Dr Usama F shaalan MD;PhD
AUTISM SPECTRUM DISORDER (ASD)
The word “autism” comes from the Greek ‘autos’ which means self. Autism is one of a range of disorders of development known as Pervasive Developmental Disorders. It is associated with profound problems of speech, behaviour and social relationships. Autism is a disorder that develops in early childhood. It is four times more prevalent in boys than in girls.
Children with autism do not display a fixed set of symptoms. This means that one child’s symptom may be different from another and the symptoms may vary in their severity. The symptoms may also combine in a unique way for each child thereby producing different sets of problems or difficulties among children with autism. For this reason, autism is commonly referred to as Autistic Spectrum Disorders.
At the mild end of the autism spectrum is Asperger Syndrome, sometimes referred to as “high functioning autism.” Children with Asperger Syndrome do not have general language delay and many have average or even above average intelligence.
In 1943 in the USA, Leo Kanner was the first to recognise autism, and published his landmark paper. Prior to this date, children with autism were categorised as either intellectually disabled or suffering from an emotional problem.
Around the same time, a Viennese paediatrician Hans Aspergerindependently made the same observations. Although there was considerable overlap in the clinical features, Asperger’s subjects tended to be less severely affected, and had a higher IQ.
Dr. Hans Asperger
In the early 1970s and 1980s, the International Classification of Diseases (ICD) Classification of Mental and Behavioural Disorders and the Diagnostic and Statistical Manual of Mental Disorder (DSM) had different concepts of autism although the diagnostic criteria for the disorder were similar. Today, both the ICD and DSM classify autism as a Pervasive Developmental Disorder.
Characteristics of Autism Spectrum Disorder (ASD)
• Does not seem to understand or ‘connected’ with other people’s feelings
• Does not relate to anyone, even close family members
• Does not show much attention
• Does not readily learn appropriate behaviour from role model
• Often does not understand abstract social concepts
• Misunderstands other people’s behaviour or feelings
• Repetitive use of language, repeats what other person has just said or repeats himself over and over again
• Uses odd, meaningless words or phrases repeatedly
• Hears but does not respond appropriately when spoken to
• Significant difficulties with turn taking in conversations
• Does not play imaginatively
• Takes things very literally
Non Verbal Communication Problems
• Limited use of eye contact to express feelings, to respond to eye contact or to physical touching and gestures
• Does not show much facial expression
• Does not often enjoy physical contacts e.g. cuddles, hugs, tickles
• Poor judgement of social distance, stands too close or too far away
Restricted Play and Interests
• Have quite restricted interest
• Have very strong preferences for doing only a few specific activities like spinning an object or arranging shoes in a particular order
• Adheres to unnecessary, meaningless routines
• Distressed by small changes to routines
Uneven Patterns of Intellectual Functioning
• Has extraordinary memory for some specific information (e.g. bus routes)
• The ability to solve advanced mathematical problems without the assistance of a calculator
• To memorize difficult and lengthy materials
• Has exceptional technical skills e.g. in music
It is generally accepted that autism is caused by abnormalities in brain structures or functions. Studies suggest that there is a genetic influence in autism. Some genes such as the X chromosome, chromosome 15 and several others have been linked to autism but the nature of this link is still not clear.
In 1967, Dr. Bernard Rimland suggested that autism was caused by mercury and heavy metal toxicity to which some children have a genetic sensitivity. He recommended treating autistic children with a gluten-free, casein-free diet and mercury chelation therapy (removal of mercury from the system). His treatment has since shown measurable success with some children.
Other environmental factors that can possibly play an important role in causing autism include viral or bacterial infections, vaccines and thalidomide.