Overview of autism
Autism is a developmental disorder of the brain. It affects children with age less than 3 years. It is characterized by a problem with social interaction, impairment in verbal and nonverbal communication and a pattern of repetitive behavior with narrow, restricted interests.
Autism is classified as one of a group of disorders known as the pervasive development disorders (PDD) by the American Psychiatric Association. In addition, PDD include Asperger syndrome, which is a childhood disintegrative disorder. This group of disorders is sometimes called the autism spectrum disorders (ASDs). Autism goes without diagnosis until the child enters school. Autism is highly genetic and genetics of autism is complex and unclear about the genes responsible for this disorder.1
This illness is poorly understood as it affects many parts of the brain. Observable signs can be seen within the first two years of life. Early intervention can help the child regain skills, social behavior and self-care as there is no cure to this illness.2
Studies suggest that the prevalence of autism is 1–2per 1000 globally.3 The number of reported cases of autism increased dramatically in the 1990s and early 2000s. This rise is contributed by factors like changes in diagnostic practices, referral patterns, availability of services, age at diagnosis and public awareness.4
Autism is found to be associated with several other conditions like genetic disorders, mental retardation, epilepsy and metabolic defects.5–8
Causes of autism
Various factors contribute to the causes of autism. Some of them are as follows.
- Obstetric (The branch of medicine that deals with the care of women during pregnancy, childbirth and the recuperative period following delivery) complications increase the risk of autism.
- Exposing to infections especially in the rubella epidemic during pregnancy increase the risk of autism in just born.
- Heredity is responsible for 90% of the autism cases.1 Researchers have identified a number of gene defects associated with autism.9
- Exposures to toxins, chemicals, poisons and other substances tend to cause autism.
Risk Factors for autism
A review conducted in 2007 has found that advanced maternal and paternal age, prenatal, perinatal, and postnatal infections, exposure to toxic agents, obstetric conditions like low birth weight, decreased gestation period and hypoxia during child birth are the risk factors of autism.10
Some other factors include:
- Genetic factors.
- Traumatic factors.
- Viral infection (rubella) during the first trimester of pregnancy.
- Children with tuberous sclerosis.
Signs and Symptoms of autism
Children with autism may show normal development for the first few months or years. Later they become less responsive. Signs and symptoms widely vary in children.
Following are the signs and symptoms.
- Fails to respond to his or her name
- Has poor eye contact
- Appears not to hear at times
- Resists cuddling and holding
- Appears unaware of others feelings
- Seems to prefer playing alone, confined to his or her ‘own world’
- Starts talking later than other children
- Loses previously acquired ability to say words or sentences
- Does not make eye contact when making requests
- Speaks with an abnormal tone or rhythm (singsong voice or robot-like speech)
- Can’t start a conversation
- May repeat words or phrases
- Performs repetitive movements, such as rocking, spinning or hand-flapping
- Develops specific routines or rituals
- Becomes disturbed at the slightest change in routines or rituals
- Moves constantly
- May be fascinated by parts of an object, such as the spinning wheels of a toy car
- May be unusually sensitive to light, sound and touch
As they mature, some children show less marked disturbance in behavior. Children with least impairment can lead a normal life or near normal life. Majority of the children with autism are very slow in acquiring skills and knowledge, but some have very high intelligence.
Diagnosis of autism
Diagnosis is based on the behavior, signs and symptoms.11 After initial identification, specialists like a child psychologist or a developmental pediatrician do assessments. They use a variety of methods like a standardardized rating scale to identify the disorder.. This evaluates the child in a variety of settings to assess communication, play and social behavior.A structured interview is conducted to gather information from parents about the child’s behavior and early development. Tests for genetic and neurological problems are done to rule out other conditions similar to autism.
Following are some of the tests performed to rule out other conditions:
- Blood tests (to rule out metabolic disorders)
- Chromosomal analysis (to rule out genetic disorders)
- Comprehensive hearing test (to rule out deafness as the cause of abnormal language development)
- Electroencephalogram (EEG, to rule out seizure disorder)
- Magnetic resonance imaging (MRI scan, to rule out brain disorders)
Treatment for autism
There is no cure for autism. Proper treatment and education can help the child to learn and develop.12 Treatment depends on the condition and individual needs of the patient. Combination of treatment methods is more effective as autism requires lifelong treatment.
Treatment involves the following:
There are several methods of behavior modification to treat inappropriate, repetitive and aggressive behavior. This involves highly structured, skill-oriented activities that are based on the patient’s needs and interests. Sensory integration, play therapy and social stories are the categories of behavior modification.13
- Sensory integration therapy: Helps to cope with sensory stimulation. Treatment includes handling the materials with different textures or listen to different sounds.
- Play therapy: Helps to improve emotional development, which in turn, improves social skills and learning. This therapy involves adult–child interaction that is controlled by the child.
- Social stories: Helps to improve undeveloped social skills. Stories are designed to help autistic patients understand the feelings, ideas and point of views of others, or to suggest an alternate response to a particular situation.
This therapy is used to help patients who are unable to communicate properly and initiate language development skills.
This therapy is used to help the patient gain ability to speak.
Autism is not caused by diet. Changing the diet by adding vitamin supplements may improve digestion and eliminate food intolerances and allergies, which contribute to the behavioral problems.
Some of the below discussed therapies are occasionally used:
- Occupational therapy: Helps improve independent function and teaches basic skills (e.g., buttoning a shirt, bathing etc.).
- Physical therapy: Involves using exercise and other physical measures (e.g., massage, eat etc.) to help patients control body movements.
Medication is used to treat various symptoms of autism like attention difficulties and anxiety. It is also used to treat epilepsy that accompanies this disorder.
The following categories of medications can be used to treat autism.
Antidepressants: Amitriptyline, Bupropion, Clomipramine, Fluvoxamine, Fluoxetine are some antidepressants, which help to
- reduce the frequency and intensity of repetitive behavior,
- recrease irritability, tantrums and aggression,
- improve eye contact, and
Antipsychotics: Clozapine, Risperidone, Olanzapine and Quetiapine are some antipsychotics, which help to:
- decrease hyperactivity,
- behavioral problems,
- withdrawal and
Stimulants: Methylphenidate, Amphetamine, and dextroamphetamine are some stimulants, which help to:
- increase focus and decrease impulsivity, and
- hyperactivity in high-functioning patients.
Stimulants lead to drug dependence on prolong usage.
These are not advised for this condition, as it has side-effects, but can be taken by monitoring the side-effects. Famotidine (low strength tablets), phenylpropanolamine (PPA), ephedrine (made from the herb Ephedra) and caffeine are some of the available OTC drugs.
Vitamin B6 or pyridoxine and vitamin B3 or niacin has shown improvement in autism. This is also known as mega-vitamin therapy. Dimethylglycine is also found to show some improvement in autism.
Prevention of autism
Autism can be prevented by
- Avoiding drugs during pregnancy
- Avoiding alcoholic beverages
- Immunization against rubella
Living with Autism
It is very difficult to raise a child with autism. The parents experience a lot of stress to meet the demands of the child. Recognizing the problem and preparing one’s self to face the challenges ahead would be helpful and make a tremendous difference. Early diagnosis and providing appropriate treatment will improve all areas of development. The parents should be aware of certain issues to deal with guidelines from specialists. Best possible support should be given to the individual from family members.
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2.Myers SM, Johnson CP, Council on children with disabilities. Management of children with autism spectrum disorders. Pediatrics. 2007; 120(5): 1162–1182.
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4.Wing L, Potter D. The epidemiology of autistic spectrum disorders: is the prevalence rising?. Ment Retard Dev Disabil Res Rev. 2002; 8(3): 151–161
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7.Levisohn PM. The autism-epilepsy connection. Epilepsia. 2007; 48(Suppl 9): 33–35.
8.Manzi B, Loizzo AL, Giana G, et al. Autism and metabolic diseases. J Child Neurol. 2007.
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10.Kolevzon A, Gross R, Reichenberg A. Prenatal and perinatal risk factors for autism. Arch Pediatr Adolesc Med. 2007; 161(4): 326–333.
11.Baird G, Cass H, Slonims V. Diagnosis of autism. BMJ. 2003; 327(7413): 488–449.
12.Available at: http://www.autism.com/treatable/treatingphysicalsymptoms.htm Accessed on: 24th Mar, 2008
13.Available at: www.neurologychannel.com/autism/treatment.shtml. Accessed on: 24th Mar, 2008.