WHAT IS AUTISM?
Autism is a developmental
disability that typically involves delays and impairment in social skills,
language, and behavior. Autism is a spectrum disorder, meaning that it affects
people differently. Some children may have speech, whereas others may have
little or no speech. Less severe cases may be diagnosed with Pervasive Developmental
Disorder (PDD) or with Asperger’s Syndrome (these children typically have
normal speech, but they have many “autistic” social and behavioral problems). Left
untreated, many autistic children will not develop effective social skills and
may not learn to talk or behave appropriately. Very few individuals recover
completely from autism without any intervention. The good news is that there
are a wide variety of treatment options which can be very helpful. Some treatments
may lead to great improvement, whereas other treatments may have little or no
effect. No treatment helps everyone. A variety of effective treatment options
will be discussed below.
What is the difference between Asperger’s Syndrome and
Autism?
Asperger syndrome is
usually considered a subtype of high-functioning autism. Most of the
individuals with Asperger syndrome are described as “social but awkward.” That
is, they want to have friends, but they do not have the social skills to begin
and/or maintain a friendship. While
high-functioning autistic individuals may also be “social but awkward,” they
are typically less interested in having friends. In addition, high-functioning
autistic individuals are often delayed in developing speech/language. Those
with Asperger syndrome tend not to have speech/language delays, but their
speech is usually described as peculiar, such as being stilted and
perseverating on unusual topics.
GENETICS OF AUTISM
Genetics appear to play an important role in
causing some cases of autism. Several studies have shown that when one identical
twin has autism, the other co-twin often has autism. In contrast, when one fraternal twin has
autism, the co-twin is rarely autistic. Studies trying to identify specific
genes associated with autism have been inconclusive. Currently, it appears that
20 or more genes may be associated with autism. This is in contrast to other disorders,
such as Fragile X or Rett’s syndrome, in which single genes have been
identified. A large number of studies have found that autistic individuals
often have compromised immune systems. In fact, autism is sometimes described
as an autoimmune system disorder. One
working hypothesis of autism is that the child’s immune system is compromised
genetically and/or environmentally (e.g., exposure to chemicals). This may predispose
the child to autism. Then, exposure to an (additional) environmental insult may
lead to autism (e.g., the MMR vaccine) or mercury-containing vaccine preservatives
(i.e., thimerosal). If parents have a child with autism, there is an increased
likelihood that their future children will also develop autism. Many studies
have identified cognitive disabilities, which sometimes go undetected, in
siblings of autistic children. Siblings should be evaluated for possible
developmental delays and learning disabilities, such as dyslexia.
COMMON CO-OCCURRING CONDITIONS IN AUTISM
1.
Mental Retardation: Although it has been estimated that up to 75% of people with autism
have mental retardation, research studies have frequently used inappropriate IQ
tests, such as verbal tests with nonverbal children and, in some cases,
estimating the child’s intelligence level without any objective evidence. Parents
should request non-verbal intelligence tests that do not require language
skills, such as the Test for Nonverbal Intelligence (TONI). Furthermore,
regardless of the result, realize that autistic children will develop more skills
as they grow older, and that appropriate therapies and education can help them
reach their true potential.
2.
Seizures: It
is estimated that 25% of autistic individuals also develop seizures, some in
early childhood and others as they go through puberty (changes in hormone
levels may trigger seizures). These seizures can range from mild (e.g., gazing
into space for a few seconds) to severe, grand mal seizures. Many autistic
individuals have subclinical seizures which are not easily noticeable but can
significantly affect mental function. A short one- or two-hour EEG may not be
able to detect any abnormal activity, so a 24-hour EEG may be necessary. Although
drugs can be used to reduce seizure activity, the child’s health must be
checked regularly because these drugs can be harmful. There is substantial
evidence that certain nutritional supplements, especially vitamin B6 and dimethylglycine
(DMG), can provide a safer and more effective alterative to drugs, for many
individuals.
3.
Chronic Constipation and/or Diarrhea: An analysis of the ARI’s autism database of thousands
of cases show over 50% of autistic children have chronic constipation and/or
diarrhea. Diarrhea may actually be due to constipation—i.e., only liquid is
able to leak past a constipated stool mass in the intestine. Manual probing often
fails to find an impaction. An endoscopy may be the only way to check for this
problem. Consultation with a pediatric gastroenterologist is required.
4.
Sleep Problems:
Many autistic individuals have sleep problems. Night waking may be due to
reflux of stomach acid into the esophagus. Placing bricks under the head of the
bed may help keep stomach acid from rising and provide better sleep. Melatonin has been very useful in helping
many autistic individuals fall asleep. Other popular interventions include
using 5-HTP and implementing a behavior modification program designed to induce
sleep. Vigorous exercise will help a child sleep, and other sleep aids are a weighted
blanket or tight fitting mummy-type sleeping bag.
5.
Pica: 30% of
children with autism have moderate to severe pica. Pica refers to eating
non-food items such as paint, sand, dirt, paper, etc. Pica can expose the child
to heavy metal poisoning, especially if there is lead in the paint or in the
soil.
6.
Low Muscle Tone: A study conducted by the first author found that 30% of autistic
children have moderate to severe loss of muscle tone, and this can limit their
gross and fine motor skills. That study found that these children tend to have
low potassium levels. Increased consumption of fruit may be helpful.
7. Sensory
Sensitivities: Many
autistic children have unusual sensitivities to sounds, sights, touch, taste,
and smells. High-pitched intermittent sounds, such as fire alarms or school bells,
may be painful to autistic children. Scratchy fabrics may also be intolerable,
and some children have visual sensitivities. They are troubled by the flickering
of fluorescent lights. If the child often has tantrums in large supermarkets,
it is possible that he/she has severe sensory oversensitivity. Sensory
sensitivities are highly variable in autism, from mild to severe. In some
children, the sensitivities are mostly auditory, and in others, mostly visual. It
is likely that many individuals who remain non-verbal have both auditory and
visual processing problems, and sensory input may be scrambled. Even though a
pure tone hearing test may imply normal hearing, the child may have difficulty
hearing auditory details and hard consonant sounds. Some children have very
high pain thresholds (i.e., be insensitive to pain), whereas others have very
low pain thresholds. Interventions
designed to help normalize their senses, such as sensory integration, Auditory
Integration Training (AIT), and Irlen lenses, are discussed later in this paper.
