Autism

Definition

Autism is a chronic and often severe disorder of brain functioning that begins during childhood. It is marked by problems with social contact, intelligence, and language, coupled with ritualistic or compulsive behavior, sensory integration and processing problems, and strange environmental responses.

Description

Autism is a lifelong disorder that interferes with the ability to understand what is seen, heard, and touched. This can cause profound problems in personal behavior

and in the ability to relate to others. A person with autism must learn how to communicate normally and how to relate to people, objects, and events. However, not all patients suffer the same degree of impairment. The severity of the condition varies between individuals, ranging from the person with extremely unusual and aggressive behavior to one with something resembling a mild personality disorder or a learning disability.

Autism occurs in as many as one in 1,000 children, and incidence is rapidly increasing. It is found three to four times more often in boys than in girls. The condition occurs around the world in all races and all social backgrounds. Autism usually is evident in the first three years of life, although in some children it is difficult to pinpoint when the problem actually takes hold. Often, the condition may not be diagnosed until the child enters school. A person with autism can have symptoms ranging from mild to severe.

Two subgroups of autism have recently been explained by clinicians. Those with essential autism, as defined by diagnostic tests, appear to have higher IQ scores and fewer seizures than those with complex autism, which offers a poorer outcome.

Causes & symptoms

Although the exact causes of autism are unknown, many possibilities have been proposed. Most experts believe that several independent factors contribute to development of autism. The number and combinations of these factors probably differ from person to person. Research points to such precipitating conditions as fetal alcohol syndrome, genetic connections (as with identical twins), brain stem defects, lead poisoning, a nervous system defect, infections, food and inhalant allergies, infant vaccination reactions, and digestive system deficiencies.

Further studies point to major disturbances in the body chemistry of children with autism. Disruption is most often found in fatty acid metabolism, electrolyte balances, problems with digestive functioning, production of red and white blood cells, and the body's balance of minerals. Diseases that may trigger autistic behavior include rubella in the pregnant mother, tuberous sclerosis, candiasis infection, fragile X syndrome, encephalitis, cytomegalovirus (CMV), a severe form of a herpes simplex infection, and untreated phenylketonuria.

There also appears to be a strong genetic basis for autism. In October 2001, the National Institutes of Health (NIH) reported that two regions of chromosomes contain genes involved with autism, and that two other chromosomes had a weaker relation to autism-related genes. Genetically identical twins are much more likely than fraternal twins to both have autism if one is affected. In a family with one autistic child, the chance of having another child with autism is about one in 20, much higher than in the normal population. Sometimes, relatives of an autistic child have mild behaviors that look very much like autism, such as repetitive behaviors and social or communication problems. Research also has found that some emotional disorders, such as manic depression, occur more often in families of a child with autism. At least one group of researchers has also found a link between an abnormal gene and autism. The gene may be just one of at least three to five genes that inter-act in some way to cause the condition. Scientists suspect that a faulty gene or genes might make a person vulnerable to develop autism in the presence of other factors, such as chemical imbalance, infection, or a lack of oxygen at birth.

Autism affects the way in which the brain uses or transmits information. Studies have found abnormalities in several parts of the brains of those with autism that almost certainly occurred during fetal development. The problem may be centered in the parts of the brain responsible for processing language and information from the senses. Profound problems with social interactions are the most common symptoms of autism. Infants with the disorder will not cuddle, avoid eye contact, and in general do not seem to like or require physical contact or affection. Often, the child will not form attachments to parents or the rest of the family. The child may not speak at all, or speak very little and may show bizarre patterns of speech, such as endlessly repeating words or phrases. About 10% of those with autism have an exceptional ability in particular areas, such as mathematics, memory, art, or music.

Most autistic children appear to be mentally retarded to at least some degree. Bizarre behavior patterns are very common and may include repeated mimicking of the actions of others, complex rituals, screaming fits, rhythmic rocking, arm flapping, finger twiddling, and crying without tears. Many of these children may react to sounds by banging their head or flapping fingers. Some less affected autistic adults who have written books about their childhood experiences report that sounds were often excruciatingly painful to them, forcing them to withdraw from the environment or to try to cope by withdrawing into their own invented world. A common characteristic of individuals with autism is an insistence on sameness. There may be strong reactions to changes in food, clothing, and routines.

Diagnosis

Autism is diagnosed by obtaining a developmental history of the child and observing and evaluating the child's behavior, communication skills, and social interactions. Because the symptoms of autism are so varied, the condition may go undiagnosed for some time. There is no medical test for autism. The condition is often missed, especially in mild cases or when additional handicaps are present. Special screening tools help physicians diagnose the condition. Medical tests are sometimes used to rule out other possible causes of autistic symptoms.

Treatment

Early intervention proves critical in managing autism. The American Academy of Pediatrics (AAP) says that many parents have chosen alternative therapies when more traditional therapies do not produce desired results. Among therapies mentioned in the group's report are nutritional supplements, elimination diets, immune globulin therapy, and secretin (a hormone) therapy.

There is often a strong nutritional dysfunction involved in autism. A major overhaul of the child's diet should be done, but very gradually. A healthy diet of whole foods with no preservatives or additives, including food dyes, is recommended. Autistic children may have particular difficulty handling Nutrasweet and monosodium glutamate (MSG), as these chemicals may further interfere with already disrupted nerve impulses. Processed foods such as white flour, white sugar, margarine, and hydrogenated fats should be avoided because they interfere with the stability of blood chemistry.

Many autistic children may be unable to effectively break down the protein in grains such as wheat, barley, and oats, called gluten, and the protein in milk called casein. Overgrowths of Candida albicans may be present and should be tested for and treated. Testing should also be done for food, chemical, and inhalant allergies. Digestive functioning should be tested and monitored. Extensive testing should be done for blood levels of chemicals in the body, as well. Allergens should be subsequently removed from the diet and environment; further dietary changes should be made to correct chemical imbalances. Possible gut and immune system dysfunction should also be addressed.

Studies have shown that supplementation with megadoses of vitamin B₆ together with magnesium improves eye contact, speech, and behavior problems. Vitamin B₆ causes fewer side effects than other medications, but megadoses should only be given under the supervision of a healthcare provider. A B-complex vitamin is probably the best way to give B₆, due to the interdependent functioning of the B vitamins. Zinc and vitamin C supple-mentation is also recommended. In addition, dimethyl-glycine (DMG) has been reported to improve speech in some children with autism in as little as a week's time. Other therapeutic methods that have been shown to be helpful include special auditory integration training (AIT) based on the Berard method or the Tomatis method. Craniosacral therapy may also improve symptoms of autism by relieving compressions of the skull bones and membranes. Autism is a complex condition. A practitioner who has already worked with cases of autism successfully will be able to offer a comprehensive treatment plan.

Allopathic treatment

Most experts recommend a complex treatment regimen for autism that begins early in life and continues through the teenage years. Behavioral therapies are used in conjunction with medications and special diets. Because the symptoms vary so widely from one person to the next, there is not a single approach that works best for every person. Interventions include special training in music, listening, vision, speech and language, and senses. Sensory integration training may be used to normalize sensory functions. Training to change aberrant behaviors should be started as early in the autistic child's life as possible, since early intervention appears to have the most influence on brain development and functioning. A child with autism is able to learn best in a specialized, structured program that emphasizes individualized instruction.

No single medication has yet proved highly effective for the major features of autism. However, a variety of drugs can control self-injurious, aggressive, and other behaviors. Drugs also can control epilepsy, which afflicts up to 20% of people with autism. Types of recommended medication may include stimulants, such as methylphenidate (Ritalin); antidepressants, such as fluroxamine (Luvox); opiate blockers, such as naltrexone (ReVia); antipsychotics; and tranquilizers.

Expected results

Studies show that people with autism can improve significantly with proper treatment. While there is no cure, the negative behaviors of autism can be made to improve. Earlier generations placed autistic children in institutions; now, even severely disabled children can be helped to eventually become more responsive to others. Children with autism usually can learn to better understand and deal with the world around them. Some can even lead nearly mainstream lives.

Prevention

The mechanisms of autism are poorly understood. There is currently no known method of prevention for the condition. However, there is much debate as to what part the measles, mumps, and rubella (MMR) vaccination and the diphtheria, pertussis, and tetanus (DPT) vaccination may play in the onset of autism. A knowledgeable alternative healthcare provider should be consulted about the necessity of vaccination and possible alternatives.

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