Autism is a complex behavioral syndrome, which impairs the behavioral development of toddlers, and its main causes and treatment are yet to be located conclusively. Increased prevalence of autism is of greatest concern for the family and practicing pediatricians because the minimum age for diagnosing autism is not clear as autism symptoms may not be evident in children under two years and this may not help rule out the future possibility. Because what causes autism is not known and which treatment approach is acceptable has not been identified so far, rigorous behavioral programs for developing positive behaviors, and increasing mixing with age peers, correcting certain sensory problems, and symptomatic treatment will be the best alternative to control problems caused by autism.
Autism spectrum disorders (ASD) is the term used to cover conditions termed autism, atypical autism, and Asperger’s syndrome, which are lifelong “complex developmental disorders” affecting behavioral, social, and communication skills. (Definitions and concepts: Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders: A national clinical guideline, 2007).
Though the origin and causes of autism are not exactly known, research findings suggest that heredity and early fetal development play a crucial role in developing autism. Some parents and child specialists believe that mumps, measles, and rubella (MMR) vaccine may cause autism, which gained popularity with the publication of an article by Wakefield et al in 1998 (Kaye, Melero-Montes & Jick, 2001).
The term “autism” is often used to refer to “autistic disorder” characterized by impaired communication and social interaction as well as restricted and repetitive interests and behaviors (Larsson. et al, 2005). Recent estimates of the prevalence of ASD are “in the range of 6.6 to 6.6 per 1000”, and are not curable, since ASDs are similar to other neurodevelopmental disorders that require chronic management (Myers & Johnson, 2007).
Twin and family studies suggest that not only genetic factors but nongenetic factors like “prenatal exposure to thalidomide, rubella, and alcohol” also are risk factors for autism spectrum disorders (Larsson et al, 2005). Pregnancy and childbirth complications as well as a family record of psychiatric history are another causative factor for autism in children. Data analysis of admissions to Danish psychiatric inpatient facilities from 1969 to 1995 by Larsson and colleagues to locate risk factors for the development of autism in children found that:
- autism is related to adverse pregnancy and delivery process;
- birth weight; and
- parental psychopathology.
A study by (Schendel & Bhasin, 2008) has shown that low birth weight or preterm children are at increased risk for autism. In a comparative study of nutrient intakes and eating behaviors of boys with and without autism, done by (Schmitt, Heiss & Campbell, 2008) they found that there were no differences in nutrient intake between groups, but boys with autism liked the texture of the food more. The International Classification of Diseases, version 10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorder 4th edition (DMS-IV) are the two major diagnostic classification systems used to diagnose ASD.
The checklist for Autism in Toddlers (CHAT) designed to identify 18-month-old children at risk of ASD and modified CHAT (m-CHAT) to measure the risk among 18-24 month children based on parent’s reports are used to screen autism as part of child health surveillance. Children and adults with autism may have anxiety, depression, attention deficit, and hyperactivity disorder, epilepsy, eating problems, and sleeping difficulty. Studies reveal that drug treatment does not help with ASD problems and there is no requirement of a special diet or taking nutritional supplements such as vitamins.
Medication may be required to treat symptoms of ADHD, aggressive behavior, and anxiety and sleep disorders. Parent mediated intervention programs, with the help of teachers, social workers, speech and language therapists, and other specialists can help assess the problem and overcome it. Rigorous behavioral programs for developing positive behaviors and increasing mixing with age peers, correcting certain sensory problems through auditory integration training (AIT) and music therapies, occupational therapies, and “facilitated communication” are found to help to improve the condition of autism (SIGN, 2007, p.19).
Studies showed that “risperidone significantly improved a mixture of behavioral problems, including aggression” and it should be prescribed by experts in the treatment of autism after careful diagnosis, appropriate screening, and monitoring. (Morgan & Taylor, 2007). Experience with autistic children shows that certain dietary restrictions will help in the management of the disease. In fact, this practice is widely accepted by both physicians and parents of affected children. The removal of two dietary proteins namely gluten and casein from the diet has shown big improvements in the condition of children with autism. “Another popular intervention for autism is the gluten-/casein-free diet. Thousands of parents throughout the world have placed their children on this restricted diet and have observed dramatic improvements”. (Edelson, 2002).
Gluten is a protein that is found in grains like wheat, barley, rye, oats, etc. Casein is also a protein found in dairy products. All these foods are likely to be eaten by children usually. Like with the disease itself it is not sure among experts why this improvement is there. But some opinion among experts is that when these proteins break down in the intestine it may act a little like morphine which can slow down the brain process.
It may also cross the ‘blood-brain barrier and negatively affect the development of the brain. The concept is so popular that many books and websites even have recipes without the presence of these two proteins. The only care is taken is not to stop the intake of these two suddenly. It will have a negative impact and withdrawal symptoms. This should be done only by slowly removing the quantity of the two proteins.
References
Definitions and concepts: Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders: A national clinical guideline. (2007). SIGN: Scottish Intercollegiate Guidelines Network. Web.
Kaye, James A., Melero-Montes, Maria del Mar., & Jick, Hershel. (2001). Papers: Mumpes, measles, and rubellavaccine and the incidence of autism recorded by general practitioners: A time trend analysis. BMJ: Medical publication of the year. Vol. 322. P. 460-463. Web.
Larsson, Heidi Jeanet. et al. (2005). Original contributions: Risk factors for autism: Perinatal factors, perinatal psychiatric history, and socioeconomic status. American Journal of Epidemiology. Vol. 161(10). P. 916-925. Web.
Myers, Scott M., & Johnson, Chris Plauche. (2007). Clinical report: Management of children with autism spectrum disorders. Pediatrics. Vol. 120(5). P. 1162-1182.
Schendel, Diana., & Bhasin, Tanya Karapurkar. (2008). Article: Birth weight and gestational age characteristics of children with autism, including a comparison with other developmental disabilities. Pediatrics. Vol. 121(6). P. 1155-1164.
Schmitt, Lauren., Heiss, Cindy j., & Campbell, Emily E. (2008). A comparison of nutrient intake and eating behaviors of boys with and without autism. Nursing Center: Better Resources for Better Care. Vol. 23(1). P. 23-31. Web.
Morgan, Susan., & Taylor, Eric. (2007). Editorials: Antipsychotic drugs in children with autism. BMJ: Medical publication of the year. Vol. 334. P. 1069-1070. Web.
Edelson, Stephen M. (2002). Leaky gut’ and the gluten- / casein-free diet. Autism Research Institute. Autism. Web.