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Definition of Autism
Autistic disorder (known also as infantile autism or
childhood autism) almost always develops before the age
of three and is characterized by impaired verbal and
non-verbal communication, social interaction, some form
of repetitive and restricted stereotyped interest,
ritual, or other behavior.
Description of Autism
Children with autism often have extreme difficulty
developing normal relationships with others. They tend
not to share in the interests their peers have. In many
cases these children are not able to interpret
non-verbal cues of communication like facial
expressions. Most people with autism have some
impairment in language and many never speak at all.
About 8.7 of every 10,000 children are autistic, and
more than 1 in 300 children have some form of pervasive
developmental disorder (PDD). PDD means that some, but
not all, symptoms of autism are present.
Autism is a lifelong disease that ranges in severity
from mild cases in which the autistic person can live
independently, to severe forms in which the patient
requires social support and medical supervision
throughout his or her life.
Causes and Risk Factors of
Autism
There are physical bases for autism's development
including genetic, infectious, and traumatic factors.
Viral infection including rubella during the first
trimester of pregnancy, have been studied as possible
causes of autism. Children with Fragile X syndrome or
tuberous sclerosis have higher rates of autism than the
general population.
Autism affects males four times more often than females,
and there is a genetic basis for the disease.
Contrary to previous notions, autism is not caused by
upbringing.
Symptoms of Autism
The symptoms vary greatly but follow a general pattern.
Not all symptoms are present in all autistic children.
Autistic infants may act relatively normal during their
first few months of life before becoming less responsive
to their parents and other stimuli. They may have
difficulty with feeding or toilet training; may not
smile in recognition of their parents' faces, and may
put up resistance to being cuddled.
As they enter toddlerhood, it becomes increasingly
apparent that these children have a world of their own.
They do not play with other children or toys in the
normal manner, rather they remain aloof and prefer to
play alone. Parents often mention that their child is so
undemanding that he or she is “too good”.
Verbal and nonverbal communication skills, such as
speech and facial expressions, develop peculiarly.
Symptoms range from mutism to prolonged use of echoing
or stilted language. When language is present, it is
often concrete, unimaginative, and immature.
Another symptom of autism is an extreme resistance to
change of any kind. Autistic children tend to want to
maintain established behavior patterns and a set
environment. They develop rituals in play, oppose change
(such as moving furniture), and may become obsessed with
one particular topic.
Other behavioral abnormalities that may be present are:
staring at hands or flapping arms and hands, walking on
tiptoe, rocking, tantrums, strange postures,
unpredictable behavior and hyperactivity.
An autistic child has poor judgment and is therefore
always at risk for danger. For instance, an autistic
child may run into a busy street without any sign of
fear.
Diagnosis of Autism
Properly diagnosing autism is very important, since
confusion may result from inappropriate and ineffective
treatment.
Deafness is often the first suspected diagnosis, since
autistic children may not respond normally to sounds and
often do not speak.
The children's appearance and muscle coordination are
often normal.
Occasionally, an autistic child has an outstanding skill
(splinter skills), such as an incredible rote memory or
musical ability. Such children may be referred to as
"autistic savants", and occur in almost 10% of cases of
autism. These skills can be quite astonishing. One
example is the ability to play a piece of music almost
perfectly after hearing it one time.
Many children with autism have a second psychiatric
disorder or a neurologic disorder. Mental retardation
and seizure disorders are very common in autistic
children and a thorough neurologic and psychiatric
evaluation is necessary in every case of autism to
ensure all the child’s medical problems are being
addressed.
Treatment of Autism
Appropriate early intervention is important. Once the
diagnosis has been made, the parents, physicians, and
specialists should discuss what is best for the child.
In most cases, parents are encouraged to take care of
the child at home.
Special education classes are available for autistic
children. Structured, behaviorally-based programs,
geared to the patient's developmental level have shown
some promise.
Most behavioral treatment
programs include:
• clear instructions to the child
• prompting to perform specific behaviors
• immediate praise and rewards for performing those
behaviors
• a gradual increase in the complexity of reinforced
behaviors
• definite distinctions of when and when not to perform
the learned behaviors
Parents should be educated in behavioral techniques so
they can participate in all aspects of the child's care
and treatment. The more specialized instruction and
behavior therapy the child receives, the more likely it
is that the condition will improve.
Medication can be recommended to treat specific symptoms
such as seizures, hyperactivity, extreme mood changes,
or self-injurious behaviors.
The autistic child requires much of the parents'
attention, often affecting the other children in the
family. Counseling and support may be helpful for the
parents.
The outlook for each child depends on his or her
intelligence and language ability. Some people with
autism become independent adults. A majority can be
taught to live in community-based homes, although they
may require supervision throughout adulthood.
Questions To Ask Your
Doctor About Autism
When will the symptoms
appear?
What type of symptoms will there be?
What if the child just likes to be left alone as opposed
to being autistic?
What type of test is given to diagnose autism?
Where is testing done?
How accurate is the test?
Is the autism mild or severe?
Will the child be able to attend public school if they
have mild autism?
Is there a cure?
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Drug Treatment
Drugs don't cure autism, but many autistic suffer from
multiple problems such as
depression or seizures, and the drugs can help with
those secondary problems.
The drugs most commonly prescribed are:
Anti psychotics (Mellaril, Haldol, Thorazine) - used to
treat severe aggression,
self-injurous behavior, agitation or insomnia.
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Anticonvulsants (Tegretol, Depakote, Dilantin) - used to
control seizures.
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Anti depression (Lithium, Depakote) - used for bipolar
manic depression.
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Anti anxiety (Valium, Librium)
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Benzodiazepines
alprazolam (Xanax)
chlordiazepoxide (Librium)
clonazepam (Klonopin)
diazepam (Valium, Valrelease, Zetran)
flurazepam (Dalmane)
lorazepam (Ativan, Alzapam)
oxazepam (Serax)
triazolam (Halcion)
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Tricyclic Antidepressants -
amitriptyline (Elavil, Endep, Enden, Tryptizol)
amoxapine (Asendin)
buproprione (Wellbutrin)
carbamazepine (Epitol, Tegretol)
clomipramine (Anafranil)
desipramine (Norpramine, Pertofrane)
doxepin (Adapin, Sinequan)
imipramine (Tofranil, Janimine)
nortriptyline (Pamelor, Ventyl, Aventyl)
trimipramine (Surmontil)
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Selective Serotonin Reuptake Inhibitors (SSRIs) used for
regular depression or compulsive behaviors.
fluoxetine (Prozac)
fluvoxamine (Luvox)
nefazodone (Serzone)
paroxetine (Paxil)
sertraline (Zoloft)
venlafaxine (Effexor)
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(MAOI) Monamine Oxidase Inhibitors - Used to treat
depression and panic. In most cases, MAOI's should not
be the first treatment choice. Rather, these drugs are
prescribed for people whose symptoms have failed to
respond to other common antidepression drugs. Although
just as effective as heterocyclic drugs, they poses a
potential problem because of the possible toxic
food-drug interactions. If you are taking one of these,
follow the dietary guidelines strictly.
moclobemide (Aurorix, Manerix)
phenelzine (Nardil)
tranylcypromine (Parnate)
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Beta Blockers (Nadolol, Buspirone)-used to decrease
aggression or hyperactivity.
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Opiate Blockers (Naltrexone/Trexan) - control self
injurious behaviors.
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Sedatives (Chloral Hydrate, Noctec, and Benadryl) - for
difficulty sleeping
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Stimulants (Ritalin, Dexedrine)-for hyperactivity and
attention or concentration problems.Some of them have
side effects.
Anti yeast therapy
There are some evidence that candida albicansmay cause
or exacerbate behavior and health problems in autistic
individuals. The only physical symptoms are vaginal
yeast infections and thrush (white patches in mouth).
An overgrowth of candida albicans causes toxins to be
released into the body which are known to impair the
central nervous system and the immune system. Some of
the behaviors related to this are, confusion,
hyperactivity, short attention span, lethargy,
irritability, and aggression. Reported health problems
can include headaches, intestinal
problems,(constipation, diarrhea, flatulence), distended
stomach, excessive genital touching in infants and young
children, cravings for carbohydrates, fruits and sweets.
Unpleasant odor of hair and feet, acetone smell from
mouth, and skin rashes.
Candida overgrowth is often attributed to long term
antibiotic treatments. It has been reported that some
children whose autistic tendencies surfaced at 18- 24
months had been continuously treated with antibiotics to
control chronic ear infections. The treatment doesn't
cure autism, but is helpful for some autistic children.
CONTACTS:
American Academy of Environmental Medicine, PO Box
16106, Denver CO 80216
Great Smokies Diagnostic Laboratory, Martin Lee &
Stephen Barrie, Associates, 18a Regent Park Boulevard,
Asheville, NC 28806 +(704) 253-0621 Can provide kit for
stool analysis used for determining yeast overgrowth.
Allergy induced Autism and Casein/Gluten
In allergy induced Autism, the symptoms usually become
apparent during the first three years of life. Some
children have autism that appears to have been triggered
by intolerance to many foods and/or chemicals, the main
offenders being wheat, cow's milk, corn, sugar and
citrus fruits, although each child may be affected by
different substances. The children also have many almost
unnoticeable physical problems, namely excessive thirst,
excessive sweating, especially at night, low blood
sugar, diarrhea, bloating, rhinitis, inability to
control temperature, red face and/or ears and dark
circles under the eyes.
It has been reported that a high percentage of autistic
children had a "mutant" protein in their urine that was
created by eating gluten (found in wheat, oats, barley
and rye grains) and/or casein (milk protein) containing
food. The mutant protein was the gluten and casein
protein bound to a morphine like substance. It's
believed that this was what was causing the kids to
become spacey and addicted to these foods. It won't cure
autism, but may help with some secondary problems.
Auditory Training
Auditory training can be considered a form of sensory
integration in which stimulation
may sensitize or desensitize one or more senses.
Theoretically speaking, if one or more
senses are impaired in an individual, he or she may
develop a distorted perception of the
environment. There has been much research in the past 15
years to indicate that many
autistic individuals have sensory dysfunction in one or
more areas.
There are two main types of auditory training methods,
the Berard approach, lasting 10
to 12 days, and the Tomatis approach, lasting 6 to 12
months.The Berard training is
accomplished by a device which randomly selects high and
low frequencies from a music
source and then sends those sounds via headphones to the
trainee. Filtering peaks are
optional for the developmentally disabled population.
The music is, in all cases, modulated
throughout the 10 hours of listening, whether or not
peaks are filtered.
We do not know what percentage of autistic children may
be helped by auditory training,
if any at all, nor how much they may be helped. The
treatment is safe, but expensive.
Music Therapy
Includes singing, movement to music, and playing
instruments. Supposed to be a
good medium for kids with developmental disabilities
because it requires no verbal
interaction, music is by nature structured, facilitates
play, can aid in socialization
and influence behavior.
Doman/ Delacato Method
Carl Delacatto wrote a book called "The Ultimate
Stranger". He had a few interesting
points about "sensoryisms", a terrifying sensations or
distortions to senses. The distortions
can be hypersensitivity (too much stimulas entering the
nervous system), hyposensitivity
(too little stimulus entering the nervous system) or
white noise (internal static that disrupts
input from external stimuli).
Delacto Method are brain stimulation activities for
brain injured children developed by
Glenn Doman and Carl Delacatto. It involves cross
patterning, patterning and sensory
exercises developed to enhance memory and processing.
The delacato team evaluate a child and tailor a program
to suit his/her needs. Programs
are working on senses in order to normalize them and are
devised for parents to carry
out at home.They include massage for tactility, auditory
and visual work, and tasks for
smell and taste, mobility and development. All tasks are
fitted into 2 to 5 minute slots so
that the child does not become bored, and are repeated
as necessary.
We do not know what percentage of autistic children may
be helped by Delacto
Method, if any at all, nor how much they may be helped.
Osteopathy/Craniosacral Therapy
Doctors who manipulate the bones of the cranium.
Holding Therapy
Holding therapy gained wide-spread attention when Dr
Martha Welch, a child psychiatrist
from New York, began using it as a means of working with
children with autism. Her work
is written in the book, Holding Time.
During holding therapy the parent attempts to make
contact with the child in various ways.
This may mean simply comforting a distressed child, but
often the parent may hold the child
for periods of time, even if the child is fighting
against the embrace. The child sits or lies
face to face with the parent, who tries to establish eye
contact, as well as to share feelings
verbally throughout the holding session. The parent
remains calm and in control and offers
comfort when the child stops resisting.
Many people feel this is a variant of SIT (sensory
integration therapy), which helps the child
adjust to and overcome sensory overload, and are holding
therapy's advocates. Some high
functioning autistic people have protested that this
treatment is too traumatic.
Sensory Integration Therapy
A person is trained to deal with sensory sensitivities.
The goal is to reduce that anxiety
through repeated exposure.
The
Squeeze Machine
Developed by Temple Grandin. Supposed to reduce
hyperactivity and tactile
defensiveness. Gives the autistic control over the
amount of pressure exerted.
Lovaas Method
Lovaas therapy refers to the treatment model developed
by Ivar Lovaas, Ph.D., at
the UCLA Clinic for the Behavioral Treatment of
Children, and is mostly behavior modification program.
Dr. Lovaas has worked with autistic children for over 30
years, and studies show it helped some kids, but
requires one-on-one with a trainer for 40 hours a week.
The
Son-Rise Program taught at the Option Institute and
Fellowship
Barry Neil and Samahria Kaufman "cured" their autistic
son, Raun, and then proceeded
to write a book about it "Son-Rise: The Miracle
Continues". They also founded the Option
Institute and Fellowship in Sheffield, MA. The Institute
offers training for families wishing
to create home based Son-Rise Programs for their
children.
At present, no formal studies or evaluations have
validated the effectiveness of the
Son-Rise Program as a treatment for children with autism
(we do not know if Raun
was ever formally diagnosed as autistic), and we do not
recommend the program.
Picture Exchange Communication System (PECS)
The Picture Exchange Communication System (PECS) was
developed as augmentative/
alternative training package that allows nonverbal
children and adults with autism and other
communication deficits to initiate communication. It was
created with educators, residential
care providers and families in mind, and so it is
readily used in a variety of settings. Verba
prompts are not used, thus building immediate initiation
and avoiding prompt dependency.
The system goes on to teach discrimination of symbols
and then puts them all together in
simple "sentences." Children are also taught to comment
and answer direct questions.
The PECS Training Manual, is written by Lori Frost, MS,
CCC/SLP and Dr. Andrew
Bondy. The manual provides all of the necessary
information to implement PECS
effectively. It guides readers through the six phases of
training and provides examples,
helpful hints, and templates for data and progress
reporting.
Higashi (Daily Life Therapy)
Daily Life Therapy, pioneered by Dr Kiyo Kitahara at the
Higashi School in Japan,
provides an education and emphasizes vigorous physical
education and the arts.
The school is open to students 3-22, who are Autistic,
Autistic like, or Pervasive
Developmental Disorder, and do not serve
Multi-Handicapped (physically disabled),
Severe/Profound Mental Retardation, Emotionally
Disturbed, Character Disorder, or
Uncontrolled Seizure Disorder.
A method is developed in Japan and imported into the
USA. It includes elements
normally found in the education of autistic children,
but places unusual attention to
physical exercise.
Upon entering high school, all students participate in
community work and ultimately
employment. Areas of employment opportunities include
clerical, custodial, stocking,
food service and landscaping. All vocational students
are paid employees.
We do not know what percentage of autistic children may
be helped by Daily
Life Therapy , if any at all, nor how much they may be
helped.
TEACCH Treatment and Education of Autistic and related
Communication Handicapped CHildren
TEACCH is not a teaching or learning system, but a
behavioral management system,
which, when properly implemented delivers more
predictable behavior and greater
cooperation from the TEACCH subject, an Autistic child.
In general I believe TEACCH
is a productive program for low functioning autistic
children, helping the child learn self
care skills and preparing the child and the family for
some degree of lifelong institutional
involvement. TEACCH uses structure and modified
environment to teach skills, using
children affinity for routines and rituals to teach and
reinforce, classrooms so structured
and routinized that children are happy, but cannot truly
learn to adapt to transitions and
changes.
We do not recommend this program for higher functioning
children who can be taught to
eventually lead a relatively normal life. While I
believe that Autism/PDD are biological in
nature, environmental factors play a major role in the
child ability to compensate for the
disorder and to better, more normal functioning. For
more information about TEACCH
go to TEACH.
Speech-Language Therapy
It is recognised that autistic children have
difficulties with language, but it is clear
that traditional approaches emphasising mastery of the
formal properties of language
are largely inappropriate: training children to speak is
not going to bring about a
transformation of their behaviour. The autistic child
needs to learn not so much how
to speak as how to use language socially to communicate.
That includes knowing how to hold a conversation,
thinking about what the other
person in a conversation understands and believes, and
tuning in to the meta-linguistic
signals of the other person, such as facial expression,
tone of voice and body language.
It is important to remember that communication is as
much nonverbal as it is verbal,
and autistic people have great difficulty understanding
nonverbal language.
A speech pathologist who specializes in the diagnosis
and treatment of language problems
and speech disorders can help a person learn how to more
effectively communicate.
Speech therapists working with a nonverbal autistic
individuals, may consider alternatives
to the spoken word such as signing, typing, or a picture
board with words.
Occupational Therapy
Commonly focuses on improving fine motor skills, or
sensory motor skills that include
balance (vestibular system), awareness of body position
(proprioceptive system), and
touch (tactile system).
After the therapist identifies a specific problem,
therapy may include sensory integration
activities such as: massage, firm touch, swinging, and
bouncing.
Vitamin/Mineral Therapy
Dimethylglycine (DMG), is a food substance and is most
often used Vitamin/Mineral Therapy.
DMG is found, in small amounts, in brown rice and liver.
Its chemical make-up resembles that
of water soluble vitamins, specifically vitamin B15. DMG
does not require a prescription, and it
can be purchased at many health food stores. There are
no apparent side effects.
Use 1/2 of a 125 mg tablet at breakfast for a few days.
May be necessary to go up to one to
four tablets a day if the results are positive.
Reports from parents giving their child DMG indicate
improvements in the areas of speech, eye
contact, social behavior, and attention span.
Two weeks after starting on the DMG, B6 and magnesium
can be added. Studies have shown that
vitamin B6 may help control hyperactivity, and improve
overall behavior. Although improvements
vary considerably among individuals, other possible
improvements are: speech improvements,
improved sleeping patterns, lessened irritability,
increased attention span, decrease in self stimulation,
and overall improvement in general health.
We do not know what percentage of autistic children may
be helped by Vitamin/Mineral
Therapy , if any at all, nor how much they may be
helped.
Flexyx Therapy (photo stimulation)
Dr. Ochs started Flexyx treatment (photo stimulation
therapy). Several other therapists have been
conducting more formalized research using brain wave
stimulation systems in various stages
of development.
Some patients and their families have been pleased with
the results of this treatment, however,
we do not have clinical trials about using EDS with the
autistic population, and, thus far,
is lacking sufficient clinical trials to met FDA
approval, or to validated the effectiveness
of the treatment.
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