Understanding Autism Spectrum Disorder
April 2 is designated as “World Autism Awareness Day.” This year is the 14th commemoration to help raise awareness of this condition and fundraise on behalf of on-going research to better understand autism and advance its treatment. The Center for Disease Control reports that 1 in 54 children and 1 in 45 adults in the United States has Autism Spectrum Disorder (ASD). But what exactly is autism, what are some of the symptoms, and how is it treated?
In the early 1940s two doctors, one at John Hopkins University, Leo Kanner, and Hans Asperger in Germany began observing children that displayed certain “emotional or social differences.” Kanner termed the condition autism (from the Greek word “autos,” meaning “self”), to describe the tendency to withdraw, which was noticeable in the children he was studying. Around the same time, Asperger’s syndrome, named after Hans Asperger, was introduced into our vocabulary to describe a similar condition.
For decades, autism and schizophrenia were thought to be related, and patients were given similar treatments (electroconvulsive therapy [ECT] and a variety of medications). With time and research, new information about autism has emerged, improving understanding of the condition and influencing how it is treated.
Today, autism is known to be a developmental disorder that affects more boys than girls. According to a study from 2016, the prevalence of this condition was about the same among black, white, and Asian or Pacific Islander children, but it was significantly lower for Hispanic children. Levels of intellectual ability vary greatly among children with autism, ranging from severe cognitive deficits to average or above-average cognitive function.
Symptoms of Autism Spectrum Disorder
Experts stress that early diagnosis is the most important method of managing this disorder and in finding the appropriate course of treatment. Some of the symptoms can manifest themselves as early as the first 18 months in a child’s development, but most diagnoses aren’t made until a child is 2-3 years old or more. Children diagnosed with autism will generally have:
- Difficulty participating in certain social situations.
- Communication impairments
- Specific behavior patterns such as fixed routines, intense interests, and repetitive behaviors
In addition to the more well-known effects of ASD on a child, there can be associated medical conditions, such as:
- Allergies or immune system deficiencies: This may manifest as rashes, allergic sensitivities, gastrointestinal, ear and other infections as a result.
- Hypotonia: Defined as abnormally-low muscle tone, or muscles that are “floppy”, it is prevalent in 30% of children with autism spectrum disorder.
- Gastrointestinal disorders: About 47% of adults on the spectrum and 45% of children with ASD have gastrointestinal symptoms. Diarrhea is most common, followed by abdominal pain.
- Cognitive impairments (intellectual disability): Nearly one in three people with autism has an intellectual disability, defined as an intelligence quotient (IQ) below 70.
- Pain: Some people with autism have a very high tolerance for pain, while others have very low pain thresholds.
- Seizure disorders: An estimated 30% of people with autism develop epilepsy. Suspected seizures should be confirmed by electroencephalogram (EEG) and treated with anticonvulsant medications.
- Sensory processing problems: This involves heightened sensitivities to sounds, sights, touch, taste, and smells. High-pitched sounds, such as fire alarms or school bells, may be intolerable to children with autism, along with scratchy fabrics or flickering fluorescent lights, for example. Sensory integration therapy is designed to help normalize the senses in people with autism spectrum disorder.
- Sleep dysfunction: Children with sensory processing difficulties may have more problems falling asleep and wake up more frequently throughout the night. Other factors that may disrupt sleep include gastrointestinal issues, allergies, environmental intolerances, seizures, or the effects of medications. Some people with ASD may also experience sleep apnea, or pauses in breathing when the airway becomes obstructed during sleep, sleep terrors, or confusional arousals.
- Pica: About 30% of children with autism have a form of pica, which is eating things that are not food such as dirt, sand, paper, etc. This is especially dangerous and can lead to choking, digestive problems, parasitic infections, and other issues.
- Hearing/Visual Problems: 6% of children with hearing problems and 7% of those with visual impairments have autism, compared with 1% of the general population.
Treating Autism Spectrum Disorder
Autism is a life-long condition; there are no easy answers or cures, but early screening can lead to a child receiving a diagnosis and treatment that’s right for them. With so much more known about autism now, treatment aims at helping children better manage emotions and behaviors in a way that improves their quality of life. Much of this can be achieved through behavior management and modification, as well as the use of a variety of services – therapy sessions, social skills training, special teaching and learning services, and medications.
Sensory Integration Therapy
As mentioned above, autism’s symptoms often include sensory-overload from certain textures, sounds, smells, tastes, brightness, and movement. Sensory integration therapy, as practiced by occupational therapists, uses play activities in ways designed to change how the brain reacts to touch, sound, sight, and movement. For example, for a child who hates touching food, the goal might be to decrease touch sensitivity so they can comfortably eat a meal. “The rationale is that by changing how sensations are processed by the brain, we help children with autism make better sense of the information they receive and use it to better participate in everyday tasks,” says Roseann Schaaf, lead researcher in a study funded by Autism Speaks.
Applied behavior analysis (ABA) is based on the simple concept that positively-reinforced behaviors will increase and become habits over time, while behaviors that are not reinforced will reduce and eventually fade. These tactics are used by therapists to help autistic children develop life skills and minimize undesired behaviors such as self-harm. Its effectiveness for children with ASD has been proven by hundreds of studies and is considered the “gold standard” in treating autism. ABA can be applied at home, school, or in group therapy.
Speech therapy is often recommended for people with ASD who struggle with any form of communication. For example, a person with autism may babble word-like sounds, grunt, shriek, use an inappropriate tone of voice, or not talk at all. Speech-language pathologists can help improve communication through a variety of different methods such as signing or typing, using picture boards with words, or working on articulation by exercising certain facial muscles. They can also teach how to read both verbal and nonverbal cues from other people such as body language and facial expressions.
Occupational therapists study human growth and development, specifically how a person interacts with their environment daily. They specialize in the social, emotional, and physiological effects of injury, illness, and other diagnoses. For people with ASD, occupational therapy can help improve quality of life through specific strategies or the use of certain tools to improve independent living skills. Occupational therapists may set specific goals that relate to social interaction, behavior, and developing positive habits. Once the OT has gathered information and observed a child with ASD, they can develop an individual program best suited to their needs.
Prescription Medication: Risperdal vs. Abilify
While prescriptions can’t cure autism, they can help ease behavioral and emotional symptoms that other therapies may not be able to address. The Food and Drug Administration (FDA) has approved two drugs for treating mood changes associated with autism: Risperdal (risperidone) and Abilify (aripiprazole). Both may help with reducing aggressive outbursts and self-injurious behaviors, but there are pros and cons of each to consider.
Risperdal: This is an atypical, or second-generation antipsychotic (SGA) that was originally approved to treat psychosis. Today, many kids on the autism spectrum take Risperdal to reduce behavior problems like aggression or self-injury, enabling them to function in school and with their families. Risperdal can have serious side effects, and it’s important to make sure a child taking it is monitored carefully. These may include substantial weight gain and metabolic, neurological, and hormonal changes that can be harmful.
Abilify: Also an atypical antipsychotic, this medication is usually prescribed for treating mania in bipolar patients, but like Risperdal, has been approved by the FDA for treating autism. It may also help improve anxiety and impulsivity. One of the advantages of Abilify, or aripiprazole, is that it doesn’t have the side effect of weight gain like Risperdal can. However, with aripiprazole, doctors recommend starting at a very low dose and gradually increasing over time in order to avoid the possible side effect of akathisia-–an intense feeling of restlessness. A similar potential side effect is dyskinesia, a movement disorder that may appear as tremors or tics. Parents should alert their physician of any such unusual movements, such as grimacing or lip-smacking.
ADHD and Autism
Nearly half of all children with autism also experience ADHD symptoms, which can further amplify autism symptoms. There are two groups of medication currently used to treat ADHD: stimulants (such as Ritalin or Adderall) and non-stimulants (such as Strattera or Intuniv). Research shows the success rate for stimulant use is near 80%. The non-stimulants tend to have lesser side effects, but also lower success rates. Side effects vary but include excessive sleepiness (Intuniv and Kapvay), irritability, stomach upset, or headache (Strattera).
Depression, Anxiety, and Autism
Anxiety and obsessive behaviors can be common challenges for people with autism. For example, avoiding new or unfamiliar situations, repetitive patterns of behavior like compulsive checking or washing, and separation anxiety can negatively impact everyday life. People with autism are also at risk for developing depression, which may become severe enough to require medication. The most commonly prescribed medications for depression are selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) or fluoxetine (Prozac). Some of these medications have been approved for use with children, although not specifically for autism. This group of medications may help with anxiety, obsessive thoughts, and compulsive behaviors. As with most mental health medications, side effects should be closely monitored.
Epilepsy and Autism
Anticonvulsant medication may be recommended for approximately 20% of people with autism spectrum disorder that also suffer from epilepsy. Epilepsy is defined as recurrent seizures that are caused by abnormal electrical firing in the brain. This condition usually presents itself in early childhood and adolescence, but some autistic people with epilepsy don’t have their first seizure until adulthood. Only a few anti-epileptic drugs (AEDs) have undergone carefully controlled trials in ASD, but these trials examined outcomes other than seizures. Several lines of evidence point to valproate, lamotrigine, and levetiracetam as the most effective and tolerable AEDs for individuals with autism spectrum disorder.
There is no “cure” for autism; however, there are therapies that may help improve the symptoms and bring healing, happiness, and increased self-awareness to people with ASD. For more information on treating the condition, visit: www.autismspeaks.org/what-autism/treatment.
A Different Ability (Not a Disability)
Perhaps one of the most positive faces of autism, and one that has changed how many people perceive autism and those who are autistic, is Temple Grandin. A professor, animal behaviorist, engineer, and best-selling author, Temple also happens to be someone with autism. She has shown the world that being wired differently does not mean that there is something wrong with you. Through her story and the HBO movie about her life (starring Claire Danes), she has helped raise awareness and has inspired a better understanding of people with autism.