Autism

UNDERSTANDING AUTISM

What is Autism?

A developmental disability that severely hinders the way information is gathered and processed by the brain, causing problems in communication, learning and social behaviors. (Autism Society Philippines)
Keynotes in the definition of Autism:

Not a disease

Pervasive Developmental Disorder

Spectrum disorder (ASD)

Behaviorally-defined


How prevalent is Autism?

*Estimated global figure:

1:166 (TIME MAGAZINE, May 2006)
1:170 (TIME MAGAZINE, October 2006)

*Philippine Situationer:

1 in every 500 Filipino children
- Phil. Advocacy Program for Autism 1997

1.4 million Filipino children affected
- Manila Bulletin, January 1999

Incidence of Autism – PCMC
(Neurodevelopmental Section : 1990-1999)
Total patients evaluated 1040
Total patients with Autism 312



How does Autism rate with other neurological disorders?

Estimated prevalence figures per 10,000 population of various
Neurological disorders

Alzheimer’s disease
100-470

Childhood epilepsy

65

Autistic spectrum disorder

10-50

Down’s syndrome

10-15

Parkinson’s disease

16

Neurofibromatosis I

3

Phenylketonuria

1

Multiple Sclerosis

0.5-3

Childhood brain tumors

0.25

Rapin, 2001



Age/Gender/Racial/Social Distribution:

Age: Autism typically occurs within the first 3 years of life

Gender: Males are 4 times more affected as compared to Females
Race/Social: Autism knows no racial, ethnic and social boundaries
What causes Autism?

Note: There is no known specific cause of Autism at present.

*Psychogenic Theory of Autism (Kanner):

1. Poor parenting causes Autism

2. Autism is caused by a lack of love

3. Autism is an emotional condition that is caused by a child’s withdrawal from his/her parents

4. Certain vaccination causes autism

*The Psychogenic theory of Autism was debunked in the 1970s when several factors have led to another theory which associates symptoms of Autism with specific abnormalities in certain parts of the brain.




*Biological/Neurological Theory of Autism:


-several neural systems in the brain are affected causing complex deficits in social, language, and behavioral areas

-3 main areas of the brain most commonly affected as pointed by current research data:

Amygdala:
- critical in emotional arousal

important in discerning fear in facial expressions
plays a role in pleasure and other emotions
Temporal lobe:

recognizing and discriminating faces

reading facial expressions and social intent thru eye-gaze direction


Frontal lobe:

holds areas critical for “social cognition” i.e.; thinking about other’s thoughts, feelings and intentions (Theory of Mind Ability)


*Genetic Theory:

- currently the most favored assumption

- believes that autism runs in families

- states that Autism is a heritable, complex genetic disorder with a heterogeneous etiology

*Evidences for the role of genetics in Autism:

Family studies:

Autism-like symptoms occur more often in parents and siblings of people with Autism, compared to families with no Autistic relatives.

Close relatives of children with autism are at higher risk (3-5%) chance for developing Autism

A member of the general population has 0.2% chance of having autism.
Twin studies:

Identical twins are more behaviorally similar than other relatives, due to genetic influence
monozygotic twin of a patient with Autism has a 60% chance of having autism, and >90% chance of being in the Autistic spectrum
Dizygotic twin of patient has 3-5% chance of having Autism
What are the Signs and Symptoms of Autism?

*Autism Triad of Impairments:

Impaired reciprocal Social interaction
Impaired reciprocal communication
Restricted, repetitive, interests/activities
*Specific Symptoms of Autism:

*Social:

-displays indifference (acts as if deaf)

-joins only if adult insists and assists

-one-sided interaction

-no eye contact

-does not play with other children

-lack of creative, pretend play


*Language:

-indicates needs by using an adult’s hand

-echolalic-copies words like a parrot

-exhibits pronoun reversals

-absence of speech



*Stims:

-talks incessantly about only one topic

-inappropriate laughing or giggling

-bizarre behavior

-handles or spins objects

-variety is not the spice of life

-some can do things very well, very quickly but not tasks
involving social understanding.



Other symptoms seen in Autism:

a.) Physical:
-is generally goodlooking

-is a picky-eater, tends to smell food/objects and put things in his mouth

-exhibits disturbed sleeping patterns

-does not seek attention when hurt; has high pain threshold and is unable to localize pain


b.) Attentional:
-poor attentional span

-overselectivity/Tunnel vision

c.) Behavioral Patterns:
-is hyperactive

-some may exhibit passive behavior

-others may display self-injurious behaviors

d.) Abnormal responses to sensory stimuli:
-overlysensitive to touch/under responsive to pain

-sight, hearing, touch, pain, smell, taste may be affected to a lesser or greater degree

e.)Cognitive Characteristics:
-splinter/savant skills(memory, music, math, art, geographical, and multiple skills)

-50% of Children with Autism(CWA) have Mental Retardation

DIFFERENTIAL DIAGNOSIS:

PERVASIVE DEVELOPMENTAL DISORDERS

SIGNS AND SYMPTOMS

Autism Spectrum Disorder

Marked impairments in communication, socialization, restricted, repetitive, interests/activities, that typically occurs within the first 3 years of life.
Asperger’s Syndrome

Severe social deficits and restricted, repetitive, interests/activities; language and cognition are normal
Rett’s Disorder

Genetically defined cause for autistic behaviors affecting virtually only girls; with physical manifestations that take place after first 6 months of life
Childhood Disintegrative Disorder

Normal early language development, followed by severe regression in language, social, cognitive, and functional skills, between 2-10 years of life


How is Autism diagnosed?

*No biological marker for Autism

*Diagnosis remains clinical

Demonstration of significant impairments in social interaction and reciprocal communication and restricted, repetitive interest/behaviors USING:

a.) Diagnostic Criteria in DSM-IV or ICD 10 manuals

b.) Childhood Autism Rating Scale (CARS)

c.) Wing Autistic Diagnostic Interview Checklist (WADIC)

d.) Others_



Who are qualified to diagnose?

Neurologists

Pediatricians

Developmental Pediatricians

SPED Diagnosticians/Specialists

Psychiatrists

Psychologists
Available Treatments/Interventions for Autism:

Note: Autism is a life-long developmental disability. There are no known cures for Autism but a wide variety of Interventions are currently available to suit the CWA’s needs:

a.) Occupational Therapy: Focuses on Sensory Integration(SI) techniques to address sensory problems of CWA.

b.) Speech Therapy: Focuses on using Picture Exchange Communication System (PECS) and Facilitated Communication techniques to develop or enhance language among CWA.

c.) Special Education(SPED): Provides wholistic Individual Educational Programs (IEP), done in a center-based one-on-one or group therapy setting.

d.) Behavior Modification:Applied Behavior Analysis(ABA)
A one-on-one, home-based intensive teaching Program designed to eliminate disruptive behaviors and build socially useful ones through carefully task-analyzing behaviors and behavioral processes.

See also : Attention Deficit Hyperactive Disorder (ADHD)