Thursday, May 31, 2007

Still a mystery, autism spectrum cases growing rapidly

Date Published | May 30, 2007


It has quickly become one of the biggest issues in medical science, and the fastest growing developmental disorder worldwide.

It’s commonly known as autism. But autism spectrum disorder (ASD) is now the umbrella idiom for the group of neurological disorders to which children are born predisposed.

No one person with an ASD responds or behaves exactly like another, even with the same diagnosis. But each has common ties.

Autism affects and changes the way the brain processes information, resulting in difficulties with communication and social interaction; unusual patterns of behaviour, activities and interests.

Disturbingly, what causes and triggers ASD is still unknown. The frequency of diagnosed cases, however, is increasing at an alarming rate.

The autism field is a young one.

Coined by Leo Kanner in a 1943 research paper entitled, Autistic Disturbances of Affective Contact, the term ‘autistic’ literally translates to “alone.”

An excerpt from that paper reads, “Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits - and, I hope, will eventually receive - a detailed consideration of its fascinating peculiarities.”

Kanner’s subjects each displayed symptoms of communicative and interactive difficulties and unusual interests. The children he identified were (often) previously labelled as schizophrenic and institutionalized.

Classic autism is a common spectrum disorder. It’s symptoms are “classic” in that they are most often associated with autism. They include: a lack of formal communication; rocking, head banging and hand flapping, lack of eye contact and the inability to interact socially. It is a spectrum disorder because its impairments differ greatly on a case-by-case basis.

Asperger’s Disorder is a fascinating, rare segment of the spectrum. Those with Asperger’s are often extremely high functioning, intelligent and verbal. However, they have difficulty with social interaction, interpreting unspoken social cues and are prone to eccentric behaviour.

They can become experts on topics and may only want to discuss those topics, but are unaware that what they are interested in may be of little interest to others.

Comedian Dan Aykroyd is one of the few public figures in Canada to have openly discussed having the disorder.

“I have a fascination with police and I always have to have a badge with me,” Aykroyd said in a 2004 NPR interview. “My grandfather was a Mountie. If I don’t have a badge on me, I feel naked.”

Aykroyd was diagnosed with Tourette’s syndrome and Asperger’s as a child in the early 1960’s.

Albert Einstein and Sir Isaac Newton are among history’s diagnosed or ASD suspected.

No biological marker is linked to autism. There is no chromosomal or blood test in existence to indicate if a child is autistic.

To be diagnosed, children must be observed displaying: difficulty with social interaction, impairment in communication and a pattern of restricted interests.

But the expression of symptoms can vary greatly among individual children. Also, kids labelled “normal” can often be observed behaving in ways generally classified as autistic.

So the question becomes not only does a child truly have a particular symptom, but also to what degree do they have it and where in the spectrum does a child fit?

The process can be quite subjective, according to Sudbury pediatrician Dr. Shawn Murray.

Murray is a specialist in the diagnosis and medical treatment of ASDs. He says a variety of factors combine to make assessment and diagnosis difficult for everyone.

“Once families are in a professional’s office, it becomes a balancing act. The diagnosis still has a stigma attached to it as well. It can take a lot of time for families to come to terms,” he said.

Murray is among a small group of three local doctors struggling to keep up with the sharp rise in ASD caseload. With a lack of services in Sudbury, long waiting lists can leave families in a state of limbo.

“From a resource point of view, it can be very difficult to get a timely diagnosis,” added Murray.

Early intervention is key. But barriers to formal, standardized treatment in Sudbury are a lack of available professionals, waiting lists and expense.

Applied behaviour analysis (ABA) is the most widely accepted form of treatment for autism. ABA is a behavioural modification approach to learning based on the work of Dr. B. F. Skinner. Highly structured and rigorous, it is centred on behaviour analysis and one-on-one teaching, making strategic use of rewards.

Intensive behavioural intervention (IBI) is based on the basic principles of ABA and is most effective in teaching pre-school-aged children. IBI includes frequent and direct measurement of a child’s development, making changes in learning or behaviour highly discernable.

Speech and language therapies are often effective in less severe cases.

While families continue to cope with the realities of ASD, Canada’s federal, provincial and territorial governments have a challenge ahead in allocating resources at a level that matches the rise in caseload.

And as research continues, medical science is left to fuse together a jumbled mix of traditional views and new findings.

The Yale School of Medicine released a study on April 21 of this year that found toddlers with ASD who have trouble making eye contact with people do not have difficulty in looking at photographs of faces. They also spend most of the time looking at photos examining…the eyes.

“This is a surprising finding, given that avoiding eye contact is one of the classic hallmarks of autism,” said Chawarska, in a Yale University news release.

Such are the mysteries of autism.

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