Autism: Causes and Management
In general, autism is caused by abnormalities in brain development, neurochemistry and genetic factors [1]. Autism occurs in children of all levels of intelligence from the gifted to those who have mental retardation [1]. In general, majority (around 75%) of individuals with autism are also identified as having mental retardation [1].
There are similar behavioural patterns in three main areas namely [1]:
- Abnormal language development and use
- Poor social skills or deficits and excessiveness (for example an exploded reaction is observed from the boy when a mother tells her son to stop playing with a certain toy)
- Insistence on sameness (or likes routine and predictability and don’t like change or surprises)
Autism [1]:
- typically appears during the first three years of life
- is four times more prevalent in Male versus Female children
- It is highly likely that there is a neurological origin to Autism
- No known racial, ethnic or social boundaries
- Prevalence is 2 to 6 per 1000 individuals (about ½ to 1.5 million people affected)
- Not related to family income or lifestyle
- Impacts normal development of brain in areas of social interaction and communication skills
- Difficult to communicate with others and relate to the outside world
- Sometimes, aggressive and/or self-injurious behaviour may be present
- May show repeated body movements (e.g. rocking or hand flapping)
- Unusual responses to people
- Attachment to objects
- Resistance to change in routine
- Sensory sensitivities
Factors that drive Autism/Etiology
- Genetic Influences are likely the most important risk factor but this risk can be managed by environmental, nutrition and lifestyle (e.g in other genetic disorders like obesity and diabetes) : Parents who have a child who has Autism Spectrum disorder have a 2 to 8% chance of having a second child who is also affected (but nature of component is unknown as it is not caused by a single gene)
- Autism is considered an autoimmune disease and seems to have important risk factor in utero as indicated by a highly increased frequency of congenital malformations
- Neurotransmitters; Higher levels of Serotonin in children with ASD, some studies have found Higher levels of Opioids in children with ASD
- No one cause has been identified
- Cause is likely multifactorial (physiology and environment always interacting)
- Poor nutritional status and/or lifestyle may be linked to Autism
- Association between autism and short intervals between pregnancies (e.g few months to less than one year)
- Low Folic Acid and Low Vitamin D status may be linked to autism
- Brain cells may migrate to the wrong place in the brain that could affect communication skills
- Scientists have found impairments of the amygdale in autistic children. The amygdala helps regulate social and emotional behaviour
- Ongoing inflammatory response may be linked to a disturbance in behaviour in ASD
Diagnosis Criteria: A child must have at least SIX of the characteristics in the 3 areas (and note minimums in each area). Also, in one of the areas, onset must be before the age of three years old [1]
(A) SOCIAL INTERACTION (must meet 2 of the following):
- Marked impairment in multiple non-verbal behaviours (e.g. eye contact, facial expressions)
- Failure to develop peer relationships for age
- Lack of spontaneous seeking to share enjoyment, interest or achievement with others
- Lack of social or emotional reciprocity
(B) COMMUNICATION (must meet 1 of the following):
- Delayed or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication)
- Marked impairment in ability to initiate or sustain conversations with others
- Stereotyped and repetitive use of language
- Lack of varied and spontaneous make believe play or social initiative play appropriate to developmental level
(C) RESTRICTED REPETITIVE ANS STEREOTHYPED PATTERNS OF BEHAVIOUR, INTERESTS AND ACTIVITIES (must meet 1 of the following):
- Preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in intensity or focus
- Inflexible adherence to specific, non-functional routines or rituals
- Stereotyped and repetitive motor mannerisms (e.g. hand flapping or rocking)
- Persistent preoccupation with parts of objects
RECOMMENDED ACTIVITIES [1]:
- Any activity requiring vigorous activity and will improve their fitness levels (flexibility, cardiovascular endurance, strength, muscular endurance)
- Walking or Hiking
- Bike Riding
- Swimming
Activities requiring use of their senses: Autistic children like deep pressure that helps relax (use of weighted backpacks/vest can help provide this deep pressure)
Factors that help manage Autism [1]
- Vitamin D3 supplementation
- Folinic Acid
- Multivitamins
- Fish Oil
- Anti-inflammatory herbs/nutrients
- Decrease Mercury
- Vigorous Exercise
- Effective teaching strategies :
- Use teaching stations
- Change activities regularly
- Eliminate distractions
- Keep directions short and age-appropriate
- Use sensory stimulation to increase attention span
- Use smooth transitions
- Instruct in an environment where noise, smells, lights will not interfere with learning (i.e. teach in less stimulating environment)
- Establish predictable routines within lessons
- Create highly structured, organized and predictable environment
- Warm up, Activity, Closure
- Using visual aids during activities
- Use vigorous aerobic exercises to keep student on task
- Use a consistent behaviour modification program
- Provide lots of practice time/repetitions
- Show enthusiasm when teaching
- Positive behaviour management strategies (reward system for good behaviour)
REFERENCES
1) AUTISM Seminar Notes 2014