Can children with autism lead a normal life?

Introduction

Autism is also known as pervasive developmental disorders (PDD). The prevalence of this condition has increased dramatically and is currently recognized as one of the most common developmental disorders. This disorder is characterized by abnormal social interaction and communication with repetitive patterns of behaviour.

Statistics

Autism occurs more often in boys than girls with a male-to-female ratio of 4:1. The reported prevalence have been increasing worldwide over the past decades, from approximately 4 per 10 000 to 6 per 1000 children.

Causes

The exact cause of this condition is still not known. It is a multi-factorial disorder resulting from genetic and non-genetic risk factors.

Genetic causes including gene defects and chromosomal anomalies

Envirnomental factors include
  • Maternal exposure to teratogens (thalidomide)
  • Prenatal infections (rubella, cytomegalovirus)
  • Maternal anticonvulsants (Valproic acid)

Apart from these factors there are minor cases less than 10%, where autism is part of another condition. Such cases are referred to as “secondary”. This includes

  • Tuberous sclerosis
  • Fragile X syndrome
  • Phenylketonuria

Clinical features

All individuals with this condition demonstrate impairments in 3 symptoms domains; social interactions, communications and repetitive behaviours

Impaired social interactions

These children when interacting socially often do not look at the person or smile. They appear to ignore a familiar person because of a lack of social interest. They may also have no friends and prefer playing alone.

Impaired of communication

In early infancy autistic children do not babble and are therefore known as "quiet babies." Moreover these children cannot compensate for the language deficiency with facial expressions or gestures.

Restricted, repetitive patterns of behavior

These children demonstrate atypical behaviors including unusual attachments to objects and self-injurious behaviors. They ask the same question repeatedly, regardless of the reply that is given and engage in highly repetitive play. Most of them demonstrate classic behavior of lining up toys or other favored objects.

Diagnosis

This condition can be reliably diagnosed in children as young as 2 years old and early intervention is beneficial. It is clinically diagnosed based on the presence of two major symptoms i.e.

  • 1. Social - communication deficits
  • 2. Restricted and repetitive behaviors
  • These symptoms must be seen from early childhood in individuals with autism (before the age of 3 years)

    Neurological evaluation
    Neurological examination

    The abnormalities in the neurologic examination include hypotonia. Hand or finger stereotypical movement, body rocking, and unusual posturing are seen in 95% of autistic individuals and these symptoms often manifest during the preschool years (2-5 years).

    Treatment

    Medicinal therapy

    The goal of medicinal therapy for children with this condition is to relieve the symptoms and specific behaviors. These symptoms include sleep problems, anxiety, repetitive behaviors, depression, mood swings, hyperactivity, aggression, and self-injurious behavior.

    Atypical antipsychotics

    Risperidone and aripiprazole help manage the irritability, such as aggression, self-injurious behavior, temper tantrums, and mood swings, in school-age children with autism.

    Serotonin reuptake inhibitors

    The symptoms causing major impairment such as anxiety and repetitive behaviors can disrupt learning in children. These disruptive behaviors are treated using serotonin reuptake inhibitors (Citalopram, fluoxetine, Paroxetine, sertraline).

    Stimulants drugs

    Hyperactivity is an important symptom in children with an autistic disorder which is effectively managed using stimulant drugs (dextroamphetamine, methylphenidate)

    Antiepileptic drugs

    Including levetiracetam and divalproex sodium was well tolerated by autistic children in relieving repetitive behavior and mood stability.

    However, certain autistic children remain refractory to medication therapy. Interventional therapy such as deep brain stimulation (DBS) may be an alternative therapeutic option for these patients.

    Educational and behavioural interventions

    Applied behavior analysis

    Is the most well known of the behavioral approaches for autistic children. This intervention is provided by a behavioral psychologist. Best outcomes occur when the applied behavior analysis is initiated early in development, preferably before 5 years of age.

    It focuses on encouraging positive behaviors while discouraging negative ones. Additionally these interventions improve social interaction, communication and behavior thereby promoting learning in children. This is performed by rewarding them for their positive behaviours (praise, gifts). This behavioral intervention improved intelligence scores (IQ), language and academic performance of children with autism.

    Augmentative and alternative communication (AAC)

    Augmentative and Alternative Communication devices and tools help compensate for the communication deficits. These interventions range from use of sign language to pictures and electronic devices. Many children with this condition do not develop functional speech, and the use of these devices enhances communication abilities.

    Prevention

    Pregnant women can prevent the occurrence of this disorder in children by following these measures during pregnancy. This includes

    • Avoid the use of anti-seizure drugs
    • Do not drink any kind of alcoholic beverages
    • Make sure you are vaccinated against rubella before you are planning to conceive
    • Daily intake of folic acid (400-800 mcg)

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