Autism

Published in Katy Family Magazine, 2006

Autism. You read the word and thought, “Rainman” then you thought “spinning, head banging, retarded.” It is sometimes both and occasionally neither.

Autism is a spectrum disorder and like other such disorders, depression, anxiety and even chronic pain, it varies in types of symptoms and severity. We are only just beginning to understand Autism and we may ultimately learn that it is several disorders with same, similar or entirely different causes.

The wide range of symptoms, variable results of diagnostic testing and difference in time of symptom onset support the hypothesis that Autism is a broad category potentially encompassing many disorders. Children and adults with Autistic Spectrum Disorders may have normal to above normal intelligence with symptoms limited to trouble with social interaction. Others may have varying degrees of learning disorders or mental retardation.

Mark was 7-years-old when he was referred to our practice. An attractive boy, he sat transfixed by his Gameboy as his mother described her frustration with his obsessional behaviors and his inability to make friends. Mark had also become increasingly aggressive when told “no” or in response to changes in routine. Mark’s mother believed his aggression had been aggravated by placement in emotionally disturbed/special education classes.

Overfocused, compulsive or repetitive behaviors such as Mark’s obsession with his Gameboy are classic autistic symptoms. Other common repetitive behaviors are fascination with movement or with certain patterns; self-injurious behaviors like head banging; and repeating words or phrases. The cause of these symptoms remains uncertain. In some cases they may be soothing coping mechanisms. They may represent attempts to communicate. In still other cases they may be a behavioral expression of internal anxiety.

Many autistic children are thought to be mentally retarded and certainly some are. However, many if not most have normal intelligence. Their trouble lies in their lack of ability to effectively communicate. Communication problems take many forms including lack of speech, stereotyped speech and/or poor social engagement.

By the time we reach adulthood we have learned the rules of social engagement. Almost by instinct we know how to interpret facial expressions, tone of voice and body language. We are acutely aware of body space and social distance. We understand the meaning of touch and know how and when to touch others. Autistic patients have what may be called a “social learning disability.” Like Mark, they may intrude into others’ space, may seem aggressive in their touch, become either overwhelmed by environmental stimuli or be unresponsive to it. Lack of ability to socially engage results in impaired academic learning and is an enormous barrier to forming normal relationships.

Impaired communication and failure of socialization contribute to the mischaracterization of many children as being retarded. Inappropriate placement in emotionally disturbed/special education classes may increase their frustration and contribute to the familiar complaint parents have that their children are “learning bad behavior” or are becoming more aggressive. Both observations may be accurate.

All children learn by imitation. Like a blind person whose hearing is extremely acute, autistic children may also have increased sensitivity to sound, speech or movement. They may therefore be more vulnerable to what they see or hear.

Frustration is almost certainly another source of aggression. Children with normal intelligence who are placed in emotionally disturbed/special education will be underchallenged which in turn leads to boredom, agitation and decreased self-esteem. Impaired communication skills and poor social awareness compounds the problem and may result in aggression as the mechanism of communicating frustration.

Research indicates the rate of autism is increasing. Current estimates are that 1 in 166 American children will have an autistic spectrum disorder. This represents a doubling of the rate one decade ago. Improved methods of diagnosis have certainly contributed to the increased number of autistic children. Environmental insults and genetic make-up are also involved.

Brain imaging studies (MRI, SPECT and others) have revealed some interesting abnormalities in autistic brains. Some areas (frontal lobes and amygdala) are enlarged, poor coordination between various regions of the brain and a tendency to process information differently through variant neural pathways. These brain abnormalities may explain the increased obsessive-compulsive symptoms and anxiety autistic people suffer from. They may also give insight into the issues of social difficulty, learning problems and information processing abnormalities.

As the incidence of autism has increased so has the number of “magic bullets,” “naturopathic and dietary miracle cures,” and special programs promising remarkable improvement and symptom reduction. Unfortunately, parents are easily victimized initially by the shock, anger and grief over their child’s diagnosis and then by these costly sham “cures.”

Autism is a “whole brain” disorder and is much more common and every bit as serious as juvenile diabetes. Like any other debilitating illness the key to best outcome is early intervention. If you suspect your child may be autistic the most important step you will make in his or her life is to get an accurate diagnosis and to get it as early as possible.

At Brainwaves Neuroimaging Clinic we believe in a complete multidisciplinary evaluation. We use brain imaging as a clinical and research tool. Brain SPECT imaging allows us to visualize brain function, to see areas that are over or underactive. Based on the pattern of findings, we are able to make a more accurate diagnosis and a more specific treatment plan. SPECT results may be correlated to other types of imaging studies such as MRI or qEEG.

Diagnostic interview with a clinician experienced with Autistic Spectrum Disorders is another vital component of a complete evaluation. The clinician reviews family and patient past and current history, interviews care providers, goes over school records and any results of any previous testing and treatment.

Psychological testing helps identify learning disorders, documents IQ and with academic planning. Because many patients with suspected autism have difficulty with communication, attention span and with disruptive behaviors, it is again very important that the psychologist is experienced with Autistic Spectrum Disorder.

Based upon results of the initial interviews and studies, additional testing (medical, laboratory and so forth) may be recommended.

When evaluation is completed a multidisciplinary plan that addresses medical, psychological and social and academic needs is developed. For optimal outcome, this process must be done as early in life as possible and by a team of professionals familiar with Autism and Autistic Spectrum Disorders.

Lisa C. Routh, M.D.