BHUTAN TODAY The New Perspective
โฆ๐ป๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐, ๐๐๐๐๐ ๐๐๐๐๐๐๐ ๐๐๐๐ ๐๐๐๐๐๐๐ ๐๐ ๐๐๐๐๐๐๐๐๐๐ ๐ ๐๐๐๐๐๐ ๐๐๐ ๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐๐๐ ๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐๐๐, ๐๐๐ ๐๐๐๐ ๐๐๐๐๐๐ ๐๐ ๐๐๐ ๐ ๐๐๐๐๐๐๐๐๐๐ ๐๐ ๐๐๐๐๐๐-๐๐๐๐ ๐๐๐๐๐๐๐๐ ๐๐ ๐๐๐๐๐ ๐๐๐.
Phurpa Wangmo
In recent months, the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) has witnessed a notable rise in the number of cases presenting features associated with Autism Spectrum Disorder (ASD) in children. Advocacy programs and heightened awareness among parents have played a significant role in bringing these concerns to light and seeking available services for their children’s speech and language development.
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulties in social interaction, communication, learning, and behavior. While autism can be identified at any stage of life, it is often referred to as a “developmental disorder” since symptoms typically manifest within the first two years of a person’s life.
The increase in literacy rates among Bhutanese parents has empowered them to access information about developmental delays and voice their concerns. Additionally, the busy schedules of parents have led to reduced parent-child interactions; limited natural speech and language stimulation, excessive dependency on electronic gadgets have contributed to the emergence of autism-like features in children.
Among the factors that may contribute to the surge in ASD like cases, excessive exposure to electronic gadgets, such as mobile phones, tablets, and television screens, stands out as a prominent concern. The phenomenon of electronic caregiving, where parents rely heavily on electronic devices for child entertainment and communication, has been linked to the development of autism-like features in children.
Until recently, Bhutan lacked a comprehensive speech and language intervention service even at national referral hospitals. Although informal assessments and general advice were available from professionals, the absence of a dedicated program limited support for children exhibiting autism-like features. However, the establishment of a specialized Speech and language Therapy unit at JDWNRH in May 2022 has addressed this gap, providing speech and language intervention services to both children and adults. They also have occupational therapists that specialize in addressing the behavioral problems of children.
Karma Tenzin, Audiologist and Speech Language Pathologist at JDWNRH, highlighted some of the speech and language challenges frequently observed in children with ASD. These include deficits in social reciprocity, reduced joint attention, difficulty in participating in group activities or peer interactions, restricted and repetitive stereotypic behavior and impaired integration of verbal and non-verbal communication. Additional challenges involve limited use and recognition of gestures and affect-facial expressions, as well as difficulties in forming and maintaining relationships and sharing interests and imaginations with others.
“The communication aspects become very challenging for both the children and caregivers,” karma emphasized. He further explained that delays in speech and language skills can impede overall skill development, including education, if appropriate intervention is not provided.
Nima Zangmo, another Audiologist and Speech Language Pathologist at JDWNRH, highlighted the importance of early intervention in managing speech challenges in children with ASD. Speech and language intervention aims to habilitate and rehabilitate to enhance all domains of communication, focusing on improving receptive and expressive language skills. The success of intervention depends on various factors, including the child’s intellectual abilities, diagnosis and interventional age, baseline comprehension and expressive language age, the environment, parental involvement, the intensity of therapy, and other needful professional services from pediatrician, Occupational therapist, Psychologist, Applied behavioral therapist among others.
Nima emphasized, “The parents and caregivers play a vital role in managing children with ASD. Their quality time, engagement, and compliance with professional guidance significantly impact the child’s speech and language development.” She also stressed the importance of parental support and the implementation of therapeutic activities at home.
The possible factors contributing to the increase in ASD-related speech challenges, genetic factors were mentioned.
Although Bhutan lacks genetically analyzed and proven data, international studies have identified genetic predisposition as one of the contributing factors. Non-genetic factors, such as electronic caregiving, reduced parent-child interaction, reduced exposure to natural language environments, and social isolation, have also been implicated.
Nima Zangmo highlighted the impact of other potential contributing factors such as problems with the motherโs immune system, certain maternal metabolic conditions or inflammation during pregnancy based on international research. To address concerns related to excessive electronic gadget use, the JDWNRH team is currently working on advocating for effective and limited screen time for children, especially before the age of three and when speech and language development is not yet adequately established.
Sonam, a 36-year-old mother, expressed her concerns about her 4-year-old daughter’s inability to speak. Seeking guidance, they visited a hospital where they were advised to increase interaction with their daughter and reduce screen time. With both parents working, they could only dedicate time on weekends. However, during the weekdays, their daughter was often given a phone to watch YouTube. Sonam is deeply worried that her daughter has not started speaking despite reaching the age of 4.
Another parent shared their feelings of distress regarding their 2-year and 4-month-old son’s lack of speech. Comparing their situation to that of a friend whose child started speaking at 15 months, they expressed worry and concern about their son’s delayed speech development.
It is noticed that self-diagnosis and panic-driven seeking of services are common among Bhutanese parents when they notice speech and language delays or atypical behaviors in their children. A comprehensive assessment by a multidisciplinary team is necessary to diagnose ASD accurately. Seeking professional services at the earliest sign of delay is crucial to ensure timely intervention, as delays in diagnosis can hinder progress and access to appropriate therapeutic interventions.
While formal statistical data is yet to be recorded and analyzed, JDWNRH has observed an increase in the number of children with ASD-like features seeking services. However, it should be noted that these cases may not always result in a definitive diagnosis of ASD. Excessive exposure to electronic gadgets and a lack of natural speech and language stimulation during critical periods are the most prevalent factors contributing to these challenges.
Early red-flag signs of ASD can be detected as early as twelve to eighteen months of age. However, a thorough assessment by a multidisciplinary team is crucial, and the diagnosis should ideally be made before the child reaches three years of age. Unfortunately, many children in Bhutan receive their diagnosis much later, leading to delayed intervention and missed opportunities for progress.
The JDWNRH team continues to advocate for timely diagnosis, intervention, and parental involvement in the management of children with ASD. They aim to address various factors that contribute to speech challenges, such as excessive use of electronic gadgets and limited exposure to natural language stimulation with the goal to enhance the communication skills and overall development of children with ASD in Bhutan.
