdown because of sensory overload.

00:13:41: These things may be very different in adulthood so but you know the presentation could be intellectually manage the situation in a different way.

00:13:58: So there may be level of awareness, not that some children don't have their awareness but adults probably over the years with experience they become more aware off their struggles and then try to adapt themselves into settings which includes group or people.

00:14:16: social setting work-setting may intellectualize it, but then they might try to struggle.

00:14:26: They might struggle to apply the coping strategies sometimes and it could read results in social anxiety... ...they might actually be intensely fatigued after a social setting or meeting….

00:14:42: …they might really struggle significantly with when their relationship becomes more complex as young adults or through their adulthood, the friendship might not be just around play.

00:14:56: It might be complex interactions about situations within the world that we live in and those kind of situations might be real big struggle.

00:15:07: and you know lasting friendships might be tricky because they might prefer to talk about their own special interest sometimes you know, colleagues or friends interest.

00:15:21: So these kind of situations might become quite tricky and some of the research also would suggest that adults with autism might have some level of adapted social skills.

00:15:38: but then the core need for routine and sensory sensitivities may just remain a longer period of time which becomes tricky to manage.

00:15:48: I suppose it's very important for whether its family, whether close friendship or when they are building relationships.

00:15:57: For them to be aware of and employers you know, even sometimes it could be that up until the point they haven't been diagnosed and recognizing those struggles at this stage.

00:16:11: And then trying to help make these referrals for diagnostic confirmation would be important.

00:16:19: so education is necessary for employers or even family members who might be closely involved with adults.

00:16:28: So we were talking about under diagnosis, weren't we?

00:16:32: So you did suggest about underdiagnosis.

00:16:35: There is experience clinically as well as data to research-wise to suggest that underdignosis is present and it's more common in women or girls.

00:16:46: Now why might be the case?

00:16:48: so sometimes It could be that We've had really superficial understanding of what autism spectrum conditions are, you know and over a period of time we've developed our understanding about the autism especially if think about some of the myths that might hold when women is actually making eye contact or conversation.

00:17:15: Is married?

00:17:16: Is her mother playing those roles?

00:17:18: That means oh maybe she's not autistic.

00:17:21: but so those generalization supply, so there may be a level of coping strategies that they might have developed.

00:17:30: There maybe the level of masking and camouflaging that they.

00:17:45: that sometimes then comes in the way of recognising and diagnosing for example, you know being able to socially adapt a bit better as a woman.

00:17:55: Now we may need actually think about some of the nuances that young person or an adult who from gender point-of view or sex point of view they might girls might show women might source certain interest, a restricted interests that might involve people.

00:18:16: That might mean they are interested in the pop group or certain literature or certain authors and there may be an interest on certain animals as compared to boys of men who have been interested in objects like planes or cars.

00:18:32: so those other things we need keep in mind.

00:18:36: also imaginative play might be present in some of the girls, but they might very much non-reciprocal playing or they may be very scripted.

00:18:47: So things that some women girls would pick up and then it maybe must in terms how their presence.

00:18:55: so we I think need to be more mindful on you know, that way we might be able to improve the diagnostic process for women and That way.

00:19:09: We might be about prevent some of the under diagnosis overall in adults also when intellectually people are very capable, individuals so very capable.

00:19:20: We do see sometimes even in our professional lives that some of the colleagues might have a lot of insight about their struggles and reflect about it but they may not been picked up because there really high functioning you know holding big jobs ,big positions .

00:19:38: And these things we need to be mindful off I suppose struggles that adults might have, and these struggles may be presented in the way of when they are trying to start living independently for example.

00:19:59: They're trying more responsibly take on full-time jobs You know, present alongside the core features of autism say for example if they are struggling with executive functioning then.

00:20:18: They might struggle with planning organizing initiating tasks or managing time so and being able to identify what individual strengths might be?

00:20:30: And What kind of jobs might better suit them.

00:20:33: For example it would be important vocational training might be indicated to help this kind of transition.

00:20:41: And as I mentioned before again, education and training for employers create a supportive nurturing environment.

00:20:49: so building new relationship with colleagues and friends might not be easy.

00:20:53: they might burn out trying to camouflage and fit in within their newfound relationships.

00:21:00: friendships and relationships become unsustainable for them.

00:21:04: So individuals being able to leverage some of the special interests, participate in structured kind of social settings with a level of predictable environment might be helpful in building confidence.

00:21:19: And I know you did say how else it might... It might be presenting.

00:21:25: even clinical setting For example can be high levels of coexisting conditions.

00:21:32: We know this from when we look after children with autism, that we do tend to find the children who have other coexistence conditions like anxiety and depression.

00:21:43: so in a similar way adults also have higher coexisting condition than they are diagnosed with autism.

00:21:50: So we will have to be mindful in identifying recognizing those psychiatric comorbidities that is.

00:22:00: So some of them can be depressive disorder, anxiety disorder obsessive-compulsive disorder attention deficit hyperactivity disorder and personality disorders.

00:22:12: so reasons That if we think about it could because co occurring disorders include shared pathophysiology with autism or the cause for example epilepsy an autism ADHD and autism, or anxiety in autism.

00:22:29: So similarly if we think about when they've lived with autism for a period of time within academic setting, within employment settings, other social settings you know how might that impact on their mood?

00:22:45: I don't know.

00:22:46: then there may be prone to developing depression.

00:22:50: And also are the ways of understanding.

00:22:53: sometimes it could be overlapping overlapping symptom dimensions and maybe there are possible shared underlying mechanisms like when there is OCD, overlapping diagnostic criteria sometimes.

00:23:08: When we think about schizoid personality disorder, schizosciple personality disorder obsessive-compulsive or anachronistic personality for example those things that need to keep in mind may not seem quite straightforward unless Professionals are able to, even from primary care point perspective, identify and refer on appropriate services for that diagnosis.

00:23:34: To be made and treated in a timely manner so they can function better in life And do their best In the lives.

00:23:44: So this is something I wanted to talk about.

00:23:49: It's quite important here Let's say about the overall functioning when the transition happened itself into an adulthood, of course it is challenging.

00:24:04: But we see a lot famous people including Bill Gates, Elon Musk

00:24:11: etc.,

00:24:12: they were diagnosed as ASDs ages before, but currently they are functioning pretty well and earning pretty well in owning the company.

00:24:23: So it is possible!

00:24:25: And of course some senses problem or mood problems may be compensated by hard work... ...or the necessity for proper skills that were required from those adults having ASDs.

00:24:45: and Dr.

00:24:47: Malek, it will be interesting to listen your opinion on this continuity.

00:24:54: What are the symptoms that are transformed into an adulthood?

00:25:01: How is they shaped by their age?

00:25:04: how as a shape by the ambience by social demands?

00:25:13: How important is this transition from the early childhood into adulthood to have this lifelong support in terms of families, medical care?

00:25:27: Could you just briefly tell us more on that topic.

00:25:32: Sure yes so I think continuing what Lavanya was saying about

00:25:38: the

00:25:38: childhood and how autism presents in childhood, adulthood.

00:25:43: And I would say similar that there is a continuation In the symptoms.

00:25:48: it's not that it changes to become another condition however.

00:25:52: The outward presentation does indeed change So they will still have the need for sameness.

00:25:59: They like routine and rigidity and structure.

00:26:02: You'll have sensory issues some difficulties with social communication But what changes a little bit, there's several things but one is that as you're getting older.

00:26:13: You are learning some new social skills.

00:26:17: so What made differ for instance?

00:26:19: One good example could be The difficulty with eye contact may be a persisting symptom, but outwardly in the younger child doesn't care.

00:26:28: Doesn't make eye contact.

00:26:30: as they get older They might learn that oh some people have said it's rude or somebody has said can you please look at me when You speak.

00:26:37: so what?

00:26:37: They do is they will make eye Contact But when you actually saw awkwardly feels like ah So I contact improves this symptom disappears.

00:26:46: When you actually speak to people with ASD, they will often say it's very effortful for me and I'm thinking constantly that should i make eye contact?

00:26:55: And when the making eye contact is saying then I am thinking Is It Too Much or Should I Break It.

00:26:59: When should I look away?

00:27:00: So obviously when you have that internal talk going on, but your answering let's say another question.

00:27:06: And so then either they can make excessive eye contact sometimes not enough sometime or sometimes it makes fine.

00:27:12: But the reason i'm giving this example is how interesting It's effortful and Then when they finish That conversation and when The other person walks out Or They walk Out will always be like I Can relax its a little bit Like if I Have Hardly Speak French and I go in to speak To A french Person And I have to constantly translate in my head.

00:27:31: So when that conversation finishes, i'll be like oh i'm relieved.

00:27:34: now the this conversations done and obviously That can then take a toll.

00:27:37: they're a bit tired than They want to take a break.

00:27:39: so This is just an example of how The core symptom might Be there but outwardly changes.

00:27:45: The other thing we notice interestingly is that when children are younger, they can avoid a lot of social contacts.

00:27:51: So children with ASD will often tell me in the clinic parents would say When the Amazon guy arrives They never open their door because they're avoiding at the cafe and easily order hot chocolate.

00:28:01: They'll do none these things And parents keep doing it.

00:28:04: But when you become an adult, suddenly you find that your on-your own and have to.

00:28:09: You will avoid.

00:28:10: if go to Tesco's or supermarket you'll go the self check out where can.

00:28:15: but there would be situations with wifi broken, plumbing is broken.

00:28:18: need call argue.

00:28:21: maybe I could write a email.

00:28:22: sometimes we directly deal people.

00:28:25: so what happens to adults with ASDs?

00:28:28: they get thrown into this world were didn't had to deal these things And they don't have a choice of while I'll opt out which.

00:28:35: that's why there is more of this sense of burnout Anxiety depression?

00:28:41: because the constantly doing things.

00:28:42: They don't want to do and then their parents also with who themselves have SDN.

00:28:47: Sometimes, I see parents in the clinic of children Who also?

00:28:50: Have and they have their struggles In terms of the school saying this are being judged as a bad parent And sometimes they have a lot of questions like, my child's reacting and some of their children don't have autism.

00:29:02: Some do so.

00:29:03: that's another area of difficulties is when you have to face all these problems then therefore more anxiety and burnout.

00:29:10: similarly Children where there are sensory issues They will just opt out.

00:29:16: Let us say we had lots of children with ASD who sibling baby sister or brothers crying and screaming and walk away keep them away from me.

00:29:24: But when you have your own child as an adult and it is your baby, and screaming is triggering your misophonia but you don't have a choice to sort of walk away so you will deal with that after you suit the baby.

00:29:34: another parent would just be watching YouTube by their parents with ASD.

00:29:37: we'll like.

00:29:39: I'm tired.

00:29:39: So The other thing We find With this transition Is That A Lot Of Young People With ASD There's quite a disconnect between what we say that if you did an IQ test and they're doing, let's say above average or even below average.

00:29:54: But when you look at their functional skills day-to-day they're much lower.

00:29:57: interestingly and it's not universal but its very common.

00:30:00: So parents are just making sure that your attend school, doing well for your exams and things...but a lot of these thing is done.

00:30:07: so the minute this children go to university sometimes obviously I'm clear no all children will.

00:30:12: ASD will go to University.

00:30:14: we often miss out on old term.

00:30:17: if you have learning disability language disorder with autism.

00:30:21: Some of those people will have intense struggles, so some of our examples today are the so-called higher functioning.

00:30:27: but actually these also apply to people with a learning disability that their transition they have to do more and make decisions.

00:30:35: But coming back to my example I've gone into university.

00:30:38: So i found that young people with autism went to University.

00:30:43: I'll give one example, a young person was taking ADHD meds and then they met because their an adult.

00:30:49: Their medicines are now... They have to manage it.

00:30:51: The GP said GPs like family doctor in the UK And said come to my clinic Because you haven't seen for six months This persons is like oh i don't know.

00:30:59: Organizing didn't go.

00:31:00: this stopped their ADHD med's.

00:31:03: Then had do everything obviously living on there own Washing clothes put washing in washing machine forgot It smelled really badly took out Put another load That the same, you know.

00:31:15: and then he thought okay run out of underwear and socks.

00:31:17: I'll go and buy new ones buying loads And loads of takeaway.

00:31:20: Then parents sent something is not right.

00:31:22: so parents drove to university and found that this young person who's now nineteen or twenty isn't in The room.

00:31:28: loads of clothes lying around on the floor dirty washing takeaways.

00:31:33: So then the mother said ok?

00:31:43: and I'm going to order a delivery of food every week online.

00:31:48: It doesn't mean they'll need it for life, just means that those we forget sometimes in the management is your anxiety okay?

00:31:54: Is your ADHD OK?

00:31:56: A lot people will take while when they transition into adult lives.

00:32:00: so they would need Occupational Therapy Support or Life Coach or Psychologist because otherwise What I see is sometimes when they find it very difficult, there's a lot of black and white meaning the push-push-pUSH.

00:32:15: And then things are very difficult.

00:32:16: so instead of saying okay i'll take or break Or reduce my time what will do?

00:32:20: Is that all or none approach which is... I left university or resigned from job.

00:32:27: So rather than say can I do flexi Can I do part-time Sometimes They need support both from employer From University somebody because it's almost like push, then you get burnout and the new just opt out.

00:32:40: And that sort of thing these patterns can repeat.

00:32:44: I think is that sort things we look for.

00:32:48: but in terms off other side where children... The changes are given only problems.

00:32:55: they will learn a lot what world expects.

00:32:58: okay.

00:32:59: So if I do this in an email, i'm more likely to get a response.

00:33:03: If I smile back out.

00:33:04: so there's also constant learning from trial and error of how to communicate.

00:33:09: And Sometimes you know people feel it's very artificial for me.

00:33:13: if go talk with someone You look lovely today because they'll think well here To ask something why should say that?

00:33:22: But then They will think okay somebody give Me a compliment.

00:33:25: maybe I Should Give them A compliment.

00:33:28: what we call slow, natural modifications in people's social communication style into adulthood.

00:33:36: We do see that but it remains a bit effortful not as natural.

00:33:43: and the last point I will make is same as the need for sometimes psychiatric input is higher.

00:33:50: unfortunately historically lot of people who weren't diagnosed ever would say ASD And then struggle, struggle and have a breakdown.

00:33:57: So they're more likely to be given diagnosis of.

00:33:59: you've got a schizoaffective disorder or personality disorder.

00:34:03: You drink alot but if take the history that they always struggled with school bullied didn't want go to school had high anxiety Then started drinking alcohol as way manage anxiety Didn't wanted out.

00:34:14: But we see the end state.

00:34:16: We say, oh this person has an alcohol addiction or this disorder.

00:34:19: but if we trace back neurodevelopmentally... ...we often find people with neurodevelopmental disorders would have had struggles all their life and then this breakdown so high need for psychiatric input later on.

00:34:31: And my feeling is that the more we detect early-on name it educate people Then there'll be less of this reverse treatment than now.

00:34:38: you've got a major mental health disorder And the etiology is like, oh you got it because you smoked this or drank too much.

00:34:46: Or its just that you found this job stressful?

00:34:49: No!

00:34:49: Its early on and there's a context for that.

00:34:53: So thats something I think hopefully will change as we go forward with more knowledge about ASD.

00:35:00: Yeah so you're absolutely correct in that What I see in my clinical practice, and they say what you also agree on that.

00:35:12: That is this transitional stage where it's quite important.

00:35:17: we should pay attention onto the child symptoms That's for sure, but we should also think about the childs future.

00:35:28: About their parental comfort.

00:35:30: Also parents often have mental breakdown because when a child is hyperactive or they use hyperprotective strategies behavioral strategy so they overreact When anybody comes close to that.

00:35:46: they hold that kid, twenty four hours a day like no sleeping.

00:35:51: They look after the child so sometimes it just exhausts their parents themselves but Also, causing this exhaustion in the child that is set for twenty-four hours with these adults and there's no social contact because they overprotect.

00:36:13: They do not keep any social events active kid and when this person they get into an adolescence, in adolescence.

00:36:26: They don't know how to behave with it or not knowing what should be done.

00:36:32: the other topic was quite important.

00:36:35: once I've been through a conference that wasn't India In fact Indian Academy of Pediatrics And i heard everything turned upside down.

00:36:47: you from Not from the childhood to adulthood, but from adulthood-to-childhood.

00:36:54: So this would happen.

00:36:56: there was one famous professor and he was saying about let's say about autism... But not in kids themselves.

00:37:10: it is called autistic doctors.

00:37:14: What does it mean?

00:37:15: So often parents say, since the early stages they state my kid doesn't speak.

00:37:22: My kid doesn' react to addressed speech.

00:37:25: My kids don't show what he wants and we do not pay attention to that.

00:37:30: We just say oh like let's wait for another year or two It will pass by.

00:37:35: Oh!

00:37:36: He doesn't want to speak.

00:37:37: Just wait, no one speaks this kind of age.

00:37:41: So let's wait a few years and after if symptoms persist they say just oh like it didn't work out.

00:37:49: but that is the baby these parents have and will have throughout their lifetime.

00:37:58: so we cannot behave like them.

00:38:00: sometimes you need to be all reactive.

00:38:03: Yeah, the other thing is it's just about hearing problem.

00:38:10: Same with visual problems.

00:38:13: sometimes you do not see this tiptoe walking.

00:38:16: we don't pay attention to that.

00:38:18: and after we have constructions developed or there's a necessity to do the surgery itself.

00:38:26: Now I had one kid also in London, they made this... They have to make a surgery because no-one paid attention onto the tiptoe walking in ASD child and the contracture developed And subsequently There was need for the surgery Because nothing helped.

00:38:45: The contractures has been fixed.

00:38:48: Also, the problem is fine-hand functioning with so called writing.

00:38:57: Sometimes we see it a patient but do not fill in all of their data.

00:39:02: We don't state exactly what we saw and after when you see this patient like one year or two years.

00:39:10: You just forget What happened three years ago because I've seen about thousand patients.

00:39:17: So it's so important to keep our senses active both hearing, both vision and hand function.

00:39:27: And that works not only for the kids When they are transformed into an adulthood stage.

00:39:34: of course there is a problem with comorbidity They have sensory problems or social interaction but still some skills that they may do even better than us.

00:39:47: There was a study on... They put like, fifty simple person of maybe twenty-five average age and twenty five patients with ASD That were adults And in the airport at the X-ray screen and to reveal amount of sharp subjects.

00:40:15: And those having ASD, they revealed more than like.

00:40:20: really try too.

00:40:21: but often we are destructed by one thousand things!

00:40:28: They're concentrated pretty well on certain aspects.

00:40:33: so sometimes there may be great architects cooks, they may be great in designing things.

00:40:44: So...in their areas.

00:40:46: yeah very helpful and really throughout the lifetime I have a lot of personal cases and i'm sure a lot.

00:40:57: you also know patients that now became adults with ASD.

00:41:03: finding good job having families, of course they may have some sensitivity problems.

00:41:10: But that is secondary yeah?

00:41:13: So if you look onto the mental state for each one us we will find some depression signs and mental breakdowns like tiredness etc.

00:41:26: so it's a usual thing.

00:41:31: but taking care of these patients socially, so paying attention on to them.

00:41:40: Paying attention as a doctor when they state that they are tired or exhausted.

00:41:48: So we should support them.

00:41:50: sometimes I need the sick leave Sometimes i need support from family members Or us.

00:41:59: They just want to speak with us.

00:42:03: helpful at all.

00:42:04: Yeah, so can you just let's say state and mention how do I think what the future awaits?

00:42:13: The patients with ASD And How may we help them?

00:42:19: yeah Dr.

00:42:19: Damodaran Can You Say Just If You Were

00:42:24: Absolutely!

00:42:24: I Think the interest in understanding around neurodevelopmental conditions overall has been improving quite significantly.

00:42:33: just as everybody's pointed out that people are fine to talk about their neurodiversity in media, social media or other news channels.

00:42:45: You know whether they're hard-to do you with your own sort of celebrity status?

00:42:53: Or whether it is children young people and adults we come across within our lives.

00:43:01: I think people are more open to talk about it and when they're more open, the recognition is there.

00:43:09: Then I suppose even healthcare system government funding commissioning all of that then improves.

00:43:16: so if you can put a point across children young families with lived experience make own personal experience, just like how clinicians we've all shared our experiences.

00:43:30: I think

00:43:31: that

00:43:32: would help in future research commissioning within clinical settings even transitioning care from adolescent to being young adults too becoming later part of adulthood.

00:43:50: so these aspects will be something I think the development is progressing, and of course use of AI.

00:44:00: Use off digital technologies in modifying our interventions, modifying other way we live all of us... We are starting to use AI in a lot of areas that we do work on.

00:44:14: so utilizing those digital advances in research, intervention, transition I think would be really good in improving outcomes for individuals with neurodiversity, including autism.

00:44:33: Dr.

00:44:33: Malek just briefly say a few words about your opinion on this transition from childhood to adulthood and how maybe it will help you?

00:44:46: Yeah, so I think it's carrying on from Lavanya's point that the important thing is recognition and education.

00:44:53: Once its recognized much more than transition to adulthood just becomes one other part of the whole process of autism and neurodevelopmental conditions.

00:45:03: And I think that the main thing is, there's been a shift not only medical but societal shifts.

00:45:08: so we've moved from say disease to it's disorder or from disorder.

00:45:12: these are conditions.

00:45:13: now even people call them neuro-developmental differences yes?

00:45:18: In some cases yes its reach is difficult.

00:45:20: So thats i think more education around it clinicians as well as individuals in society will help us support people both in adulthood and childhood.

00:45:34: but I mean one point i will add is that those with severe learning disability and autism they would always be that vulnerable group because their parents advocate even when they become adults.

00:45:45: And parents often cry saying what happened to my child?

00:45:49: When I'm not in this world because they have to fight for medical issues, his shoulder has this skin as that.

00:45:54: So i think is an area that healthcare systems need to think of people who autism would learn disability and meeting their needs.

00:46:03: Thank you Dr Malik And thanks to both of you the doctor Daumadaran The Doctor Malik Thanks For a very nice presentation Of the disease and for explaining to those who listen to us.

00:46:19: This difference of ASD patients in comparison with other groups and how may we help this transition from the early childhood-to adulthood?

00:46:32: What are challenges, problems or comorbidities?

00:46:37: And each one should be helpful as much possible for these group of patients.

00:46:43: I think it will be more of them in future, so they will be all around us and we should just support them.

00:46:54: And also educate our kids to communicate with them the correct way... We don't have to be afraid of it!

00:47:02: So that's life still was within last twenty years yeah?

00:47:15: And it's growing up and down this scale.

00:47:18: So, just to be helpful... Just work with these patients both socially Work in a medical way Be helpful in the medical way To do all what depends on us to spread information On disease.

00:47:36: What we are doing now.

00:47:46: This has been EANcast Weekly Neurology.

00:47:48: Thank you for listening!

00:47:50: Be sure to follow us on Apple Podcasts, Spotify or your preferred podcatcher for weekly updates from the European Academy of Neurology.

00:47:58: You can also listen to this and all of our previous episodes in EAN Campus to gain points.

00:48:20: Thanks for listening!