In the following essay, we shall discuss a neurodevelopmental disorder and a neurocognitive disorder. Neurodevelopmental disorders like Autism Spectrum disorders constitute a wide variety of diseases that mainly translate into behavioral deficit in children affected by it. Autistic children often show reduced social skills and being a heterogeneous spectrum no two patients are exactly similar. Neurocognitive disorders can range from mild to extreme and can be caused by various other diseases. HIV Associated Neurocognitive Disorder or HAND has emerged as one of the most prominent neurodegenerative disorders in the recent past(Mayer, 2013).
Autism Spectrum Disorder
Autism is a neurodevelopmental disorder; recent estimates of autism spectrum disorder are higher than that of the world population 30 years back. Studies show that the prevalence of autism spectrum disorder is increasing at a rapid pace.
Behavioral criteria
Autism spectrum disorders are hard to diagnose because there are many different disorders that fall within the spectrum(Lord & Cook, 2000). The symptoms of Autism-related disorders include reduced social skills in developing children, which can be measured by qualitative deficits in communication patterns of toddlers. Some of the behavioral criteria for Autism spectrum disorders are listed below:
- Qualitative impairment in social interaction, like marked impairment in basic behaviors such as eye contact while communicating. Failure to develop peer relationships can be a vague indication of Autism. Children suffering from autism often lack social empathy and fail to reciprocate social behaviors.
- Children with autism spectrum disorders will often perform stereotyped patterns of behavior patterns. For example, such children are often very particular in their routines and frequently have repetitive motor mannerisms.
- Children affected by Autism spectrum disorders fail to communicate and have difficulty maintaining a conversation with others. Such children fail to pick up nonverbal cues of communication and often develop an idiosyncratic language which, is one of the primary signatures of this disorder.
Incidence rates and causes
A 2012 global study by Elsabbagh et al., (2012) showed that autism was prevalent in 1 per 62,000 people all over the world. The study also showed that the ratio of boys: girls affected by this disorder was 4.3:1, which shows that this disorder has some genetic basis. Some studies show that epigenetic effects can also explain the occurrence of autism in lineages not previously affected by it.
Treatments
Scientific research has heavily contributed to the development of treatment regimens for children suffering from Autism Spectrum Disorders (Matson, Matson, & Rivet, 2007). The study by Matson and colleagues (2007) looked at how parents of autistic children can help develop social skills through an early intervention program. Applied Behavior Analysis is a great tool that has been utilized to diagnose, monitor, and lower the symptoms of autism in children through family-mediated early intervention treatment schemes (Harris & Delmolino, 2002; Vismara & Rogers, 2010). Drugs like Citalopram have been recently found to be ineffective at reducing the symptoms in autistic children (Uni- & Impressions, 2010). However, Thiamine tetrahydrofurfuryl disulfide administered to autistic children rectally showed a significant decrease in symptoms (Lonsdale, Shamberger, & Audhya, 2002).
HIV Associated Neurocognitive Disorder (HAND)
In the last three decades, medical science has made remarkable advances in the diagnosis and treatment of HIV. However, one of the biggest lacunae of HIV research is the impact of the virus on the Central Nervous System. HIV Associated Neurocognitive Disorder or HAND is one of the most prominent neurocognitive disorders after Schizophrenia and Alzheimer’s in the present world scenario. The HIV epidemic led to a rise in anti-retroviral treatment techniques that targeted the virus at various stages of development and thereby reduced the medical morbidity drastically (Heaton et al., 2010). In most cases patients are affected by milder forms of neurocognitive impairments due to HIV infections; this is known as Mild Neurocognitive Disorder or MND.
Behavioral Criteria
According to Mayer, (2013) since the CNS is first affected by a HIV infection, it is important to screen all HIV patients for an early diagnosis of HAND. Although no single tool has been standardized to be used across all practice settings, some computerized programs like CANTAB reaction time (Mayer, 2013) has been found to be fairly accurate. Most commonly, patients suffer from cognitive impairments that affect daily task performance. In extreme cases dementia and delirium can also indicate a marked transition into
Incidence Rates
Recent studies show that HAND prevalence is 10-24% of HIV infected individuals in Western countries and only 1-2% of time sin India. With the development of advanced retroviral techniques like CART and HAART, the chances of dementia and delirium resulting from HAND has significantly decreased. HAND is mostly caused due to the vulnerability of the immune system that is a direct result of an HIV infection, and therefore patients are often exposed to neurodegenerative diseases. Other causes of HAN include, side-effects of drug treatments, AIDS related carcinoma, and opportunistic infections.
Treatments
Combined Antiretroviral Therapy or CART has been found to be one of the effective techniques that can help reduce or control the progression of HAND. Some studies also show that Highly Active Antiretroviral Therapy or HAART can reduce the chances of developing Dementia due to HAND. Psychostimulants such as amphetamine derivatives have also shown good results in reducing symptoms in HAND, as well as Alzheimer’s patients.
References
Elsabbagh, M., Divan, G., Koh, Y.-J., Kim, Y. S., Kauchali, S., Marcín, C., Fombonne, E. (2012). Global prevalence of autism and other pervasive developmental disorders. Autism Research : Official Journal of the International Society for Autism Research, 5(3), 160–79. doi:10.1002/aur.239
Harris, S. L., & Delmolino, L. (2002). Applied behavior analysis: Its application in the treatment of autism and related disorders in young children. Infants & Young Children, 14(3), 11–17.
Heaton, R. K., Clifford, D. B., Franklin, D. R., Woods, S. P., Ake, C., Vaida, F., Grant, I. (2010). HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology, 75(23), 2087–96. doi:10.1212/WNL.0b013e318200d727
Lonsdale, D., Shamberger, R., & Audhya, T. (2002). Treatment of autism spectrum children with thiamine tetrahydrofurfuryl disulfide: a pilot study. Neuroendocrinology Letters, 23, 303–308. Retrieved from http://www.nel.edu/pdf_w/23_4/NEL230402A02_Lonsdale_rw.pdf
Lord, C., & Cook, E. (2000). Autism spectrum disorders. Neuron, 28, 355–363. Retrieved from http://books.google.com/books?hl=en&lr=&id=_WZGAQAAQBAJ&oi=fnd&pg=PA217&dq=Autism+Spectrum+Disorders&ots=7YWWm71vT_&sig=1Gm2pKnaJOcXQTQx5C8EFJOHxII
Matson, J., Matson, M., & Rivet, T. (2007). Social-skills treatments for children with autism spectrum disorders an overview. Behavior Modification, 31(5), 682–707. Retrieved from http://bmo.sagepub.com/content/31/5/682.short
Mayer, K. H. (2013). Assessment, diagnosis, and treatment of HIV-associated neurocognitive disorder: a consensus report of the mind exchange program. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 56(7), 1004–17. doi:10.1093/cid/cis975
Uni-, Y., & Impressions, G. (2010). Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior. Arch Gen Psychiatry, 66(6), 583–590.
Vismara, L. a, & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorder: what do we know? Annual Review of Clinical Psychology, 6, 447–68. doi:10.1146/annurev.clinpsy.121208.131151
