Autism

WHAT IS AUTISM? Childhood mental condition with social and communication difficulties Children with autism often have extreme difficulty developing normal relationships with others. They tend not to share in the interests their peers have. In many cases these children are not able to interpret non-verbal cues of communication like facial expressions. Most people with autism have some impairment in language and many never speak at all. Autism is not a disease, but a developmental disorder of brain function. People with classical autism show three types of symptoms: impaired social interaction, problems with verbal and nonverbal communication, and unusual or severely limited activities and interests. Symptoms of autism usually appear during the first three years of childhood and continue throughout life. Isolated in worlds of their own, people with autism appear indifferent and remote and are unable to form emotional bonds with others. Although people with this baffling brain disorder can display a wide range of symptoms and disability, many are incapable of understanding other people's thoughts, feelings, and needs. Often, language and intelligence fail to develop fully, making communication and social relationships difficult. Many people with autism engage in repetitive activities, like rocking or banging their heads, or rigidly following familiar patterns in their everyday routines. Some are painfully sensitive to sound, touch, sight, or smell. Patient Profile for Autism: Usually starts in first 3 years, typically 18-36 months. Profile for Autism: Symptoms usually appear during the first three years of childhood and continue through life. Autism strikes males about four times as often as females, and has been found throughout the world in people of all racial and social backgrounds Gender Profile for Autism: 4 times more common in males than females

CAUSES OF AUTISM Autism has no single cause. Researchers have identified a number of genes that play a role in the disorder. In some children, environmental factors also may play a role in development of the disorder. Studies of people with autism have found abnormalities in several regions of the brain, including the cerebellum, amygdala, hippocampus, septum, and mamillary bodies. Neurons in these regions appear smaller than normal and have stunted nerve fibers, which may interfere with nerve signaling. These abnormalities suggest that autism results from disruption of normal brain development early in fetal development. Other studies suggest that people with autism have abnormalities of serotonin or other signaling molecules in the brain. While these findings are intriguing, they are preliminary and require further study. The early belief that parental practices are responsible for autism has now been disproved. There are physical bases of autism’s development including genetic, infections, and traumatic factors. Viral infection including rubella during pregnancy, have been studied as possible causes of autism.

SYMPTOMS OF AUTISM The symptoms vary greatly but follow a general pattern. Not all symptoms are present in all autistic children. Autistic infants may act relatively normal during their first few months of life before becoming less responsive to their parents and other stimuli. They may have difficulty with feeding or toilet training; may not smile in recognition of their parents' faces, and may put up resistance to being cuddled. They do not play with other children or toys in the normal manner, rather they remain aloof and prefer to play alone. Parents often mention that their child is so undemanding that he or she is ?too good?. Verbal and nonverbal communication skills, such as speech and facial expressions, develop peculiarly. Symptoms range from mutism to prolonged use of echoing or stilted language. When language is present, it is often concrete, unimaginative, and immature. Another symptom of autism is an extreme resistance to change of any kind. Autistic children tend to want to maintain established behavior patterns and a set environment. They develop rituals in play, oppose change (such as moving furniture), and may become obsessed with one particular topic. Other behavioral abnormalities that may be present are: staring at hands or flapping arms and hands, walking on tiptoe, rocking, tantrums, strange postures, unpredictable behavior and hyperactivity. An autistic child has poor judgment and is therefore always at risk for danger. For instance, an autistic child may run into a busy street without any sign of fear.

DIAGNOSIS OF AUTISM (DETECTION) Properly diagnosing autism is very important, since confusion may result from inappropriate and ineffective treatment. Deafness is often the first suspected diagnosis, since autistic children may not respond normally to sounds and often do not speak. The children's appearance and muscle coordination are often normal. Occasionally, an autistic child has an outstanding skill (splinter skills), such as an incredible rote memory or musical ability. Such children may be referred to as "autistic savants", and occur in almost 10% of cases of autism. These skills can be quite astonishing. One example is the ability to play a piece of music almost perfectly after hearing it one time. Many children with autism have a second psychiatric disorder or a neurologic disorder. Mental retardation and seizure disorders are very common in autistic children and a thorough neurologic and psychiatric evaluation is necessary in every case of autism to ensure all the childs medical problems are being addressed. Some children who are autistic show abnormal but nonspecific EEG findings that suggest brain dysfunction, possibly resulting from trauma, disease, or a structural abnormality. For a diagnosis of Autism, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Autism: 

Pervasive Developmental Disorder

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Pervasive developmental disorder not otherwise specified - PDD:NOS

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Asperger syndrome

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Language delay

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Language disorder

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Speech delay (see Speech symptoms)

Childhood disintegrative disorder Deafness - social response may be impaired because of hearing difficulty. Hearing loss Schizophrenia - though usually schizophrenia arises later in life than autism.

Developmental delay (see Developmental problems) Selective Mutism Mental retardation Stereotypic movement disorder

Hidden causes of Autism may be incorrectly diagnosed:

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Rett syndrome Fragile X syndrome - found in about 10% of autism cases. Tuberous sclerosis - about 25% of autistics. Phenylketonuria Congenital rubella

TREATMENT FOR AUTISM Appropriate early intervention is important. Once the diagnosis has been made, the parents, physicians and specialists should discuss what is best for the child. In most cases, parents are encouraged to take care of the child at home. Special education classes are available for autistic children. Structured, behaviorally-based programs, geared to the patient's developmental level have shown some promise. The list of treatments mentioned in various sources for Autism includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

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Behavioral therapies Individualized Education Programs (IEPs) Applied Behavior Analysis (ABA) Positive Behavioral Interventions and Support (PBS) Parent training

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Medications - usually only for specific behavior such as self-injury or aggression

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Most behavioral treatment programs include:     

clear instructions to the child prompting to perform specific behaviors immediate praise and rewards for performing those behaviors a gradual increase in the complexity of reinforced behaviors definite distinctions of when and when not to perform the learned behaviors

Parents should be educated in behavioral techniques so they can participate in all aspects of the child's care and treatment. The more specialized instruction and behavior therapy the child receives, the more likely it is that the condition will improve. Medication can be recommended to treat specific symptoms such as seizures, hyperactivity, extreme mood changes, or self-injurious behaviors.

The autistic child requires much of the parents' attention, often affecting the other children in the family. Counseling and support may be helpful for the parents. The outlook for each child depends on his or her intelligence and language ability. Some people with autism become independent adults. A majority can be taught to live in community-based homes, although they may require supervision throughout adulthood.

LATEST TREATMENT FOR AUTISM The following are some of the latest treatments for Autism: • • • • • • •

Structured educational program Risperidone Sertraline Fluoxetine Clomipramine Buspirone Gabapentin

WHAT QUESTIONS TO ASK YOUR DOCTOR ABOUT AUTISM?         

When will the symptoms appear? What type of symptoms will there be? What if the child just likes to be left alone as opposed to being autistic? What type of test is given to diagnose autism? Where is testing done? How accurate is the test? Is the autism mild or severe? Will the child be able to attend public school if they have mild autism? Is there a cure?

How many people get Autism? Autism affects an estimated 10 to 20 of every 10,000 people, depending on diagnostic criteria used, and strikes males about four times more often than females. Autism affects an estimated 10 to 20 of every 10,000 people, depending on the diagnostic criteria used. Most estimates that include people with similar disorders are two to three times greater.

OTHER SYMPTOMS• o o o o o o o o o o

Impaired social interaction

Not responding to name Not look at people Not smiling - note that normal newborns do not smile for several weeks Avoid eye contact Not liking cuddles Lack of imaginative play Lack of social play Inability to make friends Lack stranger anxiety - this develops within the first year. Lack separation anxiety - once this develops (first year), when mother departs normal infants are

upset. o Independence - doesn't seek help or interact with others. o Plays alone o Unprovoked attacks on others • Verbal communication problems o o o o o

Inability to sustain conversation Appears deaf at times Language stereotyped Repetive language Unusual language o Not talking - many autistic infants are mute, or become mute after initially

sounds. o Echolalia - only parroting what they hear (many normal infants also do this). o Confusing pronouns - mixing up "I", "you", and "we" or similar words. • Nonverbal communication problems • Obsessions o o o o o

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Unusual or severely limited activities and interests Repetitive movements - rocking, hair twirling Inflexibility with highly specific routines and rituals Overly focused attention on specific objects Lines things up Sensory symptoms Hypersensitivity to sensory stimuli - e.g. taste, sound, etc. Reduced sensitivity to pain

making

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Extraordinarily sensitive to sensations Self-mutilation Early symptoms of possible autism

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Regression - negative change from normal early development into impaired

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o o o o o o o o o o

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abilities; about 20% of cases have a regression Delayed development - slow to speak No babbling by 12 months No gesturing by 12 months No single words by 16 months No two-word phrases by 24 months Loss of language skills already acquired Loss of words Loss of social skills already acquired Tantrums Hyperactivity Savant abilities - rare gift of very unusual abilities in music, math or other areas.

Signs and symptoms Typical features of infantile autistic disorder include unresponsiveness to people, language impairment, lack of imaginative play, bizarre behavior patterns, and abnormal reactions to sensory stimuli. Unresponsiveness to people Infants with this disorder avoid eye contact, have little or no facial expression, and are indifferent to affection and physical contact. Parents may report that the child becomes rigid or flaccid when held, cries when touched, and shows little or no interest in human contact. As the infant grows older, his smiling response is delayed or absent. He doesn’t lift his arms in anticipation of being picked up or form an attachment to a specific caregiver. Nor does he show the anxiety about strangers that’s typical in the 8-month-old infant. The autistic child fails to learn the usual socialization games (peek-a-boo, pat-a-cake, or bye-bye). He’s likely to relate to others only to fill a physical need and then without eye contact or speech. The end result may be mutual withdrawal between parents and child. Severe language impairment The child may be mute or may use immature speech patterns. For example, he may use a single word to express a series of activities; he may say “ground” when referring to any step in using a playground slide. His speech commonly shows echolalia (meaningless repetition of words or phrases addressed to him) and pronoun reversal (“you go walk” when he means “I want to go for a walk”). When answering a question, he may simply repeat the question to mean yes and remain silent to mean no.

Lack of imaginative play The child shows little imagination, seldom acting out adult roles or engaging in fantasy play. In fact, he may insist on lining up an exact number of toys in the same manner over and over or repetitively mimic the actions of someone else. Bizarre behavior The autistic child shows characteristically bizarre behavior patterns, such as screaming fits, rituals, rhythmic rocking, arm flapping, crying without tears, and disturbed sleeping and eating patterns. His behavior may be self-destructive (hand biting, eye gouging, hair pulling, or head banging) or self-stimulating (playing with his own saliva, stool, and urine). His bizarre responses to his environment include an extreme compulsion for sameness. Abnormal response to sensory stimuli The autistic child may underreact or overreact to sensory stimuli; he may ignore objects — dropping those he’s given or not looking at them — or he may become excessively absorbed in them — continually watching the objects or the movement of his own fingers over the objects. He commonly responds to stimuli by head banging, rocking, whirling, and hand flapping. He tends to avoid using sight and hearing to interact with the environment. Other behavioral abnormalities Other characteristics of an autistic child include: cognitive impairment (most have a measured IQ of 35 to 49; assessment of the patient’s true intelligence level is difficult because of poor social and verbal skills) eating, drinking, and sleeping problems — for example, limiting his diet to just a few foods, excessive drinking, or repeatedly waking during the night and rocking mood disorders, including labile mood, giggling or crying without reason, lack of emotional responses, no fear of real danger but excessive fear of harmless objects, and generalized anxiety