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Why human engagement lies at the heart of treating autism
Summary
As the number of children and adults being diagnosed with autism spectrum disorders (ASD) surges, what's needed are evidence-based practices that treat the root of the issue: human engagement
In 2000, the estimated prevalence of Autism Spectrum Disorders (ASD) in the US was about 1 in 150 children; by 2020, it had risen to 1 in 36. This increase is attributed to factors such as improved screening, heightened awareness, and changes in diagnostic criteria. The covid-19 pandemic induced lockdown has been followed by a significant increase in ASD diagnoses among both children and adults. Between 2011 and 2022, the rate of Americans diagnosed with autism increased by 175%, and the incidence is children is now pegged at one in thirty. This increase in the prevalence is attributed to delayed diagnoses due to pandemic disruptions, increased awareness and improved diagnostic practices.
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In India, autism rates vary between 0.4% in north Goa to 1.8% in Palwal, a rural area in north-central India. These variations highlight the lack of comprehensive and standardized data collection across the country.
Recent studies suggest that genetics and environmental exposures may contribute to the development of ASD. A recent study (published in Nature Medicine in January 2025) of 1.1 million pregnancies found no convincing evidence that maternal infections or health issues during pregnancy cause autism, instead pointing to genetics and environmental factors as more likely contributors. Senior researcher and author Magdalena Janecka, PhD, believes “The predominant hypothesis is that autism really starts prenatally. Even before a child receives a diagnosis for autism, developmental changes have been happening the entire time".
Challenges in current interventions
In the absence of any clear cause of autism, the traditional approach has been to target the symptoms like speech delay and behavioural problems. While autism interventions are more easily available, the results are far from satisfactory. Many children continue to suffer from lifelong impairments in social behaviour and communication. Standardized therapies often lack individualization and fail to monitor long-term outcomes. Many are limited by a symptomatic intervention approach – offering routine, patterned, repetitive activities in the name of interventions. In the absence of licensing or monitoring, these services are proliferating across the country. Moreover, the availability of unproven treatments—such as stem cell transplants or hyperbaric oxygen therapy—misguides families desperate for a solution.
Understanding autism beyond symptoms
A fresh approach to autism must move beyond these pitfalls. It requires a commitment to evidence-based, outcome-oriented practices that address the core of autism: human engagement, and recognise the most vital role of parents, family and community more than doctors or therapists.
The issue lies in our fundamental understanding—or misunderstanding—of autism. Instead of addressing its root cause, we have often treated autism symptomatically, targeting speech, academics, or specific behaviors. What we need is a paradigm shift, a fresh approach rooted in the science of human engagement.
Also read: How to care for a child with autism: A practical guide
Our practice and research tells us that children with autism are predisposed to excessive excessive object engagement (fascination with objects) and reduced human engagement (social interaction). This is evident in early symptoms, such as a lack of eye contact, absence of social smiles, and failure to respond to their name. These deficits disrupt the natural sequence of social and communication development, which includes non-verbal gestures, verbal communication, and eventually, academic skills like reading and writing. Targeting the root cause of autism requires us to focus on building human engagement. What's needed is a structured approach that emphasizes fostering social behaviors and non-verbal communication in children with autism, instead of aiming for immediate improvements in academics or speech.
The role of community: It takes a village
Raising a child with autism is not just the responsibility of parents—it requires a supportive community. From empathetic relatives to patient shopkeepers, kind neighbors and understanding teachers, every interaction helps the child navigate the diversity of human behavior.
Unfortunately, the stigma surrounding autism often isolates families. Misguided societal perceptions and a lack of inclusive spaces prevent children from participating in everyday social environments. This needs to change. People in the community have to change this attitude, and engage with these children. Communities must foster acceptance and create opportunities for children to engage, learn, and grow.
Contrary to popular belief, autism is not an enigma. While the increase in ASD diagnoses presents challenges, it also offers an opportunity to re-examine our beliefs and interventions. By understanding the contributing factors and implementing targeted strategies aiding the child on the developmental milestones, we can better serve individuals with ASD and their families. With early and correct intervention, children can make tremendous progress. Parents, professionals, and society must work together to redefine what it means to support a individual with autism.
Dr. Samir H Dalwai is a developmental behavioural paediatrician based in Mumbai.
