Autism Spectrum Disorder (ASD) is a lifelong developmental disability. As a spectrum condition it affects people in different ways, but can be characterised by challenges with social skills, repetitive behaviours, speech and nonverbal communication.
Prevalence rates vary for ASD. The World Health Organization estimates about 1 in 100 children worldwide has autism, although some studies report substantially higher figures. The Centers for Disease Control reported that approximately 1 in 36 children in the US had been diagnosed with autism.
Dr. Shannon Seymour, psychologist and director of The Wellness Centre, breaks down what ASD entails, and the specific challenges for those with the disorder on-island.
Q: What is Autism Spectrum Disorder, and what are the signs and symptoms?
A: Autism is a neurodevelopmental disorder that impacts an individual in several primary ways; differences in communication and social interactions, differences in the way they experience sensory and emotional experiences, and patterns of restricted or repetitive behaviours. Autism is a heterogeneous disorder, both etiologically and in terms of clinical presentation, with individuals having a wide range of abilities and challenges.
Q: Are there risk factors which increase the likelihood of someone having ASD?
A: The causes of autism are complex and remain largely unknown, however it is considered to be a highly heritable disorder with high rates of diagnosis in monozygotic twins and increased risk amongst sibling groups. It is also considered a multi-gene disorder, which means there are maternal, paternal and environmental factors associated. Some well researched areas are parental age, premature delivery, maternal diabetes and pollution. Despite all of the research, we still don’t have a single known cause and we definitely can’t predict autism with any level of certainty.
Q: Is there any record of the prevalence of diagnosed ASD in Cayman? Or an estimate?
A: We don’t have a diagnostic register of autism so there is no known prevalence. Within the community of specialists there is a sense that we have a prevalence rate at least consistent with global estimates of 1 in 59 children.
Q: What are the steps to an ASD diagnosis on island?
A: There is no single pathway to an autism diagnosis on island and this is a positive thing and speaks to the wonderful community of professionals we have. An autism assessment and diagnosis should always be led by a psychologist experienced in the use of diagnostic measures of autism, and should always include those other healthcare professionals who may already be supporting the family. This can include paediatricians or family doctors, early intervention specialists, educators, speech therapists and occupational therapists. For most people the starting point is a discussion with your paediatrician and insurance provider, which then guides next steps.
Q: What sort of treatment plans are available on island to those with ASD?
A: There is a robust community of well-established evidencebased intervention services available on-island. When it comes to autism there are four core elements to a comprehensive intervention plan; these include family services, behaviour therapy, speech and language therapy, occupational therapy. Not every person with autism requires all types of intervention and within each core element there are different options depending on a child or adult’s needs.
Q: Are there any organisations in Cayman which are accessible for those with ASD, aside from private therapy?
A: The Cayman Islands Government has many service branches that provide intervention and support for individuals with autism and their families. For really little ones the Early Intervention Programme is an incredible resource for families. Sunrise Adult Training Centre offers amazing programmes and support for adults with disabilities, including autism. Inclusion Cayman is a non-profit organisation which has a mandate for advocacy and public awareness. It offers family support, social support, employment opportunities and is a hub of community knowledge.
Q: What barriers exist in Cayman to treatment?
A: Early intervention is costly, and unfortunately most insurance packages do not provide the type of coverage a young child needs or deserves. This is a significant barrier to intervention and results in inequitable access to services. There can also be waiting lists for some services, particularly assessments.
Q: What else should readers know about ASD?
A: I think it’s important for the community to recognise that autism is a developmental disorder which means it spans the life span. A lot of people think of children when they think of autism, but it’s important that we continue to challenge ourselves and our community to learn more and work together diligently to ensure we are building a community where there is space for everyone.
