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What’s Behind Autism?

autism ribbonIf you’re a parent with young children, you’re almost certainly familiar with the developmental disability known as autism.

The sharp increase in the number of cases of autism, and autism spectrum disorders (ASDs), diagnosed over the last twenty years has led to a frenzy of media attention as experts try to pin down the culprit.

Most autistic diagnoses are made before a child is 3 years old.  Symptoms of classic autism include:

  • Impaired social and communicative functioning, such as the unwillingness or inability to look people in the eye or develop relationships with peers, and
  • Repetitive and stereotyped patterns of behavior and interests, such as an unusual commitment to nonfunctional routines or frequently repeated motor movements such as hand flapping.

Once thought to be an extremely rare condition, the Centers for Disease Control (CDC) now estimates that 1 in 150 8 year-old children in multiple areas of the United States has an Autism Spectrum Disorder.

Researchers studying the disorder have come up with several competing theories to explain why, for example, the number of 6-17 year olds with ASDs in public special education programs jumped from 22,664 to 211,610 between 1994 and 2006.

The possible explanations include:

  • Early childhood vaccinations,
  • Environmental degradation,
  • Genetic factors, and
  • Expanded diagnostic criteria.

Early Childhood Vaccinations

A special court, often referred to as a “vaccine court,” ruled this past February that there is no connection between early childhood vaccinations and autism.

The ruling was based on an analysis of existing medical studies and on evidence brought forward by parents of autistic children who were hoping to receive compensation from the U.S. government for the harm caused to their children.

Much of the academic and medical literature reaffirms this finding.

For example, W. Ian Lipkin, the senior author of this study conducted by the Mailman School of Public Health at Columbia University stated, “We found no connection between autism and the measles, mumps and rubella (MMR) vaccine.”

Many parents of autistic children are not convinced, and they vow to push for more research.

Included in this group is actor, father and advocate, Jim Carrey.

You can read Carrey’s concerns about the special ruling here on the Huffington Post.

Additionally, some parents have consciously decided to forego or delay certain vaccinations for their children.  They argue that children do not need 20 vaccinations in their first 18 months of life, and that children are being unnecessarily exposed to certain chemicals.

Physicians such as Dr. Todd Wolynn, a pediatrician based in Pittsburgh, PA, repeatedly stress that the vaccination schedule itself is not the cause of autism, and that skipping vaccines is actually leading to the return of some serious childhood illnesses.

  • For example, the CDC reported 131 cases of the measles virus between January and July of 2008, the highest number reported for the same time period since 1996.

Dr. Wolynn does argue that there might be other environmental factors responsible for the exponential increase in ASD cases.  He calls for further research on this particular point, as do many parents.

As of now, not much is known as what impact pollution or other environmental degradation might be having on our children’s development.

Genetic Factors

Scientists are making slow but steady progress on the genetic front when it comes to autism.

Last month, the online journal Nature published two exciting studies led by Hakon Hakonarson, director of the Center for Applied Genomics at Children’s Hospital of Philadelphia.

Dr. Hakonarson and his colleagues identified the first genetic variation that is common amongst a large group of people with autism-one that may account for 15% of the total cases.

Additionally, the research team found that:

  • The genetic variation that is common amongst autistic individuals lies between two genes that control the connections that brain cells make with each other; and
  • Folks with autism also have an abnormality in the genetic area that produces ubiquitin.  The key role of ubiquitin is to prune unnecessary or extra connections between brain cells, which helps to speed cognitive development.
    • Past research has also suggested that children with autism go through the pruning process later than their non-autistic peers.
  • These results strengthen the argument that people with autism have poorer connections between different areas of the brain than do people without the disorder.

These findings are especially interesting because of the large number of individuals who participated in the study- 5,500 with autism, 1,500 unaffected relatives, and 6,500 control-group people who do not have autism in their family.

Past studies have been much smaller, which limits the conclusions that can be drawn from the results.

The hope is that these findings can be reproduced and eventually used to create medications that improve the brain connections of autistic individuals, thus lessening or reversing the symptoms of the disease.

Expanded Diagnostic Criteria

And there are those who argue that the jump in cases may primarily be the result of expanded diagnostic criteria.

Columbia University Sociology professor Gil Eyal is studying the disorder in its historical context.

Until recently, there were only two diagnoses given to developmental disabilities:

  • Emotional Disturbance, and
  • Mental Retardation.

Today the broad middle ground between these two categorizations is filled by autism spectrum disorders.

  • Although Congress passed the precursor to the Individuals with Disabilities Act in 1975, it was not until 1990 that autism was adopted as a category in this legislation.
  • This improved diagnostic criteria led to a higher number of cases identified.

Now that we can better identify autism, treatments and insurance coverage for the disease need to improve.

The prognosis for adults with ASDs varies widely, with some individuals being fully functional and others never developing the skills needed to survive alone on a daily basis.  Autistic folks are generally better off if they undergo extensive social and cognitive therapy sessions as children.

The best of these remedies is known as Applied Behavioral Analysis (ABA) therapy.  This form of therapy focuses on teaching autistic individuals how to perform simply tasks through extensive repetition.

Unfortunately, most insurance companies refuse to cover ABA therapy.  Insurers claim that the high cost of the therapy- $100,000 per patient per year- drives up premiums for other customers and does not produce results that justify the cost.

While half of the states nationwide require insurers to cover autism treatments to some degree, only eleven have mandates when it comes ABA therapy.

Improving access to these forms of assistance is critical, as children who receive the therapies at a young age have much higher success rates as adults.

Lisa Parles, a mother and lawyer with a 17 year-old autistic son, argues that spending on early childhood therapy can save on long-term care costs for autistic adults.

“If it wasn’t for his early years of ABA, I don’t think he’d be brushing his teeth, showering, getting his own snack,” she said, “which for the future, as an adult, is going to have a huge financial impact.”

{ 1 comment… add one }
  • Dan June 13, 2009, 5:48 pm

    Thoughts Regarding Autism Spectrum Neurodevelopmental Disorders

    Of these rare neurological disorders, Autism is the most common. The autism spectrum reflects the broad range of symptoms in which the names of these autism disorders have been given their own name for their disorder.

    Autism is a disability that is suspected to be caused possibly by a brain development disorder of unknown etiology. Others suspect the cause is some sort of neurological dysfunction- possibly with a genetic predisposition. Autism is about 3 times more common in males than females as well, and it is unclear as to why this occurs.

    Usually, symptoms of the disease present themselves before the toddler reaches the age of three. Before Autism was more understood, others inaccurately labeled autistic people as childhood schizophrenia or as having a psychosis or mental retardation.

    Symptoms of the autistic patient included limited or dysfunctional social and personal or intimate relationships with others, their intelligence is affected, and the autistic person typically is adverse to change. Also, the autistic person tends to be compulsive and prefers to be alone. They lack eye contact as much as physical contact with other people.

    Out of over two dozen diagnostic criteria utilized for these disorders, eight must be present to be considered autistic, according to the DSM. As with all passive developmental disorders, the person expresses language, social, and behavioral difficulties.

    Treatment includes what are called psychotropic medications that delay the progression of the disorder, as well as relieve some of the symptoms of one who is autistic. Behavioral therapy is common as a treatment regimen as well. Boys get Autism much more than girls.

    Then there is the controversy between many who claim that thimerosal- a preservative containing mercury, which is a neurotoxin that was used in vaccines until 2001, was the catalyst for autism in children.
    Over 5000 lawsuits have been filed because of this belief, and some have been successful for the plaintiff. Yet most agree the correlation between thimersal and autism is void of scientific merit. Furthermore, the cases of autism have not decreased since the preservative was discontinued in 2001.

    Aside from Autism, the other four passive developmental disorders are known as autism spectrum disorders.

    Asperger’s Syndrome is more common than autism, and the symptoms are milder, as there is minimal delay in language abilities, if at all. What is expressed with Asperger’s syndrome is mild autistic symptoms. In time, the patient may express atypical personality disorders, though.

    While intelligence is within normal limits with the Asperger’s patient, social interactions and abilities preset difficulty for such a patient. As with Autism, medications and behavioral therapy are treatment regimens with one with this syndrome.

    Rett’s Syndrome or disorder presents with not only atypical behavior, but also suffers from restricted physical growth and movement. There is cognitive and social impairment as well. The disorder affects mostly girls, and the cause is due to a gene mutation.

    Childhood Disintegrative disorder is rare, and is 10 times less common than autism. The disorder has a late onset with mild autistic symptoms. The disorder affects mostly boys, and regression is sudden and possible with this disorder.

    Skills lost with this disorder may be language, social, self-care, as well as play or motor skills. Decreased function or impairment with this disorder may include social skills and behavioral flaws. Central Nervous System pathology is a suspected cause of this disorder.

    Finally, there are passive development disorders that are not otherwise specified. This may include atypical autism, for example. Yet as with the rest of types of these disorders, the symptoms vary in their frequency and intensity, as well as the range of abilities of these developmental disorders vary widely as well.
    Medicinal treatment is believed to be not necessary for the management of all of those who may have autistic spectrum disorders.

    Depending on the patient’s health care provider, medications may be prescribed by their doctor to manage any affective disorders autistics may present in an acute or chronic nature. However, cognitive and behavioral therapy prove to be most beneficial for all the different types of Passive Development Disorders that exist for reasons yet to be defined.

    http://www.autism-society.org

    Dan Abshear

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