FACTS PARENTS WANT TO KNOW
What is Autism?
Autism is developmental disorder that generally becomes evident by the third year of life. It causes impairment or disturbance in three main areas:
Poor Social skills
Poor Communication (verbal & non-verbal)
Repetitive and restricted behaviors.
Abnormal responses to sensations.
All these difficulties manifest in altered behaviour i.e. abnormal ways of relating to people, objects and the environment. Autism is known as a ‘spectrum disorder,’ because the severity of symptoms ranges from a mild learning and social disability to a severe impairment, with multiple problems and highly unusual behavior. The disorder may occur alone, or with accompanying problems such as mental retardation or seizures.
Autism is not a rare disorder, being the third most common developmental disorder. Typically, about 2 out of 1000 children may have autistic symptoms. 80% of those affected by autism are boys.
Autism is found throughout the world, in families of all economic, social, and racial backgrounds.
What is a child with autism like?
A child with high functioning autism may have a normal or high I.Q., be able to attend a regular school and hold a job later in life. However, this person may have difficulty expressing himself and may not know how to mix with other people. Moderately and more seriously affected children with autism will vary widely. Some autistic children do not ever develop speech, while others may develop speech but still have difficulty using language to communicate. Often, there is an unusual speech pattern, such as echoing whatever is said to them, repeating a word over and over, reversing "you" and "I" when asking for something, and speaking only to express needs, rather than emotions.
A child with autism looks just like any other child, but has distinctive behaviour patterns. A child who is autistic may enjoy rocking or spinning either himself or other objects, and may be happy to repeat the same activity for a long period of time. At other times, the child may move very quickly from one activity to another, and may appear to be hyperactive. Many autistic children have sensitivity to certain sounds or touch, and at other times, may appear not to hear anything at all. Autistic children may have very limited pretend play; they may not play appropriately with toys or may prefer to play with objects which are not toys. Autistic children may be able to do some things, like sing songs or recite rhymes very well, but may not be able to do things requiring social skills very well.
How is autism diagnosed?
There are no medical or genetic tests to detect autism. A diagnosis of autism requires a sensitive and experienced doctor to observe the child very carefully, ask the parents about the development of the child, and then objectively follow internationally recognized criteria for diagnosis. Onset may occur at birth, or a child may have a period of normal development followed by a deterioration of verbal and social skills around 1 1/2-2 1/2 years. Where onset is at birth, the disorder can be detected as early as one year. Autism may occur alongside conditions such as mental retardation and hyperactivity, but the autistic traits in the person are typically what require attention.
What is the cause of autism?
We still do not know what exactly causes Autism. However, current research indicates that structural or functional damage to the central nervous system can lead to Autism. We know that certain viruses and known genetic conditions are associated with Autism. In addition, there are families that have more than one child with autism. At present, it is believed that about 10% of all cases can be accounted for genetically. It is difficult to tell parents why their child has autism, but it is not caused by an unhappy home environment, both parents working, mental stress during the pregnancy, poor handling by the mother, an emotional trauma, or other psychological factors. You cannot cause a child to become autistic.
Can it be prevented? Can it be cured?
At present, there is no medical cure for autism. The only consistently effective treatment for autism is a supervised structured training program, started early; therefore, a combination of a good school and parent training is very important. Autistic children can make significant progress if the intervention is early, appropriate and consistent. Early intervention, before the child is three, is especially crucial to the child’s progress. This is why an early and accurate diagnosis is so important
How is it different from Mental Retardation?
In mental retardation there is equal lag in all segments of mental development, e.g., motor, communication, social, self-help, cognition etc. In Autism, there is an uneven skill development-- in some areas the child may show age-appropriate skills, in some the skills may be below average and again, in some areas exceptional skills may also be seen.
Can the child ever live an independent life?
Children with Autism have potential for building up their skills and they can be helped if they receive early, well-focused intervention. Depending on the child's individual skill profile and the appropriateness and intensity of intervention he or she receives, children with Autism can lead relatively independent lives.
What are the chances of his going to a regular school?
Autistic children can be integrated into regular schools, with the support of special education facilities. Most children with Autism have different learning styles from regular children and therefore teaching styles also need to be different. The chances of main-streaming depend on several factors, like, the child’s skill profile, early diagnosis and effective early intervention.
Will my child ever speak? When?
A large member of autistic children (about 30-50%) do not use speech. It is very difficult to say when and whether the child will ever speak. It is confirmed that there is no difficulty in their physical abilities to speak, but it is their lack of initiative to communicate that stops them from speaking. Some children who might have spoken as infants and then lost their speech may or may not get their speech back. Currently, it is unknown why some children develop speech and others do not. Experience with children with autism has shown that if the environment is accepting, and people are aware of the kind of speech they themselves need to use with the child, it can produce positive results.
Can Speech Therapy help?
Speech Therapy can help some children. It is absolutely essential for the speech therapist to understand Autism and the individual child. However, every child with autism can benefit from interventions that help build communication skills, verbal and non-verbal.
Why is he hyperactive?
Most children with Autism are restless because of an impairment of their imaginative and social skills. They cannot play with toys or other children meaningfully and find it very difficult to occupy themselves and become restless. Hyperactivity can be reduced as the children are taught new skills to keep themselves occupied.
Why does he keep playing with his fingers/ rocking himself back and forth/ spinning around etc?
Children with Autism respond to sensations differently. These unusual mannerisms like flapping and rocking etc. are natural responses or methods of coping with their sensory difficulties. These behaviours may help them to relax.
Is there any hostel for such children?
In India there are few hostels for people with mental disabilities and ones exclusively for autistic individuals do not exist here. In the early years of development, it is important for an autistic child to live and grow in a home environment. As the child grows up, he can be trained to live in a group home but it is very important for the autistic people living in such homes also to integrate with society in general and not just be abandoned in a home or hostel.
Are people with Autism also mentally retarded?
It is very difficult for people with autism to take an IQ test because they may have certain skills but are not able to use them or exhibit them in a test. About 50% of people with autism are also mentally retarded. Autism can occur in association with other difficulties like Cerebral Palsy, Dyslexia, Downs Syndrome, Visual Impairment, and Seizure Disorder.
Thursday, August 5, 2010
Saturday, May 8, 2010
AUTISM : too many doubts & querries
WHAT IS AUTISM?
Autism means a developmental disability significantly affecting verbal and nonverbal communication, social interaction and creative or imaginative play, generally evident before age three.
What is ASD?
The autism spectrum disorders (ASD) is a spectrum of psychological conditions characterized by widespread abnormalities of social interactions and communication, as well as severely restricted interests and highly repetitive behavior
The three forms of ASD are:
1. Autism
2. Asperger syndrome
3. Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), sometimes called atypical autism.
Asperger Syndrome has no significant delay in language development. They have good intelligence and are considered as high-functioning autists. PDD-NOS is diagnosed when the criteria are not met for a more specific disorder. Some sources also include Rett syndrome and childhood disintegrative disorder, which share several signs with autism but may have unrelated causes
HISTORY
Autism was first described by Leo Kenner, a psychiatrist at John Hopkins University, in 1943, in a group of children with communication problems.
In 1944, Hans Asperger, an Austrian Pediatrician described a similar condition in children, but with higher cognitive and verbal skills.
Autism first appeared as a separate entitywith specific criteria in Psychiatry texts in 1980.
How common is autism?
Current prevalence of ASD, as reported from the US in 2007 is 6.6/1000
8-year old children. Incidence is reported to be on the rise, as is evident from the graph on annual incidence data.
Is it linked to other diseases?
Autism may or may not exist with other illnesses. A recognizable associated condition in found in only 6% cases. Co-existing Mental Retardation was considered to be 90% before the ‘90s, which has come down to 50% after 2000, due to increased identification of high functioning autism.
Common diseases known to be associated with Autism are Fragile X syndrome(35-50% have autistic traits), Retts syndrome (females with a small head, seizures & autistic traits),Tuberous sclerosis, Phenylketonuria, Fetal Alcohol Syndrome, Angelman Syndrome, Smith Lemli Opitz syndrome etc.
Prenatal factors like ingestion of certain medicines by mother ( valproic acid, thalidomide), maternal illness (rubella) are being considerd as probable causative factors. A population based study by Institute of Medicine in 2001 has established that there is NO causal association between MMR & autism.
WHAT HAPPENS IN AUTISM?
Just after birth, the brains of autistic children tend to grow faster than usual, followed by normal or relatively slower growth in childhood. It is not known whether early overgrowth occurs in all autistic children. It seems to be most prominent in brain areas underlying the development of higher cognitive specialization. Hypotheses for the cellular and molecular bases of pathological early overgrowth include the following:
• An excess of neurons that cause local over-connectivity in key brain regions.
• Disturbed neuronal migration during early gestation.
• Unbalanced excitatory–inhibitory networks.
HOW?
Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood.
HOW IS THE PSYCHOLOGY OF AN AUTISTIC CHILD DIFFERENT?
Two major categories of cognitive theories have been proposed about the links between autistic brains and behavior.
The first category focuses on deficits in social cognition. The empathizing–systemizing theory postulates that autistic individuals can systemize, that is, they can develop internal rules of operation to handle events inside the brain ( like arranging things in a specific order)—but are less effective at empathizing by handling events and swquences generated by others. This theory is somewhat related to the earlier theory of mind approach, which hypothesizes that autistic behavior arises from an inability to ascribe mental states to oneself and others. He cannot guess what another person may be thinking or how another person would be looking at a particular situation. The theory of mind hypothesis is supported by autistic children's atypical responses to the Sally–Anne test for reasoning about others' motivations. The second category focuses on nonsocial or general processing. Executive dysfunction hypothesizes that there are deficits in working memory, planning, inhibition, and other forms of executive function . This theory predicts stereotyped behavior and narrow interests.
Weak central coherence theory hypothesizes that a limited ability to see the big picture underlies the central disturbance in autism. He focuses on small things, but cannot take in a situation as a whole. This theory predicts special talents and peaks in performance in autistic people
Neither category is satisfactory on its own; social cognition theories poorly address autism's rigid and repetitive behaviors, while the nonsocial theories have difficulty explaining social impairment and communication difficulties. A combined theory based on multiple deficits may prove to be more useful.
WHAT ARE THE FEATURES OF AUTISM?
The core features of ASD include social skill defects, restricted, repetitive & stereotyped behaviour, and language delay, but there is wide variation in presentation, with a lot of heterogeniety. Social deficits, though specific, may be subtle and go unrecognised. Parental concern is more with the speech delay. Presentations vary and some parents report that their babies are different during the first months of life, whereas delayed speech is reported during the 2nd year of life and still others may be normal in the early months and regress and lose skills in the 2nd year. Some ASD children may present at school age because of poor peer interaction.
Social skill defects include:
May be content being alone, not seeking connectedness
Poor eye contact
Difficulty sharing the emotional state of others
Joint attention deficit : does not enjoy sharing an object, event or emotion
Inappropriate peer relationships
Impaired central coherence: inability to interpret stimuli in a global way.
Difficulty understanding the perspective of others.
Difficulty with empathy, sharing and comforting due to severe ToM (theory of mind) deficits…refered to as ‘mindblindedness’
Communication Deficits:
Mostly present with speech delay
Lack of desire to communicate
Lack of non-verbal communication
Speech maybe scripted and stereotyped.
Echolalia is common
Use of pop-up words: spontaneous, inconsistent words uttered out of context
Use of giant words: phrases uttered as single words (wanna-go-home, give-it-to-me)
Earlier pre-speech deficits like lack of warm, joyful expression with gaze, lack of recognition of mother’s voice, to & fro communication with mother, disregard for vocalization, delayed babbling etc facilitate early diagnosis.
Regression : In 25-30% regression of skills occur around 15-24 months, including regression of speech.
Play skills
Lack of pretend play
Persistence of sensory-motor and ritualistic play
Repititive play with lack of creativity & imagination (eg. Spinning wheels of cars)
Behavioural Pattern:
Peculir mannerisms
Unusual attachment to objects
Compulsive behaviour: rigidly follows certain rules like arranging in lines
Obsessive about sameness: resistant to change
Ritualistic behaviour: Unvarying pattern of daily activities like unchanging menu, dressing ritual etc.
Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program, toy, or game
Repititive & stereotyped movements like rocking, head rolling, flapping hands etc
Other symptoms
Unusual abilities: 0.5% to 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia (rote memory) to the extraordinarily rare talents of prodigious autistic savants. Many individuals with ASD show superior skills in perception and attention, relative to the general population.
Sensory abnormalities are found in over 90% of those with autism, and are considered core features by some. Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements. Children with autism are less capable of simultaneously using the different senses to take in the varied information from the environment and combine them to produce a clear understanding of the world around, therefore they may have trouble responding appropriately to different stimuli (is unable to listen to the teacher, when looking at the board).
An estimated 60%–80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking; deficits in motor coordination are pervasive across ASD and are greater in autism proper.
Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator
The Red Flag Signs of Autism Spectrum Disorders:
If your baby shows two or more of these signs, please ask your pediatric healthcare provider for an immediate evaluation.
Impairment in Social Interaction:
• Lack of appropriate eye gaze
• Lack of warm, joyful expressions
• Lack of sharing interest or enjoyment
• Lack of response to name
Impairment in Communication:
• Lack of showing gestures
• Lack of coordination of nonverbal communication
• Unusual prosody (little variation in pitch, odd intonation, irregular rhythm, unusual voice quality)
Repetitive Behaviors & Restricted Interests:
• Repetitive movements with objects
• Repetitive movements or posturing of body, arms, hands, or fingers
TREATMENT
The main goals when treating children with autism are to lessen associated deficits and family distress, and to increase quality of life and functional independence. No single treatment is best and treatment is typically tailored to the child's needs. Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills and often improve functioning and decrease symptom severity and maladaptive behaviors.
Basic treatment of the child includes:
Routine immunizations as per schedule
Treatment of any acute illnesses
Manage sleep disturbance
Treatment of seizures
Normal mixed diet. Mega vitamins & food supplements are not recommended. Dietary restrictions only if food allergy is proved.
There is no medicine to cure autism. Medicines are sometimes used to ameliorate target behaviors like hyperactivity, tantrums, physical aggression, self-injurious behavior, and anxiety symptoms, when they interfere with socialization, learning, health & quality of life.
The mainstay of treatment is BEHAVIOURAL THERAPY: Various intervention modules are in use, which include:
• Applied Behavior Analysis (ABA).
Intensive Behavioral Intervention is based on Applied Behavior Analysis (ABA). Lovaas, a psychologist, first applied ABA to autism at the Psychology Department at UCLA in 1987. His idea was that social and behavioral skills could be taught, even to profoundly autistic children.
ABA starts with "discrete trial" therapy. A discrete trial consists of a therapist asking a child for a particular behaviour, if the child complies, he is given a "reinforcer" or reward in the form of a tiny food treat, or any other reward that means something to the child. If the child does not comply, he does not receive the reward, and the trial is repeated.
The rewards, called reinforcers, should be based on the interests and preferences of the individual child. They should be so interesting to the child that they are worth the hard work of responding to the therapist
The specific content of the discrete trials therapy is based on an evaluation of the individual child, his needs, and his abilities. They aim at acquisition of compliance behavior, imitation activities, language acquisition, and integration with peers.
The very young children (under age three) receive a modified form of ABA which is much closer to play therapy
Effective ABA involves 40 hr/wk of intensive 1:1 behavioral training.
ABA has a reputation for being the most successful form of therapy available for autistic children, but it also has a dis-reputation for creating robotic, emotionless children.
ABA has been more fully researched and replicated than any other form of therapy. Lovaas and his team can show significant success in their work; according to one Lovaas study: “We found that 48% of all children showed rapid learning, achieved average post-treatment scores, and at age 7, were succeeding in regular education classrooms. These results are consistent with those reported by Lovaas and colleagues (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993).”
The bottom line is that therapy should be fun for the child.
• The Developmental, Individual Difference, Relationship-based (DIR®/Floortime™) Model
It is a parent oriented, developmental approach, teaching the child how to relate socially, communicate and think, based on a comprehensive framework which enables clinicians, parents and educators to construct a program tailored to the child’s unique challenges and strengths.
In the DIR model D stands for Developmental, I for Individual differences & R for Relationship-based approach.
In DIR/ Floortime model intervention program is tailored to the unique challenges and strengths of children with Autism Spectrum Disorders, to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors.
Understanding where the child is developmentally is critical to planning a treatment program. The aim is to help children to develop capacities to attend and remain calm and regulated, engage and relate to others, initiate and respond to all types of communication beginning with emotional and social affect based gestures, engage in shared social problem-solving and intentional behavior involving a continuous flow of interactions in a row, use ideas to communicate needs and think and play creatively.
Individual differences stem from the unique biologically-based ways in which each child takes in, regulates, responds to, and comprehends sensations such as sound, touch. Accordingly, the planning and sequencing of actions and ideas also vary from child to child. Special emphasis is laid on sensory impact on the child.
Relationship with the therapist & care-giver is essential for successful therapy. The role of the child’s natural emotions and interests which has been shown to be essential for learning interactions that enable the different parts of the mind and brain to work together and to build successively higher levels of social, emotional, and intellectual capacities. Floortime is a specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities. It involves a team approach with speech therapy, occupational therapy, educational programs, and, mental health (developmental-psychological) intervention. It emphasizes the critical role of parents and other family members because of the importance of their emotional relationships with the child.
• TEACCH (Treatment and Education of Autistic & Communication –handicapped Children) :
The TEACCH approach is a family-centered, evidence-based practice for autism, based on a theoretical conceptualization of autism, supported by empirical research, enriched by extensive clinical expertise, and notable for its flexible and person-centered support of individuals of all ages and skill levels.
Founded in the early 1970s by the late Eric Schopler, Ph.D., TEACCH developed the concept of the “Culture of Autism” as a way of thinking about the characteristic patterns of thinking and behavior seen in individuals with this diagnosis. The “Culture of Autism” involves:
1. Relative strength in and preference for processing visual information (compared to difficulties with auditory processing, particularly of language).
2. Frequent attention to details but difficulty understanding the meaning of how those details fit together.
3. Difficulty combining ideas.
4. Difficulty with organizing ideas, materials, and activities.
5. Difficulties with attention. (Some individuals are very distractible, others have difficulty shifting attention when it’s time to make transitions.)
6. Communication problems, which vary by developmental level but always include impairments in the social use of language (called “pragmatics”).
7. Difficulty with concepts of time, including moving too quickly or too slowly and having problems recognizing the beginning, middle, or end of an activity.
8. Tendency to become attached to routines, with the result that activities may be difficult to generalize from the original learning situation and disruptions in routines can be upsetting, confusing, or uncomfortable.
9. Very strong interests and impulses to engage in favored activities, with difficulties disengaging once engaged.
10. Marked sensory preferences and dislikes.
The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence. To accomplish these goals, TEACCH developed the intervention approach called “Structured Teaching.”
The principles of Structured Teaching include:
o Understanding the culture of autism.
o Developing an individualized person- and family-centered plan for each client or student, rather than using a standard curriculum.
o Structuring the physical environment.
o Using visual supports to make the sequence of daily activities predictable and understandable .
o Using visual supports to make individual tasks understandable
TEACCH provides a structured teaching program where the environment is adapted to the child with ASD. The focus is on teaching independent skills that can lead to independent work in future.
o Son-rise:
This is also a program based on parent focused, developmental approach. The basic philosophy of the program is understanding & acceptance of the child.
The principles of Son Rise program state that, Autism is a neurological challenge where children have difficulty relating and connecting to those around them; most of their so-called behavioral challenges stem from this relational deficit. So, their play-oriented methods focus extensively on socialization and rapport building. The therapist joins in the child's repetitive, exclusive and ritualistic behaviors instead of trying to curb it, and, thereby builds a rapport and connection, the platform for all future education and development. Participating with a child in these behaviors facilitates eye contact, social development and inclusion of others in play.
Parents are involved, empowered & provided with the skills & training they need to help their child.
Most children on the Autism Spectrum are highly over stimulated by a plethora of distractions that most of us do not even notice. This program shows how to create an optimal learning environment so that distractions are eliminated and interactions are facilitated
The program is designed to be customized to each child's needs.
Additional therapies like sensory integration, occupational therapy etc. are included along with The Son-Rise Program® principles, making it even more effective than when used individually.
PECS (Picture exchange communications) :
This method is used to to improve communication skills with use of picture cards, communication boards etc.
I. OCCUPATIONAL THERAPY & SENSORY INTEGRATION
Occupational therapy assists in developing skills for daily activities. In autism Occupational therapy has various roles:
Helps in developing skills like hand writing, buttoning shirts, tying shoe laces, self feeding etc.
Developing play skills & social skills
Basic personal skills for independent living
Sensory integration
OT interventions include:
• Swinging, brushing, playing in a ball pit etc to help the child manage his body in space.
• Facilitate play activities that instruct & aid a child in interacting and communicating.
• Develop adaptive techniques and strategies to get around apparent disabilities.
• Sensory integration therapy is based on the assumption that the child is either hyper or hypo sensitive to sensory stimuli in the environment. They are also unable to combine the various senses (sight, sound, smell, taste & touch) to make sense of the environment. In sensory integration the child is placed in a room designed to stimulate & challenge all the senses. SI therapy aims to improve the ability of the brain to process the multiple sensory inputs, so that the child functions better in his daily activities. During SI therapy the child interacts 1:1 with the therapist and performs activities that combine sensory inputs with motion. Activities include:
Swinging in a hammock
Dancing to music
Playing in bean filled boxes
Crawling through tunnels
Hitting swinging balls
Spinning on a chair
Balancing on a beamof
The focus of sensory Integration therapy is to help children with autism combine appropriate movements with the input they get from different sources.the world around
II. SPEECH & LANGUAGE THERAPY
This should focus on non-verbal & verbal communication, receptive & expressive language.
PROGNOSIS.
o No cure is known as yet. Some children do recover occassionally, but the actual recovery rate is not known.
o A better prognosis is associated with higher intelligence, functional speech, and less bizarre symptoms and behavior. Children acquiring language before age six and having an IQ above 50 may grow up to live self-sufficient, employed, albeit isolated, lives in the community.
o Many others remain dependent on their family for their everyday lives
o A 2004 British study of 68 adults who were diagnosed before 1980 as autistic children with IQ above 50 found that 12% achieved a high level of independence as adults, 10% had some friends and were generally in work but required some support, 19% had some independence but were generally living at home and needed considerable support and supervision in daily living, 46% needed specialist residential provision from facilities specializing in ASD with a high level of support and very limited autonomy, and 12% needed high-level hospital care.
o There is no increased risk of schizophrenia in adulthood
o The symptom profile for some children may change as they grow older.
CONCLUSION
Autism is not exactly a disease, its just a different way of looking at and accepting this world. Left to themselves., autistic children would have nothing to complain of. But, the real problem is that we parents and care-givers expect something different from him, which he fails to comply with, and, that creates a frustration in us, a despair, ‘How is this child going to survive in this society?’
We definitely will thrive to bring about certain changes in the autistic child, to make him more fit for this world, this society. But we must remember that it is as difficult for him to change as it is for us to change our concept of communication and relationships. So instead of burdening the poor child with all the ‘hard to accept’ modifications, cant we modify ourselves to accept him as he is? Lets try, for once, to identify ourselves with him, try to look at the world through his eyes….that might be a great help, a real eye opener.
Autism means a developmental disability significantly affecting verbal and nonverbal communication, social interaction and creative or imaginative play, generally evident before age three.
What is ASD?
The autism spectrum disorders (ASD) is a spectrum of psychological conditions characterized by widespread abnormalities of social interactions and communication, as well as severely restricted interests and highly repetitive behavior
The three forms of ASD are:
1. Autism
2. Asperger syndrome
3. Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), sometimes called atypical autism.
Asperger Syndrome has no significant delay in language development. They have good intelligence and are considered as high-functioning autists. PDD-NOS is diagnosed when the criteria are not met for a more specific disorder. Some sources also include Rett syndrome and childhood disintegrative disorder, which share several signs with autism but may have unrelated causes
HISTORY
Autism was first described by Leo Kenner, a psychiatrist at John Hopkins University, in 1943, in a group of children with communication problems.
In 1944, Hans Asperger, an Austrian Pediatrician described a similar condition in children, but with higher cognitive and verbal skills.
Autism first appeared as a separate entitywith specific criteria in Psychiatry texts in 1980.
How common is autism?
Current prevalence of ASD, as reported from the US in 2007 is 6.6/1000
8-year old children. Incidence is reported to be on the rise, as is evident from the graph on annual incidence data.
Is it linked to other diseases?
Autism may or may not exist with other illnesses. A recognizable associated condition in found in only 6% cases. Co-existing Mental Retardation was considered to be 90% before the ‘90s, which has come down to 50% after 2000, due to increased identification of high functioning autism.
Common diseases known to be associated with Autism are Fragile X syndrome(35-50% have autistic traits), Retts syndrome (females with a small head, seizures & autistic traits),Tuberous sclerosis, Phenylketonuria, Fetal Alcohol Syndrome, Angelman Syndrome, Smith Lemli Opitz syndrome etc.
Prenatal factors like ingestion of certain medicines by mother ( valproic acid, thalidomide), maternal illness (rubella) are being considerd as probable causative factors. A population based study by Institute of Medicine in 2001 has established that there is NO causal association between MMR & autism.
WHAT HAPPENS IN AUTISM?
Just after birth, the brains of autistic children tend to grow faster than usual, followed by normal or relatively slower growth in childhood. It is not known whether early overgrowth occurs in all autistic children. It seems to be most prominent in brain areas underlying the development of higher cognitive specialization. Hypotheses for the cellular and molecular bases of pathological early overgrowth include the following:
• An excess of neurons that cause local over-connectivity in key brain regions.
• Disturbed neuronal migration during early gestation.
• Unbalanced excitatory–inhibitory networks.
HOW?
Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood.
HOW IS THE PSYCHOLOGY OF AN AUTISTIC CHILD DIFFERENT?
Two major categories of cognitive theories have been proposed about the links between autistic brains and behavior.
The first category focuses on deficits in social cognition. The empathizing–systemizing theory postulates that autistic individuals can systemize, that is, they can develop internal rules of operation to handle events inside the brain ( like arranging things in a specific order)—but are less effective at empathizing by handling events and swquences generated by others. This theory is somewhat related to the earlier theory of mind approach, which hypothesizes that autistic behavior arises from an inability to ascribe mental states to oneself and others. He cannot guess what another person may be thinking or how another person would be looking at a particular situation. The theory of mind hypothesis is supported by autistic children's atypical responses to the Sally–Anne test for reasoning about others' motivations. The second category focuses on nonsocial or general processing. Executive dysfunction hypothesizes that there are deficits in working memory, planning, inhibition, and other forms of executive function . This theory predicts stereotyped behavior and narrow interests.
Weak central coherence theory hypothesizes that a limited ability to see the big picture underlies the central disturbance in autism. He focuses on small things, but cannot take in a situation as a whole. This theory predicts special talents and peaks in performance in autistic people
Neither category is satisfactory on its own; social cognition theories poorly address autism's rigid and repetitive behaviors, while the nonsocial theories have difficulty explaining social impairment and communication difficulties. A combined theory based on multiple deficits may prove to be more useful.
WHAT ARE THE FEATURES OF AUTISM?
The core features of ASD include social skill defects, restricted, repetitive & stereotyped behaviour, and language delay, but there is wide variation in presentation, with a lot of heterogeniety. Social deficits, though specific, may be subtle and go unrecognised. Parental concern is more with the speech delay. Presentations vary and some parents report that their babies are different during the first months of life, whereas delayed speech is reported during the 2nd year of life and still others may be normal in the early months and regress and lose skills in the 2nd year. Some ASD children may present at school age because of poor peer interaction.
Social skill defects include:
May be content being alone, not seeking connectedness
Poor eye contact
Difficulty sharing the emotional state of others
Joint attention deficit : does not enjoy sharing an object, event or emotion
Inappropriate peer relationships
Impaired central coherence: inability to interpret stimuli in a global way.
Difficulty understanding the perspective of others.
Difficulty with empathy, sharing and comforting due to severe ToM (theory of mind) deficits…refered to as ‘mindblindedness’
Communication Deficits:
Mostly present with speech delay
Lack of desire to communicate
Lack of non-verbal communication
Speech maybe scripted and stereotyped.
Echolalia is common
Use of pop-up words: spontaneous, inconsistent words uttered out of context
Use of giant words: phrases uttered as single words (wanna-go-home, give-it-to-me)
Earlier pre-speech deficits like lack of warm, joyful expression with gaze, lack of recognition of mother’s voice, to & fro communication with mother, disregard for vocalization, delayed babbling etc facilitate early diagnosis.
Regression : In 25-30% regression of skills occur around 15-24 months, including regression of speech.
Play skills
Lack of pretend play
Persistence of sensory-motor and ritualistic play
Repititive play with lack of creativity & imagination (eg. Spinning wheels of cars)
Behavioural Pattern:
Peculir mannerisms
Unusual attachment to objects
Compulsive behaviour: rigidly follows certain rules like arranging in lines
Obsessive about sameness: resistant to change
Ritualistic behaviour: Unvarying pattern of daily activities like unchanging menu, dressing ritual etc.
Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program, toy, or game
Repititive & stereotyped movements like rocking, head rolling, flapping hands etc
Other symptoms
Unusual abilities: 0.5% to 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia (rote memory) to the extraordinarily rare talents of prodigious autistic savants. Many individuals with ASD show superior skills in perception and attention, relative to the general population.
Sensory abnormalities are found in over 90% of those with autism, and are considered core features by some. Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements. Children with autism are less capable of simultaneously using the different senses to take in the varied information from the environment and combine them to produce a clear understanding of the world around, therefore they may have trouble responding appropriately to different stimuli (is unable to listen to the teacher, when looking at the board).
An estimated 60%–80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking; deficits in motor coordination are pervasive across ASD and are greater in autism proper.
Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator
The Red Flag Signs of Autism Spectrum Disorders:
If your baby shows two or more of these signs, please ask your pediatric healthcare provider for an immediate evaluation.
Impairment in Social Interaction:
• Lack of appropriate eye gaze
• Lack of warm, joyful expressions
• Lack of sharing interest or enjoyment
• Lack of response to name
Impairment in Communication:
• Lack of showing gestures
• Lack of coordination of nonverbal communication
• Unusual prosody (little variation in pitch, odd intonation, irregular rhythm, unusual voice quality)
Repetitive Behaviors & Restricted Interests:
• Repetitive movements with objects
• Repetitive movements or posturing of body, arms, hands, or fingers
TREATMENT
The main goals when treating children with autism are to lessen associated deficits and family distress, and to increase quality of life and functional independence. No single treatment is best and treatment is typically tailored to the child's needs. Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills and often improve functioning and decrease symptom severity and maladaptive behaviors.
Basic treatment of the child includes:
Routine immunizations as per schedule
Treatment of any acute illnesses
Manage sleep disturbance
Treatment of seizures
Normal mixed diet. Mega vitamins & food supplements are not recommended. Dietary restrictions only if food allergy is proved.
There is no medicine to cure autism. Medicines are sometimes used to ameliorate target behaviors like hyperactivity, tantrums, physical aggression, self-injurious behavior, and anxiety symptoms, when they interfere with socialization, learning, health & quality of life.
The mainstay of treatment is BEHAVIOURAL THERAPY: Various intervention modules are in use, which include:
• Applied Behavior Analysis (ABA).
Intensive Behavioral Intervention is based on Applied Behavior Analysis (ABA). Lovaas, a psychologist, first applied ABA to autism at the Psychology Department at UCLA in 1987. His idea was that social and behavioral skills could be taught, even to profoundly autistic children.
ABA starts with "discrete trial" therapy. A discrete trial consists of a therapist asking a child for a particular behaviour, if the child complies, he is given a "reinforcer" or reward in the form of a tiny food treat, or any other reward that means something to the child. If the child does not comply, he does not receive the reward, and the trial is repeated.
The rewards, called reinforcers, should be based on the interests and preferences of the individual child. They should be so interesting to the child that they are worth the hard work of responding to the therapist
The specific content of the discrete trials therapy is based on an evaluation of the individual child, his needs, and his abilities. They aim at acquisition of compliance behavior, imitation activities, language acquisition, and integration with peers.
The very young children (under age three) receive a modified form of ABA which is much closer to play therapy
Effective ABA involves 40 hr/wk of intensive 1:1 behavioral training.
ABA has a reputation for being the most successful form of therapy available for autistic children, but it also has a dis-reputation for creating robotic, emotionless children.
ABA has been more fully researched and replicated than any other form of therapy. Lovaas and his team can show significant success in their work; according to one Lovaas study: “We found that 48% of all children showed rapid learning, achieved average post-treatment scores, and at age 7, were succeeding in regular education classrooms. These results are consistent with those reported by Lovaas and colleagues (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993).”
The bottom line is that therapy should be fun for the child.
• The Developmental, Individual Difference, Relationship-based (DIR®/Floortime™) Model
It is a parent oriented, developmental approach, teaching the child how to relate socially, communicate and think, based on a comprehensive framework which enables clinicians, parents and educators to construct a program tailored to the child’s unique challenges and strengths.
In the DIR model D stands for Developmental, I for Individual differences & R for Relationship-based approach.
In DIR/ Floortime model intervention program is tailored to the unique challenges and strengths of children with Autism Spectrum Disorders, to build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors.
Understanding where the child is developmentally is critical to planning a treatment program. The aim is to help children to develop capacities to attend and remain calm and regulated, engage and relate to others, initiate and respond to all types of communication beginning with emotional and social affect based gestures, engage in shared social problem-solving and intentional behavior involving a continuous flow of interactions in a row, use ideas to communicate needs and think and play creatively.
Individual differences stem from the unique biologically-based ways in which each child takes in, regulates, responds to, and comprehends sensations such as sound, touch. Accordingly, the planning and sequencing of actions and ideas also vary from child to child. Special emphasis is laid on sensory impact on the child.
Relationship with the therapist & care-giver is essential for successful therapy. The role of the child’s natural emotions and interests which has been shown to be essential for learning interactions that enable the different parts of the mind and brain to work together and to build successively higher levels of social, emotional, and intellectual capacities. Floortime is a specific technique to both follow the child’s natural emotional interests (lead) and at the same time challenge the child towards greater and greater mastery of the social, emotional and intellectual capacities. It involves a team approach with speech therapy, occupational therapy, educational programs, and, mental health (developmental-psychological) intervention. It emphasizes the critical role of parents and other family members because of the importance of their emotional relationships with the child.
• TEACCH (Treatment and Education of Autistic & Communication –handicapped Children) :
The TEACCH approach is a family-centered, evidence-based practice for autism, based on a theoretical conceptualization of autism, supported by empirical research, enriched by extensive clinical expertise, and notable for its flexible and person-centered support of individuals of all ages and skill levels.
Founded in the early 1970s by the late Eric Schopler, Ph.D., TEACCH developed the concept of the “Culture of Autism” as a way of thinking about the characteristic patterns of thinking and behavior seen in individuals with this diagnosis. The “Culture of Autism” involves:
1. Relative strength in and preference for processing visual information (compared to difficulties with auditory processing, particularly of language).
2. Frequent attention to details but difficulty understanding the meaning of how those details fit together.
3. Difficulty combining ideas.
4. Difficulty with organizing ideas, materials, and activities.
5. Difficulties with attention. (Some individuals are very distractible, others have difficulty shifting attention when it’s time to make transitions.)
6. Communication problems, which vary by developmental level but always include impairments in the social use of language (called “pragmatics”).
7. Difficulty with concepts of time, including moving too quickly or too slowly and having problems recognizing the beginning, middle, or end of an activity.
8. Tendency to become attached to routines, with the result that activities may be difficult to generalize from the original learning situation and disruptions in routines can be upsetting, confusing, or uncomfortable.
9. Very strong interests and impulses to engage in favored activities, with difficulties disengaging once engaged.
10. Marked sensory preferences and dislikes.
The long-term goals of the TEACCH approach are both skill development and fulfillment of fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence. To accomplish these goals, TEACCH developed the intervention approach called “Structured Teaching.”
The principles of Structured Teaching include:
o Understanding the culture of autism.
o Developing an individualized person- and family-centered plan for each client or student, rather than using a standard curriculum.
o Structuring the physical environment.
o Using visual supports to make the sequence of daily activities predictable and understandable .
o Using visual supports to make individual tasks understandable
TEACCH provides a structured teaching program where the environment is adapted to the child with ASD. The focus is on teaching independent skills that can lead to independent work in future.
o Son-rise:
This is also a program based on parent focused, developmental approach. The basic philosophy of the program is understanding & acceptance of the child.
The principles of Son Rise program state that, Autism is a neurological challenge where children have difficulty relating and connecting to those around them; most of their so-called behavioral challenges stem from this relational deficit. So, their play-oriented methods focus extensively on socialization and rapport building. The therapist joins in the child's repetitive, exclusive and ritualistic behaviors instead of trying to curb it, and, thereby builds a rapport and connection, the platform for all future education and development. Participating with a child in these behaviors facilitates eye contact, social development and inclusion of others in play.
Parents are involved, empowered & provided with the skills & training they need to help their child.
Most children on the Autism Spectrum are highly over stimulated by a plethora of distractions that most of us do not even notice. This program shows how to create an optimal learning environment so that distractions are eliminated and interactions are facilitated
The program is designed to be customized to each child's needs.
Additional therapies like sensory integration, occupational therapy etc. are included along with The Son-Rise Program® principles, making it even more effective than when used individually.
PECS (Picture exchange communications) :
This method is used to to improve communication skills with use of picture cards, communication boards etc.
I. OCCUPATIONAL THERAPY & SENSORY INTEGRATION
Occupational therapy assists in developing skills for daily activities. In autism Occupational therapy has various roles:
Helps in developing skills like hand writing, buttoning shirts, tying shoe laces, self feeding etc.
Developing play skills & social skills
Basic personal skills for independent living
Sensory integration
OT interventions include:
• Swinging, brushing, playing in a ball pit etc to help the child manage his body in space.
• Facilitate play activities that instruct & aid a child in interacting and communicating.
• Develop adaptive techniques and strategies to get around apparent disabilities.
• Sensory integration therapy is based on the assumption that the child is either hyper or hypo sensitive to sensory stimuli in the environment. They are also unable to combine the various senses (sight, sound, smell, taste & touch) to make sense of the environment. In sensory integration the child is placed in a room designed to stimulate & challenge all the senses. SI therapy aims to improve the ability of the brain to process the multiple sensory inputs, so that the child functions better in his daily activities. During SI therapy the child interacts 1:1 with the therapist and performs activities that combine sensory inputs with motion. Activities include:
Swinging in a hammock
Dancing to music
Playing in bean filled boxes
Crawling through tunnels
Hitting swinging balls
Spinning on a chair
Balancing on a beamof
The focus of sensory Integration therapy is to help children with autism combine appropriate movements with the input they get from different sources.the world around
II. SPEECH & LANGUAGE THERAPY
This should focus on non-verbal & verbal communication, receptive & expressive language.
PROGNOSIS.
o No cure is known as yet. Some children do recover occassionally, but the actual recovery rate is not known.
o A better prognosis is associated with higher intelligence, functional speech, and less bizarre symptoms and behavior. Children acquiring language before age six and having an IQ above 50 may grow up to live self-sufficient, employed, albeit isolated, lives in the community.
o Many others remain dependent on their family for their everyday lives
o A 2004 British study of 68 adults who were diagnosed before 1980 as autistic children with IQ above 50 found that 12% achieved a high level of independence as adults, 10% had some friends and were generally in work but required some support, 19% had some independence but were generally living at home and needed considerable support and supervision in daily living, 46% needed specialist residential provision from facilities specializing in ASD with a high level of support and very limited autonomy, and 12% needed high-level hospital care.
o There is no increased risk of schizophrenia in adulthood
o The symptom profile for some children may change as they grow older.
CONCLUSION
Autism is not exactly a disease, its just a different way of looking at and accepting this world. Left to themselves., autistic children would have nothing to complain of. But, the real problem is that we parents and care-givers expect something different from him, which he fails to comply with, and, that creates a frustration in us, a despair, ‘How is this child going to survive in this society?’
We definitely will thrive to bring about certain changes in the autistic child, to make him more fit for this world, this society. But we must remember that it is as difficult for him to change as it is for us to change our concept of communication and relationships. So instead of burdening the poor child with all the ‘hard to accept’ modifications, cant we modify ourselves to accept him as he is? Lets try, for once, to identify ourselves with him, try to look at the world through his eyes….that might be a great help, a real eye opener.
Thursday, January 21, 2010
THE ULTIMATE LESSON
21st January, 1978, an hour & half past midnight. A conspicuously silent & dark winter night. Yes, that’s what it seemed, to the young medico preparing for her Surgery exams, in her room on the 2nd floor of the Students’ Hostel at the Medical College.
“Strange, with all those huge buildings around, why is it so silent? Are all asleep at the Casualty Block? The Maternity Wards? The Surgery? The morgue? Poor me, I have to keep awake & keep on mugging”, thought Namu, the young medico.
From Appendicitis to Crohn’s Disease, she was about to turn pages, when a screeching sound of iron gates suddenly broke the silence, then a couple of hushed up voices. These were familiar sounds. “Another body entering the morgue!” she mumbled to herself. “Funny”, she pondered,” Few hours ago this person was alive, moving, eating, crying, laughing, hankering and lamenting, and now there’s no ‘ing’ left in him! No verbs, just a noun, a ‘corpse’, that is a bundle of flesh, bones and organs. In a few days he’ll be on the table for dissection, smelling of stale barbeque. So what was it that was there & is gone now? Anatomically, its all there in place!...”
“Enough of your philosophy, young lady, and back to your books now!” retorted Mr. Conscience.
So again back to treatment of Crohn’s Disease. Half an hour later, Namu was just about to snooze off, when a shrill cry from behind shook her up. That was from the Maternity Ward. Another woman in labour. The shrieks came back at shorter intervals, each time sharper than the previous one, then a sudden silence. “Thank God, the baby’s been delivered.” “Oh, that means another new life! Exciting! Then this tiny baby is going to grow & eat and move and cry & laugh, bla, bla, bla, till all verbs come to an end…. Anyhow, for today, this is new life, a new creation! Just makes me happy” she mused and went back to her books.
Going through pages of intestinal malignancies, she felt disgusted. Diseases you read about but didn’t learn how to cure always left a bitter taste in her mouth. Just then came that heart rendering hoarse yelling from the Casualty…. Some badly hurt person was being carried in, or maybe an acute abdomen in pain. Oh, these voices sound so loud at the wee hours of night! “So that’s the missing link”, she thought, “We start life with one shrill cry, then go on groaning, moaning, crying & yelling till the final silence comes” A few sounds & some noise had opened her mind to a new perception. It reminded her of a line from Shakespeare she often quoted in school, but didn‘t really understand then, ‘Life is a dream between a sleep & a sleep, full of sound & fury, signifying nothing” Is this what he meant?
“Shakespeare or Surgery, what is your priority, Ma'am?” snapped Mr. Conscience.
“Oh, shut up! There is something here I’ve got to understand now. If I have to accept surgery & Medicine, I’ve got to get this straight first. I was just mugging up Surgery, but here I have a definite conception” Namu retorted.
“Birth, age, death & suffering… is this the cover to cover story of life? No, there must be something beyond all this. It definitely is not just ‘sound & fury’. That’s what we are busy with, so we don’t look beyond….”
“Weren’t these the things Goutam Buddha had witnessed when he renounced the world? In search of what? .Nirvana?... .What is Nirvana?
“I don’t understand Nirvana and I’m not renouncing, not even giving up the Surgery exam! But I’m disturbed because there is a message I can’t decipher”
With this Namu went back to Cholecystitis in Surgery. The exams went well; she scored good marks, got a good job and has been busy with her profession and family for all these years. But the lesson she learnt on this day 32 years back is still considered by her as her ultimate lesson.
A lesson on which she has been striving to give an open book exam all her life. “If we have to go through this apparently meaningless sound & fury which ends in nothing, how can we make the journey purposeful & cut out the extra ‘sound & fury’? Can we trace that “something beyond all this’ into our lives here on this earth, to add some meaning to it?”
“Oh God, teach me to lead a life by which I can touch that eternal light here in this life, in this world”
“Strange, with all those huge buildings around, why is it so silent? Are all asleep at the Casualty Block? The Maternity Wards? The Surgery? The morgue? Poor me, I have to keep awake & keep on mugging”, thought Namu, the young medico.
From Appendicitis to Crohn’s Disease, she was about to turn pages, when a screeching sound of iron gates suddenly broke the silence, then a couple of hushed up voices. These were familiar sounds. “Another body entering the morgue!” she mumbled to herself. “Funny”, she pondered,” Few hours ago this person was alive, moving, eating, crying, laughing, hankering and lamenting, and now there’s no ‘ing’ left in him! No verbs, just a noun, a ‘corpse’, that is a bundle of flesh, bones and organs. In a few days he’ll be on the table for dissection, smelling of stale barbeque. So what was it that was there & is gone now? Anatomically, its all there in place!...”
“Enough of your philosophy, young lady, and back to your books now!” retorted Mr. Conscience.
So again back to treatment of Crohn’s Disease. Half an hour later, Namu was just about to snooze off, when a shrill cry from behind shook her up. That was from the Maternity Ward. Another woman in labour. The shrieks came back at shorter intervals, each time sharper than the previous one, then a sudden silence. “Thank God, the baby’s been delivered.” “Oh, that means another new life! Exciting! Then this tiny baby is going to grow & eat and move and cry & laugh, bla, bla, bla, till all verbs come to an end…. Anyhow, for today, this is new life, a new creation! Just makes me happy” she mused and went back to her books.
Going through pages of intestinal malignancies, she felt disgusted. Diseases you read about but didn’t learn how to cure always left a bitter taste in her mouth. Just then came that heart rendering hoarse yelling from the Casualty…. Some badly hurt person was being carried in, or maybe an acute abdomen in pain. Oh, these voices sound so loud at the wee hours of night! “So that’s the missing link”, she thought, “We start life with one shrill cry, then go on groaning, moaning, crying & yelling till the final silence comes” A few sounds & some noise had opened her mind to a new perception. It reminded her of a line from Shakespeare she often quoted in school, but didn‘t really understand then, ‘Life is a dream between a sleep & a sleep, full of sound & fury, signifying nothing” Is this what he meant?
“Shakespeare or Surgery, what is your priority, Ma'am?” snapped Mr. Conscience.
“Oh, shut up! There is something here I’ve got to understand now. If I have to accept surgery & Medicine, I’ve got to get this straight first. I was just mugging up Surgery, but here I have a definite conception” Namu retorted.
“Birth, age, death & suffering… is this the cover to cover story of life? No, there must be something beyond all this. It definitely is not just ‘sound & fury’. That’s what we are busy with, so we don’t look beyond….”
“Weren’t these the things Goutam Buddha had witnessed when he renounced the world? In search of what? .Nirvana?... .What is Nirvana?
“I don’t understand Nirvana and I’m not renouncing, not even giving up the Surgery exam! But I’m disturbed because there is a message I can’t decipher”
With this Namu went back to Cholecystitis in Surgery. The exams went well; she scored good marks, got a good job and has been busy with her profession and family for all these years. But the lesson she learnt on this day 32 years back is still considered by her as her ultimate lesson.
A lesson on which she has been striving to give an open book exam all her life. “If we have to go through this apparently meaningless sound & fury which ends in nothing, how can we make the journey purposeful & cut out the extra ‘sound & fury’? Can we trace that “something beyond all this’ into our lives here on this earth, to add some meaning to it?”
“Oh God, teach me to lead a life by which I can touch that eternal light here in this life, in this world”
Saturday, July 4, 2009
IRON IN HER SOUL, NOT IN HER BLOOD
Durga Puja. Maha Ashtami.
“Vidya samastastava devi veda, Striya samastah sakala jagatsu”** went the chanting, with the rhythmic beats of the dhak at the background.
Bharati stood silently, holding onto her crippled child, staring with awe at the grand image of the Goddess Durga, the idol of strength personified. Along with an ardent prayer, there was also a tinge of identification in her expression. Did she feel the strength of the Goddess within herself?
Bharati, a frail looking ordinary Indian woman was a young mother of three girls—the youngest being a congenitally crippled child of seven. This 3rd childbirth had been a disgrace to the family—so the 22 year old, sickly and malnourished Bharati had been dumped with her three kids at her parents’ place, where again she was just a great burden, borne with much resentment. What was Bharati’s fate? Plunging into utter darkness and gradual demolition? No. Young and frail, Bharati had the courage to live, the guts to hope. Or maybe, she was too big a fool to despair. With her utterly impractical hopefulness she ran from post to pillar with her 1.8 kg deformed newborn, struggling for her survival. It meant long queues at the hospital outdoor, even longer waits at the local leader’s office for a BPL card. At the end of a long wait a ray of hope would prompt her to run again—now to an orthopaedic surgeon, then to a physiotherapist; once to a neurologist, later to a special educator. The race was un-ending, but tire she knew not of. In between all this she had to keep her job as a domestic help to provide for herself and her kids. Her day started at 5 AM: household chores, feeding the children & sending them to school, then rushing to the apartment she worked at. Washing, cleaning, scrubbing continued till she sought a break to run to the hospital for the little baby. Coming back home at 2PM, cooking a fast lunch for the children, she would again rush off to work. Later in the evening, she would return home, only to find loads of chores still waiting for her. Her food? Yes, bits here & there were her fill.
This is how days, months & years have been passing for Bharati. In the mean time the deformed, distorted child had miraculously survived and was growing up. The bud, which seemed destined to be nipped, was blooming! Yes, a miracle indeed. She had learnt to sit, to stand and walk (of course with the support device Bharati had managed to buy with her petty savings), to talk, sing, read & write! The greatest miracle was that she had a brilliant brain. She was going to school now and doing real well. Still deformed with a defective gait and grip, she was excelling in everything: studies, music, elocution, even drawing! A winner in all, she was now a real wonder, vibrant and happy, full of life. And behind her was the real winner: Bharati.
Now, after seven long years, her family, her husband, her in-laws all realized her potentiality. The hidden strength & ability in this apparently frail and foolish speck of a girl was evident now. She had it in her—the Iron Will.
Bharati depicts the true picture of an ordinary Indian woman with iron in her soul: the manifestation of the Goddess of Shakti in her. “Ya Devi sarva bhuteshu shakti rupena sangsthita….. Ya Devi sarva bhuteshu matri rupena sangsthita” Devi manifests as shakti, as a mother. This is why we hear Swami Vivekananda proclaim “The real shakti worshipper is he who knows that God is the omnipresent force of the universe and sees in the woman the manifestation of that force.
Yet sadly enough, the Bharatis of our country do have the strong will of Ma Durga, but what of Her rosy cheeks? They are replaced by a pale, sunken facies. Had a little of the iron from Bharati’s soul trickled to her blood, the haemoglobin would have risen to an acceptable level. But, unfortunately, neglect from day one has prevented that.
The Bharatis of our Bharat are born unwanted into the family and grow up as a by-product. They are deprived of nutrition at all levels: the mother’s milk, the family food, nutritional additives, all. Illness is inadequately attended to, what to speak of convalescence. Education is considered an extravagancy. Then at a tender pubertal age they are wed off or rather, got rid of. She now lands up in a life of greater deprivation and oppression, from the frying pan to the fire. Added to this comes the brunt of an underage pregnancy, again with very little medical attention. The ordeal continues with childbirth, lactation, another pregnancy, a new member. Yet one more…and one more… the story goes on. The net result is that she gets drained of all vitality—severe anaemia is the ultimate picture.
This is the sad story of the common Indian woman, all our Bharatis, who have iron in their soul but lack it in their blood. Our energy sources are thus being reduced to weaklings, and every single Indian should feel responsible for this negligence & deprivation of women. To quote Swami Vivekananda once more, “That nation which does not respect women has never become great and never will ever be in future…. The uplift of women must come first and then only can any real good come about for the country, for India”
** You are in every woman in the universe as her beauty, her knowledge, her modesty.
“Vidya samastastava devi veda, Striya samastah sakala jagatsu”** went the chanting, with the rhythmic beats of the dhak at the background.
Bharati stood silently, holding onto her crippled child, staring with awe at the grand image of the Goddess Durga, the idol of strength personified. Along with an ardent prayer, there was also a tinge of identification in her expression. Did she feel the strength of the Goddess within herself?
Bharati, a frail looking ordinary Indian woman was a young mother of three girls—the youngest being a congenitally crippled child of seven. This 3rd childbirth had been a disgrace to the family—so the 22 year old, sickly and malnourished Bharati had been dumped with her three kids at her parents’ place, where again she was just a great burden, borne with much resentment. What was Bharati’s fate? Plunging into utter darkness and gradual demolition? No. Young and frail, Bharati had the courage to live, the guts to hope. Or maybe, she was too big a fool to despair. With her utterly impractical hopefulness she ran from post to pillar with her 1.8 kg deformed newborn, struggling for her survival. It meant long queues at the hospital outdoor, even longer waits at the local leader’s office for a BPL card. At the end of a long wait a ray of hope would prompt her to run again—now to an orthopaedic surgeon, then to a physiotherapist; once to a neurologist, later to a special educator. The race was un-ending, but tire she knew not of. In between all this she had to keep her job as a domestic help to provide for herself and her kids. Her day started at 5 AM: household chores, feeding the children & sending them to school, then rushing to the apartment she worked at. Washing, cleaning, scrubbing continued till she sought a break to run to the hospital for the little baby. Coming back home at 2PM, cooking a fast lunch for the children, she would again rush off to work. Later in the evening, she would return home, only to find loads of chores still waiting for her. Her food? Yes, bits here & there were her fill.
This is how days, months & years have been passing for Bharati. In the mean time the deformed, distorted child had miraculously survived and was growing up. The bud, which seemed destined to be nipped, was blooming! Yes, a miracle indeed. She had learnt to sit, to stand and walk (of course with the support device Bharati had managed to buy with her petty savings), to talk, sing, read & write! The greatest miracle was that she had a brilliant brain. She was going to school now and doing real well. Still deformed with a defective gait and grip, she was excelling in everything: studies, music, elocution, even drawing! A winner in all, she was now a real wonder, vibrant and happy, full of life. And behind her was the real winner: Bharati.
Now, after seven long years, her family, her husband, her in-laws all realized her potentiality. The hidden strength & ability in this apparently frail and foolish speck of a girl was evident now. She had it in her—the Iron Will.
Bharati depicts the true picture of an ordinary Indian woman with iron in her soul: the manifestation of the Goddess of Shakti in her. “Ya Devi sarva bhuteshu shakti rupena sangsthita….. Ya Devi sarva bhuteshu matri rupena sangsthita” Devi manifests as shakti, as a mother. This is why we hear Swami Vivekananda proclaim “The real shakti worshipper is he who knows that God is the omnipresent force of the universe and sees in the woman the manifestation of that force.
Yet sadly enough, the Bharatis of our country do have the strong will of Ma Durga, but what of Her rosy cheeks? They are replaced by a pale, sunken facies. Had a little of the iron from Bharati’s soul trickled to her blood, the haemoglobin would have risen to an acceptable level. But, unfortunately, neglect from day one has prevented that.
The Bharatis of our Bharat are born unwanted into the family and grow up as a by-product. They are deprived of nutrition at all levels: the mother’s milk, the family food, nutritional additives, all. Illness is inadequately attended to, what to speak of convalescence. Education is considered an extravagancy. Then at a tender pubertal age they are wed off or rather, got rid of. She now lands up in a life of greater deprivation and oppression, from the frying pan to the fire. Added to this comes the brunt of an underage pregnancy, again with very little medical attention. The ordeal continues with childbirth, lactation, another pregnancy, a new member. Yet one more…and one more… the story goes on. The net result is that she gets drained of all vitality—severe anaemia is the ultimate picture.
This is the sad story of the common Indian woman, all our Bharatis, who have iron in their soul but lack it in their blood. Our energy sources are thus being reduced to weaklings, and every single Indian should feel responsible for this negligence & deprivation of women. To quote Swami Vivekananda once more, “That nation which does not respect women has never become great and never will ever be in future…. The uplift of women must come first and then only can any real good come about for the country, for India”
** You are in every woman in the universe as her beauty, her knowledge, her modesty.
Sunday, June 28, 2009
WHAT EVERY MOTHER SHOULD KNOW
Was my baby healthy at birth?
“Dear Mom, you brought me into this new land, don’t you want to know how I’m feeling?” this is what the newborn baby seems to be saying imploringly.
Sure, the new mother should be abreast of her baby’s condition:
• What’s his birth weight?
• Is he premature?
• Did he cry after birth?
• Is he feeding properly?
• Is he sick?
• Does he have any abnormality?
• Does he need any special treatment?
During the baby’s stay in the hospital it is preferred that the mother be constantly involved in the baby care. This early mother-child bonding is the 1st step of early intervention to support normal development.
Is my child developing normally?
This is a question that comes to every mother’s mind as she fondly cradles her baby. But unfortunately, very few have a clear concept of the developmental milestones and we professionals fail to provide the required information to them.
In an attempt to make up for this shortfall, I put forth here a simple list of achievements of your little master, for you mothers to go through:
At three months of age, most babies:
• turn their heads toward bright colors and lights
• move both eyes in the same direction together
• respond to their mother's voice
• make cooing sounds
• bring their hands together
• wiggle and kick with arms and legs
• lift head when on stomach
• become quiet in response to sound, especially to speech
• smile
At six months of age, most babies:
• follow moving objects with their eyes
• turn toward the source of normal sound
• reach for objects and pick them up
• switch toys from one hand to the other
• play with their toes
• recognize familiar faces
• imitate speech sounds
• respond to soft sounds, especially talking
• roll over
At 12 months of age, most babies:
• get to a sitting position
• pull to a standing position
• stand briefly without support
• crawl
• imitate adults using a cup or telephone
• play peek-a-boo and pat-a-cake
• retrieves a hidden toy
• wave bye-bye
• put objects in a container
• say at least one word
• make "ma-ma" or "da-da" sounds
At 18 months of age, most children:
• like to push and pull objects
• say at least six words
• follow simple directions ("Bring the ball")
• pull off shoes, socks and mittens
• can point to a picture that you name in a book
• feed themselves
• make marks on paper with crayons
• walk without help
• point, make sounds, or try to use words to ask for things
• say "no," shake their head, or push away things they don't want
At two years of age, most children:
• use two-to-three-word sentences
• say about 50 words
• recognize familiar pictures
• kick a ball forward
• feed themselves with a spoon
• demand a lot of your attention
• turn two or three pages together
• like to imitate their parent
• identify hair, eyes, ears, and nose by pointing
• build a tower of four blocks
• show affection
At three years of age, most children:
• throw a ball overhand
• ride a tricycle
• put on their shoes
• open the door
• turn one page at a time
• play with other children for a few minutes
• repeat common rhymes
• use three-to-five-word sentences
• name at least one color correctly
Of all these, 4 achievements must be noted:
• Social smile by 2 months
• Head holding by 4 months
• Sitting alone by 8 months
• Standing alone by 12 months
What is developmental delay?
A developmental delay is any significant lag in a child's physical, cognitive, behavioral, emotional, or social development, in comparison with the normal.
A baby's rate of development is determined partly before birth, primarily as a result of genetic make-up and partly due to various physical insults during and just after delivery. Normal development is again quite flexible, occurring over a range of time. Definite deviation beyond that range in any sector of development is developmental delay. When a child consistently reaches developmental milestones much later than other children, a professional consultation is usually warranted. Few babies develop at a uniform rate; most develop quickly in some areas and slower in others. Some babies reach most or all developmental milestones slightly later than "average." As long as a child's development falls within the broad range that is considered normal, reaching one or more milestones late is generally not a cause for concern.
Several developmental areas are of interest: gross motor skills (e.g., crawling, walking), fine motor skills (e.g., grasping and manipulating objects), receptive (understanding) and expressive (speaking) language, self-help (e.g., feeding, dressing), and social and play skills. While it is important to consider each of these areas, some are more important predictors of developmental difficulties than others.
Gross motor skills tend to be of particular importance to parents. They are readily observable and easy to compare from one child to the next. The timing of concrete achievements such as first steps is usually easy for any parent to pinpoint. But a particular achievement such as early walking bears little relationship to later intelligence. Communication and social skills are generally more important in understanding a child's developmental progress.
During the first half of the first year, baby's communication skills are largely nonverbal. Smiling, making eye contact and turning in the direction of a familiar voice, are all signs that baby is connecting with and relating to his social environment. Later in the first year, babbling begins and words may start to appear. In most cases, baby's vocabulary will continue to grow by leaps and bounds as he moves through the second year. Again, however, it is the ability to use language to communicate and relate to the social world that is most important. A child who has a limited speaking vocabulary late into the second year, but is able to communicate needs through gestures, point to named objects in books, and follow simple directions, is most likely not exhibiting significant developmental delay.
The nature of a child's play also provides important information about intellectual development. Very young children tend to play alongside, rather than with, other children. Early play consists largely of using body and senses to interact with the environment. During the toddler years there is a move toward pretend play and increasingly interactive play with other children. Flexibility and creativity become more evident as a child begins to engage in symbolic play (e.g., using a block to represent a car) and role-playing (e.g., "I'll be the mommy and you be the baby"). Steady progression toward more social and complex play suggests that development in this area is on track.
Some red flag warning signs that a child's development may not be on track include:
0-2 years:
• Little interest in surroundings and caregivers
• Absence or minimal eye-contact or smiling
• Lack of responsiveness to sound
• Absence of babbling by end of first year
• Failure to walk by 15 months of age
• Failure to use hands to manipulate and explore objects.
Toddlers (2-3 years):
• Little interest in other children
• Limited use of words or gestures to communicate needs
• Repetitive non-communicative or parrot-like speech
• Very repetitive, non-purposeful play (e.g., focuses only on parts of objects such a wheels, knobs; obsessively turns pages of book without attending to or recognizing content).
Pre-schoolers (3-5 years):
• Speech that is very difficult to understand
• Little or no pretend or imaginary play
• Little interest in social interaction
• Difficulties with balance, running
• Difficulty using crayons or scissors, manipulating small objects.
What are the different developmental disabilities (NDD)?
At least 8 percent of all children from birth to six years have developmental problems and delays in one or more areas of development. Some have global delays, which means they lag in all developmental areas.
Common neuro developmental disabilities (NDD) include:
• Cerebral Palsy
• Mental Retardation
• Speech and language disorders
• Attention Deficit Hyperkinetic Disorder (ADHD)
• Autism
• Learning disabilities
• Visual and hearing defects
Where do I go to?
Consult your Pediatrician immediately.
Remember to get an Eye and Hearing test done.
You will be referred to a Child Developmental Clinic for Early Intervention Therapy through a team approach.
What is done for Early Intervention?
Early intervention starts right from the baby’s stay at the NICU. The environment is rendered developmentally supportive through the following:
• Optimizing lights in the Nursery & mimicking diurnal variation
• Reduce noise to minimum
• Use of soft music
• Club painful procedures & interventions
• Non nutritive sucking
• Tactile stimulation through soft stroking and caressing.
• Kangaroo mother care
Later, early intervention is continued through the provision of :
• Stimulation in all sectors of development
• Stimulate the child through the normal developmental channel and help him to achieve the next milestone every time.
• Passive exercises to prevent stiffness
• Parents are encouraged to constantly provide appropriate stimulation.
• Counsel the parents. Assess the parenting skills and provide necessary education.
What can I expect?
Early Intervention is neither a single dose therapy nor a magic medicine. We do not expect miracles that the child will be absolutely normal, coming 1st in class or winning an obstacle race. But we help him to win his own obstacle race.
Through EIP the child gradually achieves the best of his potentiality. He is taught to perform to the best of his ability to survive independently in society. His strong points are brought into focus, through which his life is made purposeful.
And again, in some, much is achieved beyond expectation, bordering on a miracle!
The take home message is “Be patient and sincere, you will be rewarded.”
Saturday, June 27, 2009
HOW IMPORTANT IS EARLY INTERVENTION?
We often refer to a person as a ‘complete man’. Have you ever wondered what we exactly meant by ‘complete’? We all seem to be complete; nobody has seen a half-man after all! But no, completeness encompasses many a parameters & dimensions.
A baby grows from a neonate to a toddler, and then through the stages of childhood and adolescence, gradually evolves into an adult. All the while he grows in length, breadth and weight; his sensory perception, cognitive ability & intelligence develop so that he gradually gains control over his own self, then over his surrounding environment. The better control he has over himself, the more poised his personality becomes. The extent and magnitude of his control over his environment determines his level of success. This constant evolution starts from the moment of conception of life. It occurs in different dimensions: physical, mental, intellectual, emotional and spiritual. Evolution to the fullest in all these dimensions ultimately produces a complete personality.
We, the care-givers of small babies, visualize this evolution when we think of his growth & development. Any deficit, any deviation at any point will curb the blooming process. A thousand and one deficits may be silently residing in the baby’s system, which, if not identified in time, will manifest as a hindered development in later days. For example, a child who doesn’t learn to smile in time may not learn to interact and play like other children and he may develop mental retardation later on. Similarly, a baby who is late in holding his head may be late in all limb activities like sitting, standing, walking, etc. So all who care for babies and children must know the markers of normal development and must learn to pick up deviations EARLY.
How does this early detection help? Any inherent deficit in a developing child can be supported and the process of development in that area enhanced through early intervention. It’s like offering a hand to a person unable to climb a high step. He can make it with your help and the next time he has the confidence to try it himself.
What exactly is early intervention? It is a comprehensive process, by means of which stimulation is given to the child in areas where his development is faltering, thus guides him through the normal developmental channel. Through these techniques the affected brain parts are stimulated to become more active. But how can a dead cell in the brain become alive and active? It has been proved that though brain cells do not regenerate, synapses (connections between cells) are regenerable and with early stimulation healthy brain cells, through new synapses, take up the job of the damaged cells. Thus brain activity can be made to improve. This plasticity of the brain is made use of in early intervention techniques.
Who does this early intervention? As different aspects of brain function, like gross motor (sitting, walking etc), fine motor ( picking up things, handling etc), cognitive
(understanding, imagination etc), language, learning etc may need to be assessed and supported, this process calls for a very well co-ordinated team approach. The team comprises of a developmental Pediatrician, Ophthalmologist, Psychiatrist, Physiotherapist, occupational therapist, developmental psychologist, speech therapist, special educator and counselor. Whatever these specialists have to offer need to be conveyed regularly to the child, and, who else, but the mother, will happily render this effort 24 X 7? So she remains the pivot of the early Intervention program. It is thus obligatory for her to be well informed and convinced about the whole approach, to get the best benefits for her child. This is a long process and calls for a lot of perseverance and patience to reap the ultimate reward.
So, mothers (& fathers as well), get informed about your child’s normal development and danger signs to be identified. Next time we will talk about these issues.
Monday, June 15, 2009
What Silence Had To Say
A FIRE WAS BURNING. We were terrorized. The crowd was in frenzy. Everybody seemed to be asking, “How did this happen? Who is to blame?” Replies came as sparks, “They did it”, “It’s him”, “Hit him”, “Beat them up”…. Flames, fumes and wrath filled the space… suffocating destruction was engulfing us as we screamed and ran frantically like a bunch of lunatics. Only the little girl, Silence, stood aside, tears streaming down her cheeks. She knew the answer, but nobody asked her for it, because her name was silence. Silence never speaks where commotion reigns. But, she had the answer.
No, I did not recognize silence on that day of gloom and destruction. I discovered her much later, one summer afternoon when I was lazing alone on the grass on the bank of Lake Eire. She was humming softly, with a sweet smile on her face. Stretching my ears, I heard, “Be gentle, be soft. Don’t let the trifles in life upset you. Feel the tranquility of the lake within yourself.” Yes, she was right! I could feel the calmness! “Silence, why didn’t you tell us this on that fated day? You were there then.” “You never asked” came the answer.
Her personality charmed me. It was instant love. I kept looking for her till I again met her at a small village inPurulia. She was sitting under the old Banyan tree. “How long have you been here?” I asked her. “I’ve always been here. You can stay on too, but you’ve got to be patient.” “Learn to give and wait for no return, like this huge tree … she asks for nothing for the shade & shelter she has been giving to us for ages. Patience will give you peace” “Silence, you are wonderful!” I blurted out.
We became fast friends. She kept beckoning me, I kept looking for her. Chatting with her was always a treat. There she was when I looked out of my bedroom window, dancing merrily with the young maple leaves against the clear blue sky in spring. Like me, a tiny squirrel was also waiting for her, in a small hole in the tree trunk. Silence talked a lot of blissful joy that spring morning at Dunkirk.
By now she had divulged a secret to me. Aloft the sky, she could always be found. Now I knew, looking up, I could always see her smiling at me. We started a new game. Up in the sky I saw her in new dresses every time. In her beautiful black shimmering dress on a star studded midnight sky at Purulia, or a sunset sky over the St Laurence River where she had spilt her colour palate on her dress, spreading red, yellow, orange, purple and blue all-over, she would always talk of her sister, ‘Eternity’. She actually introduced me to Eternity on these wonderful occasions.
I invited her to my place. But, a shy girl, she would only drop in at dawn, when the bleeding hearts bloomed, to say Good Morning. Smiling at the pretty flowers, she would say, “Endure your own pain, but never cause pain to others. The Bleeding Heart bleeds to bloom, to give you pleasure. Love and endurance is the magic word of Nature. That is why Mother Nature thrives on, through thick and thin and is always smiling.”
Last week it was along day I spent with Silence, at Shenandoah. As we drove through the mountains, a long 100 miles through solitude and beauty, she constantly kept company, pointing out the depth of blue in the layers of mountain ranges ahead, the tranquil enormity of the lofty hills. Yes, she was right, eternal peace and harmony reined in the mountains and valleys, through which the clouds gently breezed through. The bold stature and the undaunted stance of the tall peaks quietly seemed to instill a unique strength of tenacity into one: a strength that rises out of Truth and conviction.
“ Mountains stand for Truth and strength” she whispered in my ears.
That reminds me of another enchanting experience with her in the mountains. It was up in the hills of Arunachal Pradesh, where Silence would sing a wonderful humming tune. Straining our ears, we used to hear the tinkling of the temple bells all around, as if Mother Nature was performing arati to deify the Almighty. I still wonder where she got that heavenly melody! Was it from the tiny cricket like insects in the woods?
Now Silence visits me regularly, morning and evening, in the little corner of my room they call my Thakur Ghar, but I call a chat room. Its here I get to chat with Silence. She keeps explaining how love, patience, endurance, truth—all are manifestations of the Divine. The Divine we tend to search for, but cannot reach because of the haze created by the ‘sound and fury’ of life. Silence, I’m grateful to you, you let me get a glimpse of the truth! Oh Silence, don’t leave me, or I wont be able to get that glimpse again!
Last night I met her again, at a very unusual place, at an International Airport, at the strike of midnight. Lots of people, lots of colours, lots of religions, all walking through their own tracks, with no commotion, no conflicts & no controversies. At that late hour one thing was common to all that was weariness. So a faint smile or a gesture of accommodation was the only communication between the transit passengers. Here again, the world met together, but there was no scourge, no sting, no scoff. Silence, you were standing there, in the midst of all, with a gleaming smile, at that wee hour!
But then, why didn’t you speak on that fated day, Silence? You know we all need you, only that most of us aren’t quite acquainted with you. Why didn’t you come forward to put the fire out? Poor thing, you are such a shy and sensitive person, you withdraw from all commotion. And who ever lends an ear to the beautiful music of Silence?
No, I did not recognize silence on that day of gloom and destruction. I discovered her much later, one summer afternoon when I was lazing alone on the grass on the bank of Lake Eire. She was humming softly, with a sweet smile on her face. Stretching my ears, I heard, “Be gentle, be soft. Don’t let the trifles in life upset you. Feel the tranquility of the lake within yourself.” Yes, she was right! I could feel the calmness! “Silence, why didn’t you tell us this on that fated day? You were there then.” “You never asked” came the answer.
Her personality charmed me. It was instant love. I kept looking for her till I again met her at a small village inPurulia. She was sitting under the old Banyan tree. “How long have you been here?” I asked her. “I’ve always been here. You can stay on too, but you’ve got to be patient.” “Learn to give and wait for no return, like this huge tree … she asks for nothing for the shade & shelter she has been giving to us for ages. Patience will give you peace” “Silence, you are wonderful!” I blurted out.
We became fast friends. She kept beckoning me, I kept looking for her. Chatting with her was always a treat. There she was when I looked out of my bedroom window, dancing merrily with the young maple leaves against the clear blue sky in spring. Like me, a tiny squirrel was also waiting for her, in a small hole in the tree trunk. Silence talked a lot of blissful joy that spring morning at Dunkirk.
By now she had divulged a secret to me. Aloft the sky, she could always be found. Now I knew, looking up, I could always see her smiling at me. We started a new game. Up in the sky I saw her in new dresses every time. In her beautiful black shimmering dress on a star studded midnight sky at Purulia, or a sunset sky over the St Laurence River where she had spilt her colour palate on her dress, spreading red, yellow, orange, purple and blue all-over, she would always talk of her sister, ‘Eternity’. She actually introduced me to Eternity on these wonderful occasions.
I invited her to my place. But, a shy girl, she would only drop in at dawn, when the bleeding hearts bloomed, to say Good Morning. Smiling at the pretty flowers, she would say, “Endure your own pain, but never cause pain to others. The Bleeding Heart bleeds to bloom, to give you pleasure. Love and endurance is the magic word of Nature. That is why Mother Nature thrives on, through thick and thin and is always smiling.”
Last week it was along day I spent with Silence, at Shenandoah. As we drove through the mountains, a long 100 miles through solitude and beauty, she constantly kept company, pointing out the depth of blue in the layers of mountain ranges ahead, the tranquil enormity of the lofty hills. Yes, she was right, eternal peace and harmony reined in the mountains and valleys, through which the clouds gently breezed through. The bold stature and the undaunted stance of the tall peaks quietly seemed to instill a unique strength of tenacity into one: a strength that rises out of Truth and conviction.
“ Mountains stand for Truth and strength” she whispered in my ears.
That reminds me of another enchanting experience with her in the mountains. It was up in the hills of Arunachal Pradesh, where Silence would sing a wonderful humming tune. Straining our ears, we used to hear the tinkling of the temple bells all around, as if Mother Nature was performing arati to deify the Almighty. I still wonder where she got that heavenly melody! Was it from the tiny cricket like insects in the woods?
Now Silence visits me regularly, morning and evening, in the little corner of my room they call my Thakur Ghar, but I call a chat room. Its here I get to chat with Silence. She keeps explaining how love, patience, endurance, truth—all are manifestations of the Divine. The Divine we tend to search for, but cannot reach because of the haze created by the ‘sound and fury’ of life. Silence, I’m grateful to you, you let me get a glimpse of the truth! Oh Silence, don’t leave me, or I wont be able to get that glimpse again!
Last night I met her again, at a very unusual place, at an International Airport, at the strike of midnight. Lots of people, lots of colours, lots of religions, all walking through their own tracks, with no commotion, no conflicts & no controversies. At that late hour one thing was common to all that was weariness. So a faint smile or a gesture of accommodation was the only communication between the transit passengers. Here again, the world met together, but there was no scourge, no sting, no scoff. Silence, you were standing there, in the midst of all, with a gleaming smile, at that wee hour!
But then, why didn’t you speak on that fated day, Silence? You know we all need you, only that most of us aren’t quite acquainted with you. Why didn’t you come forward to put the fire out? Poor thing, you are such a shy and sensitive person, you withdraw from all commotion. And who ever lends an ear to the beautiful music of Silence?
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