Autism

Autism is a neurological condition that starts in early childhood and affects the development of language and social skills. In most cases, children are noticed to have delay in their language and speech and sometimes their motor function. In some cases, children are noted to develop normally, but at some point, usually around 18 months of age, they start losing several skills that they had mastered, including words and social skills. This is called regressive autism. This page provides a summary of the various symptoms, recommended evaluation and available treatments for autism. For further questions, you may contact us by email or by sending a message.

Symptoms of Autism

Communication

The most prominent symptom of autism is difficulty with communication. There are two forms of communication, Verbal and Non-verbal. Verbal communication consists of language and speech, in addition to the intonation of speech. Language is a very complicated function of the human brain. The most basic form of language is probably naming. Children typically first learn to name objects and people, like “Mommy” or “banana” or “table”. As their brain develops, they start understanding more language and add simple verbs, mostly to request objects, like “want milk”. Eventually, both language comprehension and expressive speech continue to develop, as children learn to ask questions, make spontaneous comments and tell stories. In addition, when we speak, we usually add an intonation into words. Intonation, also called prosody, adds important meanings to the words and relate the way we feel about the words we are saying. Abnormal prosody in autism usually presents as either decreased intonation or a monotone speech. Language is usually delayed in children with autism. Some children never develop speech, others develop limited speech and are able to name objects and make requests only and some with higher functioning autism develop more advanced language skills.

Non-verbal communication is as complex as verbal language. It includes facial expression, hand gestures and body language. Just like verbal language, body language consists of expression and comprehension. Understanding the body language of others is extremely important in helping us function in society. Children with autism frequently have difficulty understanding the body language of others and this may cause difficulties in social life and interactions with peers.

Social Skills

It is difficult to separate social skills from communication skills. Proper social skills require adequate communication skills. It is not entirely clear if the difficulties in interpersonal relationships experienced by individuals with autism are just another symptom of their difficulty communicating and understanding the communication of others. Individuals with autism may prefer to be alone and spend time playing by themselves. However, many children with autism enjoy having friends, but sometimes have difficulties engaging in reciprocal play, mostly due to their communication difficulties. For example, an individual may have a large vocabulary and even good basic language skills, and still experience difficulties with his interaction with peers because of deficits in more complex language skills and non-verbal communication. That individual will usually have trouble keeping up with the higher language demands required by certain social situations. More importantly, he might be rejected by peers because his behavior might look strange.

Excessive Motor Activity

Many individuals with autism have repetitive stereotyped movements sometimes called “stimming” or “stimulatory behaviors”. The cause of such behaviors is not clear and they are sometimes worsened by anxiety or excitement. They may simply be an atypical form of non-verbal communication or a tic. In addition, individuals with autism frequently have obsessive compulsive behaviors which can present as a motor activity.

Causes of Autism

Autism is probably not a single disease; it consists of various brain disorders with similar symptoms. There is probably not a single cause of autism and different patients might have different causes of their symptoms. There seems to be a genetic predisposition for autism, however, genetics alone does not explain the high rates of autism. The current scientific paradigm stipulates that a genetically predisposed individual is exposed to an unknown environmental trigger at a critical point in development. Environmental triggers may include toxins or substances that alter the immune system.

Seizures and Autism

The relationship between Epilepsy and Autism is very complicated. Both diseases are believed to be due to abnormal electrical networks in the brain. Therefore, the incidence of seizure activity in patients with autism is very high. Two types of seizures are seen in individuals with Autism: Clinical seizures and Silent Seizure Activity.

Clinical seizures are regular seizures, like those described in the Epilepsy section. About one third of individuals with autism develop clinical seizures at some point during their life. There are two peaks of onset, infancy and adolescence; however, seizures can start at any time.

Silent seizure activity, also known as sub-clinical seizure activity, consists of brief but frequent electrical discharges seen on the EEG that do not cause any symptoms. Patients are not aware of this activity and the only way to detect it is with an EEG. It is estimated that two thirds of individuals with Autism have silent seizure activity. Many experts believe that silent seizure activity contributes to the symptoms of Autism. Treatment of silent seizure activity in individuals who never had clinical seizures is controversial, however, some scientific studies revealed that treatment may actually improve cognitive functions and language.

The majority of individuals with autism who develop clinical seizures tend to have them for life with only a small minority of patients outgrowing them. It is not known whether silent seizure activity subsides by itself or not, however, recent experience suggests that many individuals will stop having silent seizure activity, either as the result of treatment, or as their brain matures. Treatment of epilepsy in individual with Autism is similar to treatment of epilepsy in general. However, not all treatments that work to prevent clinical seizures are successful in eliminating or reducing silent seizure activity. Some seizure medications and diet therapy seem to be the most effective treatments for silent seizure activity. In addition, steroids and other forms of immune therapies are sometimes used.

Evaluation and Testing

Neurodevelopmental Evaluation

Detailed developmental, cognitive and behavioral assessment is sometimes performed to confirm the diagnosis, assess the severity and come up with recommendations for therapies and school placement. Such evaluation also serves to track progress and response to treatment over time.

Medical Evaluation

Medical evaluation is less standardized than developmental evaluation and depends on the practitioner. Certain genetic tests are usually recommended to rule out genetic conditions that can cause symptoms similar to autism. In addition, evaluation for mitochondrial dysfunction is recommended by certain practitioners to help guide treatment with certain vitamins and supplements. Less conventional tests are frequently recommended by practitioners who use alternative approaches and include immune, biochemical, infectious and toxic tests. Finally, the importance of a good quality prolonged EEG study cannot be over emphasized to assess for subclinical seizure activity, even in children who never had clinical seizures.

Treatment of Autism

Behavioral Treatments

The most common type of treatment offered to children with autism is a type of behavioral therapy called Applied Behavioral Analysis (ABA). This type of therapy has been shown to improved several aspects and symptoms of autism, including language, social skills and behavioral disturbances. A subtype of ABA called Verbal Behavior uses the principles of ABA and applies them to language and has been shown to be very successful in teaching patients basic language skills. Other types of behavioral intervention are also used, including Floortime and Relationship Development Intervention (RDI). In addition, traditional speech therapy, occupational therapy and physical therapy are frequently offered to individuals with autism and may have various levels of success in improving symptoms and helping speech.

Medical Treatments

Unfortunately, there are not specific treatments that cure autism. Most conventional treatments target specific symptoms. Several types of psychochotropic medications are frequently prescribed to address certain symptoms. For example, anti-depressant medications are used to treat Obsessive Compulsive Behavior, Amphetamines are used to help attention deficit and hyperactivity and anti-psychotics are used to treat behavioral disturbances and aggressive behavior.

Several unconventional types of treatments are frequently used by practitioners who use alternative therapies. These treatments have variable reported rates of success in improving certain symptoms. Treatments typically target specific biochemical, immune or infectious disturbances that are believed to exist in certain individuals with autism. Examples of such treatments including Vitamins and Supplements, heavy metal chelation, immune therapies, antibiotics and anti-fungal treatments, hyperbaric chamber, different diets and others.