Are they impermeable to make-believe? In a month dedicated to autistic children, Reem Leila walks into a world of their own "My son Adel," recounts psychologist Fayza Moharram, "was born in 1964; and you could tell from birth that there was something wrong with him. He had strange, extreme moods that sometimes gave way to violent rage. I had earned my PhD in experimental psychology five years earlier, and I had never encountered the word 'autism'. Our paediatrician, notwithstanding her 35 years of experience, had never heard of it either..." Autism was extremely rare then, Moharram goes on to explain; it is very common now. Nearly 30 years ago, two to four out of every 10,000 children were autistic, 75 per cent of them boys; at present, one out of 500 children is autistic. A few years later, when she found out what was wrong with her son, Moharram began to collect data on the symptoms and causes of the condition. "I began to hear from other parents that their children were normal until they got the triple vaccine," says Moharram, "the DPT shot. I began to query parents about responses to the DPT shot, and many reported deterioration. Aware of the problem of mercury, I asked about dental work during pregnancy. And I looked into hereditary factors. But unfortunately none of these has so far proven to be the principal cause." Autistic people concentrate on one thing to the exclusion of others; they find it very difficult to shift or divide their attention. Moving from one activity to another, or interrupting a routine, can provoke an emotional crisis. They impose a strict regime on every aspect of their lives, and panic at so insignificant a change as the introduction of a new pen to the pencil case. They want to wear the same clothes every day, follow the same schedules, and take the same routes every time they go anywhere. They are afraid of harmless novelties, but -- so long as it occurs within the framework of something they are used to, a route they take, for example -- they will recklessly expose themselves to a serious risk -- like cars in motion. One striking characteristic of autism is stereotyped, repetitive movement: clapping, hand flapping, finger biting, rocking, dipping, swaying... Sufferers are incapable of eye contact. Some of them, as children, are hyperactive, impulsive, aggressive, even destructive. Many are unpredictably hypersensitive to minor noises, smells or pain. Others may repeatedly bite their wrists, punch themselves, or bang their heads against the wall. According to Medhat Shehata, Ain Shams University paediatrician, in the last 20 years the number of autistic children has risen, and public awareness of autism has correspondingly improved. Partly as a result of the film Rain Man, extensive research was undertaken, but, since they have been restricted to a clinical context -- the effect of adult antidepressants on children with autism, for example -- such studies, Shehata says, may or may not pay off in the long term: "They have very little bearing on developing a safe and effective cure for children who are suffering from autism at present." Research has established, with near certainty, a genetic basis for the condition: among the siblings of sufferers, the rate, whether of autism or of related symptoms, is 50-100 times higher than average, though for identical twins the rate of concordance is 65-90, i.e. close to sibling average. Very few cases have been cured, Shehata adds; and they are able to live normal lives. Maha Helaly, founder of the autistic child Learning Resource Centre (LRC), describes her 11-year-old son Mustafa: "as a baby he did not sleep much and refused most foods except breast milk, but he walked and talked on time." Before too long, she recalls, he was singing and reciting nursery rhymes, producing detailed drawings. But by his 20th month Mustafa changed: he talked less, was preoccupied with daydreams, and gradually withdrew into himself, he had all but lost the ability to speak by the end of his second year. This too is typical: for autistic children, language may be altogether absent or else its development is delayed and/or distorted; echoing others, they will nonetheless seldom sustain a conversation or understand simple questions. Yet, though a few of them are retarded -- and they tend to be severely so -- most are quite intelligent: "Mustafa speaks of a chaotic world in which everything seems inconstant and unpredictable. Noises are too loud, smells overpowering, and the touch of other people unbearable. Other people frighten him, complex feelings confuse him. Because he cannot find words, he feels that he must scream to make his needs understood; he was among those whose IQ was affected by the condition." Experts agree that parents should seek help as soon as possible, for autistic children are in need of a full-time programme of medication. They need drugs as well as behavioural, speech, and occupational therapy -- to help them process information normally. Centres like Helaly's provide expert guidance, with a specialist to each child -- responding to the fact that autistic people are different from each other; no improvement is likely to occur under standardised treatment. That is why children attend both group and one-on-one sessions. "Three teachers and one intern look after a group of six children. The curriculum focuses on improving language and behaviour. Children are taught how to sustain attention, maintain eye contact, look and listen at the same time, feed and dress themselves, and behave in more acceptable ways. Social skills are developed through community trips. They have to visit restaurants, supermarkets and social clubs to learn to deal with the outside world without depending on other people." Beth Noujaim, a psychological therapist at the LRC, believes that constant encouragement is necessary even if the child has not achieved much: "It is useful for their psychological condition." This is partly due to the fact that their learning is never easily generalised. A change in one situation has little effect on even the same change in a different situation, however slight the difference. The therapist must start anew every time conditions alter, and there is a high rate of relapse once training ends. Noujaim goes on, "at first, autistic children do not show much response to attention and praise, which makes it difficult to reward them. To win a child's interest and assent, a therapist may start by offering candy along with praise and smiles for correct behaviour until, by association, the child comes to care about attention and approval as well as sweets." For his part Ahmed Kotb, Qasr Al-Aini paediatrician, points out that 12 per cent of the population have special needs. "One cannot ignore such a percentage of one's community, and the only way to deal with it is to upgrade skills. You have to cater to them, it is the only civilised thing to do. I always say that anyone can be handicapped in a minute. Anyone crossing the street can be hit by a car. And then how do you want to be treated? As a priority, or a burden?"
