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Essay On Autism Treatments

California State University, Northridge



Introduction

Do people realize how lucky they are? Do we as one species realize how vulnerable we are? Do families who's worries revolve around picking "Little Joey" up from practice and what they will do for family vacation this summer realize that they have been blessed with a "normal" family? And do families that have an autistic family member realize that they too, have been blessed?

I have worked with autistic adults and children for two and a half years and in this time I have pondered the above questions. I realize that I grew up in a family that didn't know how fortunate we were to have four happy, healthy children. This realization led me to the topic of this paper: how does having an autistic family member affect a family?

In order to understand the effects this disability has on a family it is first mandatory to understand the characteristics of an individual living with autism. This paper will introduce the history, current theoretical causes and treatments of autism. After doing research to write a concise paper addressing the above topics I realized something was missing; the admiration I feel for the parents of autistic children, the emotions behind working and living with autistic children and the grief of realizing these children are autistic. So, also included in this paper are personal statements and stories of mothers and fathers of autistic children. Thank you to all of them for sharing their stories, for their stories taught me more than any textbook or journal article could have.

The word autism stems from the Greek word autos which means "self." This term was first applied to schizophrenics by Eugen Bleuler, a Swiss psychiatrist. Bleuler used this term to address the characteristic of certain schizophrenics who appeared to have their own style of thinking, autistic thinking. Autistic thinking is the view that the universe revolves around oneself and that the outside world has no effect on the self (Nevid et al., 1994). It was not until 1943 that another psychiatrist used the word autism. Dr. Leo Kanner, a professor at Johns Hopkins University at the time, applied the word autism to a group of children who he observed as having behavioral problems, social problems, communication problems and appeared to be self-absorbed (Edelson, 1995.). It is due to the lack of social interaction that Kanner applied the term autism (Society For The Autistically Handicapped, 1996.). In the fifty three years that autism has been the term of choice for the developmental disorder consisting of avoiding social contact, stereotyped behaviors and slow, or lack of, development of a useful language; much has been discovered. Much more needs to be.

The diagnosis of autism is a difficult one to make. Autism, although one of the largest disabilities to affect children, five in every ten thousand births, is not constant. It affects individuals in varying ways and in varying degrees. This is something I have noticed a great deal. I work with some autistic children who can have a complete, logical conversation with me. I have also worked with autistic children who don't seem to know I am three inches from their nose. A diagnosis of autism is usually made by the child's third birthday but, there are signs from birth that the child is different. An autistic child is more likely to resist affection, arching back and not staying still when being held, than is a child without autism. Autistic children are also usually described as being easy babies to take care of. It is not until the child should be developing language and social skills that parents realize something is different about their child. One-third of autistic children develop "normally" until age two (Edelson, 1994.).

The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, has changed the diagnosis drastically. The DSM-IV is the first psychologically based text that identifies the varying degrees of autism. Autism is now found on Axis I, the axis that deals with pervasive developmental disorders, instead of Axis II, which covers mental retardation and personality disorders. For a diagnosis of autism to be made six symptoms from three major areas: social interaction, communication and stereotyped behavior patterns must be present before the age of three. There must be at least two symptoms associated with social interaction and one in each of the other areas (Edelson,, 1994.). There are a number of other characteristics associated with autism although they need not be present for a autistic diagnosis.

Features of autism may also include the following: resistance of being touched, ignorance of heat and cold, no sensation of pain, fascination with sounds and tastes, giggling or weeping for no apparent reason, absence of emotions or reactions, self-injurious behaviors and self-stimulatory behaviors (Society For The Autistically Handicapped, 1996.). I observe these associated features of autism on a daily basis. An example of an autistic child's ignorance of heat and cold occurred recently when we were at the beach. The water at the beach was very cold to the touch of my co-workers and yet, a young girl who is diagnosed with autism ran straight into the water with no reaction to the coolness of it. Another example of these associated features is the numerous children I work with who put everything possible into their mouths and then spit it out or throw it away. Almost all of these children smell the object before placing it into their mouth. Self-stimulatory and self-injurious behaviors are the more prevalent of the associated features of autism and will be discussed in length below.

Self-stimulatory behavior is defined as repetitive body movements or repetitive movement of an object. Self-stimulatory behaviors can be split into the five senses. An individual with a visual self-stimulatory behavior is likely to stare at lights, move fingers in front of his/her eyes and flap his/her hands. I have observed this behavior in an adult male living with autism. His hand flapping behavior is usually preceding a self-injurious behavior or an act of injurious behavior towards another person. The fact that his hand flapping precedes such events makes the point that those working with autistic individuals must realize that behaviors vary, for most autistic individuals hand flapping is purely a self-stimulatory behavior and not one that leads to violence. Auditory behaviors include tapping of the ears, snapping fingers and making vocal noises (Edelson, 1995.). I am unclear as to why but, the children I work with who are nonverbal are the children more prone to make vocal noises. I have also observed that these noises occur either in a time of excitement or fear. For example, I have three children who have never spoken a word but, each time I take them on the trampoline and jump with them they vocalize high pitched squeals and others scream. I will have to look into the reason for this. I do notice that tactile stimulation is highly prevalent. Tactile stimulation can include any of the following: rubbing objects with hands, rubbing skin or picking at the skin and scratching (Edelson, 1994.). Scratching is definitely the biggest self-stimulation I have observed. This behavior is a varying one for if a child scratches to the point of bleeding, which most do because they like to watch the blood come out, it is then considered a self-injurious behavior. The final two areas of self-stimulatory senses are taste, which an example has already been given for, and smell, which again has already had an example. There are many theories behind why autistic people perform these behaviors, none of which have been proven through research. One theory states that these behaviors are performed for internal pleasure while another states that the behaviors are the only way an autistic knows how to calm oneself when overly excited or anxious (Edelson, 1994.). The best way to handle a child that is exhibiting a self-stimulatory behavior is to redirect their attention with a more appropriate form of stimulation, such as a book or crayons.

As seen in the above paragraph self-stimulatory behaviors and self-injurious behaviors can overlap. Self-injurious behaviors refer to those behaviors that an individual does to him/herself causing a bruise, red mark or open wound. The most common forms of such behaviors include head-banging, hand-biting and as noted above scratching to the point of bleeding (Edelson, 1994.). One of the most difficult things for me to adjust to at a previous job was the scars on children's hands from biting. Due to the lack of response to pain, autistic individuals will bite their hand out of frustration until they calm themselves, regardless of the depth or size of the bite. Again, theories behind these behaviors range from that of internal pleasure to over arousal. Another theory suggests that these behaviors may be the result of sub-clinical seizures, which is an abnormality in EEG patterns (Edelson, 1994.).

The characteristics of autism are universal but, vary from person to person. Although the characteristics are universal the guidelines for the diagnosis of autism are not universal which is why some countries report higher rates of occurrence whereas other countries, Japan for example, report lower rates of occurrence. Possibly the biggest barrier to joining psychology professionals on the diagnosis of autism is the cause, or more accurately the lack thereof.

The cause of autism remains unknown yet, many theoretical causes exist. Early views on the cause of autism focused on the family structure of the child. It was believed that parents of autistic children must be cold and detached. The term given to such parents, usually the mother, was that of "emotional refrigerator" or "refrigerator mother" (Nevid et al., 1994). There is no evidence to support this theory. Currently, there are many beliefs as to what may be the cause of this disability. The general thought in the psychology field today is that autism may be caused by a variety of coexisting problems (Edelson, 1995.).

There is some evidence to support the claim that autism may be an effect of exposure to a virus. The virus at hand is that of rubella. Studies have shown that there is an increased risk of a child being born with autism if the mother was exposed to rubella during the first trimester of pregnancy. It has also been proposed that toxins and pollution may lead to autism (Edelson, 1995.). This theory has no scientific evidence at this time. The widest held beliefs about the causes of autism appear to be in the fields of genetics and neurology (Society For The Autistically Handicapped, 1996.).

Researchers have identified four possible neurological explanations: over arousal of the reticular system, dysfunction of the limbic system, left hemisphere dysfunction and perceptual inconstancy associated with brain stem dysfunction (Society For The Autistically Handicapped, 1996).

The hypothesis that autism may be due to over arousal of the reticular system has been set aside due to the results of recent studies that do not allow researchers to claim that there is in fact a relationship between arousal and overt behaviors (Society For The Autistically Handicapped, 1996.).

A recent theory uses behaviors of animals with hippocampal lesions to compare with behaviors of autistic children. Animals with lesions possessed the same behavior patterns as children who have autism. Although this similarity suggests underlying mechanisms, there also appears to be behavioral differences which is why this theory is compatible with the current knowledge of autism (Society For The Autistically Handicapped, 1996.).

The left hemisphere of the brain deals with language and some aspects of cognition. The fact that the areas of language and cognitive thought are affected by autism has led researchers to the theory that the limbic system of those living with autism may have impairments. The only fault with this theory is that because the onset of autism is at a young age the right hemisphere of the brain should compensate for what the left side does not accomplish but, this does not appear to be the case (Society For The Autistically Handicapped, 1996.).

Finally, the theory that those living with autism have an inability to regulate sensory input, which affects ones view of external reality, is known as perceptual inconstancy. Again, this theory has not been able to show the nature of these instabilities (Society For The Autistically Handicapped, 1996.).

Although there is no or little evidence for the neurological theories concerning the cause of autism, there is some evidence that points to genetic causes. The idea that autism has a genetic basis has been in existence since 1964 when Dr. Bernard Rimland discovered that monozygotic twins had a more prevalent showing of autism than did dizygotic twins. Since 1964 this finding has been confirmed by other researchers. One supporter of the genetics theory is University of California Los Angeles (UCLA). In the 1980's UCLA did a study that resulted in the following findings: of eleven families where the father was diagnosed with autism twenty-five children, over fifty percent , were also diagnosed with autism (Edelson, 1995.). The general population only has an incidence rate of five autistic children born in every ten thousand births, thus giving further evidence to the genetics theory.

The remaining two genetic theories; that of a genetic mutation and a genetic predisposition, I feel can be integrated together. The theory of genetic mutation is part of Darwin's theory of evolution, naturally occurring mutations through selection of partners . Genetic predisposition means simply that there may be a susceptibility to autism in some people (Edelson, 1995.). In combining these two theories it is my belief that if genetic mutation is due to the selection of a partner and then a child is produced who has been diagnosed autistic, that there must have been a genetic predisposition to autism for the child due to the genes of the parents. Therefore the predisposition is not in the child's genes rather, it is the combining of the parents genes. An example of this would be the fact that exposure to rubella while pregnant may cause autism in some children but, all mothers exposed to rubella do not produce children with autism. There must be a missing link as to why some children do, and some don't, have autism; the genes of the parents and their predisposition to autistic characteristics. Although this is just my theory, it has been shown that there is evidence of genetics playing a part in the cause of autism. I look forward to the day, if there is one, when the true cause of autism is discovered.

Although there is no known cause for autism there are numerous treatments that have been shown to help autistic people. Again, there are varying degrees of autism therefore the treatment given to an individual may work for him/her but, may not work for another. Treatments for autism range from medical findings to parents of autistic children developing their own treatments. Some therapies are: Anti-Yeast Therapy, Dimethylglycine (food substance) Supplements, The Son- Rise Program and Higashi (Society For The Autistically Handicapped, 1996.). Whereas the Anti-Yeast and the Dimethylglycine therapies focus on medical findings and/or vitamins to help modify the behaviors of an autistic individual, the Son-Rise Program and Higashi, which means Daily Life Therapy in Japanese, focuses on the roles that the people around an autistic person have in modifying behaviors (,A HREF="http://www.rmplc.co.uk/eduweb/sites/autism/autism5.html">Society For The Autistically Handicapped, 1996.). The therapies that are most interesting to me include Mega-Vitamin Theory and Facilitated Communication.

Dr. Bernard Rimland researched the claims from parents that certain vitamins and foods affected their autistic child's behaviors (Society For The Autistically Handicapped, 1996. Treatments). It was concluded that Vitamin B6 is an effective treatment for forty-five percent of autistic people. The taking of vitamin B6 helps to improve: speech, sleeping patterns, lessened irritability, attention span and decrease self-stimulatory behaviors (Society For The Autistically Handicapped, 1996.). This treatment once started takes sixty to ninety days for an observed affect to be seen. I know some children who are currently on this from of treatment. I have only experienced the full treatment with one child and there has been a noticeable difference in self-stimulatory behaviors and mostly with attention span. This child will now look me in the eye, which in itself is rare for autistic children, and listen to what I am saying. I know that the child is listening because the actions taken are what I have instructed him to do. I can see why this theory would be a blessing to parents.

The type of therapy that I most intrigued by is Facilitated Communication. I first heard of this therapy in 1992. Facilitated Communication is a method of helping an autistic individual express him/herself by giving physical support to an arm or fingers, enabling the individual to use a typewriter, picture board or alphabet board. This form of therapy is very controversial because of the fact that there is a facilitator and that the autistic individual does not do this on his/her own. When using this form of therapy it has often been typed by the autistic individual that he/she is not retarded or stupid but intelligent (Society For The Autistically Handicapped, 1996.). Through my own research of this treatment method, I have also come across stories where the autistic individual has expressed anger because he/she understands everything happening in daily life yet, can not express thoughts or feelings. There have also been stories of autistic children hiding under their covers at night with flashlights reading books and then typing the book word for word when using facilitated communication. This amazes me! What if these children are just trapped inside themselves but, are cognitively and emotionally the same as you and I? Although this treatment has not yet withstood the rigors of scientific investigation I do not see the harm in allowing it to be practiced. If it does in fact prove to be a scientifically sound treatment then the world of autistic individuals and their families will forever be changed.

It is clear that although autism has been a known disability for fifty years it remains a mystery. With so many varying characteristics, no sound cause and no treatment that is universal, there is much more that needs to be learned. Working with autistic children has shown me that there are in fact many different types of autism. Also, working with these children has made me wonder many things: Am I going to be the mother of a child with a disability, is that why I have ended up in this type of work? How do the parents deal with having an autistic child? Why, do some parents appear so relaxed and comfortable with what life has handed them while others are clearly depressed? How does having an autistic sibling affect brothers and sisters? Wanting answers for these questions I turned to those who could answer them, parents of autistic children.

Donna Reagan, the mother of an autistic child, touched me with her story. David, her son, is now twenty years old. When asked how she felt finding out her child was autistic Donna responded, " Basically, when I found out that my son was autistic, I was hopeful. Since then I have moved pretty much into heartbreak and despair. I imagine the next step will be acceptance. It seems to me that this is like the grieving process and we move from one step to another, it just takes longer when the object of your grief is living." Donna has experienced other effects of having an autistic child.

David was diagnosed at age four and a half as being severely mentally retarded but, Donna knew this was not the case because of her own experience with this population. Donna was labeled as being in denial. This is an example of how much more needs to be learned about the characteristics of autism and as previously discussed the DSM-IV has taken the first step in clarifying the varying degrees of the disability.

Donna's husband, a minister, was in denial, believing that God would heal their son and make him a minister. Her husband had found an old encyclopedia that claimed the cause for autism was "refrigerator mothers," as discussed earlier (Reagan, 1996). This lead to the physical, emotional and mental abuse of Donna. And the physical abuse of David at the hands of his father. Donna moved her family away from the man that was once her husband. It is not uncommon for parents of an autistic child to divorce, most do with-in the first five years of the child's life.

Atop of what was going on with her marriage and own life , Donna still had to care for a hyper autistic child. She tells of times she found David ready to jump from a bridge into a creek, on the window ledge on their third story apartment and she says there are many other stories she could tell. David's safety was her biggest concern, with reason.

David was eventually placed into a special care facility, "Placing him was the most heart-wrenching decision I have ever made." David has been in placement care for ten years now. His father has seen him once. In two years he will again move to other placement. Donna's biggest worry, who will care for David when she is gone? "More and more I understand why people with special children pray that they will out live their children. I have begun to pray that prayer as well."

Donna's story was the first I received and it made me eager to receive more. I then received an email from Suzanne, the mother of a seven year old autistic girl. Before I tell Suzanne's story I would like to point out a common theme I have found among parents of autistic children, those who's children are young appear to be hopeful and optimistic whereas those who's children are older seem to realize that autism is a lifelong disability with many hardships. The most common theme I have found though is this; what will happen when I, the parent, am gone. Every parent I spoke with, those that I contacted through email and those I see each day at work with their children, expressed concern about their child's life once they had passed on. Suzanne expresses this very well, as you will see.

Suzanne says that the diagnosis of her daughter was not a surprise, because the word had been thrown around so much in all of the tests that were being done but, she does say that, "It is certainly a life sentence." Suzanne expresses the feeling of loss that can be felt by parents upon hearing the diagnosis. "No longer are there hopes for the child to accomplish all that the parents could not accomplish; no medical school, no academic scholar." Due to the stress of raising an autistic child Suzanne and her husband sought counseling for six months and have now learned to work through all of the emotions and responsibilities of having a special child together.

Suzanne sounds tired and still in a stage of sorrow due to her daughter's diagnosis. She explains how the family doesn't go out much, "It is very tiring to have this kind of kid." Her and her husband assume that their daughter will live with them until they are gone and yet, she speaks of the hope that maybe her daughter will be able to buy her own groceries, pay taxes and get a job she will enjoy. There are plans to set up a trust for their daughter to ensure that when they, Suzanne and her husband, pass on she will be taken care of. Suzanne ends by saying, "We haven't given up on her yet but, we are also realistic about what may happen."

I would like to point out a couple that I know through work. Their daughter is nine years old and I have taken a liking to her. She amazes me each day and I look forward to what she will teach me next. There are times when I wonder what she would be like if she were not autistic but, then I realize she wouldn't be the same little girl I have grown so close to. I admire her parents greatly for their outlook on her disability. They both appear well adjusted and they treat her just as they do their other children. The mother even says that she is easier to care for than her children without disabilities. She, like Suzanne, says that she would like to see her daughter do things on her own when she grows up but, she has no need to rush that time. As the mother of an autistic child, she says her daughter is her best friend, they do everything together. I know, from working with her daughter that she is not of the highest functioning autistic children but, she is not the lowest either. Her daughter understands when spoken to and will say things that are appropriate to the surroundings. I can not express how wonderful it is to work with this child. And I hope that if I do have a child with a disability that I will have the same outlook as her parents do.

Most of the research that has been done concerning autistic families is how siblings are affected. In a study done by Royers and Mycke in 1995, it was found that siblings of autistic children had a fair understanding of the disability and this finding was independent of age. Also found was the fact that children who have an autistic sibling rate their relationship with their brother/sister better than two siblings of which neither has a disability.

From what I have seen at work, the siblings of the autistic children take responsibility for their brother/sister and at the same time do not truly understand why their brother/sister can't do such things for him/herself. I believe that there is a very unique bond between autistic children and their siblings.

Conclusion

Autism is a lifelong, developmental disability. The characteristics of the disability; little or lack of speech development, avoiding social contact or awareness and routines of behaviors are not experienced in the same degree for everyone living with autism. The lack of a single identified cause for autism leaves much to be discovered in the field. Theoretical causes, such as neurological and genetic, may prove to be a link to the true cause of the disability. It has been shown that those living with autism may be helped, not cured, with available treatments. Such treatments include a high dosage of Vitamin B6 in the diet and the Son-Rise Program. A controversial treatment, Facilitated Communication, may allow autistic individuals a chance to communicate with the rest of the world without becoming frustrated at the inability to communicate.

Parents of autistic children deserve all the support and help they can handle. By hearing Donna and Suzanne's stories I have learned more about autism and the range of emotions that are felt by parents than any textbook could of taught. Donna's story of basically having to start a new life due to having an autistic child and all the hardships she has gone through in trying to do the best for David. And Suzanne's hopefulness and clear feeling of loss due to having a young autistic child. I am thankful for all of the children that I work with and I treasure each day I spend with them and all they teach me. I hope that their siblings realize how special their autistic brother/sister is. Doing this paper and the research involved in it I have come to realize that I am blessed for having known each and every one of the autistic individuals I work with, for they may live in a world all their own but, every so often they let you in and that, that is a blessing.


References

Nevid, J., S. Rathus and B. Greene. 1994. Abnormal Psychology In A Changing World. New Jersey: Prentice Hall. pp. 488-493.

Roeyers, H. and K. MYcke. 1995. Stiblings of a child with autism, with mental retardation and with normal development. Child: Care, Health, Development, 21:305-319.



Stephen M. Edelson, Ph.D.

It has been over 50 years since Dr. Leo Kanner, a psychiatrist at Johns Hopkins University, wrote the first paper applying the term 'autism' to a group of children who were self-absorbed and who had severe social, communication, and behavioral problems. This paper provides a general overview of the complexity of this developmental disability by summarizing many of the major topics in autism.

Prevalence

For many years, the most cited statistic is that autism occurs in 4.5 out of 10,000 live births. This was based on large-scale surveys conducted in the United States and England. More recently, estimates on the prevalence of autism have ranged been as high as 1/4% to 1/2% of the population. These estimates typically include those with autism, Asperger syndrome, and PDD.

Autism is three times more likely to affect males than females. This gender difference is not unique to autism since many developmental disabilities have a greater male to female ratio.

Major characteristics

Many autistic infants are different from birth. Two common characteristics they may exhibit include arching their back away from their caregiver to avoid physical contact and failing to anticipate being picked up (i.e., becoming limp). As infants, they are often described as either passive or overly agitated babies. A passive baby refers to one who is quiet most of the time making little, if any, demands on his/her parents. An overly agitated baby refers to an infant who cries a great deal, sometimes non-stop, during his/her waking hours. During infancy, many begin to rock and/or bang their head against the crib; but this is not always the case.

In the first few years of life, some autistic toddlers reach developmental milestones, such as talking, crawling, and walking, much earlier than the average child; whereas others are considerably delayed. Approximately one-half of autistic children develop normally until somewhere between 1 1/2 to 3 years of age; then autistic symptoms begin to emerge. These individuals are often referred to as having 'regressive' autism. Some people in the field believe that candida albicans, vaccinations, exposure to a virus, or the onset of seizures may be responsible for this regression. It is also thought that some children with 'regressive' autism may have Landau-Kleffner Syndrome (see next section).

During childhood, autistic children may fall behind their same-aged peers in the areas of communication, social skills, and cognition. In addition, dysfunctional behaviors may start to appear, such as self-stimulatory behaviors (i.e., repetitive, non-goal directed behavior, such as rocking, hand-flapping), self-injury (e.g., hand-biting, headbanging), sleeping and eating problems, poor eye contact, insensitivity to pain, hyper-/hypo-activity, and attention deficits.

One characteristic which is quite common in autism is the individual's ‘insistence on sameness’ or 'perseverative' behavior. Many children become overly insistent on routines; if one is changed, even slightly, the child may become upset and tantrum. Some common examples are: drinking and/or eating the same food items at every meal, wearing certain clothing or insisting that others wear the same clothes, and going to school using the same route. One possible reason for ‘insistence on sameness’ may be the person's inability to understand and cope with novel situations.

Autistic individuals sometimes have difficulty with the transition to puberty. Approximately 25% have seizures for the first time during puberty which may be due to hormonal changes. In addition, many behavior problems can become more frequent and more severe during this period. However, others experience puberty with relative ease.

In contrast to 20 years ago when many autistic individuals were institutionalized, there are now many flexible living arrangements. Usually, only the most severe individuals live in institutions. In adulthood, some people with autism live at home with their parents; some live in residential facilities; some live semi-independently (such as in a group home); and others live independently. There are autistic adults who graduate from college and receive graduate degrees; and some develop adult relationships and may marry. In the work environment, many autistic adults can be reliable and conscientious workers. Unfortunately, these individuals may have difficulty getting a job. Since many of them are socially awkward and may appear to be 'eccentric' or 'different,' they often have difficulty with the job interview.

Subgroups and Related Disorders

There is no adjective which can be used to describe every type of person with autism because there are many forms of this disorder. For example, some individuals are anti-social, some are asocial, and others are social. Some are aggressive toward themselves and/or aggressive toward others. Approximately half have little or no language, some repeat (or echo) words and/or phrases, and others may have normal language skills. Since there are no physiological tests at this time to determine whether a person has autism, the diagnosis of autism is given when an individual displays a number of characteristic behaviors.

In the last five years, research has shown that many people who engage in autistic behaviors have related but distinct disorders. These include: Asperger Syndrome, Fragile X Syndrome, Landau-Kleffner Syndrome, Rett Syndrome, and Williams Syndrome. Asperger Syndrome is characterized by concrete and literal thinking, obsession with certain topics, excellent memories, and being 'eccentric.' These individuals are considered high-functioning and are capable of holding a job and of living independently.

Fragile X Syndrome is a form of mental retardation in which the long arm on the X chromosome is constricted. Approximately 15% of people with Fragile X Syndrome exhibit autistic behaviors. These behaviors include: delay in speech/language, hyperactivity, poor eye contact, and hand-flapping. The majority of these individuals function at a mild to moderate level. As they grow older, their unique physical facial features may become more prominent (e.g., elongated face and ears), and they may develop heart problems.

People with Landau-Kleffner Syndrome also exhibit many autistic behaviors, such as social withdrawal, insistence on sameness, and language problems. These individuals are often thought of as having 'regressive' autism because they appear to be normal until sometime between ages 3 and 7. They often have good language skills in early childhood but gradually lose their ability to talk. They also have abnormal brain wave patterns which can be diagnosed by analyzing their EEG pattern during an extended sleep period.

Rett Syndrome is a degenerative disorder which affects mostly females and usually develops between 1/2 to 1 1/2 years of age. Some of their characteristic behaviors include: loss of speech, repetitive hand-wringing, body rocking, and social withdrawal. Those individuals suffering from this disorder may be severely to profoundly mentally retarded.

Williams Syndrome is characterized by several autistic behaviors including: developmental and language delays, sound sensitivity, attention deficits, and social problems. In contrast to many autistic individuals, those with Williams Syndrome are quite sociable and have heart problems.

Causes

Although there is no known unique cause of autism, there is growing evidence that autism can be caused by a variety of problems. There is some indication of a genetic influence in autism. For example, there is a greater likelihood that two monozygotic twins (i.e., identical twins) will have autism than two dizygotic twins (i.e., fraternal twins). In the case of monozygotic twins, there is a 100% overlap in genes; whereas in dizygotic twins, there is a 50% overlap in genes, the same overlap as in non-twin siblings. Currently, a great deal of research has focused on locating the 'autism gene;' however, many researchers speculate that three to five genes will likely be associated with autism. There is also evidence that the genetic link to autism may be a weakened or compromised immune system. Other research has shown that depression and/or dyslexia are quite common in one or both sides of the family when autism is present.

There is also evidence that a virus can cause autism. There is an increased risk in having an autistic child after exposure to rubella during the first trimester of the pregnancy. Cytolomegalo virus has also been associated with autism. Additionally, there is also a growing concern that viruses associated with vaccinations, such as the measles component of the MMR vaccine and the pertussis component of the DPT shot, may cause autism.

There is growing concern that toxins and pollution in the environment can also lead to autism. There is a high prevalence of autism in the small town of Leomenster, Massachusetts, where a factory manufacturing sunglasses was once located. Interestingly, the highest proportion of autism cases were found in the homes down-wind from the factory smokestacks. Recently, a large proportion of autistic children were identified in Brick Township, New Jersey. Several agencies are now attempting to uncover the reason(s) for the high proportion of autism in this community.

Physical abnormalities

Researchers have located several brain abnormalities in individuals with autism; however, the reasons for these abnormalities is not known nor is the influence they have on behavior. These abnormalities can be classified into two types--dysfunctions in the neural structure of the brain and abnormal biochemistry of the brain. It will be important for future researchers to examine the relationship between these two types of abnormalities.

With respect to brain structure, Drs. Bauman and Kemper examined post-mortem brains of several autistic individuals and have located two areas in the limbic system which are underdeveloped--the amygdala and the hippocampus. These two areas are responsible for emotions, aggression, sensory input, and learning. These researchers also found a deficiency of Purkinje cells in the cerebellum. Using Magnetic Resonance Imaging, Dr. Courchesne has found two areas in the cerebellum, vermal lobules VI and VII, which are significantly smaller than normal in autistic individuals. Interestingly, there are a some autistic individuals whose vermal lobules VI and VII are larger than normal. One or both of these areas of the cerebellum are believed to be responsible for attention.

With respect to biochemistry, many autistic individuals have elevated levels of serotonin in their blood and cerebral spinal fluid, whereas others have relatively low levels of serotonin. It should be mentioned that other disorders, such as Down Syndrome, attention deficit/hyperactivity disorder, and unipolar depression are also associated with abnormal levels of serotonin. There is also evidence that some autistic individuals have elevated levels of beta-endorphins, an endogenous opiate-like substance in the body. It is felt that those individuals who have an increased pain tolerance may likely be due to elevated levels of beta-endorphins.

A dysfunctional immune system has also been associated with autism. It is thought that a viral infection or an environmental toxin may be responsible for damaging the immune system. As mentioned above, there is also evidence of a genetic association to a compromised immune system. Researchers have found that many autistic individuals have a decreased number of helper t-cells which help the immune system fight infection.

There is growing evidence that the gut or intestinal tract of autism children is impaired. Researchers have documented yeast overgrowths (candida albicans), low levels of phenyl sulfur transferase, and measles virus in their intestinal tract.

Sensory impairments

Many autistic individuals seem to have an impairment in one or more of their senses. This impairment can involve the auditory, visual, tactile, taste, vestibular, olfactory (smell), and proprioceptive senses. These senses may be hypersensitive, hyposensitive, or may result in the person experiencing interference such as in the case of tinnitus, (a persistent ringing or buzzing in the ears). As a result, it may be difficult for individuals with autism to process incoming sensory information properly.

Sensory impairments may also make it difficult for the individual to withstand normal stimulation. For example, some autistic individuals are tactilely defensive and avoid all forms of body contact. Others, in contrast, have little or no tactile or pain sensitivity. Furthermore, some people with autism seem to 'crave' deep pressure. Another example of sensory abnormalities is hypersensitive hearing. Approximately 40% of autistic individuals experience discomfort when exposed to certain sounds or frequencies. These individuals often cover their ears and/or tantrum after hearing sounds such as a baby's cry or the sound of a motor. In contrast, some parents suspect their children of being deaf because they appear unresponsive to sounds.

Cognition

"Theory of mind" refers to one's inability to realize that other people have their own unique point of view about the world. Many autistic individuals do not realize that others may have different thoughts, plans, and perspectives than their own. For example, a child may be asked to show a photograph of an animal to another child. Rather than turning the picture around to face the other child, the autistic child may, instead, show the back of the photograph. In this example, the autistic child can view the picture but does not realize that the other child has a different perspective or point of view.

About 10% of autistic individuals have savant skills. This refers to an ability which is considered remarkable by most standards. These skills are often spatial in nature, such as special talents in music and art. Another common savant skill is mathematical ability in which some autistic individuals can multiply large numbers in their head within a short period of time; others can determine the day of the week when given a specific date in history or memorize complete airline schedules.

Many autistic individuals also have a narrow or focused attention span; this has been termed 'stimulus overselectivity.' Basically, their attention is focused on only one, often irrelevant, aspect of an object. For example, they may focus on the color of a utensil, and ignore other aspects such as the shape. In this case, it may be difficult for a child to discriminate between a fork and a spoon if he/she attends only to the color. Since attention is the first stage in processing information, failure to attend to the relevant aspects of an object or person may limit one's ability to learn about objects and people in one's environment.

Interventions

Over the years, families have tried various types of traditional and non-traditional treatments to reduce autistic behaviors and to increase appropriate behaviors. Although some individuals are given medications to improve general well-being, there is no primary drug which has been shown to be consistently effective in treating symptoms of autism. The most widely prescribed medication for autistic children is Ritalin, (a stimulant used to treat Attention Deficit/Hyperactivity Disorder). However, there are no double-blind controlled studies to demonstrate its effectiveness for those with autism.

The two treatments which have received the most empirical support are Applied Behavior Analysis (ABA; behavior modification) and the use of vitamin B6 with magnesium supplements. Behavior modification involves a variety of strategies, (e.g., positive reinforcement, time-out), to increase appropriate behaviors, such as communication and social behavior, and to decrease inappropriate behaviors, such as self-stimulatory and self-injurious behavior.

Vitamin B6 taken with magnesium has been shown to increase general well-being, awareness, and attention in approximately 45% of autistic children. There are also a number of recent reports about the benefits of another nutritional supplement, Di-methylglycine (DMG). DMG also seems to help the person's general well-being, and there are many anecdotal reports of it enhancing communication skills.

Some people with autism have excessive amounts of a type of yeast called 'candida albicans' in their intestinal tract. It is thought that high levels of candida albicans may be a contributing factor to many of their behavioral problems. One scenario is that when a child develops a middle ear infection, the antibiotics that help fight the infection may destroy microbes that regulate the amount of yeast in the intestinal tract. As a result, the yeast grows rapidly and releases toxins in the blood; and these toxins may influence the functioning of the brain. Excessive candida albicans can be treated with rather mild medications such as Nystatin.

Food intolerances and food sensitivities are beginning to receive much attention as possible contributors to autistic behaviors. Many families have observed rather dramatic changes after removing certain food items from their children's diet. Researchers have recently detected the presence of abnormal peptides in the urine of autistic individuals. It is thought that these peptides may be due to the body's inability to breakdown certain proteins into amino acids; these proteins are gluten (e.g., wheat, barley, oats) and casein (found in human and cow's milk). Many parents have removed these substances from their children's diets and have, in many cases, observed dramatic, positive changes in health and behavior.

As mentioned earlier, many autistic individuals have sensory impairments. Sensory integration techniques are often used to treat dysfunctional tactile, vestibular, and proprioceptive senses. Some of the techniques involve swinging a child on a swing in various ways to help normalize the vestibular sense and rubbing different textures on the skin to normalize the tactile sense. In addition, an autistic woman, Dr. Temple Grandin, developed a hug machine which provides the individuals with deep pressure which appears to have a calming effect on the person.

Many autistic individuals are also sensitive to sounds in their environment. They may hear sounds beyond the normal range and/or certain sounds may be perceived as painful. Auditory integration training, (listening to processed music for ten hours), is an intervention which is often used to reduce these sensitivities. Visual training is another sensory intervention designed to normalize one's vision. There are several different methods of visual training. One popular program, developed by Dr. Melvin Kaplan, involves wearing ambient (prism) lenses and performing movement exercises which appear to reorganize and normalize the visual system.

Conclusion

Autism is a very complex disorder; and the needs of these individuals vary greatly. After 50 years of research, traditional and contemporary approaches are enabling us to understand and treat these individuals. It is also important to mention that parents and professionals are beginning to realize that the symptoms of autism are treatable--there are many interventions that can make a significant difference.

The logo for the national parent support group, the Autism Society of America, is a picture of a child embedded in a puzzle. Most of the pieces of the puzzle are on the table, but we are still trying to figure out how they fit together. We must also keep in mind that these pieces may fit several different puzzles.