Some parents report normal development untill age three and then noticing regression, feeling of the child “slipping away”, and by age five the child displays autism. Kanner dscribed the childhood condition as “infantile” this condition persisits even in adulthood. It cnbe concluded that the onset is very early. Now age is not a criteria for diagnosis. Associated features include hyperactivity, motor behaviour, unusual responses to sensations, obsessions, self injurious behavour etc.
DSM-IV has included several categories of Pervasive Developmental Disorders that are similar to autism; Rett’s Syndrome is diagnosed only in females and there is a deceleration of gowth, the most striking feature is handwashing gesture.
Compared to persons with Mental Retardation persons with autism can have above average intellectual skills in some areas. Gross motor skills of children wih autism is better compared to those of mental retardation, While children with autism are good in fine motor skills, children with Asperger’s syndrome have problems coordinating gross and fine motor movements.
With respect to brain structure, Dr. Bauman and Dr.Kemper have found that two areas in the limbic system; the amygdala and the hippocampus are underdeveloped. Using MRI scan Dr. Courchesne has found deficiency of Purkinje cells in the cerebellum. These two areas are responsible for emotions like aggression and fear. Areas responsible for attention are found to be smaller in size in persons with autism compared to “normals”.
With respect to biochemistry, many autistic individuals have elevated levels of seretonin and beta -endorphins, an endogenous opiate -like substance.
Retrolental fibroplasia, tuberous sclerosis, congenital syphyllis, phenylketonuria, Hydrocephalus, neurolipidosis etc. Seizure disorder is an associated condition with chidren with autism.
Children with autism experience hypo and hyper sensory perceptions resulting in higher level of stress. The same child/person can exhibit the paradox, eg. The child may appear “deaf'” but could locate the sound of father’s car way ahead.
Autism is considered not as a single entity, the many theories as to what constitutes autism are incomplete and inadequate. Most early theories were psychogenic pinning the parents as the causative factor, following the decline of psychodynamic theory four new hypothesis came up; overarousal of the reticular system, perceptual inconsistancy associated with brain stem dysfunction, dysfunction of the limbic system, and that of left hemisphere. “Theory of Mind” refers to one’s inability to understand another person’s state of mind. One the one end you can have total “mindblindness” and on the other persons having the ability to be telpathic- read other’s thoughts. We normally fall in between. Children with autism and Asperger’s Syndrome appear to be rude and egocentric, this can be attributed to the Theory of Mind.
Over the years many tradition and non traditional therapies and remedies have been tried in manging autism. The most widely prescribed medication is Ritalin a stimulant used to treat Attention Deficit Hyperactivity Disorder. Parents are advised go with caution while trying any drug, however attractively packaged, as no one drug has effectively cured autism. My advice to parents is since they have the best interest of their child they must check various sources and read the fine print. Parents have tried a variety of diets; often claiming dramatic results, Vitamin B6 taken with magnesium, has shown to increase general well being, awareness and attention. Di- methylglycine (DMG) also seem to produce the same results.
Applied Behaviour Analysis (ABA) is a widely used approach, currently renamed as Lovaas method. Visually Mediated communication is the basic tenet of TEACCH philosophy. Hyperacusis experienced by children with autism is often manifested by plugging ears and running/rocking can be greatly allieviated by Auditory Integration Training. Imbalances in integration in the Vestibular system, proprioception problems, hyperactivity and other Central Nervous System Dysfunction can be treated with Sensory Integration Therapy.
Alternative Therapies include Yoga and Meditation, Homeopathy, Pranic Healing, Reiki healing, Acupressure, Hyppotherapy, Ayurveda etc are also very popular in our country.
Autism is still a puzzle, we have some of the pieces, we have to fit them together. Primary caregivers should not try to straight jacket the child in any methodology, it is better to learn from all the options, widen one’s horizon and most important of all listen to the child – accept him in totality.