The keyword in autism spectrum disorder isn’t ‘autism’, it’s spectrum. Autism isn’t one thing — it’s a wide range of experiences, strengths, and challenges. Some autistic children speak fluently; others may be nonverbal. No two are alike.
Autism is a neurodevelopmental condition affecting how a person communicates, relates to others, and processes the world. It’s not caused by parenting, screen time, or vaccines — but by differences in brain development, often starting before birth.
Globally, the World Health Organisation estimates one in 100 children are autistic. In higher-income countries, where screening and specialist care are more accessible, numbers are even higher — one in 36 in the US, according to the CDC (Centre of Disease Control and Prevention). Pakistan lacks national data, but small studies, like one from Karachi in 2018 (one in 166), almost certainly underestimate the true prevalence. Stigma, limited awareness and lack of specialist access all contribute to missed or delayed diagnoses.
In many parts of Pakistan, especially rural areas, parents — and even primary care doctors — may never have heard of autism. Misunderstandings persist and autism is often mistaken as stubbornness, poor discipline or even a spiritual affliction. As a result, children are punished, scolded or dragged to spiritual healers — when what they really need is understanding and support.
One of the most dangerous myths is that autism is just about ‘social awkwardness’. In fact, some children speak fluently but still struggle with things like reading body language or understanding sarcasm. They may be labeled ‘weird’, ‘rude’ or ‘too sensitive’ — and only much later recognised as autistic, often after years of shame and isolation.
The more visibly impaired a child is — nonverbal, developmentally delayed — the more likely they are to be recognized early. But the verbal child who is socially “off”? That child is often missed until the damage is done.
As a society, we respond more compassionately to visible disability than to invisible suffering. We open doors for someone in a wheelchair but recoil or call for help when seeing someone in a psychiatric crisis. The eyes can’t see what the mind doesn’t know.
The rise in autism diagnoses doesn’t mean more children are becoming autistic — it means we’re getting better at recognising it. But modern medicine also plays a role: many premature or medically fragile babies who would not have survived 50 years ago now do — and some go on to be diagnosed with autism, often on the more severe end of the spectrum.
In Pakistan, additional factors matter — including the high prevalence of cousin marriages, which can increase the risk of inherited developmental conditions. This isn’t about blame; it’s about empowering families with science-based, culturally respectful information.
Autism is diagnosed four times more often in boys, but girls are frequently missed — especially those on the higher-functioning end. Girls tend to mask their symptoms more effectively and are more likely to be dismissed as ‘just shy’. Many aren’t diagnosed until adolescence, after struggling for years with anxiety or depression.
In a country like Pakistan where resources are scarce, early identification is our most powerful tool. If your child isn’t making eye contact, responding to their name, pointing, speaking, or has sensory sensitivities or unusual fixations — don’t wait. Don’t assume they’ll grow out of it. Early recognition can be life-changing.
Autism has no cure, but there is plenty of help — far more than there was a generation ago. Simple, evidence-based therapies like speech, occupational, and physical therapy, if started early, can be transformative. I’ve seen nonverbal toddlers go on to speak in full sentences by age five — not because of a miracle, but because someone caught it early and intervened.
In autism, every month counts. Waiting years to ‘see what happens’ is a risk we can no longer afford.
Diagnosis should also prompt screening for reversible conditions that mimic autism — including hearing loss, seizure disorders, hypothyroidism, lead poisoning, and malnutrition. Some of these children may not be autistic at all, but are mislabeled due to missed medical conditions that are treatable.
Puberty adds a new layer of complexity. Emotional storms, aggression, or obsessive behaviours may intensify — especially without prior support. By age 16, what began as treatable behaviors can harden into identity and coping mechanisms. One would rather treat a seven-year-old with severe behaviours than a 16-year-old who’s been left to flounder.
Medication is only one part of the solution. Applied behavior analysis (ABA) remains the gold standard of care — teaching both children and their caregivers how to build routines, navigate transitions, and reduce maladaptive behaviors. For children with autism, routine isn’t just helpful — it’s essential.
What looks like “bad behavior” is often a communication breakdown. Many nonverbal children can thrive once given the right tools: picture boards, sign language, or speech-generating devices. When children can finally express their needs, behaviors often improve dramatically.
Occupational therapy also plays a vital role in managing sensory processing issues. Tools like weighted blankets or sensory-friendly clothing may sound simple, but for some children, they’re lifelines — calming their bodies and preventing self-harm.
We still have much to learn. But even with limited resources, there is so much we can do. Let’s start with awareness and honesty.
Published in Dawn, May 21st, 2025
