Friday, October 26, 2012



Autism is a developmental disability that typically involves delays and impairment in social skills, language, and behavior. Autism is a spectrum disorder, meaning that it affects people differently. Some children may have speech, whereas others may have little or no speech. Less severe cases may be diagnosed with Pervasive Developmental Disorder (PDD) or with Asperger’s Syndrome (these children typically have normal speech, but they have many “autistic” social and behavioral problems). Left untreated, many autistic children will not develop effective social skills and may not learn to talk or behave appropriately. Very few individuals recover completely from autism without any intervention. The good news is that there are a wide variety of treatment options which can be very helpful. Some treatments may lead to great improvement, whereas other treatments may have little or no effect. No treatment helps everyone. A variety of effective treatment options will be discussed below.

What is the difference between Asperger’s Syndrome and Autism?

Asperger syndrome is usually considered a subtype of high-functioning autism. Most of the individuals with Asperger syndrome are described as “social but awkward.” That is, they want to have friends, but they do not have the social skills to begin and/or maintain a friendship.  While high-functioning autistic individuals may also be “social but awkward,” they are typically less interested in having friends. In addition, high-functioning autistic individuals are often delayed in developing speech/language. Those with Asperger syndrome tend not to have speech/language delays, but their speech is usually described as peculiar, such as being stilted and perseverating on unusual topics.


Genetics appear to play an important role in causing some cases of autism. Several studies have shown that when one identical twin has autism, the other co-twin often has autism.  In contrast, when one fraternal twin has autism, the co-twin is rarely autistic. Studies trying to identify specific genes associated with autism have been inconclusive. Currently, it appears that 20 or more genes may be associated with autism. This is in contrast to other disorders, such as Fragile X or Rett’s syndrome, in which single genes have been identified. A large number of studies have found that autistic individuals often have compromised immune systems. In fact, autism is sometimes described as an autoimmune system disorder.  One working hypothesis of autism is that the child’s immune system is compromised genetically and/or environmentally (e.g., exposure to chemicals). This may predispose the child to autism. Then, exposure to an (additional) environmental insult may lead to autism (e.g., the MMR vaccine) or mercury-containing vaccine preservatives (i.e., thimerosal). If parents have a child with autism, there is an increased likelihood that their future children will also develop autism. Many studies have identified cognitive disabilities, which sometimes go undetected, in siblings of autistic children. Siblings should be evaluated for possible developmental delays and learning disabilities, such as dyslexia.


1.     Mental Retardation: Although it has been estimated that up to 75% of people with autism have mental retardation, research studies have frequently used inappropriate IQ tests, such as verbal tests with nonverbal children and, in some cases, estimating the child’s intelligence level without any objective evidence. Parents should request non-verbal intelligence tests that do not require language skills, such as the Test for Nonverbal Intelligence (TONI). Furthermore, regardless of the result, realize that autistic children will develop more skills as they grow older, and that appropriate therapies and education can help them reach their true potential.
2.     Seizures: It is estimated that 25% of autistic individuals also develop seizures, some in early childhood and others as they go through puberty (changes in hormone levels may trigger seizures). These seizures can range from mild (e.g., gazing into space for a few seconds) to severe, grand mal seizures. Many autistic individuals have subclinical seizures which are not easily noticeable but can significantly affect mental function. A short one- or two-hour EEG may not be able to detect any abnormal activity, so a 24-hour EEG may be necessary. Although drugs can be used to reduce seizure activity, the child’s health must be checked regularly because these drugs can be harmful. There is substantial evidence that certain nutritional supplements, especially vitamin B6 and dimethylglycine (DMG), can provide a safer and more effective alterative to drugs, for many individuals.
3.     Chronic Constipation and/or Diarrhea: An analysis of the ARI’s autism database of thousands of cases show over 50% of autistic children have chronic constipation and/or diarrhea. Diarrhea may actually be due to constipation—i.e., only liquid is able to leak past a constipated stool mass in the intestine. Manual probing often fails to find an impaction. An endoscopy may be the only way to check for this problem. Consultation with a pediatric gastroenterologist is required.
4.     Sleep Problems: Many autistic individuals have sleep problems. Night waking may be due to reflux of stomach acid into the esophagus. Placing bricks under the head of the bed may help keep stomach acid from rising and provide better sleep.  Melatonin has been very useful in helping many autistic individuals fall asleep. Other popular interventions include using 5-HTP and implementing a behavior modification program designed to induce sleep. Vigorous exercise will help a child sleep, and other sleep aids are a weighted blanket or tight fitting mummy-type sleeping bag.
5.     Pica: 30% of children with autism have moderate to severe pica. Pica refers to eating non-food items such as paint, sand, dirt, paper, etc. Pica can expose the child to heavy metal poisoning, especially if there is lead in the paint or in the soil.
6.     Low Muscle Tone: A study conducted by the first author found that 30% of autistic children have moderate to severe loss of muscle tone, and this can limit their gross and fine motor skills. That study found that these children tend to have low potassium levels. Increased consumption of fruit may be helpful.
7.  Sensory Sensitivities: Many autistic children have unusual sensitivities to sounds, sights, touch, taste, and smells. High-pitched intermittent sounds, such as fire alarms or school bells, may be painful to autistic children. Scratchy fabrics may also be intolerable, and some children have visual sensitivities. They are troubled by the flickering of fluorescent lights. If the child often has tantrums in large supermarkets, it is possible that he/she has severe sensory oversensitivity. Sensory sensitivities are highly variable in autism, from mild to severe. In some children, the sensitivities are mostly auditory, and in others, mostly visual. It is likely that many individuals who remain non-verbal have both auditory and visual processing problems, and sensory input may be scrambled. Even though a pure tone hearing test may imply normal hearing, the child may have difficulty hearing auditory details and hard consonant sounds. Some children have very high pain thresholds (i.e., be insensitive to pain), whereas others have very low pain thresholds.  Interventions designed to help normalize their senses, such as sensory integration, Auditory Integration Training (AIT), and Irlen lenses, are discussed later in this paper.

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