Autism is a developmental disorder that usually first diagnosed in early childhood or in the first 3 years of life. Autism mainly affects the brain's normal development of social interaction and communication skills. Autism disorder is also called as autistic spectrum disorder (ASD) and pervasive developmental disorder (PDD). Autism causes children to experience the world in the different way from the most other children do.
Most autistic children are perfectly normal in appearance but they spend their most time engaged in puzzling and disturbing behaviors. These types of behaviors are markedly different from those of typical children. Less severe cases of autism may be diagnosed with Asperger's Syndrome (these children typically have normal speech, but they have many "autistic" social and behavioral problems). Autistic children have difficulty to talk with other people and express themselves using words. They may say the same sentence again and again to calm themselves down or they may have to line up their pencils before they can pay attention.
Causes of autism:
Autism is a physical condition, produced as a result of a neurologic abnormality. The cause of the problems with the nervous system is unknown in most cases. Environmental, immunologic, and metabolic factors also manipulate the development of these disorder. Genetic factors are also important. For example, identical twins are much more likely to have autism than fraternal twins or siblings. Chromosomal abnormalities and other nervous system (neurological) problems are more common causes of autism in families with autism.
A number of other possible causes of autism have been suspected, but they are not proven. They involve:
- Vaccine sensitivity
- Digestive tract changes
- Mercury poisoning
- The body's inability to properly use vitamins and minerals
In some children, autism is associated to an underlying medical condition. For examples, metabolic disorders (untreated phenylketonuria [PKU]), genetic disorders (fragile X syndrome, tuberous sclerosis), developmental brain abnormalities (microcephaly, macrocephaly, cerebral dysgenesis), congenital infections (rubella, cytomegalovirus [CMV], toxoplasmosis), and neurologic disorders acquired after birth (lead encephalopathy, bacterial meningitis). These medical disorders alone do not cause autism. Since most children having these conditions does not have autism.
Environmental factors and exposures may interact with genetic factors to cause a raised risk of autism in some families.
Possibly, no single gene or genetic defect is responsible for autism. Researchers revealed that there are number of different genes that, when combined to other, increase the risk of autism. In families with one child with autism, the risk of having autism in another child is 3-8%. Several studies have suggested that first-degree relatives of children with autism also have an increased risk of autism spectrum disorders.
Symptoms of Autism:
Children with autism characteristically have difficulties in:
- Social interactions
- Pretend play
- Verbal and nonverbal communication
Sometimes, most parents of autistic children suspect that something is wrong by the time as the age of child increases. Some children having autism appear normal before age 1 or 2 and then they suddenly "regress" and mislay language or social skills that they had previously gained. This condition is called as the regressive type of autism.
People having autism may:
- Show unusual attachments to objects
- Have unusual distress when routines are changed
- Perform repeated body movements
- Be overly sensitive in sight, hearing, touch, smell, or taste (for example, they may refuse to wear "itchy" clothes and become distressed if they are forced to wear the clothes)
The symptoms may vary from moderate to severe.
Communication problems may include:
- Uses nonsense rhyming
- Develops language slowly or not at all
- Communicates with gestures instead of words
- Does not point to direct others' attention to objects (occurs in the first 14 months of life)
- Does not adjust gaze to look at objects that others are looking at
- Does not refer to self correctly (for example, says "you want water" when the child means "I want water")
- Repeat words or memorized passages, such as commercials
- Cannot start or maintain a social conversation
- Shows a lack of empathy
- Does not make friends
- May treat others as if they are objects
- Prefers to spend time alone, rather than with others
- May not respond to eye contact or smiles, or may avoid eye contact
- Is withdrawn
- Does not play interactive games
Response to sensory information:
- Give the impression to have a heightened or low response to pain
- Does not amaze at loud noises
- Rubs surfaces, mouths or licks objects
- May withdraw from physical contact because it is overstimulating or overwhelming
- May find normal noises painful and hold hands over ears
- Has heightened or low senses of sight, hearing, touch, smell, or taste
- Shows little pretend or imaginative play
- Does not imitate the actions of others
- Prefers solitary or ritualistic play
- Shows aggression to others or self
- "Acts up" with intense tantrums
- Has very narrow interests
- Shows a strong need for sameness
- Uses repetitive body movements
- Has a short attention span
- Is overactive or very passive
- Gets stuck on a single topic or task (perseveration)
The following delays deserve an immediate evaluation by child’s pediatrician:
- By 6 months: No big smiles or other warm, joyful expressions.
- By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions.
- By 12 months: No babbling or “baby talk.”
- By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving.
- By 16 months: No spoken words.
- By 24 months: No meaningful two-word phrases that do not involve imitating or repeating.
- At any age: Any loss of speech, babbling, or social skills.
Diagnosis of Autism or Tests for Autism:
To confirm the diagnosis of autism, no lab test or x-ray is necessary. The diagnosis of autism depends on clinical judgment concerning observations of the individual's behavior. Primary importance in making the diagnosis of autism is information from family members and other observers. But, the pediatrician may order tests to prohibit other conditions that might be confused with autism, such as mental retardation, metabolic or genetic diseases, or deafness. To establish the diagnosis of autism, one single visit with the pediatrician is not enough.
- If a developmental problem may be present, then the pediatrician observes the child and may do a simple screening test to see. These screening tests do not diagnose autism but they indicate an existing problem. They observe specific behaviors (for very young children) or how a child responds to simple commands or questions (for older children).
- Some extensively used screening tests are the Checklist for Autism in Toddlers (CHAT) for children aged 18 months and the Autism Screening Questionnaire for children aged 4 years and older.
- Other conditions must be prohibited, and the diagnosis of autism must be established with certainty before treatment starts.
- In the evaluation process, other professionals, such as speech and language pathologists, audiologists (specialists in testing hearing), occupational therapists, physical therapists, and social workers, may be involved.
- Pediatrician will refer the child to a professional who specializes in developmental disorders if he or she believes that further evaluation is necessary. This specialist may be a developmental pediatrician, a psychiatrist, a neurologist, or a psychologist.
The wide-ranging evaluation of a child with autism might include,
- Complete medical and family history
- Physical exam
- Formal audiology evaluation
- Selected medical/lab tests on an individual basis (lead level, genetic tests, metabolic tests, brain MRI, EEG)
- Speech, language, and communication assessment; cognitive and behavioral assessments (focus on social skills and relationships, problem behaviors, motivation and reinforcement, sensory functioning, and self regulation); and academic assessment (educational functioning, learning style)
Treatment of Autism:
Most treatment programs will build on the child interests in a highly structured schedule of constructive activities. Visual aids are frequently helpful for this condition. Autism Treatment is most successful when it is geared toward the child's particular needs.
Variety of therapies is available to treat autism. These includes,
- Physical therapy
- Occupational therapy
- Speech-language therapy
- Applied behavior analysis (ABA)
Applied Behavioral Analysis (ABA):
This program can be effective in some cases and it is especially for younger children with an autism spectrum disorder. A one-on-one teaching approach is used by ABA to strengthen the practice of various skills with the goal to get the child close to normal developmental functioning. This program is generally done in a child's home under the supervision of a behavioral psychologist and they can be very expensive and have not been widely adopted by school systems.
This is another program, called as Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH). In North Carolina, TEACCH was developed as a statewide program. It is a visualization program, uses picture schedules and other visual cues that help the child to work independently and organize and structure their environments. However, TEACCH tries to improve a child's adaptation and skills; it also accepts the problems linked with autism spectrum disorders.
To treat behavior or emotional problems of autism, medicines are often used. Medicines are used for following condition:
- Mood swings
- Extreme compulsions that the child cannot stop
- Attention problems
- Sleep difficulty
Recently, for the irritability and aggression only risperidone is approved to treat children ages 5 - 16 with autism. SSRIs, divalproex sodium and other mood stabilizers, and possibly stimulants such as methylphenidate are other medicines which are used.
Some autistic children only responds to a gluten-free or casein-free diet. Foods which contain wheat, rye, and barley also contain gluten. Milk, cheese, and other dairy products contain casein. All experts are not agreeing with difference in dietary changes, and not all studies of this method have shown positive results. Consult to both a doctor who specializes in the digestive system (gastroenterologist) and a registered dietitian if you are considering these or other dietary changes. While carrying out dietary changes, you must be sure that the child is still receiving enough calories, nutrients, and a balanced diet.
Extensively publicized treatments for autism that do not have scientific support, and reports of "miracle cures" that do not live up to expectations, beware from this treatment. It may be helpful to talk with other parents of children with autism and autism specialists if your child has autism. Also, follow the rapidly developing progress of research in this area. There was enormous excitement about using secretin infusions at one time but after many studies it's possible that secretin is not effective after all. But, research still continues.
To prevent autism, no ways are available. The genetics of autism are researched, may ultimately offer interventions that can correct genetic errors before developing the signs and symptoms of autism.
However, now researchers at Imperial College London have revealed a potential way of spotting the disorder in children as young as six months old.
Today’s research shows that it is possible to distinguish among autistic and non-autistic children by looking at the by-products of gut bacteria and the body’s metabolic processes in the children’s urine.
Overview of Autism, Prof. Fred Volkmar video from youtube:
Video of Identities of Autism: Genetic Testing from youtube:
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