Autism, or more correctly, Autistic Spectrum Disorders (ASD), are a series of neurodevelopmental disorders characterised by repetitive behaviours, social withdrawal and communication deficits.
People with ASD display a wide range of cognitive ability, ranging from mental retardation to high functioning adults with an above average IQ. There are three main categories of ASD and two subtypes:
1. Autistic disorder – The diagnosis of autistic disorder is given to individuals with significant impairments in social interaction and communication as well as restricted and repetitive interests, activities and behaviours which are generally evident prior to three years of age.
subtype a. Regressive Autism: When a child appears to develop normally but then starts to lose speech and social skills, typically between the ages of 15 and 30 months.
subtype b. Infantile Autism: When a child does not achieve developmental milestones and is effectively determined to have had autism from infancy.
2.Asperger’s disorder – Individuals with Asperger’s disorder have some difficulties with social interaction and social communication as well as restricted and repetitive interests, activities and behaviours. However, those with Asperger’s disorder do not have a significant delay in early language acquisition, cognitive abilities or self-help skills. The condition is often detected later than autism as speech usually develops at the expected age.
3. Pervasive Developmental Disorder – This diagnosis is made when an individual has a marked social impairment but fails to meet the full criteria for either autistic disorder or Asperger’s disorder. These individulas may also have some communication impairments and/or restricted or repetitive interests, activities and behaviours.
The diagnosis of ASD is based exclusively on a particular developmental pattern in the child and has historically been considered a psychiatric disorder. Whilst a diagnosis is made on observation (see signs and symptoms below) and there are no quantitative biochemical tests to confirm diagnosis, there is evidence that indicates numerous biochemical abnormalities in these children, including oxidative stress, decreased methylation capacity, mitochondrial dysfunction, heavy metal accumulation, intestinal dysbiosis, inflammatory bowel disease, immune dysregulation and cerebral hypofusion.
Aetiology / Risk factors
Some possibilities include:
• Heritable genetic polymorphisms influencing detoxification, methylation and dopamine signalling.
• Gender bias, with a 4:1 ratio (males to females)
• Heavy metal exposure – especially mercury, but others may be implicated.
• Immune dysfunction – Severe maternal inflammation, infections, allergy and autoimmunity during pregnancy may lead to a ‘cytokine storm’ causing microglial activation and CNS inflammation, influencing neurodevelopment.
• Immune dysfunction – mild acute or chronic gut mucosal inflammation with ileo-colonic lymphoid nodular hyperplasia (LNH) leading to “autistic colitis” may be a cause or consequence of systemic oxidative stress and inflammation associated with autism.
Signs and Symptoms (Including diagnostic criteria)
Qualitative impairment in social interaction, as manifested by at least 2 of the following:
• Marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
• Failure to develop peer relationships appropriate to developmental level
• A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out objects of interests)
• Lack of social or emotional reciprocity.
Qualitative impairments in communication, as manifested by at least 1 of the following:
• Delay in, or total lack of, development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime).
• In individuals with adequate speech, marked impairment in the ability to initiate or sustain conversation with others.
• Stereotyped and repetitive use of language or idiosyncratic language.
• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
Restricted repetitive and stereotypical patterns of behaviour, interests, and activities, as manifested by at least one of the following:
• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or in focus.
• Apparently inflexible adherence to specific, nonfunctional routines or rituals.
• Stereotypical and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements).
• Persistent preoccupation with parts of objects.
Characteristic deviant communication features in autism include a lack of social chat, pragmatic deficits, pronoun reversal, delayed echolalia, neologisms, lack of emotion in speech, phrase repetitions, and idiosyncratic use of language. Behavioural manifestations frequently involve repetitive, self-stimulatory behaviour, especially in more severely affected individuals. This behaviour can be self-injurious in some, as with arm biting, head slapping, and skin picking.
Diet and Lifestyle Behavioural modification programs are recommended to assist sufferers and parents establish suitable routines and systems for managing undesirable behaviour. Programs exist to assist communication development and socialisation. Depending on the severity, many will need ongoing support and care in adulthood. Programs are generally more effective when begun early (2-4 years) and are intensive. Referral to speech therapy and behavioural psychology practitioners is recommended.
Diet Children should avoid coffee, cola and other caffeinated drinks (if taking stimulants). Diet should be low in sugar and carbohydrates, as hypoglycaemia may trigger symptoms. Each meal should have protein to provide adequate amino acids for healthy neurotransmitter production. Emphasise foods high in magnesium, such as green vegetables and nuts. Children should eat small, regular meals.
EPA and DHA have been shown beneficial for behavioural / learning disorders, so including oily fish in the diet 3-4 times per week will be beneficial. Avoid known food allergens – an elimination and rechallenge diet may be beneficial to determine sensitivities. Avoid artificial colours, flavours and preservatives.