Autism: few facts to look at

Disclaimer: This article is for general medical information & health education purpose only. People without basic bachelor degree in medical science are requested not to use this information for diagnosis and treatment of the related condition as many signs & symptoms of various diseases can also be seen in normal people. Consult a good clinician for proper diagnosis and treatment. Thank you & enjoy reading

Autism or broadly speaking ASD (autism spectrum disorder) is one of the commonest childhood psychosocial disorder affecting around 1 in every 160 children worldwide & the prevalence is increasing. It begins in childhood and may persist into adolescence and adult hood. (1) ASD is characterized by three core symptoms (i) impaired social interaction and communication,(ii) a pattern of repetitive behavior and/or(iii) restricted interests in early childhood or first 3 years of life.(2) The distinctive social behaviors include an avoidance of eye contact, problems with emotional control or understanding the emotions of others, and a markedly restricted range of activities and interests.(3) Usually, children with autism have other health problems associated such as epilepsy, depression, anxiety and attention deficit hyperactivity disorder (ADHD). But intelligence level in such kids is extremely variable ranging from very low to even higher than other normal counterparts.(1)

            Available scientific data suggests both genetic and environmental factors as cause. Male children are more at risk with 2-3times more incidence rate than females.(4)  Hans Asperger who first described  "autistic psychopathy" now known as Asperger syndrome & Leo Kanner who first used autism in its modern sense introducing the term “early infantile autism”, have together designed the modern study of autism.(4) as genetic factors are hardly modifiable and need extensive research, we are going to focus more on environmental factors, possible preventive measures and treatment options.

Environmental causes of ASD:(5–7)

            Broadly speaking, definite cause of ASD is not yet known. Still strong scientific evidences exist for following factors

• advanced parental age
• preterm birth
• Birth complications like trauma or ischemia and hypoxia
• maternal obesity
• maternal diabetes
• maternal rubella infection
• use of drugs like valproate, serotonin reuptake inhibitors by mother
• maternal hypothyroxinemia
• caesarian section
• air pollution
• exposure to toxins like styrene, chromium, cyanide, methylene chloride, methanol, and arsenic during pregnancy
• short interpregnancy interval etc

Certain previously suspected factors such as vaccination, maternal smoking, and assisted reproductive technologies were not found to be related to ASD by various large level researches.(5) Also lack of warmth and affection in parents or any other emotional or psychological parental deficits also does not appear to be the cause.(7) Though the risk factors should be avoided, their avoidance does not guaranty a ASD free child to be borne. Hence the treatment remains the main stay of management which includes intensive behavioral, educational, and psychological training. As a cure is not available till date, Regular screening of infants and toddlers for symptoms and signs of autism & cooperation of parents/caregivers is crucial for an early intervention & better outcome.(1,7)

Management:(8)

•       Behavioral training and management:

opositive reinforcement, self-help, and social skills training to improve behavior and communication. many protocols have been developed such as

o  Applied Behavioral Analysis (ABA)(9)

o Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)(10)

osensory integration

oincreased use of written and visual information

oadapted cognitive behavioral therapy (CBT)

•      Specialized therapies:

oSpeech therapy: to improve language & social skills,

oOccupational therapy: to learn to process information from the senses like sight, sound, hearing, touch, and smell,

oand physical therapy

•      Medicines: not much effective. Commonly used medications are, anxiolytics & antidepressants

•     Community support and parent training: a good psychiatrist or autism community should be consulted for learning this.

Some recent advances:

• multicomponent peer-mediated intervention (PMI)(11)
• social motivation hypothesis. (12)
• Social skills training(13)
• Pivotal Response Treatment (PRT)(14)

Autism or ASD is already a global pandemic with more than 1.5% of children being affected by this condition & the incidence rate is on a rise. The pity is there is no effective treatment yet and drugs do not help much. Major part of management targets at improving the overall psychosocial skills of affected kids as early as possible. For all these, the participation of parents or caregivers is a must. So it appears most logical to be well informed about this problem and its management for all of us. Take care, be healthy & keep smiling….

Refences:

1.         WHO | Autism spectrum disorders [Internet]. WHO. [cited 2018 Jan 25]. Available from: http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en/

2.         Sener EF, Canatan H, Ozkul Y. Recent Advances in Autism Spectrum Disorders: Applications of Whole Exome Sequencing Technology. Psychiatry Investig. 2016 May;13(3):255–64.

3.         Park HR, Lee JM, Moon HE, Lee DS, Kim B-N, Kim J, et al. A Short Review on the Current Understanding of Autism Spectrum Disorders. Experimental Neurobiology. 2016 Feb;25(1):1.

4.         Park HR, Lee JM, Moon HE, Lee DS, Kim B-N, Kim J, et al. A Short Review on the Current Understanding of Autism Spectrum Disorders. Experimental Neurobiology. 2016 Feb;25(1):1.

5.         Modabbernia A, Velthorst E, Reichenberg A. Environmental risk factors for autism: an evidence-based review of systematic reviews and meta-analyses. Molecular Autism. 2017 Mar 17;8:13.

6.         Lyall K, Croen L, Daniels J, Fallin MD, Ladd-Acosta C, Lee BK, et al. The Changing Epidemiology of Autism Spectrum Disorders. Annual Review of Public Health. 2017;38(1):81–102.

7.         Autism: Practice Essentials, Background, Pathophysiology. 2017 Dec 6 [cited 2018 Jan 26]; Available from: https://emedicine.medscape.com/article/912781-overview

8.         Autism-Treatment Overview [Internet]. WebMD. [cited 2018 Jan 26]. Available from: https://www.webmd.com/brain/autism/autism-treatment-overview

9.         Fernandes FDM, Amato CA de la H. Applied behavior analysis and autism spectrum disorders: literature review. Codas. 2013;25(3):289–96.

10.       The TEACCH program for children and adults with autism: A meta-analysis of intervention studies. Clinical Psychology Review. 2013 Dec 1;33(8):940–53.

11.       Bambara LM, Cole CL, Chovanes J, Telesford A, Thomas A, Tsai S-C, et al. Improving the assertive conversational skills of adolescents with autism spectrum disorder in a natural context. Research in Autism Spectrum Disorders. 2018 Apr;48:1–16.

12.       Bottini S. Social reward processing in individuals with autism spectrum disorder: A systematic review of the social motivation hypothesis. Research in Autism Spectrum Disorders. 2018 Jan 1;45:9–26.

13.       Ashman R, Banks K, Philip RCM, Walley R, Stanfield AC. A pilot randomised controlled trial of a group based social skills intervention for adults with autism spectrum disorder. Research in Autism Spectrum Disorders. 2017 Nov 1;43–44:67–75.

14.       Lei J, Sukhodolsky DG, Abdullahi SM, Braconnier ML, Ventola P. Reduced anxiety following pivotal response treatment in young children with autism spectrum disorder. Research in Autism Spectrum Disorders. 2017 Nov 1;43–44:1–7.