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Autism: When It’s Your Jigsaw Puzzle

What is Autism?

You are an eager tourist planning a trip to the heart of Asia. You learn to read, as well as write, both Mandarin and Cantonese dialects of the Chinese language. You eagerly assimilate their customs; perusing their geographical, spiritual and historical books. You even struggle to adapt to their foods and cook to the point that you would be viewed as a top notch chef by anyone native to their land.

The fateful day arrives and you board the plane to the journey of your dreams but you disembark only to find that you are in Denmark, there are no flights back to the United States nor can you get to China. All the sights, sounds and smells – everything is not what you planned for and you have to adapt to what this journey unexpectedly is.

This is how a fellow parent of an autistic child described the experience. This analogy has consistently proven to be a great way for those of us who face this challenge to communicate what it is like to others.

In my Child & Adolescent fellowship training, many psychiatric disorders and syndromes were addressed in our lectures including autism. In the early 1990’s, not much clinical time/attention was given to this longstanding diagnosis first described by Dr. Leo Kanner in 1943. Little did I know then that I would not only treat an ever-growing population of children (with this odd mix of traits, disabilities, abilities and characteristic behaviors), but that I would also gain first hand experience with my own son.

Anyone with access to modern media – print, radio, television or internet – likely has an awareness of the uptick in autistic spectrum disorders being diagnosed in this country. The causative factors/ eiology of autism is largely unknown and likely multifactorial as is the presentation/ manifestation of the disorder(s).

Recent studies in neuroscience are currently attempting to differentiate (as well as quantify differences) between a normally developing brain and that of an autistic child (eg. Ecker et.al; The journal of neuroscience, August 11, 2010) both in the realm of function as well as morphology.

The disorder usually presents itself well before the age of 3 and is characterized by impaired social interactions and communications. In addition there are usually restricted and repetitive behaviors such as stacking or lining up of objects. Children with the disorder may have restrictive diets, compulsive behaviors, may make strange sounds or repetitive movements (like flapping their hands), they often struggle with transitioning from one activity to another.

Oftentimes these children have self-injurious behaviors such as head- banging. There are also delays in the attainment of normal developmental milestones especially in the realm of speech both receptive and expressive language. There is a genetic component to this spectrum of disorders as well as a predominance of males vs. female cases but no definitive culprit has been identified (eg. vaccines, pesticides, exposure to heavy metals).

Authorities on the subject agree that early intervention programs (before kindergarten) and special education classification/individualized education plans are helpful in allowing children with the disorder reach maximum functionality. These interventions include behavior modification programs, occupational and speech therapies. Medications can sometimes be of assistance especially when there are comorbid problems such as Obsessive-Compulsive Disorder, Attention Deficit Hyperactivity Disorder or severe tantrums.

The specific types of Autism, such as Aspergers disorder (a less debilitative form of the illness that is associated with a higher IQ and hence better prognosis) are beyond the scope of this brief article. However, the interested reader or parent can find valuable information on line at such sites as:

www.jneurosci.org – The Journal of Neuroscience

www.aacap.org – The American Academy of Child and Adolescent Psychiatry

www.autism-society.org – an online support group for friends and family

www.autismspeaks.org – an online source for friends that help identify local resources for families.

By Edward Moore, M.D.

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