Understanding autism

By

Malai Haji Abdullah bin Malai Haji Othman

Senior Nursing Officer

Ministry of Health

There is no theory of the cause of autism which everyone has found convincing. There may be multiple causes. Thus we will review some of the proposed causes.

Most researchers are absolutely convinced that the cause is biological rather than psychological.

Bernard Rimland in his book, "Infantile Autism", cited the following evidence for a biological genesis and against the idea that parents cause their children to be autistic:

- Some clearly autistic children are born to parents who do not fit the autistic parent personality pattern.
- Parents who do fit the description of the supposedly pathogenic parent almost invariably have normal, non-autistic children.
- With very few exceptions, the siblings of autistic children are normal.
Autistic children are behaviourally unusual "from the moment of birth".
- There is a consistent ratio of three or four boys to one girl.
- Virtually all cases of twins reported in the literature have been identical, with both twins afflicted.
- Autism can occur or be closely simulated in children with known organic brain damage.
- The symptomatology is highly unique and specific.
- There is an absence of gradations of infantile autism which would create "blends" from normal to severely afflicted.

Points four and nine are not generally accepted now, perhaps because of the broadening of the condition's definition over time, and perhaps because of additional observation & data collection.

There is still controversy over neurological differences in the brains of autistic people and the rest of the population.

However, it does appear from evidence obtained through autopsies, MRI and PET scans that there are subtle cellular changes in the autistic brain.
The increased incidence of seizures (20-30 per cent develop seizures in adolescence) also points to neurological differences.

Some specific theories as to the cause of autistic symptoms:
- Yeast infections.
- Intolerance to specific food substances.
- Gluten intolerance ("leaky gut syndrome"), casein intolerance causing intestinal permeability and allowing improperly digested peptides to enter the bloodstream and cross the blood-brain barrier which may mimic neurotransmitters and result in the scrambling of sensory input. I've also heard "Leaky Gut Syndrome" described as lack of the beneficial bacteria that aids digestion, and that the resulting matter in the bloodstream invokes an unnecessary immune reaction.

Phenolsulphortransferase (PST) deficiency theory that some with autism are low on sulphate or an enzyme that uses this, called phenol-sulphotransferase-P. This means that they will be unable to get rid of amines and phenolic compounds once they no longer have any use for them. These then stay in their body and may cause adverse effects, even in the brain. Treatment is dietary as well as epsom salts baths.

A phrase you will sometimes hear is "theory of mind" or "the theory of mind hypothesis". This is not so much a supposed cause of autism as an assertion as to its nature. The basic idea of the hypothesis is that autistic people lack an awareness of other people's minds that typical people start developing at a relatively young age, that is, the autistic person doesn't so readily develop theories about what is going on in other people's minds. A corollary is that an autistic person's awareness of other people's minds is something that is developed intellectually through their own efforts.
Furthermore, adherents of this theory suppose that some or all the other typical characteristics of autism stem from this one main deficit. The hypothesis is explained in some books (some have "Theory of Mind" in the title, also Uta Frith has written on it and simple tests have been devised to test a person's awareness of other minds.

These are the frequently asked questions by members of the public with regards to autism and I will try to address some if not all of the questions.

What is Autism?
Autism is a life-long developmental disability that prevents individuals from properly understanding what they see, hear, and otherwise sense. This results in severe problems of social relationships, communication, and behaviour.

Individuals with autism have to painstakingly learn normal patterns of speech and communication, and appropriate ways to relate to people, objects, and events, in a similar manner to those who have had a stroke.

What are the characteristics of autism?
The degree of severity of characteristics differs from person to person, but usually includes the following:
Severe delays in language development
Language is slow to develop, if it develops at all. If it does develop, it usually includes peculiar speech patterns or the use of words without attachment to their normal meaning. Those who are able to use language effectively may still use unusual metaphors or speak in a formal and monotone voice.
Severe delays in understanding social relationships
The autistic child often avoids eye contact, resists being picked up, and seems to "tune out" the world around him. This results in a lack of cooperative play with peers, an impaired ability to develop friendships, and an inability to understand other people's feelings.
Inconsistent Patterns of sensory responses
The child who has autism at times may appear to be deaf and fail to respond to words or other sounds. At other times, the same child may be extremely distressed by an everyday noise such as a vacuum cleaner or a dog's barking. The child also may show an apparent insensitivity to pain and a lack of responsiveness to cold or heat, or may over-react to any of these.
Uneven patterns of intellectual functioning
The individual may have peak skills - scattered things done quite well in relation to overall functioning - such as drawing, music, computations in math, or memorisation of facts with no regard to importance or lack of it.
On the other hand, the majority of autistic persons have varying degrees of mental retardation, with only 20 per cent having average or above-average intelligence. This combination of intellectual variations makes autism especially perplexing.
Marked restriction of activity and interests
A person who has autism may perform repetitive body movements, such as hand flicking, twisting, spinning, or rocking. This individual may also display repetition by following the same route, the same order of dressing, or the same schedule every day. If changes occur in these routines, the preoccupied child or adult usually becomes very distressed.
Autistic children display unusual behaviour. A typical autistic child's behaviour is likely to include: no speech; non-speech vocalisations; delayed development of speech echolalia; delayed echolalia: repeating something heard at an earlier time; confusion between the pronouns "I" and "You"; lack of interaction with other children; lack of eye contact; lack of response to people; treating other people as if they were inanimate objects; when picked up, offering no "help" ("feels like lifting a sack of potatoes"); preoccupation with hands; flapping hands; spinning; balancing, such as standing on a fence; walking on tiptoes; extreme dislike of certain sounds; extreme dislike of touching certain textures; dislike of being touched; either extremely passive behaviour or extremely nervous, active behaviour; extreme dislike of certain foods; behaviour that is aggressive to others; lack of interest in toys; desire to follow set patterns of behaviour/interaction; desire to keep objects in a certain physical pattern; repetitive behaviour (perseveration); self-injurious behaviour; and "Islets of competence", areas where the child has normal or even advanced competence, such as drawing, music, arithmetic and memory.

There are other conditions which sometimes coincide with autism: synesthesia (an unexpected sensation arises when a particular sense modality is stimulated); and cerebellar abnormalities revealed by MRI scans raised levels of serotonin in the brain

What causes autism?
Autism is a brain disorder, present from birth, which affects the way the brain uses information. The cause of autism is still unknown. Some research suggests a physical problem affecting those parts of the brain that process language and information coming in from the senses. There may be some imbalance of certain chemicals in the brain. Genetic factors may sometimes be involved. Autism may indeed result from a combination of several "causes". No factors in the psychological environment of the child cause autism.

How common is autism?
Autism is one of the four major developmental disabilities. It occurs in one to two of every 1,000 births.

Who is affected with autism?
Autism is distributed throughout the world among all races, nationalities, and social classes. Four of every five people with autism are male.

What is the most common problem in autism?
Individuals with autism have extreme difficulty in learning language and social skills and in relating to people.

How does autism affect behaviour?
In addition to severe language and socialisation problems, people with autism often experience extreme hyperactivity or unusual passivity in relating to parents, family members, and other people.

How severe are behavioural problems in people with autism?
In autism, behavioural problems range from very severe to mild. Severe behavioural problems take the form of highly unusual, aggressive, and in some cases, even self-injurious behaviour. These behaviours may persist and be difficult to change.
In its milder form, autism resembles a learning disability. Usually, however, even people who are only mildly affected are substantially handicapped due to deficits in the areas of communication and socialisation.
Does autism occur in conjunction with other disabilities?
Autism can occur by itself or in association with other developmental disorders such as mental retardation, learning disabilities, and epilepsy.
Autism is best considered as a disability on a continuum from mild to severe. The number of handicaps and degree of mental retardation will determine the location on that continuum.
What is the difference between autism and mental retardation?
Most people with mental retardation show relatively even skill development, while individuals with autism typically show uneven skill development with deficits in certain areas - most frequently in their ability to communicate and relate to others - and distinct skills in other areas.
It is important to distinguish autism from mental retardation or other disorders since diagnostic confusion may result in referral to inappropriate and ineffective treatment techniques.

Can people with autism be helped?
Yes, autism is treatable. Studies show that all people who have autism can improve significantly with proper instruction. Many individuals with autism eventually become more responsive to others as they learn to understand the world around them.

How can persons with autism learn best?
Through specially trained teachers, using specially structured programmes that emphasise individual instruction, persons with autism can learn to function at home and in the community. Some can lead nearly normal lives.

What kinds of jobs can individuals with autism do?
In general, individuals with autism perform best at jobs which are structured and involve a degree of repetition. Some people who have autism are working as artists, piano tuners, painters, farm workers, office workers, computer operators, dishwashers, assembly line workers, or competent employees of sheltered workshops or other sheltered work settings.

What leisure activities do persons with autism enjoy?
Individuals who have autism often enjoy the same recreational activities as their non-handicapped peers. They usually like music, swimming, hiking, camping, working puzzles, and playing table games.

What services are available for people with autism in Brunei Darussalam?
The Child Development Centre (CDC) of Ministry of Health, The Special Education Unit of Ministry of Education as well as Pusat Bahagia of Ministry of Culture, Youth and Sports, there are also organisation such as KACA and Pusat Ehsan.
There are school classrooms, social skills training, job training, and life planning services for persons with autism in Brunei Darussalam for persons with autism provided by SMARTER Brunei.

What additional services are needed for children with autism in Brunei Darussalam?
Children with autism need: respite care; before- and after-school care; recreational programmes; and prevocational training.
What do people with autism need when they become adults?
Adults with autism need: vocational training; job opportunities; and recreational opportunities.

How can people who have autism learn meaningful job skills?
With the help of specially trained job coaches, people with autism can learn skills that will enable them to successfully work in competitive employment, supported employment, or in sheltered workshop programmes.

In what ways can persons with autism have relative independence in living?
They can learn skills to live as independently as possible through specifically designed programmes in appropriate centres and supervised home programmes.

What groups in Brunei Darussalam working to help people with autism?
Besides the CDC of Ministry of Health, the Special Education Unit of Ministry of Education as well as Pusat Bahagia of Ministry of Culture, Youth and Sports, there are also organisation such as KACA and Pusat Ehsan, while SMARTER Brunei, which is a family support group comprising parents, professionals, students, and others, focusses only on dealing with autism spectrum disorder and its existence is to raising the visibility of autism and broadening services for individuals who have autism.
The organisation furnishes support to parents, siblings, and professionals in the form of information and referral, autism spectrum disorder centre for early intervention programme, intermediatery intervention programme and also high functioning intervention centre, job coach services, public education, advocacy for adult centre and life planning services, and news and information to everyone.

Source: Weekend 4 April 2009