AUTISM SPECTRUM DISORDER (ASD): A GENERAL OVERVIEW

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AUTISM SPECTRUM DISORDER (ASD) A GENERAL OVERVIEW

• A PAPER PRESENTED BY
• OKEY-MARTINS NWOKOLO
• Mphil/Ph.D student, Developmental Psychology
  Department UNILAG.
• Programme Supervisor, Acceleration Therapy,
  Lagos.
• E-mailizuogu44_at_yahoo.co.uk Cell 08039112839

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WHAT TO EXPECT

• INTRODUCTION
• WHAT IS AUTISM SPECTRUM DISORDER (ASD) ?
• DIAGNOSTIC CRITERIA FOR PERVASIVE DEVELOPMENTAL
  DISORDERS (APA, 2000)
• THE TRIAD OF IMPAIRMENT/SYMPTONS OF ASD
• ADDITIONAL FEATURES COMMON WITH ASD
• WHAT CAUSES ASD?
• SOME FACTS ABOUT ASD
• DETECTING ASD AT AN EARLY AGE
• EARLY SIGNS TO LOOK FOR
• OBSERVATIONS TO MAKE
• MAKING A COMPREHENSIVE ASSESSMENT
• INTERVENTION STRATEGIES
• REFERENCES

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• INTRODUCTION  The term autism is scary. It is
  replete with stigma, fear, frustration and
  controversy. Stigma against persons and families
  with autism. Fear for parents who are worried
  over the future of their child diagnosed with
  autism and frustration for parents and teachers
  who struggle daily with the challenging
  behaviours and demands of supporting children
  with the condition. The controversial image of
  autism is even more serious and concerns
  professionals(including medical doctors)
  differences in opinion regarding definition,
  causes presences, intervention and cure. This
  situations leaves parents even more confused. Yet
  , they are interested in knowing more about their
  childs development and pediatric practitioners
  in Nigeria need to better prepared for this. The
  best thing you can do for these children and
  their families is to keep abreast on current
  developments in the filed and make informed
  decision about treatment.

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WHAT IS AUTISM SPECTRUM DISORDER ?

• Autism was first described by Leo Kanner of Johns
  Hopkins in 1943. He identified it as a disorder
  with impairment in 1.     Reciprocal Social
  Interaction 2.     Language and Communication
  development 3.     Behaviour development.
   Autism is actually a subtype of a class of
  disorders known as Pervasive Developmental
  Disorder (PDD.) and there are 5 of these
  disorders. 1. Autism (Autistic disorder)
  2.     Asperger Syndrome 3.     Retts disorder
  also called Retts syndrome4.     Childhood
  Disintegrative (CDD) Sometimes referred to as
  Hellers syndrome or disintegrative
  psychosis 5.     Pervasive Development
  Disorder Not Otherwise Specified (PDD.Nos)
  sometimes called a typical autism. Although the
  term Autistic Spectrum Disorders (ASD) has
  gained acceptance and is now used to mean the
  same thing as PDD, it is not yet an official
  diagnostic label. This means that you cant find
  the term ASD in either the Diagnostic and
  Statistical Manual of mental disorder (DSM. IV)
  or the world health organizations International
  Classification of Disorder (ICD).

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DIAGNOSTIC CRITERIASEE LEAFLET
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THE TRIAD OF IMPAIRMENT
.SYMPTOMS OF ASD LANGUAGE AND
COMMUNICATION        Child may not babble, may
be mute         The development of speech and
language may be abnormal delayed or absent
        May act as though deaf / or not respond
when called by name or even by gesture.       
May echo or repeat words, phrases, sentences / or
questions over and over again echolalic speech.
        Facial expressions and gestures may be
unusual or absent         Incorrect
understanding of speech . Words may be used
incorrectly         Production of speech may be
unusual. A flat monotonous tone or inappropriate
variation is tone are of noted        
Difficulties in initiating and or sustaining
conversations.  SOCIAL INTERATION       
Prefers to play alone         Little awareness
of others or of their feelings        
Difficulty in forming relationships.       
Theory of mind issues         Indifference to
or dislike being held, cuddled or hugged
        The most severe form in aloofness and
indifference to others, although most show an
attachment in a simple level of family members or
careers.
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BEHAVIOR AND IMAGINATION Symbolic or
imaginative play may be limited or absent e.g.
cannot play with a match box as if it is a
car.May be routine bound. Insist on sameness
and resist change. Do not tolerate change in
routine or environment as this may cause
distress. E.g. changing his toy, school bag or
position of furniture.Inappropriate use of toys
in play.Morbid attachment to objects may hold
onto a teddy for the whole day.Throw tantrums,
screams often for no apparent reason.A tendency
to focus on minor or trivial aspects of things in
the environment, instead of being aware of the
meaning of the complete situation.
Hyperactivity or under-activity.May have a
limited interest and range of activities. E.g.
only interested in building legos.Some may have
exceptional abilities e.g. outstanding memory of
calendars, dates, painting, computing arithmetic,
music, etc.
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ADDITIONAL FEATURES

• Odd response to sensory input e.g. covering
  ears.
• Engaging in self injurious behaviors e.g. head
  banging, hand biting, face/head slapping.
• Stereotypical behaviors e.g. hand flapping,
  incessant rocking, jumping up and down, aimless
  wandering.
• Repetitive/compulsive patterns of behavior
  opening and closing door.
• Repetitive lining of objects such as legos,
  finger twisting or curling.
• Language and or social regression e.g. sudden
  loss of previous ability to point, kiss, eye
  contact, etc.
• Walking on toes
• Sleep disturbances
• Bizarre eating patterns food fads
• Poor muscle tone e.g. clumsy with picking up
  small objects
• No real fear of dangers may run into a moving
  car or put finger on a burning gas.

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WHAT CAUSES AUTISTIC SPECTRUM DISORDER?No one
has been able to answer this question precisely
and conclusively. The complex and pervasive
nature of the disorder makes it even more
complicated to pin-point the exact cause or
causes. It would appear that ASD occurs as the
result of varied and different biochemical causes
and presents as malfunctioning of the brain (ASA,
2003).

• ASD is definitely NOT the result of bad parenting
  and children with ASD do not just choose to
  misbehave. This had been the impression during
  1950s.
• Volkmar and Wielsner (2004) gave the following as
  evidence that autism was a brain-based disorder
• The prevalence of seizures As children with
  autism were followed over time, it was clear that
  many of them went on to develop seizures.
• The prevalence of neurological problems Many
  children with autism exhibit unusual features on
  neurological examination such as persistent
  primitive reflexes(which are present at birth
  but typically disappear in children after a few
  months).
• The high rate of prematurity or other birth
  problems Some studies have reported that
  children with autism are more likely to have had
  complications during the pregnancy or after
  birth.
• The association of autism with a number of
  medical conditions that are known to affect brain
  development e.g. phenylketonuria, congenital
  rubella, tuberous sclerosis, and fragile x
  syndrome. These associations are strongest with
  fragile x syndrome and tuberous sclerosis but
  research is ongoing.

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GENETICS AND ENVIRONMENTAL FACTORS

• There is evidence that genetic factors are very
  much involved in autism.Research on genetics of
  autism suggest that the predisposition to develop
  autism can be inherited, and that a range of
  other problems in language, learning, and
  social interaction might also be inherited.
• There is currently much controversy and interest
  in the question of whether the environment can
  cause autism.Some reports suggest a link between
  immunizations or exposure to mercury in vaccines
  and autism. My opinion in this matter would be
  that Nigerian professionals should find out why
  many states in USA outlaw thimerosal. Also ,it
  may be needful to reevaluate the quality of
  vaccines that our children are getting in terms
  of ensuring that they are of the safest
  standards..and not rejected commodities from the
  west and USA. Furthermore, we might need to check
  or review the safety levels our current
  immunization schedules.
• The Center for Autism and Related Disabilities
  (CARD) listed many biochemical factors that may
  be implicated in the etiology of autism,e.g.
  allergens,leaky gut,vaccines, etc. More
  information can be obtained from their
  website(see reference)

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SOME FACTS ABOUT AUTISM

• Autism is the third most common developmental
  disorder, following mental retardation and
  cerebral palsy.
• Autism as yet, has no known medical test or cure
  but is TREATABLE.
• It occurs more in males than in females at a
  ratio of 41
• It appears to have 2 forms
• (a) Infantile/static In which case
  symptoms are present from birth.
• (b) Regressive In this case, there is an
  actual loss of previously learned skill. May
  present from fifteen months to two and half
  years.
• Autism has no boundaries . It can affect anybody
  regardless of social status, religion, country or
  creed.

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NEED FOR EARLY DETECTION OF ASDEarly diagnosis
and appropriate intervention leads to great
positive outcomes.Research has shown that the
earlier the intervention the better the prognosis.

• Children do not simply outgrow ASD
• It appears to be a deteriorating conditionsome
  describe it as progressively degenerative.
• The human brain is very plastic. Prior to age 5,
  major neural networks are possible (Volkmar and
  Wiesner,2004). If a child does not develop or use
  certain tracts in the brain during these critical
  time limit, he may never fully do so. Obviously,
  children between 6 and 10 or more do improve, but
  it is a slower process, often requiring more
  effort to learn the basics ,and grow up
  developmentally. From personal experience, I
  cant say that I have the same top hope for a
  patient who is 9 or 10 that I may have for a 2-4
  year old.

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EARLY SIGNS TO LOOK FOR Although there are
individual differences,some characteristics
appear to be universal among children with a
high risk of developing ASD.

• Child does not babble or point at 12 months.
• Child does not use single words at 16 months.
• Child does not try to imitate words, scribbling
• Child shows regression or loss of previously
  learned skill.
• This may be language regression (e.g. stopped
  using words) or social regression (e.g. stopped
  pointing, kissing, etc.)
• Acts as deaf or does not respond to name when
  called
• Avoids eye contact
• Does not take interest in other children
• Does not like to be swung, cuddled, or bounced on
  knees
• Does not play appropriately with toys (e.g.
  cars) but only mouths, fiddles or drops them.

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OBSERVATIONS TO MAKEDuring your observation of
the child notice the following

• Does the child recognize your presence?
• Does he respond toHello or a handshake?
• Does he make eye contact
• Does he point or follow your pointing
• See the Checklist for Autism in Toddles (CHAT)
  at www.featnt.org/info/chattest.asp

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COMPREHENSIVE ASSESSMENTSIf your suspicion of
autism is still strong, you may consider more
specialized assessments by members of other
disciplines. Service providers such as
Acceleration Therapy, Lagos, may be helpful as
well.A comprehensive assessment will normally
involve the following

• History
• Medical Assessments
• Psychological Assessments
• Speech-Language Communication Assessment
• Occupational and Therapy physical Assessments

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Considering that the audience is made up of
mostly medical personnel, it might be necessary
to outline some of the recommended medical tests
for Autism. There is no specific medical test
for ASD. However, once you have a suspicion of
autism, you may want to run some recommended
tests to rule out other possible causes. Doctors
may check for

•      Lead levels
•         Hearing
•         MRI scan
•         EEG- for possible seizures
•         Fragile x syndrome 5-10 of children
  with ASD present with
• fragile x.
•     Metabolic Screening Some treatable
  metabolic disorders may result in the
  manifestation of ASD.
•       Chromosomal Testing
•       Immunological dysfunction Allergens such
  as gluten and casein may be affecting the
  childs behaviour

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INTERVENTION STRATEGES

• To date, (medically speaking) there is no cure
  for ASD. Behaviour and Educational intervention
  approaches have proved beneficial to most
  children on the spectrum. Research has shown that
  approaches such as ABA, which offer structured
  intensive programming can be extremely helpful .
• There are however, numerous other approaches
  which have been beneficial for some people with
  ASD. Some of the techniques overlap but there are
  basically two approaches those that attempt to
  change the child and those that attempt to change
  the environment for the benefit of the child. The
  latter has gained more research acceptance.
• Intervention techniques which have been found to
  be beneficial to people with ASD, include
•      Lovaas (ABA)
•      Specialized Education
•      Behaviour modification
•     Occupational therapy
•      Speech Language and communication therapy
  
•     Auditory integration
•     Relationship Development Intervention (RDI)
•     Picture Exchange communication system (PECS)
• TEACCH (Treatment and Education of Autistic and
  Related Communication Handicapped Children)

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Sensory Integration Vitamin therapy Dietary
modification etc Option Institute (Son Rise
Programme) Drug treatments. Autism is here
with us. More and more children are being
reported to be on the spectrum. My biggest wish
today is that everyone here will become an
advocate for these vulnerable children and
families. We need to get parents out of shame and
denial. We need to campaign for availability of
appropriate services. We need to educate the
government and the public about ASD, we need to
get schools to open their gates for our children.

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REFERENCES American Psychiatric Association
(APA). 1994. The Diagnostic and Statistical
Manual of mental disorders. 4th ed. (DSM-IV)
Washington D.C. APA Autism South Africa (2003)
My Child May be affected by Autism Spectrum
Disorder (information for parents). CARD (2004)
Biochemical Flowchart http//www.centerforautism.
com /biological / biochemical/ Jordan, R.
(1997). Education of Children and Young People
with Autism Birmingham Volkmar, F.R, and
Wiesner, L.G. (2004). Healthcare for Children on
the Autism Spectrum. Bethesda, Woodbine House.
 Wing. L. (2003) The Autism Spectrum. A, guide
for parents and professionals. Wing. L. (1993).
Autistic Spectrum Disorders An Aid to
Diagnosis. Wing, L., and Atwood. T. (1987).
Syndromes of autism and atypical development. In
D. Cohen and A. Donnell an, editors. Handbook of
autism and pervasive development disorders. New
York John Wiley Sons, 3-19.
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THANKS FOR LISTENINGYours in pursuit
of hope and help for children in Nigeria with
ASD.