Autism: Many unanswered questions
Many of the delightful moments that new parents treasure are denied to those nurturing an autistic child.
Instead of snuggling contentedly when being held, the autistic child cries and squirms to be put down. He avoids eye contact and plays on his own, with no interest in peek-a-boo or imaginative role-play.
Instead of running to greet you at the day care center, the autistic child barely looks up and continues to focus on a piece of an abandoned puzzle.
Autism is a brain disorder that affects a person’s communication, social skills and behavior. A lifelong disorder, it usually becomes apparent in the first three years of a child’s life. While there’s a great deal of variation in the type and severity of symptoms, an autistic child may:
- Seem indifferent to the feelings of others.
- Have a difficult time learning to talk.
- Speak in ungrammatical ways with misplaced pronouns and an unusual intonation and rhythm.
- Echo what others say rather than responding.
- Develop compulsive routines.
- Resist even trivial change.
- Be hyperactive and prone to screaming spells.
- Have trouble learning manual tasks.
- Frequently try to injure himself on purpose.
About 75 percent of autistic individuals have at least some degree of retardation, while about 10 percent have what is known as Asperger’s Syndrome with high intelligence, but many of the other symptoms. Autism is four times more likely in males than females.
Doctors have more questions than answers regarding autism, but they know that the symptoms have nothing to do with the way parents relate to their child, as some doctors believed in the 1950s and ’60s. Autism involves abnormal brain development and function that is believed to be at least partially genetic but perhaps triggered by certain environmental factors.
Why the increased
incidence?
One of the biggest questions involves why the incidence of autism has been increasingly so rapidly since the late 1980s. Controversy swirls about possible environmental causes for the increase and even whether the increase really exists, apart from changes in reporting, definition and diagnosis.
One recent review, published in Public Health Reports concluded that U.S. incidence increased from less than three per 10,000 population to more than 30 per 10,000 while incidence in the United Kingdom rose from less than 10 to about 30 per 10,000.
“A precautionary approach therefore suggests that increased rates of autism and related disorders be accepted as an urgent public health problem,” the authors wrote.
Proposed environmental triggers include exposure to heavy metals such as mercury and lead, viral infections, wheat allergies, food additives, antibiotics and thimerosal, a mercury-based additive used in the measles/mumps/rubella vaccine.
The vaccine theory, which attracted a great deal of attention, was disproven by several recent studies. A Mayo Clinic review of 20 years of data collected from Minnesota school systems found no correlation between MMR vaccination and autism and concluded that the increased incidence coincide with broadened diagnostic criteria, improved understanding and inclusion of autism as a disability under the Disabilities Education Act — increasing the willingness of parents to accept the autism label.
In Scandinavian countries, the rate of diagnosed autism began to rise during a period when thimerosal had already been eliminated from vaccines.
One theory links autism to immune system problems in the mother or developing child. Autoimmune disorders such as rheumatoid arthritis are common among autistic individuals and their families.
Some researchers believe autism may be linked to too much brain growth too early in life. Autistic children have a smaller than average head circumference at birth and greater than average growth during the first year.
This disorderly growth, according to the theory, could interfere with normal brain development.
Whatever the cause, it’s important for parents to recognize autism early when treatment can be most effective.
Warning signs, according to the National Institute of Child Health and Human Development, include:
- A baby that doesn’t babble or coo during the first year of life.
- A baby that doesn’t point, wave or grasp during the first 12 months of life.
- Failure to repeat single words by 16 months or two-word phrases by 24 months.
- Sudden loss of language or social skills at any age.
Parents should suspect autism in a young child who doesn’t smile, make eye contact or respond to funny sounds or conversations. Autistic babies may not roll over the typical corkscrew pattern but rather use an awkward lifting motion with their pelvis and head.
Although there’s no cure, the most troubling symptoms can be managed, decreasing the disabling long-term effects. A behavioral approach, rewarding any effort at speech or social interaction, is generally favored and has been found effective.
Treatment usually involves specific training in language, social skills, listening, music and use of the senses. In most cases, experts said patients do better when they are treated at home rather than an institution and in regular rather than special education classrooms.
Life is never easy for autistic individuals or their families. In one study of 68 autistic people followed for 20 to 25 years, 12 percent were rated as having a very good outcome — a paying job, some friends and some degree of independence.
The majority, however, were not able to keep a job or complete formal schooling and required help with day-to-day living. An IQ of 70 or over increased, but did not assure, the likelihood of a good outcome.
Without treatment, on the other hand, an autistic person has little or no chance of leading a normal life. As the incidence of autism has increased, so has our understanding of the disorder and our ability to diagnose it early and make meaningful social interventions.
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