Autism

Autism is a developmental disability that affects, often severely, a person’s ability to communicate and socially interact with others. It usually manifests during the first one or two years of life. There may be other problems associated with autism such as convulsions, low levels of intelligence, and impaired verbal fluency.

Early views of autistic disorder suggested a psychogenic cause. Autistic disorder was thought to result from early environmental stress or trauma, deficient parent-child interaction, or parental psychopathology. Research does not support this view. Organic conditions such as brain lesions have been reported in 28 – 49% of individuals with autistic disorder. In some cases exposures to hazardous and toxic substances, such as mercury, have been implicated as a cause.

Autistic disorder was originally thought to occur in about 1 out of 1000 children but it is now thought to affect 1 out of every 150-175 children. It is distributed equally among economic and social classes, with a male-to-female ratio of about 3:1. Although females are affected less frequently, they tend to be affected more severely, functioning at lower intellectual levels with greater evidence of neurological impairment.

Autism Spectrum Disorders (ASD) is an umbrella term that includes classic autism (also known as Kanner’s autism or Kanner’s syndrome), Asperger’s syndrome, and pervasive developmental disorder (PDD). Asperger’s syndrome is sometimes called high-functioning autism, as although these children have some symptoms of classic autism including problems with social skills they also have normal to elevated use of vocabulary. PDD is a form of autism but with a later age of onset.

Symptoms

The overall severity of ASD, as well as the specific behavioural manifestations of each characteristic, can vary as a function of age and developmental level. For example, very young children are unlikely to demonstrate the language abnormalities or repetitive rituals and routines that characterise older children.

In toddlers, problems include deficiencies in imitative play and a relative lack of interest in interactions with others. Language development is often quite delayed. In fact, children are often first referred for audiologic evaluation because of failure to respond as expected to sounds. When speech does begin to develop, it may be nonsensical. Autistic children often display peculiar interests; bizarre responses to sensory stimuli; repetitive behaviours (e.g., twirling, hand-flapping); odd posturing; self-injurious behaviour; abnormal patterns of eating and sleeping; and unpredictable mood changes. An intense preoccupation with an age-unusual interest (e.g., power poles) may replace the usual broad range of interests of the child’s age-mates. About 70% of autistic children have intelligence quotients under 70.

One of the earliest social deficits is in movement. Young children with autistic disorder have been consistently found to have more difficulty imitating body movements and the use of objects than do developmentally matched control subjects. Although these skills tend to improve with age, subtle deficits in the imitation of body movements have been found even in high-functioning autistic adolescents.

Children with autistic disorder smile less often in response to their mothers’ smiles and pay less attention to an adult simulating distress. Unusual affective expressions and difficulty with affective understanding and empathy have also been noted in older, high-functioning individuals with autistic disorder. Social problems and relating to others are currently viewed as the core characteristics of autistic disorder. Social difficulties are usually first apparent in the child’s interaction with parents. Peer problems (i.e., lack of interest, inability to play cooperatively, failure to make friends) become evident in the preschool years.

Diagnosis and Pharmaceutical Interventions

The accurate diagnosis of ASD is complicated by the variability of the symptoms. No single neurobiological factor has been uniquely and universally associated with autistic disorder. Rather, a variety of organic conditions may contribute to the development of ASD. Diagnosis may have to rely on observation rather than self-report. Abnormal electroencephalograms (EEGs) have been reported in 32 – 43% of autistic children.

The most consistent finding has been increased levels of serotonin; however, the implications of this finding are unclear, as it is found in only about one third of autistic patients, and elevated serotonin levels are also common in non autistic patients with mental retardation

Pharmaceutical Interventions

There is no cure for autistic disorder. The primary goals of treatment are to promote social, communicative, and adaptive living skills; and to alleviate family stress. Pharmacotherapy is not a routine component of treatment, although in some cases it can be a useful adjunct. Neuroleptic medications to reduce seizures (eg, risperidone, olanzapine, and haloperidol) may modify a variety of disruptive symptoms, including hyperactivity and aggressiveness. However, haloperidol in particular it is associated with side effects such as tardive dyskinesia, which may not be reversible.

The best-established treatments for children with autistic disorder use educational and behavioural interventions. Early intervention programs appear to be beneficial.

Lifestyle and Dietary Modifications

Parents and families need strong support as well as education in caring for a child with autism. Early interventions to facilitate the development of positive interactions, language, and social skills are critical. Occupational therapy for sensory integration is also an integral component of the comprehensive assessment. These help the autistic child and help the family better support the child and adapt the environment to their specific needs.

Preliminary research suggests that some autistic children may be allergic or sensitive to certain foods and removal of these foods from the diet has appeared to improve some behaviour. Gluten free and casein free diets have been developed for those individuals who have allergic responses to gluten, which is found in wheat, oats, rye and barley; and casein, which is found in dairy products. It has been shown that milk consumption is linked to increased autism incidence among the immigrant population in Sweden as compared to the indigenous population. Food additives can also be a particular problem for autistic subjects.

Exposure to elevated levels of heavy metals, especially mercury from vaccines received very early in life, has been implicated to being a possible cause for ASD. Mercury detoxification (chelation) is sometimes recommended for those who have been exposed to high levels of mercury or are very sensitive to it.

Nutritional Factors Shown to be Beneficial

Multivitamin/Mineral supplement

Because several deficiencies can exist in children with autism, extra supplementation with a well rounded multivitamin and mineral formula is recommended.
Dose: as directed

Vitamin B6

Pyridoxine (vitamin B6) may be helpful in autism by reducing aggressiveness and self-stimulation, and improving social relatedness and speech.
Dose: 2-3 mg a day

Magnesium

Magnesium should be taken with Vitamin B6 for it to be most effective in treating autism.
Dose: 200-400 mg a day

Vitamin C

Vitamin C has been used to reduce symptoms associated with ASD.
Dose: 500-2000 mg a day

Omega 3 Fatty Acids

It has been found omega-3 fatty acids are deficient in nearly 100 percent of ASD cases. Essential fatty acids, particularly the omega-3s, are also deficient in other neurodevelopmental disorders, including ADHD, dyslexia, and dyspraxia.
Dose: 2-6 grams a day

Dimethylglycine

Dimethylglycine (DMG) is present in small amounts in foods, and has some antioxidant properties. Early feedback from parents promoted interest in DMG for autism.
Dose: 125 mg a day

Taurine

Taurine deficiency is common in autistic children. Taurine is also a potent antioxidant, and has activity in the brain.
Dose: 1-2 grams a day