AUTISM
Introduction:
Autism is a complex developmental disability that typically appears during the first 3 years of life. It affects the functioning of brain. Children & adults with autism typically have difficulties in verbal & non-verbal communication, Social interaction, and leisure or play activities. Children, who have autism often have delayed language development, prefer to spend time alone & show less interest in making friends. They also have mental retardation; some are of average or high intelligence.
Autism is four times more common in boys than girls. Autism is one of five disorders coming under the umbrella of pervasive developmental disorders (PDD). The five disorders under this are-
Autism is the most common of the PDD affecting an estimated 1 in 250 births. The overall incidence of autism is consistent around the globe but is 4 times more prevalent in boys than girls. Autism knows no racial, ethnic or social boundaries & family income, lifestyle & educational level. Causes:
There is no known single cause for autism. Current theory classifies autism as a neuro-biological disorder & the focus is on changes in the neuroanatomy & neurochemistry of the brain. CT scans have isolated a subgroup of autistic children with enlarged ventricles and MRI has identified a subgroup of autistic adults with hypoplasia of the cerebellar vernius. No one gene has been identified as causing autism. Autism tends to occur more frequently than expected among individuals who have certain medical conditions including--
There are no medical tests for diagnosing autism. An accurate diagnosis must be based on observation of the individual's communication, behavior & developmental levels. Parental & other caregivers input & developmental history are very important components of making an accurate diagnosis. At first glance, some persons with autism may appear to have mental retardation, a behavior disorder, and problems with hearing or even odd and eccentric behavior.
Assessment tools:
The characteristic behavior of autism spectrum disorders may or may not be apparent in infancy(18 to24 months) but usually become obvious during early childhood(24 months to 6 years). As part of a well-baby / well-child visit, child's doctor should do a "developmental screening" asking specific questions about baby's progress. The National Institute of Child Health & Human Development lists, there are five behaviors that signal further is warranted.
DSM definition
Autism is defined in section 299.00 of the Diagnostic and statistical Manual of Mental disorders (DSM-IV) as:
Differential diagnosis:
Child's pediatrician is the first to suspect autism; child will need to be referred to someone who specializes in diagnosing autism spectrum disorders. This may be a developmental pediatrician, a psychiatrist or psychologist. Other professionals may be included who are better able to observe & test child in specific areas. This multidisciplinary assessment team may include some or all of the following professionals. They may also be involved in treatment programs.
Available treatments:
There is no cure for autism, however with appropriate treatment and education many children with the disorder can learn & develop. Early intervention often can reduce challenges associated with the disorder, lesser disruptive behavior & provide some degree of independence. Treatment depends on the individual needs of the patient. In most cases, combination of treatment method is more effective. Autism usually requires lifelong treatment .DT / OT / PT are sometimes used to treat autism. DT / OT helps improves dependent function & teaches basic skills (e.g. buttoning a shirt, bathing). PT involves using exercise & other physical measures (e.g massage, heat) to help patient control body movement.
Approaches:
This therapy is used to treat autistic patients who are unable to communicate verbally or to initiate language development. In young children with the disorder, speech therapy may be used to help the patients gain the ability to speak.
Dietary modification
Autism is not caused by diet & the use of dietary modifications & supplements to treat the disorder is controversial. Changing the diet or adding vitamin supplements may improve digestion and eliminate food intolerances or allergies which may contribute to behavioral problems in autistic patients. Vitamin B, magnesium & cod liver oil supplements (contain A&D) may improve behavior, eye contact, attention span & learning in autistic patients. Vitamin C improves depression.
Medication
Medication may be used to treat various symptom of autism e.g attention difficulties, anxiety& can also be used to treat that may accompany the disorder (eg-epilepsy). Depression, obsessive-compulsive behavior & anxiety may be treated using antidepressants. These drugs often reduce the frequency & intensity of repetitive behavior & irritability, tantrums & aggression & improve eye contact & responsiveness.
Role of inheritance:
Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.
Prognosis:
About 10-20% autistic children begin to improve between 4 to 6 years of age and eventually attend an ordinary school and obtain work.
Introduction:
Autism is a complex developmental disability that typically appears during the first 3 years of life. It affects the functioning of brain. Children & adults with autism typically have difficulties in verbal & non-verbal communication, Social interaction, and leisure or play activities. Children, who have autism often have delayed language development, prefer to spend time alone & show less interest in making friends. They also have mental retardation; some are of average or high intelligence.
Autism is four times more common in boys than girls. Autism is one of five disorders coming under the umbrella of pervasive developmental disorders (PDD). The five disorders under this are-
- Autistic disorder
- Asperger's disorder
- Childhood disintegrative disorder
- Rett's disorder
- PDD-Not otherwise specified(NOS)
Autism is the most common of the PDD affecting an estimated 1 in 250 births. The overall incidence of autism is consistent around the globe but is 4 times more prevalent in boys than girls. Autism knows no racial, ethnic or social boundaries & family income, lifestyle & educational level. Causes:
There is no known single cause for autism. Current theory classifies autism as a neuro-biological disorder & the focus is on changes in the neuroanatomy & neurochemistry of the brain. CT scans have isolated a subgroup of autistic children with enlarged ventricles and MRI has identified a subgroup of autistic adults with hypoplasia of the cerebellar vernius. No one gene has been identified as causing autism. Autism tends to occur more frequently than expected among individuals who have certain medical conditions including--
- Fragile X syndrome
- Tuberous sclerosis
- Congenital rubella syndrome
- Untreated PKU
- Difficulty in expressing needs, use gestures or pointing instead of words
- Insistence on sameness, resistance to change
- Repeating words or phrases in place of normal, responsive language.
- Laughing, crying, showing distress for reasons not apparent to others
- Prefers to be alone, in aloof manner
- Tantrums difficulty in mixing with other
- Little or no eye contact
- Unresponsiveness to normal teaching methods
- Inappropriate attachments to objects
- No real fear of danger
- Spins objects, not responsive to verbal uses.
There are no medical tests for diagnosing autism. An accurate diagnosis must be based on observation of the individual's communication, behavior & developmental levels. Parental & other caregivers input & developmental history are very important components of making an accurate diagnosis. At first glance, some persons with autism may appear to have mental retardation, a behavior disorder, and problems with hearing or even odd and eccentric behavior.
Assessment tools:
The characteristic behavior of autism spectrum disorders may or may not be apparent in infancy(18 to24 months) but usually become obvious during early childhood(24 months to 6 years). As part of a well-baby / well-child visit, child's doctor should do a "developmental screening" asking specific questions about baby's progress. The National Institute of Child Health & Human Development lists, there are five behaviors that signal further is warranted.
- Does not babble or coo by 12 months.
- Does not gesture (point, wave, grasp) by 12 months
- Does not say single words by 16months
- Does not say two-word phrases on his/her own by 24 months
- Has any loss of any language or social skill at any age
DSM definition
Autism is defined in section 299.00 of the Diagnostic and statistical Manual of Mental disorders (DSM-IV) as:
-
A total of six (or more) items from (1), (2) and (3), with at least two from (1), and one each from (2) and (3):
-
qualitative impairment in social interaction, as manifested by at least two of the following:
- marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
- failure to develop peer relationships appropriate to developmental level
- a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
- lack of social or emotional reciprocity
- qualitative impairments in communication as manifested by at least one of the following:
- delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
- in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
- stereotyped and repetitive use of language or idiosyncratic language
- lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
- restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
- encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- apparently inflexible adherence to specific, nonfunctional routines or rituals -
- stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
- persistent preoccupation with parts of objects
-
qualitative impairment in social interaction, as manifested by at least two of the following:
- Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
- social interaction
- language as used in social communication
- Symbolic or imaginative play.
- The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.
Differential diagnosis:
- Child Schizophrenia: In infantile autism in contrast to children schizophrenia there is little or no period of normal development, mental retardation & epilepsy are common, have symptoms suggestive of negative symptoms of schizophrenia & there are no hallucination or delusions.
- Reactive attachment disorder of infancy: This disorder is characterized by a failure to establish normal attachment to a caregiver or an indiscriminate sociability. This is the result of psychosocial deprivation or abuse. These children have potentials for normal imaginative play & normal responses to the environment. There are no motor abnormalities & they are not mentally retarded.
- Elective mutism: There is absence of speech in some but not necessarily all environments. This may be acute (following social or familiar factors). These children communicate via gesture, nodding or short monosyllabic utterances.
- Others: The other disorders need to be differentiated are Tourette's disorder, habit disorder' obsessive compulsive disorder, attention deficit, specific developmental (language) disorder, acquired aphasia with convulsions, schizoid personality, neuro-degenerative diseases & Mental retardation.
Child's pediatrician is the first to suspect autism; child will need to be referred to someone who specializes in diagnosing autism spectrum disorders. This may be a developmental pediatrician, a psychiatrist or psychologist. Other professionals may be included who are better able to observe & test child in specific areas. This multidisciplinary assessment team may include some or all of the following professionals. They may also be involved in treatment programs.
- Developmental pediatrician
- Child psychiatrist
- Clinical psychologist
- Developmental therapist / Occupational therapist / Physiotherapist
- Speech therapist
- Social worker
- Special educator
Available treatments:
There is no cure for autism, however with appropriate treatment and education many children with the disorder can learn & develop. Early intervention often can reduce challenges associated with the disorder, lesser disruptive behavior & provide some degree of independence. Treatment depends on the individual needs of the patient. In most cases, combination of treatment method is more effective. Autism usually requires lifelong treatment .DT / OT / PT are sometimes used to treat autism. DT / OT helps improves dependent function & teaches basic skills (e.g. buttoning a shirt, bathing). PT involves using exercise & other physical measures (e.g massage, heat) to help patient control body movement.
Approaches:
- Behavior modification
- Communication therapy
- Dietary modifications
- Medication
- Positive reinforcement to teach self care skills
- Speech therapy(also sign language teaching)
- Structured class room training (to learn new material & maintain the acquired learning, ''special schooling'').
- Development of regular routine with minimum or no changes
- Behavioral techniques to encourage social & interpersonal interaction.
This therapy is used to treat autistic patients who are unable to communicate verbally or to initiate language development. In young children with the disorder, speech therapy may be used to help the patients gain the ability to speak.
Dietary modification
Autism is not caused by diet & the use of dietary modifications & supplements to treat the disorder is controversial. Changing the diet or adding vitamin supplements may improve digestion and eliminate food intolerances or allergies which may contribute to behavioral problems in autistic patients. Vitamin B, magnesium & cod liver oil supplements (contain A&D) may improve behavior, eye contact, attention span & learning in autistic patients. Vitamin C improves depression.
Medication
Medication may be used to treat various symptom of autism e.g attention difficulties, anxiety& can also be used to treat that may accompany the disorder (eg-epilepsy). Depression, obsessive-compulsive behavior & anxiety may be treated using antidepressants. These drugs often reduce the frequency & intensity of repetitive behavior & irritability, tantrums & aggression & improve eye contact & responsiveness.
Role of inheritance:
Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.
Prognosis:
About 10-20% autistic children begin to improve between 4 to 6 years of age and eventually attend an ordinary school and obtain work.
- 10-20% can live at home but need to attend a special school or training centre and cannot work.
- 60% improve little and unable to lead an independent life, most needing long term residential care.
- Those who improve may continue to show language problems, emotional coldness and behavior.
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