Table of Contents

The Autistic Child

A disturbed child may be someone who appears different from the expected normal for his parents or society. Parents worry excessively when they notice abnormality in the behavior of their children. Sometimes, this abnormality is clear other times it may be subtle. When behavioral disturbance reach a certain cutoff point in the divergence from normal, the child may be considered handicapped. His relationships or academic performance and his subjective happiness become impaired.

Autism is one of the causes of disturbed behavior in children. Awareness of this condition has increased and more information about it has reached both parents and educators. In the past, some forms of autism were labeled childhood psychosis. Currently, it is known that this condition is distinct from any psychotic disease. Many psychologists now are aware that autism is a wide spectrum of disability, which ranges from the very mild to the severest forms.

What are the main features of autism?

Signs of autistic behavior starts early in life even before age three. However, as the child grow, more features attract the attention of his or her parents.

When a child starts to use language, it becomes evident that he or she has a major deficit and that he lags behind what usually is achieved by his peers. Furthermore, the normal social interaction between the child and his parents and later with other children seems to be clearly disturbed. The normal ability to play a game with other children and role playing or living a fantasy character may be impaired.

The child prefers to play alone, away from others and he avoids eye contact, does not exchange emotions and doesn't feel the impact of his behavior on others. He can inflict pain on others, for example, because he's unable to understand how others feel. This may cause problems in parenting as the child seems not responsive to emotions, rather, callous, disobedient and defiant.

The third component of autistic behaviour is ritualistic behaviour. From early years, the child resists vigorously any change in his environment, and insist on keeping things in certain place or certain order. In fact, the child becomes irrationally attracted to certain objects, and any change to the routine of his daily life may cause a lot of anxiety, which manifests as an outburst of rage, disturbance, destructiveness or even self harm.

The three components of language impairment, impairment of social interactions, and ritualistic behavior are not always present in all children who suffer from autism. Sometimes, a milder form of this condition affects mainly social adjustment and interactions as well as some degree of ritualism. This is known as Asperger's syndrome.

Language is usually well developed in those presenting with Asperger's syndrome. There may be other features in those with severe form of the condition. There is a noticeable predisposition to experience severe anxiety for undeclared reasons, which leads to unpredictable outbursts of fear, screaming or self destructive behavior. Some autistic children show evidence of increased and excessive restlessness and hyperkinesis. Others show repetitive mannerism, stereotypes and abnormal movements such as piroting or revolving around in circles.

Many children with autism has learning and educational disability. About 40% have IQ below 50, which falls within the learning disability range. About a third of autistic children will have mild learning disability. Occasionally, an autistic child may have an isolated skill, such as ability to memorize information by rote. In general, autistic children lacks skills and may find difficulties learning practical tasks.

What causes autism?

It is not fully established how autism develops and what causes it. genetic factors are involved but it is not established as the main factor. There is evidence of neurological and brain abnormalities in 25% of cases of autism. Once third, develop convulsions during adolescence. Maternal rubella has been attributed as a cause of autism, and other brain diseases such as phenyl ketonuria, meningitis, encephalitis are among predisposing factors. Environmental and emotional factors were suggested in the past, but the role is controversial. It is generally agreed that biological factors are the main triggers for this condition.

How Autism is treated.

There is no specific treatment or definite cure. Parents needs support and advice, education and help in managing their children's behavior. Sometimes, a child may be allocated a place in an educational establishment for autistic children, either on a daytime, residential or respondent basis. The main approach for management of autism is behavioral modification.

Autistic children do benefit from learning new language skills, better social behavior and improvement in interactions with others. A tailored plan of behavioral modification is used in management. Sometimes, their behavior is disturbed, aggressive, disruptive and self damaging, which warrants use of sedative drugs, such as neuroleptics, to control the situation and restores the ability of the person to be back into control. However, there is no evidence that big doses of such drugs have any benefit more than a small dose which just alleviate the anxiety of the child.

Autism

Autism is a developmental disorder of the brain. It affects very young children when it first appears, but it lasts for the rest of their lives. Most children affected are boys rather than girls.

Autism is usually discovered very early in life before the child is three years in age. Even if it is not diagnosed at that time, parents report typical symptoms appearing at such an early age, even when the child is seen by a clinician later on in life. Sometimes, it can be identified in children who are as young as 18 month old. This is the youngest age at which definite signs of autism may be recognized by parents or doctors.

Autism affects all aspects of the person's development. It affects between three to five of every thousand children. This rate of incidence has been increasing recently for unknown causes, probably augmented by clinical and the public awareness of the condition.

Features of autism :

People with autism have problems talking and understanding. This is due to poor language development. They are also known to have poor social skills and their interactions with others are characteristically abnormal. As children, autistic individuals often play alone by themselves, and they don't seek others to play with them or to share their feelings. They frequently have difficulty learning to speak, and their use of language is not what is expected at their age. Their speech is full of gramatic and syntax errors.

Autistic people are characteristically repetitive in their behavior, actions and movements. They may be seen to be rocking or tapping over and over again. Thus, the three typical features of autism are language impairment, social skills impairment, and repetitive ritualistic behavior.

Children with autism are also different from their peers or other children their age. They have many physical and biological peculiarities. They are often very sensitive to stimulation of special senses, such as vision, taste, smell, hearing, or touch. They may respond strongly to such sensations. For example, by becoming nervous in bright lights, or loud noises or strong smells or being touched. This make them appear withdrawn and avoid contact with other people. On the other hand, some autistic people are insensitive to pain or heat to the extent of suffering injuries or burns, either accidentally or through self inflicted injuries such as poking, picking, or scratching of skin, eyes or hair.

Types of autism :

Autism is not a single condition. It is actually a complex disorder with many grades and a range of symptoms from the mild to the most severe forms. For this reason, this condition is better called Autism spectrum disorder (ASD). The autistic spectrum disorder includes Asperger's Syndrome, Rett's disease and Childhood Disintegrative disorder.

Asperger syndrome is a mild form of autism which presents with normal language skills and poor social skills as well as obsessional repetitive behavior such as peculiar interest in machines, cars, trains or mechanics. People with Asperger's Syndrome find it difficult to perceive things from the other people's perspectives. They cannot understand the feeling of others which make them awkward in social situations.

Rett syndrome and Childhood Disintegrative disorders are rare. Rett Syndrome affects girls almost exclusively in a rate of one in 10,000 to 15,000. Childhood Disintegrative disorder (CDD) affects mostly boys in rate of one in 50,000. In these two conditions, the child loses communication and social skills previously acquired. Another condition is known as Pervasive Developmental Disorder (PDD, Not Otherwise Specified) which includes any disorder that has symptoms similar to autism that doesn't clearly fall in any of the typical categories mentioned above.

What are the causes of autism?

There is a definite genetic aspect to autism. The mechanism of how that effect of gene causes the symptoms of autism is complex and involves many biochemical and neurological changes in the brain. However, other factors contribute to autism including environmental changes during pregnancy, and such problems as abnormality in the immune system, or exposure to toxic substances by the mother. Parental age also plays a role in the incidence of autism.

Autism is not a mental illness. It is a neuro developmental disorder. Its origins are in the brain structural abnormalities and not in psychological or mental mechanisms. In the past, it was suggested that autism is caused by both mental and biological factors. Bruno Bettelheim, who was influential expert in childhood disorders in Chicago, USA, believed that autism was a mental disorder caused by what he called 'refrigerator mother'. He used this term to describe mothers who were cold and distant from their children.

During 1940s to 1960s, it was common to blame the mother if the child was autistic. In 1990, Bettelheim was discredited when it was discovered that he had lied about his academic training, and made up many of his reports. However, Bettelheim theory remained popular for some time, until further research, unraveled the neural chemical and molecular causes of autism. By 1960s, autism was identified as a specific disorder, which is different from mental disorder and mental retardation. Bernard Rimland wrote a book in 1964 called 'Infantile Autism Syndrome and its Implications for Neural Theory of Behavior'. Rimland, discussed in his book possible genetic basis for Autism. In 1967, Rimland founded Autism Research Institute.

The word autism was coined by Eugene Bleuler in 1911. Bleuler was a Swiss psychiatrist who used the term derived from the Greek word 'autos' which means self. He was actually describing a feature of schizophrenia, which makes a mental patient withdrawn from outside reality into their own personal fantasies. The use of the term autism to refer to children who lack of interest in other people and engage in repetitive behavior was for the first time used by an American psychiatrist named Dr. Leo Kanar who identified those symptoms and children. He studied at Johns Johns Hopkins Hospital in Baltimore in 1943. In 1944, Dr. Hans Asperger, a German pediatrician, identified a minor form of autism that featured problem in communication and social interactions. People with Asperger's Syndrome appear to function rather well in certain areas of life, and sometimes, they show exceptional skills, such as a highly developed artistic talent.

Since that time, the definition of autism evolved from the very narrow view of early infant time autism to an expanded and more detailed description. As delineated in the Diagnostic and Statistical Manual (DSM IV), the current classification includes autism within the broader category of pervasive developmental disorder. Along with Asperger's Syndrome, Rett's syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder not otherwise specified. Recently, it has become clear that autism involves a continuum of severity and symptoms and as a result, the term autistic spectrum disorder is used in the new Diagnostic and Statistical Manual. (DSM V).

Causes :

Autism is not uncommon. It is one of the most common developmental disorders across the world. Current prevalence is suggested as one in 150 children. The increase in reported prevalence of ASD has been attributed to improved diagnostic and assessment, broadening the diagnostic definition and improved public and professional awareness. Some potential identified environmental factors may have contributed to the upsurge in cases identified.

Genetic basis for autism.

Epidemiological studies have provided compelling evidence for a genetic evidence for autism. A twin study by a Folstein and Rutter in 1977 has highlighted that concept of ASD as largely genetic disorder. They identified a higher concordance in monozygotic twins, than in dizygotic twins. Studies which attempted to link autism to certain chromosome has associated the condition with chromosomes 7q, 15q, 22q and 2q. Genes implicated included the genes of GABA, serotonin transporter genes, engrailed 2, neuroligin, MECP, WNT2, PTEN and MET genes. Autism is four times more common in males than in females with a higher ratio in milder forms. Autism is associated with a significant familial recurrence.

Thus in families having one affected child, there is an estimated risk of 15% of having another child with ASD, which is much higher than in general population. If the family has two affected children's the recurrence rate of subsequent children increases up substantially up to 25 to 50%.

A number of syndrome have been associated with is ASD including Fragile X syndrome, tuberous sclerosis, Smith-Lemli_Opitz syndrome and Rett Syndrome. Current opinion on the cause of ASD strongly suggest multifactorial inheritance, including genetic heterogeneity with multiple major gene effects, possibly influenced by contributing environmental effects and physiological process with multiple genes. One of the potential risk factors for ADHD is the role of advanced parental age. This may be related to age related chromosomal changes, complications of pregnancy or possible environmental exposure during pregnancy to mutogenetic effects. These children may be more susceptible to auto immune responses affecting neuro development. It is possible that maternal exposure to neuro toxic chemicals is passed to the offspring transplancentally or in breast milk combined with advanced maternal age.

Autism is a developmental disorder. It was first described by Kanner in 1943. The following year, Hans Asperger, a German paediatrician reported milder form in four children which he called “autistic psychopathy”. The definition of autism has developed from a narrow concept to a group of conditions with similar features which comes under the rubric of “Autism Spectrum Disorders” or ASDs. In the American Diagnostic and Statistical Manual (DSM IV), autism comes under the category of pervasive developmental disorders together with Asperger’s syndrome, Rett’s syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (PDD — NOS). Autism is becoming more frequent and the United States centres for disease control (CDC) suggested that there is an increase of 30% in the incidence of autism over the last few years. The increase in reported cases of autism is attributed to improved diagnosis, as well as, an increase in the awareness of professionals and parents of the condition, in addition to broadening the definition of autism to variable grades and degrees of the symptoms. It is probable that there are environmental factors such as exposure of the mothers to toxic substances during pregnancy due to pollution and the increasing age of parenthood.

There is a piece of compelling evidence for a genetic basis for autism. In 1977, a study by Folstein and Rutter on twins identified more frequent cases of autism in twins who come from the same ovum (monozygotic twins). This indicates an important role for genes in this condition. Since that time, many studies have reported linkage between autism and abnormalities with chromosomes and genes such as:

chromosomes 7Q chromosome 15 Q chromosome 22Q chromosome 2Q gamma amino-butyric acid GABA gene serotonin gene transporter genes Engrailed 2 gene Neuroligin gene MECP 2 gene WNT2 gene PTEN gene MET gene Autism is 4 to 5 times more common in males than in females. ASD is also associated with a higher recurrence of autism in other children of the same family much more than in the general population. In families who have more than one affected child is the rate of recurrence in subsequent children is sometimes as high as 50%.

Conditions associated with ASD:

Fragile X syndrome Tuberous Sclerosis Smith-Lemli-Opitz syndrome Retts syndrome In conclusion, ASD is a multifactorial genetic condition that is a product of multiple major genes effects and possible contributing environmental effects interacting with the physiological processes initiated by those defective multiple genes.

The role of advance parental age:

Both increasing maternal and paternal age were found to be associated with autism independently. The first offspring of two older parents were three times more likely to develop autism than the later-born offsprings. The following were suggested as the mechanisms:

age-related chromosomal changes complications of pregnancy are more likely in older women environmental exposures during pregnancy to mutagenic effects of pollutants firstborn children are more likely to have autoimmune responses that affect neurodevelopment exposure to neurotoxic chemicals passed through the placenta or breast milk.

Reference: G.J. Blatt (ed.): The Neurochemical Basis of Autism: From Molecules to Minicolumns, Springer (2010)