The Psychiatric Times has a round up of medication used in connection with autismanxiolytics. Psychopharmacology of Autism Spectrum Disorders looks at the role of antipsychotics, antidepressants, mood stabilizers, stimulants and anxiolytics.
Autism
Autism, its causes, diagnosis and treatment
The Senses of Autism
One of the defining aspects of autism is how autistic children react to different stimuli. Some children find being touched highly disturbing or particular noises may set off screaming fits. This article: Ideas on Autism: Building sensory communication with your child from PregnancyAndBaby.com explores how autistic child develop their own sensory preferences and how a parent can observe and use this information.
This hypersensitivity can evident in people with aspergers, dyslexics, ADHD and indeed normal people (see Hearing Things). It is sometimes known as Sensory Integration Dysfunction and sensory integration training has been an effective form of treatment. Such hypersensitivity might not be just limited to the five senses: sight, hearing, taste, touch and smell. In addition to proprioception, the awareness of where your limbs are) there are internal senses known as Interoceptors. These tell you how full your bladder is, if you are thirsty or how hot you are. Rather than five senses we may have twenty one or more. This is a relatively new area of research but when trying to understand an autistic child’s behavior its worth remembering that the way they sense the world around them and what inside them is unlikely to be the way you do.
DSM-IV Criteria
Diagnosing autism is not a precise affair. There is not a blood test or trademark symptom that can be relied upon as proof positive of the diagnosis. Instead the patient’s symptoms are compared to a range diagnostic criteria and the doctor makes a judgment call. This might be one explanation for the apparent increase in autistic children. As doctors have become more aware of the condition, they are more likely to match a child’s symptoms with the diagnostic criteria of autism rather than marking them down as mentally retarded. See Autism Epidemic! What Autism Epidemic?.
The criteria used in the USA is the Diagnostic and Statistical Manual of Mental Disorders, currently in its fourth version, and generally known by its short hand of DSM-IV. It defines autism as:
DSM-IV Criteria, Pervasive Developmental Disorders. 299.00 Autistic Disorder
A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
- (1) qualitative impairment in social interaction, as manifested by at least two of the following:
- (a) marked impairment in the use of multiple nonverbal behaviors, such as eye-to- eye gaze, facial expression, body postures, and gestures to regulate social interaction
- (b) failure to develop peer relationships appropriate to developmental level
- (c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
- (d) lack of social or emotional reciprocity
- (2) qualitative impairments in communication, as manifested by at least one of the following:
- (a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
- (b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
- (c) stereotyped and repetitive use of language or idiosyncratic language
- (d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
- (3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:
- (a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
- (b) apparently inflexible adherence to specific, nonfunctional routines or rituals
- (c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting or complex whole-body movements)
- (d) persistent precoccupation with parts of objects
B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
- (1) social interaction
- (2) language as used in social communication
- (3) symbolic or imaginative play.
C. The disturbance is not better accounted for by Rett’s disorder or childhood disintegrative disorder.
Autism Detection At Six Months Old?
Early diagnosis of autism is vital as the earlier treatment begins the more effective it is. (See Predicting Autism in Infants at 12 Months). Now a Florida, USA, based team is proposing they can predict Auspergers and Autism as early as six months.
I picked this up from a HOI News article though the original paper was published in 2002. The paper, Reflexes Gone Astray in Autistism in Infants [PDF], was published in Early Indicators of Autistic Spectrum Disorders and Related Challenges [PDF], the 2002 issue of the Journal of Developmental and Learning Disorders . In 2004, the same team published Eshkol–Wachman movement notation in diagnosis: The early detection of Asperger’s syndrome .
The 2002 paper looks at the role primitive and postural reflexes play in early development particularly on a ‘Tilt Test’ which examines how an infant moves their head when their body is tilt by 45 degrees. The researchers acquired videos of infants who had at a later stage been diagnosed as autistic. They examined the autistic children’s movement in the video and compared it to ‘healthy’ children. This an effective way of spotting indicative behavior but the research paper doesn’t give any statistical analysis. e.g. did all autistic children behave in this way and did none of the ‘normal’ children exhibit the behavior? The paper also makes no mention of the work by Sally Goddard and Peter Blythe at the INPP. Their work has shown that primitive reflexes have a significant role in learning difficulties of all sorts including dyslexia, ADHD / ADD, dyspraxia and autism. Sally Goddard’s book Reflexes, Learning and Behaviour covers the ’tilt test’ when discussing the Labyrinthine and Oculo Headrighting reflexes.
Any research into early detection of autism and the role reflexes play in development is important. However this work is very light on detail and over simplifies the problem. The ’tilt test’ is a useful diagnostic tool but in itself is not a predictor of autism.
Autism Epidemic! What Autism Epidemic?
It is a widely held belief that we are seeing a massive growth in the number of cases of autism. However accoreding to a new paper: Three Reasons Not to Believe in an Autism Epidemic [PDF] there is no epidemic. They conclude "…no sound scientific evidence indicates that the increasing number of diagnosed cases of autism arises from anything other than purposely broadened diagnostic criteria, coupled with deliberately greater public awareness and intentionally improved case finding". The paper is highly readable, well argued and worth a read by anyone involved in dealing with autism.
Evidence of Harm by David Kirby
David Kirby’s book, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy looks at the role mercury plays in autism (see Mercury & Autism; Ethyl Mercury Versus Methyl Mercury). There is an extensive and well written review of it on Spiked-Online by Dr Michael Fitzpatrick, author of MMR and Autism: What Parents Need to Know.
“I fear that his misguided endorsement of the anti-mercury cause can only compound the damage that this campaign has already done, both to families affected by autism and, by undermining public confidence in the childhood immunisation programme, to the welfare of children in general.
Kirby, a freelance journalist in New York, presents this ‘medical controversy’ as a confrontation between two camps. On the one side are heroic, suffering, struggling parents and their courageous supporters; on the other are cold, scheming, faceless bureaucrats of the medical establishment, big pharma and big government. Kirby’s character sketches leave readers in no doubt about his allegiances.”
Blood Test for Autism?
New research by the University of Arkansas points to the possibility of a blood test to detect autism. The study by Dr James (Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism) points to autistic children having a impaired capacity for methylation, which has many functions in the human body including dealing with heavy metals, including mercury. Specifically, 80 per cent of autistic children in the study had notably low levels of active glutathione. A reduction of glutathione can wreak damage on the brain, gastro-intestinal tract and immune system. Heavy metals also reach higher levels more quickly in children with low glutathione. The build-up may act as an environmental trigger, turning on latent autism-causing genes. The Arkansas team has also found that the genes controlling glutathione metabolism are more likely to be disrupted in autistic children than in healthy ones.
Source: Times Online Science Notebook
See Also: Mercury & Autism; Ethyl Mercury Versus Methyl Mercury
Predicting Succesful Autism Treatments
Autism is a very individualistic problem which requires finding the right approach for the individual. It is also very important to treat it early so months spent on a treatment that isn’t suitable can be costly in more ways than one.
An article on Medical News Today looks at a study designed to identify children who are most likely to benefit from a treatment programme called Pivotal Response Training (PRT). Researchers looked at children who had either responded very well to the treatment or had responded very poorly. They built up profiles of those children and used them to predict which of a new group of children would respond and which would not. This was a double-blind study so neither the patients or the PRT trainers knew what the study was about to avoid the children accidentally receiving different treatment. After five weeks those predicted as not responding hadn’t shown any sign of improvement and the treatment was stopped for them. For those benefiting from the therapy the treatment was continued. Importantly, one of the non-responding children started a different treatment programme and made significant progress. This demonstrates the important fact that the screening process did not just identify those who could not be treated by any method.
Facilitated Communication, Autism and the Oscar Nomination
Back in February we reported Autism Documentary Nominated for Oscar. In the documentary an autistic young woman appears to make a miraculous recovery from using a technique called Facilitated Communication.
An article in the Pasadena Weekly and featured on AltWeeklies.com gives a good overview of autism and highlights the discredited nature Facilitated Communication. “Then the phenomenon took a strange turn. An inordinate number of children and their facilitators started accusing their parents or others of sexual abuse. Parents and caretakers were arrested, children were placed in foster care, and many lives were ruined. Not until it reached this level of controversy did people begin to question some obvious inconsistencies. For instance, often the autistic people did not even look at the keyboard, while the facilitators never took their eyes off of it. … When scientists stepped in, more than 50 controlled studies and blind tests, in addition to numerous controlled tests conducted in legal cases, revealed FC as a hoax. These studies showed, without a doubt, that the FC messages were controlled by the facilitators, not the disabled people.”
Ethyl Mercury Versus Methyl Mercury
One of the proposed links between Mercury and Autism is Thimerosal, a compound that has been used in vaccinations. A new study [PDF of abstract] from the University of Washington, Seattle, USA has examine the different effects of ethyl mercury, used in Thimerosal, and methyl mercury, commonly used in industrial processes. Most of the toxicology data on mercury is based on accidental exposure to Methyl Mercury in the work place.
The study inject new born monkeys with either ethyl mercury (in the form of thimerosal) or methyl mercury in doses equivalent to that found in vaccinations for human babies. Mercury levels were then monitored and it was found that the ethyl mercury cleared from the body a lot quicker than the methyl mercury. Critically brain concentrations of total mercury were significantly lower by about three-fold for the thimerosal exposed infants when compared to the methyl mercury infants. This is important because mercury causes brain damage only through long-term exposure (a fact that gave us the phrase ‘as mad as a hatter‘). Thus if the body is cleaning itself quickly of the ethyl mercury, it doesn’t have the chance to build up and cause damage.
Coverage from Rueters: Mercury in Vaccines Different, Study Shows