Research sheds little light on autism

JAKARTA (JP): Autism remains one of the medical world's unsolved mysteries.

This is despite a sharp increase in its prevalence. Today, it affects 15 of 10,000 newborns worldwide, compared to only two in 10,000 births 30 years ago.

Even doctors knew very little about the condition up until a few years ago, and public knowledge was negligible. This has changed slightly, but the increase in autistic children has not been matched by developments in effective treatments.

Historically, autism was regarded as a childhood psychosis. This has been revised as a childhood developmental disorder since there is no apparent relationship between autism and adult psychoses such as schizophrenia.

The disorder is hard to define and frequently misdiagnosed. But there are several distinguishable symptoms.

According to Dr. Melly Budiman, a child psychiatrist at the Metropolitan Medical Center in Jakarta, symptoms are generally apparent within the first two years of life and may occasionally be noted from the time of birth.

She said the development of autistic children was initially marked by aberrant patterns of attachment, which may be seen in early infancy as they avoid eye contact, fail to make appropriate emotional responses and do not develop normal attachments to caregivers.

Language skill and speech are delayed. Language may fail to develop; if it does, it is often characterized by confusion over pronoun usage (for example the use of "You," for "I" ), abnormal speech, tone and rhythm and an impaired ability to use abstract terms or communicate symbolic information. Concern about the child's poor communication or fears of deafness often leads parents to consult doctors.

Characteristic disturbance also includes disruption of social, cognitive, motor and perceptual development. Autistic children often fail to engage in appropriate interpersonal relations.

An American Psychiatric Association study in 1980 showed about 70 percent of autistic individuals have an Intelligence Quotient (IQ) below 70. The remainder have normal IQ levels and some can even be categorized as gifted.

In the 1960s, autism was reported to be more common in upper socioeconomic status families. This observation is no longer accurate, and was probably skewed initially by differences in referral, pattern of diagnosis and differential availability of services.

Autism is found among families of all income levels, occupation and education, and in every racial and ethnic group. Boys are significantly more likely to be affected than girls, with four male autistics to every female.

Cause

Cause remains unknown for most autistic cases.

Some believe changes in people's lifestyles and global environmental degradation, including the thinning of the ozone layer and pollution, have caused the rise in the number of autistics. There is, however, no concrete research to support this theory.

Lack of consensus on the definition of autism and the relative rarity of the disorder have impeded research efforts. Research has yielded results, however, in the last decade.

In the late 1980s, Dr. Eric Courchesne conducted a promising study. It involved many autistic individuals, and revealed disturbances in the sixth and seventh lobules of the cerebellum, the center for language skill and emotional development. He discovered hipoplacia and hiperplacia in the lobules. Other experts presumed the condition was caused by congenital or in- utero diseases, such as maternal German measles, and metabolic and genetic illnesses.

Dr. Margaret Bauman and Dr. Thomas Kemper of Harvard Medical School made another breakthrough. Their studies disclosed particular disturbance in the limbic systems called amygdala and hippocampus, which are located inside the cerebellum. Any disturbance in this area will likely affect a child's emotional development and learning ability. The child tends to be more aggressive and hyperactive.

The study also suggested that children suffering from disturbance of this part of their nervous system would likely have unusual responses to the environment, including resistance to change and exaggerated reactions to sensory stimuli. They frequently perform ritualistic behavior and peculiar attachments to inanimate objects.

Motoric abnormalities also include unusual posturing and stereotyped movements such as walking on toes and spinning. Self- injurious behavior such as head banging is also common among the autistics.

Perhaps the most consistently replicated biochemical finding is the significant number of autistics who exhibit elevated levels of serotonin, a biogenic amine which serves as a neotransmitter in the central nervous system.

These findings have overruled previous theories which stressed interpersonal factors. Various personality characteristics of the parents were presumed to lead to the child's developmental disturbance. The available evidence does not support this.

Ironically, the low incidence in siblings and lower rates of mental disorders of parents compared to parents of other severely disturbed children suggest that family or psychological factors play very little role in autism.

Diagnosis

Dr. Melly said the differential diagnosis of infantile autism and mild autism should include a careful search for inherited diseases, chromosomal abnormalities, central nervous system diseases and sensory impairment, especially deafness.

The diagnosis must be made as early as possible, preferably between two and five years old, she said. Therapy may be less effective for a child older than five.

Different treatments have been used in the management of autistic children. These have included psychotherapy, pharmacotherapy, speech therapy, behavioral therapy, physical treatments, integrated sensory stimulation and early educational intervention.

Highly-structured educational interventions and intensive psychological and physical therapies are of the greatest overall benefit. These programs should cover between 40 and 80 hours a week, she said.

There must be close cooperation and empathy between the therapist, subject and parents to provide a conducive home and school environment that can help these children develop their interaction with the outside world.

Dr. Ivar Lovaas from the Psychological Department at the University of California at Los Angeles is famous for his behavior therapy with autistics. With intensive and integrated therapies, he has successfully drawn many autistic kids aged between two and five years old out of their isolated worlds. These children were able to integrate themselves within the community, and are now enrolled at several public schools around the U.S.

Dr. Melly admitted the effectiveness of treatments and therapies have yet to be studied in detail. Parents' expectations must be realistic. Gains depend on the seriousness of the condition.

But therapy is not a cure. It is mainly designed to help autistics adjust to their surroundings and to make their adult lives more gainful and fulfilling. (raw)