The month of April is used in some countries to bring greater awareness to Autism. Autism is a fast-growing developmental disability. The emotional and economic costs of autism to the family and the community are tremendous. It has been estimated that the cost of autism over a lifespan is 3.2 million dollars per person, but the cost of lifelong care can be reduced by 2/3 with early diagnosis and intervention. Early diagnosis and intervention are critical and may also help to maximize a child’s ability to speak, learn, and function.
What is autism?
Autism is a complex neurobehavioral (brain) disorder that includes impairments in social interaction, developmental language and communication deficits, and rigid, repetitive behaviours. It ranges in severity from a handicap that limits an otherwise normal life to a devastating disability that may require institutional care.
Children with autism have trouble communicating. They have trouble understanding what other people think and feel. This makes it very hard for them to express themselves either with words or through gestures, facial expressions, and touch.
A child with autism who is very sensitive may be greatly troubled — sometimes even pained — by sounds, touches, smells, or sights that seem normal to others.
Children who are autistic may have repeated body movements such as rocking or hand flapping. They may have unusual responses to people, attachments to objects, resistance to change in their routines, and/or aggressive or self-injurious behavior. At times they may seem not to notice people, objects, or activities in their surroundings.
Many people with autism are mentally challenged. They may have problems in certain areas especially the ability to communicate and relate to others. Children with autism may have unusually developed skills in other areas such as drawing, creating music, solving math problems, or memorizing facts. For this reason, they may test higher — perhaps even in the average or above average range — on nonverbal intelligence tests.
Autism typically appears during the first three years of life. Some children show signs from birth. Others seem to develop normally at first, only to slip suddenly into symptoms when they are 18 to 36 months old. Autism is four times more common in boys than in girls. It knows no racial, ethnic, or social boundaries. Family income, lifestyle, or educational levels do not affect a child’s chance of being autistic.
What causes autism?
The recent study that indicated that autism might start as early as the second trimester, while the fetus is in the womb, provides us with much insight that might allow researchers to finally find the cause of this disorder. At this time there is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function.
In many families, there appears to be a pattern of autism or related disabilities, further supporting the theory that the disorder has a genetic basis. It also appears that some children are born with a susceptibility to autism.
Other researchers are investigating the possibility that, under certain conditions, a cluster of unstable genes may interfere with brain development, resulting in autism. Still other researchers are investigating problems during pregnancy or delivery, as well as environmental factors such as viral infections, metabolic imbalances and exposure to environmental chemicals.
Environmental factors
Research indicates that other factors besides the genetic component are contributing to the rise in increasing occurrence of autism. These include environmental toxins (e.g. heavy metals such as mercury) which are more prevalent in our environment than in the past. Those with autism (or those at risk) may be especially vulnerable as their ability to metabolize and detoxify these exposures can be compromised.
Vaccines and autism
To date, there is no known evidence that any vaccine can cause autism. A suspected link between the measles, mumps, rubella (MMR) vaccine and autism has been suggested by some parents of children with autism. Typically, symptoms of autism are first noted by parents as their child begins to have difficulty with delays in speaking after age 1. Around this same time, the MMR vaccine is first given to children, but autism symptoms that arise around the same time are, scientists say, an unrelated chance occurrence. A study from Great Britain trying to prove this “link between autism and the MMR” was discovered to have been falsified by the lead author who has subsequently lost his license to practice medicine.
A report debunking the link between the MMR vaccine and the development of autism spectrum disorder showed no significant increase in autism cases after doctors began using the MMR vaccine in 1988. It also showed that children in the study showed signs of autism spectrum disorder at the same ages, regardless of when they were vaccinated. Finally, the study found that by the age of 2, vaccination coverage among children with autism was nearly equal to that for children of the same age who did not have autism.
Despite much concern about vaccines, the safety of vaccines has been fully studied, and the serious life threatening diseases that can result if our children are not vaccinated make it important that we encourage all of our children to be fully vaccinated as recommended by our health care professionals.
What are the symptoms of autism spectrum disorder?
The characteristic behaviours of autism spectrum disorder may or may not be apparent in infancy (18 to 24 months), but usually become obvious during early childhood (24 months to 6 years).
As part of a well-baby/well-child visit, your child’s doctor should perform a “developmental screening,” asking specific questions about your baby’s progress. The following five behaviours warrant further evaluation:
• Does not babble or coo by 12 months
• Does not gesture (point, wave, grasp) by 12 months
• Does not say single words by 16 months
• Does not say two-word phrases on his or her own by 24 months
• Has any loss of any language or social skill at any age
Any of these five “red flags” does not mean your child has autism, but because the symptoms of the disorder vary so much, a child showing these behaviours should have further evaluations by a multidisciplinary team.
The different types of autism
Some of the different types of autism include:
• Autistic disorder. This is what most people think of when they hear the word “autism.” It refers to problems with social interactions, communication, and imaginative play in children younger than age 3.
• Asperger’s syndrome. Children with Asperger’s syndrome have some traits of autism, especially weak social skills and a preference for sameness and routine but, unlike those with autism, children with Asperger’s syndrome usually start to talk around 2 years of age (the age at which speech normally develops). They have normal to above-normal intelligence.
• Rett syndrome. Known to occur primarily in girls, children with Rett syndrome begin to develop normally. Then they begin to lose their communication and social skills. Head growth slows during the first months of life and a loss of purposeful hand movements occurs. Muscle movement is startling and mental retardation is typical.
• Childhood disintegrative disorder. This condition resembles autism. These children develop normally for at least two years and then lose some or most of their communication and social skills.
How is autism treated?
Treatment of autism will vary from one individual to another as symptoms vary in severity. Treatment strategies are tailored to individual needs and available family resources.
While there is no cure for autism, early intervention and treatment may allow for relatively normal development in the child and reduce undesirable behaviours. Children with autism generally benefit most from a highly structured environment and the use of routines. Treatment for autism may include a combination of special education, behaviour modification, speech, physical or occupational therapy, and social skills training.
There are no drugs approved to treat autism, but medications may be used to treat specific symptoms such as anxiety, depression, hyperactivity, and obsessive-compulsive behaviors or behaviours that may result in injury
Conclusion
Autism is a brain disorder that often makes it hard to communicate with, and relate to, others. With autism, the different areas of the brain fail to work together. Most people with autism will always have some trouble relating to others, but early diagnosis and treatment have helped more and more people, who have autism, to reach their full potential. It is very important that all children see a pediatrician or family doctor regularly so that any signs of autism can be detected early. The earlier treatment is started, the more effective it can be.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
