BY RICK VOAKES, MD

Health-Bytes      

Autism Spectrum Disorders

There is a spectrum or range of disorders that look like autism and have shared features of autism. These include Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder. Autism Spectrum Disorders (ASD’s) may be associated with certain other diseases such as Fragile X Syndrome, Rett Syndrome, Angelman Syndrome, Landau-Kleffner Syndrome, congenital rubella, PKU, or tuberous sclerosis. About 1 in 120 children have some form of autistic condition.

Children with autism have a higher chance of developing other medical and behavioral problems as well. They are more likely to get a seizure, or develop a tic disorder (involuntary movements). They have more stomach problems such as diarrhea, constipation, food allergies and GERD (reflux).

WELLNESS

FOR KIDS AND ADULTS

© RICK VOAKES 2021

What are the signs of autism?

Social deficits:

Doesn't snuggle, arches back when held

Very little eye contact

Doesn't smile back

Doesn't look at objects that parents point to

Doesn't show or point to objects for others to see

Unable to perceive feelings of others

Doesn't show concern for others

Unable or difficult to make friends

Communication problems:

Doesn't say any words until after 15 months

No 2-word phrases before 24 months

Flat vocal quality, little expressivenessor odd intonation

Responds to noises but not to his name being called

Refer to self as "you", and others as "I"

Doesn't want to communicate

Doesn't start a conversation

Doesn't use toys to represent people in pretend play

May have a good rote memory for numbers, songs, etc

May regress or lose language skills between 15-24 months

Behavioral differences:

Repetitive behaviors (rocking, spinning, swaying, twirling fingers)

Likes routines or rituals

Obsessed with a few activities that are repeated many times per day

May read at an early age but does not understandwhat it means

Doesn't cry if in pain

Unusual or intense but narrow interests

Plays with parts of toys, rather than the whole toy

Looks at objects from odd angles

Behavior regresses after 12-15 months (for example, stops saying words)

Lack of pretend play by 18 months

Many kids with ASD have sleep disorders (not enough REM sleep)

Eating problems, which may lead to constipation or diarrhea

Is there a test for autism?

Unfortunately, no, but the signs listed above, and many other signs, can lead to the diagnosis by a qualified developmental specialist.

What causes autism?

The exact cause is not known, but we do see a tendency for it to run in families. The sibling of a child with ASD has a risk of developing ASD which is 10 times higher than the general population, and may also be at higher risk for other developmental problems. There are changes seen on some imaging tests of the brain (such as MRI or PET scans) but these changes are not specific enough to be diagnostic or to show what the actual cause of autism is.

Some doctors in England once thought (back in the 1980's) that Autism might be related to certain vaccines, however this theory has now been completely proven false. Several large studies show no difference in the number of children with autism, whether or not they received vaccines.

What treatments are available?

There are no medications known that can improve the symptoms of autism. Sometimes medications are used to treat other problems that a child may have in addition to their autism, such as using stimulants if they have ADHD as well. Sometimes melatonin or Clonidine are used to help with sleep disorders associated with autism.

The major thrust of therapy is to help children learn to deal with their disabilities in each area. Autism clinics or therapists can train children with ASD's to improve their communication skills, work on specific developmental and behavior challenges, and develop better social skills.

Another form of therapy addresses the problems that autistic children have with sensory-motor integration. They may have extreme over-reaction to touching or noises. Therapies that use weighted vested, colored glasses, deep pressure, brushing or swinging have been occasionally successful, but no scientific studies have shown a consistent improvement. Obviously more investigation needs to be done, but the American Academy of Pediatrics currently does not endorse any of these treatments.

Applied Behavioral Analysis (ABA Therapy)

At the current time, the most promising therapy for improving the symptoms of autism is ABA, or Applied Behavioral Analysis therapy. This uses one-on-one learning sessions with a therapist who uses positive rewards for strengthening the child’s social skills, communication skills, and reducing negative behaviors.

Some parents fear that behavioral therapy will stifle a child’s creativity. That is not the goal of ABA therapy, in which a child’s creativity could be more easily expressed to others through teaching communication skills, while reducing disruptive behaviors.

Beware of phony treatments!

Families with autistic children are often desperate to find a treatment for their child, especially when traditional treatments are very slow to show progress. About 50% of families with ASD children are using some form of alternative medicine. Some of these treatments may seem to help, even though scientific studies fail to show any consistent results in large groups of child. However, it is important to inform your pediatrician about any alternative treatments, especially if they involve ingesting any substances, since even "natural" or "herbal" treatments can have serious or even fatal side effects. Even something that sounds harmless like vitamins could be toxic if given in large doses.

Some treatments are benign, but just don't have any proven effectiveness, and might drain a family's financial resources. Beware of costly treatments that do not have any scientific basis.

Gluten-free casein-free diet has been touted as a treatment for autism, but there are not yet any reliable studies, and the treatment is still considered controversial. Sometimes dietary changes or using probiotics may be needed to control stomach symptoms, such as constipation or lactose intolerance which are more common in ASD. So far no drugs have been proven effective in treating autism. Secretin has been tried, but several studies have that it does not work. Several other drugs are being tested now but nothing looks promising yet.

Auditory integration training (AIT) involves listening to filtered music in a booth over a period of time. There is no evidence that this is effective at all.

Facilitated communication (where a "facilitator" is used to help a child communicate) is largely a hoax. This is different fromaugmentative communicationwhere a child learns to use a letter board or computer to communicate. This is a helpful technique.

Source: Understanding Autism Spectrum Disorders (ASD's) published by the American Academy of Pediatrics.

Autism Support Group for Bowling Green

Contact Karen Thomas at karenmthomas@bellsouth.net or call 270-781-2118.

We meet severaltimes each year on the second Sunday of the month at 2:00 p.m. Our meeting location is usually the BG Public Library on State Street in the conference room. Any parents, family members or professionals are always welcome.We sometimes have a speaker but alwayshave ample time during the meeting forparents to sharetheir current questions and concerns.

A Parent's Perspective

(Submitted by Lisa Logsdon)

As a parent of an autistic child, I know that it is often difficult to find the help that a child needs. Consider the following:

Many necessary therapies such as speech and occupational therapies are very expensive, and young children often need weekly visits. Most insurance companies cap payment for autism services at $500 each month, so even families that have health insurance struggle to meet the needs of their autistic children. Impact Plus and Medicaid offer excellent healthcare insurance for families that qualify. Community based services canprovide more information.

Phoenix Rehab Group in Bowling Green is especially interested in sensory integration therapy. The objective is to help autistic kids make sense of their environment and desensitize them if they have sensory issues.

WKU offers low cost speech therapy and IQ testing.

Kelly Autism Center is supposed to help older children with autism. ( This is primarily for teens and up.)

There is a parent support group that meets in BG every month at the State Street Public Library. Allen County has one that meets the third Saturday of each month at the Scottsville Community Center.

The WCEC (Weiskopf Child Evaluation Center) and Vanderbilt both offer multidisciplinary evaluations, but often the waiting list is lengthy. I waited almost eight months for an appointment at WCEC.

New Beginnings Therapeutic Riding in Bowling Green (Drake's Creek,actually) is a certified facility that offers recreational therapy that is customized for each child's need. My child is starting his third year with them, and it has done wonders for a wide variety of problems including social skills, balance, fear of animals, and fear of crowds. It has also helped his interest in reading and writing because now he has an interest in something other than the usual obsessions. Scholarships are available for those who have financial need.

Books, books and more books. There are so many good ones out there. Anything by Temple Grandin is especially helpful to parents who want to understand the world from the autistic point of view. BG Public Library has many books on autism.