Autism Spectrum Disorder

'Original Editor - Kirenga Bamurange Liliane Top Contributors - Kirenga Bamurange Liliane, Lucinda hampton, Jess Bell, Kim Jackson, Nupur Smit Shah, Robin Tacchetti and Naomi O'Reilly

Introduction

Autism, referred to as Autism Spectrum Disorder (ASD), is a different way of thinking involving a neurological developmental difference that changes the way a person relates to the environment and people around them. A person with autism sees, experiences and understands the world in a different manner.

Autism traits may be evident in childhood but often not diagnosed until later. Some individual have severe disabilities and require life-long care and support, whilst others can live an independent life.

Challenges that people on the autism spectrum face include:

• Struggling to communicate their needs and desires
• Problems with interpreting peoples meaning
• Processing sensory and cognitive information

Autism has impacts on education and employment opportunities, and adds stress to the families providing care and support.

In the video below, the neuroscience of autism along with potential factors and mechanisms involved in the development of autism is discussed (2 minutes).

Co-Occurring Condition

ASD individuals frequently have co-occurring conditions (eg epilepsy, depression, anxiety and attention deficit hyperactivity disorder) and challenging behaviours (eg difficulty sleeping and self-injury). Intellectual functioning levels among autistic people differs greatly, ranging from from profound impairment to superior levels.

Etiology/Epidemiology

ASD is a neurobiological disorder influenced by both genetic and environmental factors affecting the developing brain. Currently, no single universal cause has been identified but research is ongoing to discover potential etiologic mechanisms in ASD .

• ASD (according to some research) is becoming more prevalent. This finding is questioned, possibly be attributed to increased awareness, overdiagnosis, or overinclusive diagnostic criteria.
• Its prevalence is reported to be 1 in 68.

Signs and Symptoms

Signs and symptoms of ADS include:

• Struggling to communicate their needs and desires
• Problems with interpreting peoples meaning
• Problems with processing sensory and cognitive information

Children and youth with ADS have different intellectual abilities. Ranging from from superior levels of intellect to severe intellectual disability, limited or no verbal communication, and very limited adaptive behaviour .

Risk Factors

The following factors have been linked to ASD:

• Hereditary factors, parental history of psychiatric disorders, pre-term births.
• Parental age ( advance maternal and paternal age)
• Maternal history of autoimmune disease such as diabetes, thyroid disease and psoriasis.
• Prenatal exposure to psychotropic drugs or insecticides like thalidomide and valproic acid.
• Some of the known genetic disorders such as fragile X, tuberous sclerosis, Down syndrome, Rett syndrome even though they represent a very small amount of overall ASD cases .
• Maternal infection or immune activation during pregnancy
• Obstetric factors like uterine bleeding, caesarian delivery, low birth weight, preterm delivery, and low Apgar scores are more consistently associated with autism.

Diagnosis

ADS advocates rebel against negative stereotypes

ASD can be diagnosed by various professionals, ideally with input from multiple disciplines.

• Diagnoses based on combined clinician observation and caregiver reports are consistently more reliable than those based on either observation or reports alone.
• Later diagnoses often occur in presence of co-occurring problems such as anxiety, hyperactivity, or mood disorders that might have triggered the ASD, along with the same factors that play a part in delayed diagnoses in younger children.
• There is a need for clinical follow-up and reassessments of children diagnosed with ASDs, especially during the preschool years.
• There are currently no clear existing ASD biomarkers or diagnostic measures. The diagnosis is made based on the completion of descriptive criteria. .

To identify early symptoms of ASDs and sometimes help make a definitive diagnosis, different approaches/tools are used in different countries. The following ones are used :

• The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R). A screener that asks a series of 20 questions about the child’s behavior. It's intended for toddlers between 16 and 30 months of age. See here
• CARS: Childhood Autism Rating Scale. The form is used with individuals of all ages and in both clinical and research settings.
• ADOS : Autism Diagnostic Observation Schedule. A standardised, semi-structured observational assessment of features relevant to the diagnosis of ASD across the lifespan.

Asperger’s syndrome is an outdated name for people who have a high-functioning form of autism spectrum disorder. There is no longer a separate diagnosis for Asperger's syndrome, although some people may prefer to keep using this term.

Treatment

ADS service dog encourages outward expression

There are lots of autism treatments, with the right ones needing to be being an individualised to the individuals in regard to needs and challenges.Selecting the correct treatments is a collaborative affair, between health professionals, the individual and care givers.

The more common treatments for autism include:

1. Behavioural Therapies: aim to improve specific behaviours and develop skills, and employs orthodox behaviour strategies, for example rewarding suitable behaviors and ignoring/discouraging inappropriate behaviours.
2. Occupational Therapy to concentrate on the adaptive skills needed for the activities of daily living (ADLs).
3. Sensory Therapy. Numerous sensory interventions have been developed to normalise various sensory-challenges including sensory, visual and auditory interventions.
4. Speech Therapy to improve the child's speech pattern and language understanding.
5. Physical Therapy to improve physical and motor skills. You can read more about the Physiotherapy Management on this page. Physiotherapy for Autism Spectrum Disorder Children With Motor Control Disabilities
6. Complementary and alternative treatments including chiropractic care, animal therapy, art therapy, music therapy, or relaxation therapies are also used as treatment options for people with ASD .
7. Medications may be are used to treat the symptoms, the following can be used if agreed upon. Antipsychotic medications for repetitive behavior patterns and aggression. Serotonin reuptake inhibitors (SSRIs), stimulants, and other antipsychotics for problematic behaviours (like aggression) etc.

Prognosis

Autism is a lifelong condition, and an extensive variety of treatments are available for people with ASD. Early intervention gives the best results. Any ADS treatment should be sought from qualified medical professionals.

Autism Low Resource Settings

The prevalence of autism in many low- and middle-income countries is unknown. Research about the ASD diagnosis process in LMICs is still limited. The mean age at ASD diagnosis was very similar across LMICs but older than in high-income countries . Studies are required, specifically, epidemiological studies, to define the magnitude of the problem of ASD in LMICs. The scarcity of these studies is due to different barriers included:

• Lack of knowledge about epidemiological research.
• Need of contextualization of research tools.
• Shortage of experienced health professionals
• Stigma and lack of awareness about ASDs among these professionals (health, social and educational care).

ASDs in LMICs currently face a lot of barriers, however efforts to raise awareness about ASDs through different organizations and institutions is occurring. There is a need to put in place research infrastructure, funding, and capacity, and inclusive education policies. This will help with an improvement in the quality of life of people with ASD and bring their acceptance into society.

References