Medicosnext
Ms. Ritika Dangol is a medical student at Universal College of Medical Sciences (UCMS). An avid learner, she is actively engaged in various research projects. A graduate of St. Xavier’s College, Jawalakhel, Miss Ritika aims to advocate for better understanding and care in women’s healthcare. Through articles like this one on endometriosis, she aims to shed light on overlooked conditions and empower women to seek proper care.
Is autism a modern epidemic, or are we simply finally opening our eyes to a condition that has always been there?
Autism Spectrum Disorder is arguably the most talked-about developmental condition of the 21st century. It is not a single, uniform disease but a “spectrum,” meaning the experience varies wildly. One child may possess exceptional intelligence yet struggle with basic social cues, while another may be non-verbal and sensitive to loud noises. Common traits often include a lack of eye contact, delayed speech, and repetitive behaviors like hand-flapping or rocking. The Global vs. Local Reality Globally, the numbers are startling. Prevalence has leaped from 1 in 150 children in the early 2000s to approximately 1 in 36 today. However, in Nepal, the picture is obscured by silence. Due to limited specialists and deep-rooted social stigma, official records show fewer than 10,000 cases nationwide. Yet, local surveys, such as one in Jhapa identifying over 300 individuals， prove that low numbers reflect under-diagnosis, not a lack of cases.
Why the Increase? This sharp rise is largely due to better awareness and broader diagnostic definitions that now include milder cases. It is not caused by vaccines, a dangerous myth that has been scientifically disproven. Early detection changes lives.
Autism Spectrum Disorder is now a growing and the most talked about developmental conditions of the 21st century. Once considered rare, autism is being diagnosed across the globe in rising numbers. This sharp rise in prevalence of this disorder has generated widespread concern, curiosity and scientific exploration. For parents, health care professionals and educators knowing about autism is essential. This growing burden of ASD calls for awareness, early detection and inclusive support system that ensures every child reaches their full potential.
Autism Spectrum disorder is a lifelong neurodevelopmental disorder characterized by impaired social interaction and communication, along with restricted, repetitive patterns of behavior, interests and activities with onset in early childhood. The word ‘spectrum’ reflects wide variability of presentation and severity. Some children having autism may have average intellectual but some may have exceptional intelligence with subtle social challenges.
Common features include lack of eye contact, delayed speech, difficulty in understanding social cues, and heightened sensitivity to sensory stimuli such as sound, light or touch. Because of this diversity, autism does not present as a single uniform disorder but as a broad range of related conditions.
GLOBAL PREVALENCE
Over the past few decades, there has been a dramatic increase in children diagnosed with Autism. According to the data, its prevalence has risen from 1 in 150 children in the early 2000s to approximately 1 in 36 in developed countries today, with similar trends in low and middle income countries.
Again autism is more commonly diagnosed in boys than girls with male to female ratio approximately 4:1. However, recent research suggests that autism in girls may be underdiagnosed because they often present with subtler symptoms or better social masking skills.
LOCAL PREVALENCE
Though Autism is a rising concern globally, it is yet to be properly documented in Nepal. Due to this there is scarcity of data of autism, which reflects under diagnosis not true lower incidence. As autism is grouped under ‘neurodevelopmental disabilities’ less than 10,000 children are officially registered with autism as many families do not register due to stigma and lack of diagnosis. This low reported prevalence may mainly be also due to; limited child psychiatrists and developmental pediatricians, lack of routine autism screening program, low public and professional awareness and the social stigma.
But recently, according to comprehensive survey conducted by Karuna Foundation in collaboration with Ministry of social development in Koshi province, over 300 children are living with autism in Jhapa district. This survey identified a total of 381 persons with autism across 15 local levels in the district, comprising 254 male children, 28 female children and 45 adults.
This just shows the lack of awareness and social stigma regarding autism in Nepal.
REASONS FOR INCREASE
This rise in prevalence of autism is due to improved awareness and better diagnostic practices worldwide. Parents globally are more informed about developmental milestones and healthcare professionals are now better trained to identify early signs. Screening tools have become more sensitive and diagnostic criteria have broadened to include even the mild symptoms that were ignored in the past.
Changes in diagnostic definition, especially with the introduction of Autism Spectrum concept, have also contributed to increased numbers. Conditions previously diagnosed separately such as Asperger’s syndrome and pervasive developmental disorder are now included under ASD.
Despite extensive research, it is important to emphasize that vaccines do not cause autism- a misconception that has been scientifically disproven and has fortunately fueled fear and stigmaamong the laymen.
EARLY SIGNS AND IMPORTANCE OF DIAGNOSIS
Early signs of autism are vital because timely intervention greatly improves developmental outcomes. The early signs usually begin at around 6 to 12 months, by 12-18 months the symptoms become clearer, by 2 years the signs become recognizable and by 3 years the diagnosis is often reliable. The early signs may include: little or no eye contact, poor response to name being called, prefers to be alone and limited interest in people or faces. Some unusual behaviors may include hand flapping, rocking, spinning, distress over small changes and unusual sensory reactions to sound, light or touch.
Screening for autism should be part of routine pediatric checkups. Tools such as the Modified Checklist for Autism in Toddlers (M-CHAT) allow early detection and referral for further evaluation. Diagnosis is usually based on detailed developmental history, behavioral observation, and standardized assessment tools, often requiring a multidisciplinary team involving pediatricians, psychiatrists, psychologists, and speech therapists.
Early diagnosis not only initiates appropriate therapy but also guides parents on how to take care of the child and also provides access to essential support services.
SOCIAL AND EMOTIONAL IMPACT
ASD not only impacts an individual but also impacts those around him. Parents not only have emotional burden but also have a financial burden regarding the therapy needed for their child and also have emotional stress on discrimination from the society and the long term care that child needs.
The child who are often on the spectrum are isolated from the society, are bullied and they frequently encounter social stigma. This is because of lack of awareness among the people. Later in life they may also face barrier in assessing quality education and employment issues. This highlights the need for societal acceptance, community support and strong advocacy for the rights of individuals with autism.
Even though autism is still taken as a social stigma in Nepal, people globally are more aware about this condition. Famous people like Greta Thunberg who is world renowned climate activist has publicly shared to have the Autism Spectrum disorder. Not just her, but personalities like Elon Musk, Sir Anthony Hopkins, Susan Boyle and many more have come out to spread awareness about this condition as to make people realize that they are not any different from a normal human being.
Hence creating an autism friendly environment or spreading awareness about this condition can foster inclusion and allow individuals with ASD to participate meaningfully in the society.
CONCLUSION
The rising prevalence of autism in children is one of the most significant developmental challenges of 21st century. While improved diagnosis and awareness accounts for such increase in prevalence we must also dive into the genetic and environmental factors which may cause such neurodevelopmental conditions.
The shift from viewing autism as a disease to understanding it as form of neurodiversity is an important cultural transformation. Recognizing and respecting neurological differences allows society to move from mere awareness to true acceptance hence ensuring that every child, regardless of neurological differences is given the opportunity to live with dignity, independence and purpose.
