Autism: Symptoms, Causes, Treatments

The Autism spectrum disorders (TEA), popularly known as autism, are a disorder of neurobiological origin manifested in the first 3 years of life.

Within this category are included several disorders with different symptoms (although the DSM-V no longer mention these disorders): autistic disorder, Asperger's syndrome, childhood disintegrative disorder and general unspecified developmental disorder.

All disorders of the autistic spectrum share the following symptoms: inability to relate in a manner consistent with social norms, inability to develop communicative ability and the presence of repetitive and stereotyped behaviors. In addition, most people with ASD also have cognitive deficits (75% of people are associated with an Intellectual Disability).

However, the severity with which people with ASD manifest these symptoms is very heterogeneous, and may even vary throughout their life, so it is necessary to know the specific case well to be able to design the appropriate therapy.

The formerly diagnosed as Asperger syndrome Is the type of less severe ASD, people who suffer from it do not usually have problems in language development and do not usually suffer from severe cognitive deficits.

He Child Disintegrative Disorder Is characterized because it appears when the child has already begun to speak, can appear between 2 and 10 years, and the child seems to unlearn all the communicative and social skills he had developed so far.

How Many People Have Autism?

Recent epidemiological studies indicate that 1 out of 166 children in the educational stage suffer from this disorder. There are no statistical data on how many people with ASD exist in adulthood. I could seem that this is nonsense because children will grow and there will be the same number of child cases as adults

The number of people diagnosed with ASD has increased considerably in recent years (as can be seen in the chart below), but, although it may seem so, this does not mean that there is an epidemic of autism but that today the criteria have changed Diagnoses for this disorder and that it has been given more importance and more cases have been studied in developing countries, ie, it is not that these cases did not exist before, they were not diagnosed.

Prevalence data in the US According to Autism Speaks

How is autism diagnosed?

Diagnostic criteria according to the DSM-V

Well I've talked to you about the DSM-V before, but what is it? The DSM-V is the Diagnostic and Statistical Manual of Mental Disorders, Ie a diagnostic and statistical manual of mental disorders. This manual is one of the most widely used worldwide and is based on statistics to determine which behaviors are within the norm (or are normal) and which are outside the standard deviation and could constitute a disorder.

That said, I leave you the diagnostic criteria that DSM-V uses to diagnose Autism Spectrum Disorders.

1- Persistent deficits in social communication and social interaction Throughout multiple contexts, as manifested in the following current or past symptoms (examples are illustrative, not exhaustive, see text):

1. Deficits in socio-emotional reciprocity ; Range of behaviors ranging, for example, from showing unusual social approaches and problems in maintaining the normal round-trip flow of conversations; To a reduced provision for sharing interests, emotions and affection; To a failure to initiate social interaction or respond to it.
2. Deficits in nonverbal communicative behaviors used in social interaction ; Range of behaviors that, for example, range from showing difficulty in integrating verbal and nonverbal communicative behaviors; To anomalies in visual contact and body language or deficits in the understanding and use of gestures; To a total lack of emotional expressiveness or non-verbal communication.
3. Deficits to develop, maintain and understand relationships ; Range of behaviors ranging, for example, from difficulties adjusting behavior to fit into different social contexts; Difficulties in sharing fictional games or making friends; To an apparent lack of interest in people.

Specify The current severity:

Severity is based on social and communicative alteration and on the presence of patterns of repetitive and restricted behavior (See table below).

2- Repeated and restricted patterns of behaviors, activities and interests , Which are manifested in, at least two Of the following symptoms, current or past (examples are illustrative, not exhaustive, see text):

1. Motor movements, use of stereotyped or repetitive objects or speech (Eg, simple stereotyped motor movements, aligning objects, turning objects, echolalia, idiosyncratic phrases).
2. Insist on equality, uncompromising adherence to routines or patterns of verbal and non-verbal ritualized behavior (For example, extreme discomfort in the face of small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, the need to always follow the same path, or always eat the same).
3. Highly restricted, obsessive interests that are abnormal because of their intensity or focus (Eg excessive attachment or excessive preoccupation with unusual objects, overly circumscribed or persevering interests).
4. Hyper- or sensorial hypo-reactivity or unusual interest in sensory aspects of the environment (Eg., Apparent indifference to pain / temperature, adverse response to specific sounds or textures, smelling or touching excess objects, fascination with lights or rotating objects).

Specify The current severity:

Severity is based on social and communicative alteration and on the presence of patterns of repetitive and restricted behavior (See table below).

3- The symptoms must be present in the early development period (Although they may not fully manifest until the demands of the environment exceed the child's abilities, or may be masked in later life by learned skills).

4- Symptoms cause clinically significant alterations Socially, occupationally or in other important areas of current functioning.

5- These alterations are not better explained by the presence of an intellectual disability (intellectual development disorder) or a global developmental delay . Intellectual disability and autism spectrum disorder often co-occur; To make a diagnosis of comorbidity of autism spectrum disorder and intellectual disability, social communication must be below expectations as a function of the overall level of development.

Note : Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's syndrome or generalized unspecified developmental disorder should receive the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not meet the criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify

• Whether or not accompanied by intellectual disability .
• Whether or not it is accompanied by a language disorder .
• It is associated with a medical or genetic condition or with a known environmental factor ( Coding note : Use additional code to identify medical or genetic condition).
• It is associated with another neurodevelopmental, mental or behavioral disorder ( Coding note : Use other additional code (s) to identify neurodevelopmental, mental or behavioral disorder).
• With Catatonia (Refer to the criteria for catatonia associated with another mental disorder) ( Coding note : Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of comorbid catatonia).

Levels of severity of autism spectrum disorder How to detect it?

These disorders can be differentiated from a very early age (except for the Child Disintegrative Disorder mentioned above), but there is no reliable diagnostic test until the child is about 18-24 months old, although a new test is developing that seems very promising. Doctor Ami Klin explains it in the following video:

The main warning signs are as follows:

• To the 12 months developmental:
  • Do not babble.
  • Do not use gestures like pointing.
  • Do not respond to his name.
• To the 18 months
  • Do not utter any words.
• To the 24 months
  • Do not utter two-word phrases spontaneously.
• TO any age
  • Loss of language or social skills (could be indicative of Childhood Disintegrative Disorder).

If any of these signs is observed, it is advisable to take the child to the evaluation and diagnosis service

Here are the signs and symptoms of people with Autism Spectrum Disorders in more detail:

• Social deficits. These deficits are the first to appear, the child shows little interest in relating to people even seems to shy away when parents try to catch or touch him, do not usually look into the eyes, show no signs of sadness or joy, do not usually seek comfort in Their parents are harmed or hungry, do not imitate the movements of their parents and do not usually gesture or gesture. As they grow older they also show these signs to children their age, and seem to have no interest in having social relationships and have trouble understanding and expressing emotions. In short, they seem not to have well developed theory of mind (concept explained in an earlier article).
• Communicative deficits. When they are babies they show signs like not looking when they pronounce their name and lack of communication either verbal or nonverbal. When they grow and develop the language this is very limited, they do not seem to understand what they are saying, they usually repeat the same sentence they have just said and use the second person to refer to themselves, for example"You want to eat spaghetti"in Instead of"I want to eat spaghetti". People with ASD who succeed in developing understandable language and more or less adapted to society fail to choose a topic that may interest the people with whom they are speaking and usually understand the sentences literally (eg, answer Simply"Yes"when asked"Do you have time?").
• Repetitive and stereotyped interests . When they are babies they present unusual responses to sensory stimulation. When they grow up they start to show stereotyped and repetitive movements (like rocking), and their games are strange, they usually focus on a particular object or the organization of their toys rather than using them to represent actions (for example, Others do not represent that they are moving at any time), are also very resistant to change, do not like to change plans, change the decoration, etc. When they are older they tend to have unusual interests and lead a fairly planned life.

This description of the symptoms and signs is only an aid to better understand this disorder, but in no case pretends to be a diagnostic guide. The diagnosis should always be made by specialized professionals, so that we can start treating them as soon as possible and design a program tailored to the particular characteristics of each individual.

Possible causes of ASD

The cause of autism is not yet known, but according to the latest research, it seems that there is no single cause that can explain the whole disorder, but that multiple factors influence it, although there is clear evidence of these factors are biological, as indicated by the Researcher Leo Kanner when he first described autism in 1943.

There have been many theories about the causes of autism, but they have all been proven to be uncertain.

The first theory developed by the clinicians of the time of Kanner was that autism was caused by lack of sensitivity and distant treatment of parents, more specifically of the mother since at this time it was very usual for women to deal with Form of child care.

One researcher, Bettelheim, even compared children with autism to cases of World War II survivors with apathy and hopelessness. This theory was like an ax to the parents of children with autism, as they blamed them for all the problems that their children suffered.

Fortunately it has been shown that this theory is not true since some studies have found that there are no significant differences between the parents of children with autism and the parents of children without autism in terms of sociability and sensitivity.

In the following video Dr. Wendy Chung will explain the theories have been formulated and discarded so far and new lines of research on the causes of autism.

References

1. American Psychiatric Association. (2014). Autism Spectrum Disorder 299.00 (F84.0). In A. P. Association, DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Pan American Medical Publishing.
2. Carlson, N. R. (2010). Autistic Disorder. In N. R. Carlson, Physiology of Behavior (Pages 593-597). Boston: Pearson.
3. Chica Martínez, A., & Checa Fernández, P. (2014). Developmental Disorders. In D. Redolar, Cognitive Neuroscience (Pages 406-408). Madrid: Medical Editorial Panamericana.
4. King, M., & Bearman, P. (2009). Diagnostic change and the increased prevalence of autism. International Journal of Epidemiology , 1224-1234. Doi: 10.1093 / ije / dyp261.
5. Presmanes Hill, A., Zuckerman, K., & Fombonne, E. (2015). Epidemiology of Autism Spectrum Disorders. In M. d. Robinson-Agramonte, Translational Approaches to Autism Spectrum Disorder (Pp. 13-38). Springer International Publishing. Doi: 10.1007 / 978-3-319-16321-5_2.
6. Weintraub, K. (2011). The prevalence puzzle: Autism counts. Nature , 22-24. Doi: 10.1038 / 479022a.