Introduction
Autism is a childhood developmental disorder that affects the brain’s normal development of communication and social skills. It is a physical condition that appears in the first three years of life and is linked with abnormal biochemistry in the brain. The causes of autism are not ascertained but autism is largely attributed to genetic predisposition and the environment. A plethora of research studies have also suspected other causative factors like mercury poisoning, diet and vaccine sensitivity among others but these factors are yet to be proven (Pubmed, 2010).
Autism has a variety of symptoms depending on the level of infection but most of them involve communication, repetitive behavior, response to sensory information and social interactions. Other symptoms include sensitivity to light, distress to change in routines, slow or lack of language development, withdrawal and the holding of hands over ears at normal sounds which are painful to the autistic child. Due to the broad spectrum of symptoms, the tests for autism are also a series of evaluations including physical and neurological examinations. Autism has no specific cure and as such the treatment plan is aimed at remedying specific symptoms. The treatment regimen involves education therapies for instance the applied behavior analysis that reinforces practice of skills, medication for specific autism symptoms like anxiety and behavioral therapies among other methods (Pubmed, 2010).
Autism although untreatable is curable hence it has been asserted that behavioral and therapeutic theories may be the methods of treating the symptoms of autism. This is because most of the symptoms of autism are either behavioral or based on communication; symptoms that can be rectified by therapy. Therapy offers a child a chance of learning development skills giving them a chance of leading a normal life despite the fact that they suffer from autism[ CITATION Pub10 \l 1033 ]. The goal of this paper therefore is to explore autism as a developmental disorder. To achieve this goal this paper will be divided into five sections namely: the history of autism, the symptoms of autism, the progression of the disease and the treatment of the disease. The paper will then be concluded by an outlook for the cures for autism. To appreciate autism as a developmental disorder it is imperative to begin by exploring the history of the disorder.
History of Autism
A historical exploration of autism as a developmental disorder is incomplete without a discussion of the origins of the name of the disorder. The word ‘autism’ is rooted in the Greek language meaning ‘self’. When the word is combined with the Greek suffix, ‘ismos’ which means the state of being the original root meaning is loosely translated as being absorbed in one’s self. The root meaning of the word perhaps explains the symptomatic conditions of the disease best. However the history of autism is not only encompassed in the meaning word and as such there is much more to the history of autism[ CITATION Ada10 \p 9-11 \l 1033 ].
The term autism was first coined by Eugene Bleuler, a Swiss psychiatrist who used the word to describe some of the symptoms of schizophrenia in patients who were self absorbed[ CITATION Ada10 \p 9 \l 1033 ]. It is however worth noting that at that time the word autism was used in reference to adult schizophrenic patients. In 1943, autism was first associated as a developmental disease for children by Dr. Leo Kanner. Five years earlier, Kanner had begun to study children who had withdrawal symptoms and despite being slow learners they did not have the symptomatic patterns of emotionally disturbed children. In 1943, after five years of studying the symptoms, Kanner published a paper that identified the condition as infantile autism. At this same time another scientist identified another condition that is regarded as a type of autism known as Asperger’s syndrome. During this decade and the following two decades till the sixties the medical community often assumed that children who had autism were schizophrenic [CITATION Ada10 \p 37 \l 1033 ].
In the minds of many researchers in the medical field, autism and schizophrenia remained linked until in the sixties when the medical community began to understand the concept of autism in children. During this period, treatment for autism was varied beginning with the Freudian theory being very popular as it asserted that the lack of development was rooted in the severing of psychological bonds between parents and their children. The linkage between schizophrenia and autism led to a lot of parents feeling that they caused the disorder popularizing Freudian psychology[ CITATION Ada10 \p 54 \l 1033 ]. Other common methods were electric shock and behavior change techniques which relied on imposing pain through punishment. The 1980s and the 1990s marked the advent of the behavioral therapy and usage of highly controlled environments as the primary treatments to the different types of autism[ CITATION Ada10 \p 203 \l 1033 ]. As explored above many aspects of autism as a developmental disorder are dependent on the type of autism and it is therefore important to mention the types of autism.
Types of Autism
Autism or autism spectrum disorders hereinafter referred to as ASDs is a group of developmental disabilities that often causes significant communication, social and behavioral challenges. As such people with the ASDs handle information in their brain differently from other people as illustrated below by the three types of ASDs.
- Autistic Disorder
This is the most common type of autism and it is the disorder that most people associate with the word autism. This disorder is also known as ‘classic’ autism. Children who suffer from this disorder often have social/ communication challenges, intellectual disability, language delays and odd behavior.
- Asperger Syndrome
This disorder was discovered by a German scientist who isolated patients with autistic symptoms which were milder in nature. Children who suffer from the Asperger’s syndrome therefore may have symptoms like unusual behavior/interests and social challenges. However these patients rarely have intellectual disability or problems with language.
- Pervasive Developmental Disorder- Not Otherwise Specified
Also known as atypical autism and hereinafter referred to as PDD-NOS is diagnosed in people who only have social and communication challenges. As such many people who suffer from any of the above two disorders may also be diagnosed with PDD-NOS. people with PDD-NOS however have less symptoms which are milder than patients who have autistic disorder. The symptoms of ADS are explained in depth below.
Symptoms and progression of Autism
Ignorance concerning autism has led to a lot of generalization and myths concerning the symptoms of the disease. Furthermore the symptoms are often unique in each autistic individual but they are basically divided into three categories. Impaired social interaction symptoms include poor use of body language, lack of expression of feelings (for instant the autistic may not laugh or cry appropriately), aloofness, difficulties in interacting with others, impaired communication many other symptoms(underdeveloped speech, abnormal content or quality of speech and low capacity to initiate or sustain conversation), mood swings, repetitive and compulsive behavior. There may be symptoms related to cognitive functions which are associated with lower IQ in about 75% of cases. Neurological symptoms occur in 25 to 35% of autistic children and are expressed in form of seizures that may be resistant to treatment. Finally there are behavioral symptoms which include self-injurious behavior, extreme under activity or over activity, tantrums, abnormal eating and sleeping habits, paranoia, restricted and narrow interest, preoccupation with objects or repetitive motion and inappropriate attachment to objects[ CITATION Rox11 \l 1033 ].
The diagnosis of autism can only occur at the school going or preschool age but the symptoms are apparent by the age of 12 to 18 months. The behavioral symptoms are usually evident at the age of 3 years with delayed speech and language in severe cases. The child becomes more aggressive and agitated with age but may also become aloof. The symptoms persist throughout life but many individuals learn to modify and control their behavior with time.
Mechanism of Illness
Autism is associated with developmental changes in various areas of the brain culminating in the classical symptoms of autism. The precise mechanism of autism is not well understood but two pathways explain the onset and progression of the disease. The first has to do with the pathophysiology of the structural changes in the brain and the associated process while the second deals with the neuropsychological associations between behaviours and brain structure.
The brain structural changes associated with autism are not as clearly understood as those associated with other developmental disorders. It is not clear whether autism results from a few mutational disorders converging on common pathways or many disorders with divergent mechanisms and pathways. It has been suggested that many developmental factors affect several areas of the brain altering the development of the brain soon after conception. The result is a cascade of pathological occurrences that may be influenced by certain environmental factors. Soon after birth the brain of autistic children grows faster than usual then later resumes normal rate of growth or grows at a relatively low rate. These developmental disturbances appear to affect the areas of the brain responsible for cognitive functions more than other areas of the brain.
Several hypotheses have been advanced to explain the cellular and molecular basis of initial pathological elevated growth rate of the brain. Some scholars postulate that there is an over connectivity in some key brain regions resulting from excess neurons. Other hypotheses include unbalanced and abnormal excitatory-inhibitory networks, disregulated and abnormal migration of neurons during pregnancy and the abnormal formation of dendritic spines and synapses[ CITATION Pau09 \l 1033 ]. Abnormal immune activity during the early stages of the development of the nervous system has also been found to play a role in the mechanism of some types of ASDs. The role of some neurotransmitters in autism is not clear but there are indications that a group of metabotropic glutamate receptors play a role in the pathogenesis of a certain form of autism[ CITATION MGC00 \l 1033 ]. Some studies also implicate increase in a number of growth hormones for the overgrowth of the brain soon after birth. There are also claims of disruption of the development of the mirror neuron system resulting the communication difficulties and social impairment associated with autism. There is also evidence of abnormal activation of different brain regions for example the low connectivity of default network that mediates emotional and social processing. Autism has also been associated with abnormal electrical activity in the brain.
Again very little is known about the neuropsychological linkages between behavior and the structural changes in the brain. One theory postulates that the autistics are able to form internal rules of operation to tackle events in the brain (systemize) but are generally inadequate in handling events initiated by external sources. An earlier theory postulates that the behavior patterns of autistic individuals are as a result of an inability to assign mental states to others and oneself. Another theory postulates that autistic behavior emanates from a deficiency in the executive f brain functions such as planning, memory and inhibition. The weakness of this theory lies in the difficulty in measuring the executive functions and the fact that these deficiencies have not been found in younger autistic children. Finally the weak central coherence theory attributes autistic behavior to limitations in the ability to see the broad picture of things as a result of disturbance in the brain[ CITATION IRa08 \l 1033 ]. In conclusion there is no conclusive theory or hypothesis to adequately explain both the mechanism of the structural changes in the autistic brain and the linkages between these changes and autistic behavior. There are conflicting claims on the actual mechanisms, causes and pathophysiology of autism.
Treatment of Autism
A plethora of research has established that although autism is not treatable largely through clinical or educational settings. It is however important to note from the start that there is no standard method of treating autism and therefore different medics use different regimens in caring for their autistic patients. Education programs have however prevailed over time because through education autistic patients have been documented to improve their developmental level of performances. Regardless of success, there is an array of treatment regimens available for instance auditory training, vitamin therapy, music therapy, discrete trial training, anti-yeast therapy, occupational therapy, facilitated communication, sensory integration and physical therapy. These array of treatment regimens can however be categorized into the four broad categories below[ CITATION Rox11 \l 1033 ].
Applied Behavior Analysis( ABA)
ABA which is commonly used in many medical facilities and schools across global boundaries encourages positive behaviors while discouraging negative behaviors so as to improve a range of skills[ CITATION JLM08 \l 1033 ]. There are different types of ABA although through each type the autistic child’s progress is tracked and measured. Types of ABA include:
Pivotal Response Training which is aimed at increasing a child’s motivation to monitor their personal behavior and also initiate communication with other people.
Discrete Trial Training is a teaching style that utilizes series of trials so as to teach desired behavior step by step. The lessons are made into simple units and positive behavior is reinforced while incorrect answers are ignored.
Verbal behavior intervention teaches verbal skills
Relation based approach also called ‘floortime’ focuses on relationships with the caregivers and a child’s sensory abilities.
- Occupational Therapy - it equips the autistic patient with skills that help them to live independently for instance dressing, interpersonal communication and eating.
Sensory Integration Therapy- is aimed at helping the autistic patient to deal with sensory information like smell, sights and sounds.
Speech therapy is aimed at improving communication skills
The picture exchange communication system uses pictures to teach autistic patients how to communicate using pictures[ CITATION CDCnd \l 1033 ].
- Dietary Approaches
There are a number of dietary treatment regimens developed by therapists although many of these regimens lack scientific support that is necessary for widespread communication. In the biomedical field, many of the regimens recommend a change in diet for instance by the use of vitamin/mineral supplements. These dietary treatments are thereby based on the assertion that ASD is caused by the lack of vitamins or certain food allergies. It is therefore not very popular as a regimen as the success stories are unique to the individual and rarely have scientific backing[ CITATION CDCnd \l 1033 ].
- Medication
ASD or its symptoms does not have any medication that can cure it as explained above. However some medications help people that have autistic related symptoms for instance seizures, inability to focus and high energy. Notable in this category is risperidone- an antipsychotic drug that treats autistic children with severe aggression/ tantrums that can cause self injury[ CITATION CDCnd \l 1033 ].
- Complementary and Alternative Medicine
These are treatment regimens used by parents or healthcare professionals to relieve the symptoms of ASD. These treatments many of which are not recommended by pediatricians include special diets, body based systems and chelation where heavy metals like lead are removed from the body. This type of treatment is commonly plagued with controversies[ CITATION CDCnd \l 1033 ].
Outlook for a Cure
There is a lot of research being undertaken in an attempt to understand the pathophysiology, etiology and pathogenesis of autism. It is believed that a clear understanding of the disease will produce more effective management strategies and even cure for the disorder. Most of the current research has focused on establishing and evaluating the risk factors, particularly certain vaccines given to infants, associated with the disease. However research on the mechanisms of the disease at the molecular and cellular level appears to be promising in terms of coming up with a cure for the disorder. One particular study by a team at the University of Louisville has yielded very promising results. The team led by Dr. Manuel Casanova established that people with autism have a defect in the principle building blocks of the brain cortex referred to as mini-columns[ CITATION New11 \l 1033 ]. The team has also been experimenting on the treatment of autism by magnetic stimulation. The study indicates that transcranial magnetic stimulation (magnetic therapy) significantly improves the quality of life of individuals with autism[ CITATION Mel11 \l 1033 ]. The magnetic therapy appears to build a protective coat around the mini-columns thereby preventing flow of information to the wrong areas of the brain. In addition the researchers believe that by targeting and correcting one area of abnormality the other areas will correct themselves[ CITATION New11 \l 1033 ]. These results are very promising and research in magnetic stimulation as a possible cure for autism and other developmental disorders are ongoing.
Conclusively despite autism affecting 1 in every about 100 children and a lot of research in the disease very little is known about the disease leading to the lack of cure for autism although there is hope of finding a cure soon. The symptoms of autism are very diverse and similar to those of other developmental disorders.
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