January 30, 2018
ARTICLE:

Autistic Spectrum Disorder – Part 1

By Dr Megan Yap - Paediatrician

So it’s a big couple of weeks for parents and kids hasn’t it?  School has gone back for the year and things are returning to normal after what has hopefully been a relaxing and rejuvenating break for everyone.   My daughter started school last week for the first time as a preppie.  I’d be totally lying if I said I didn’t feel stressed about it (and I HAVE lost sleep), even though Gwennie was completely fine!  I have already forgotten things for her school bag (yep… Mother of the year, right here)… today forgot her sleeping mat.  Seriously, I don’t know how other mums (and dads) manage to remember everything!! I noticed also that I hadn’t wrapped her “Bento” lunch box (that I was recommended to get) in a cold lunch bag either.  Hopefully she doesn’t get food poisoning…  Sighhhhh…

She has her first FULL day (after half days last week) today.  Just did drop off.  Phew.

So anyhoo, enough about back to school, I have been prepping for a couple of weeks to broach a topic that I have been putting off blogging on for ages.

Autism.  It is such a huge topic to write about.

When I started this blog a few months ago, I knew of course that this was a subject that parents would want to hear about.  I have a special interest in developmental paediatrics, and children with Autistic Spectrum Disorders (or queries about possible diagnosis) make up a large portion of my practice, both private AND public.

So why have I put off writing about it for so long??

I have been anxious about it to be honest.  I think I just wanted to make sure I found the right words to use to explain this condition.  I know how deeply a diagnosis affected one of my best friends, when her son was diagnosed (and that diagnosis was communicated very bluntly and poorly), and how profoundly it affects the parents of the patients that I have with the condition at the time of diagnosis.  I wanted to make sure that parents took the right message from the blog, weren’t unduly stressed by it, left with a greater understanding of what the diagnosis means, and also with a sense of optimism about “what could be” for their child in the future… all the while being frank, honest and open about the difficulties that people with this condition face (exactly as I try to do in my clinic too I guess).   I hope I manage to do that in this post.  At the end of the day, if you are concerned that your child might have ASD, get a referral from your GP to see a paediatrician.

It is such a massive subject that I’ve decided to break it up into two parts, over 2 weeks.

Part 1: 

  1. What is it?
  2. How common is it?
  3. What causes it?
  4. What does it look like (and when should a parent become concerned/seek advice)?

Part 2:

  1. What are the different types of autism (classification)?
  2. How is autism diagnosed (and who exactly can diagnose it)?
  3. Other conditions that can LOOK like autism, that aren’t autism
  4. How is ASD treated?

ALL of the info at once is really too much to take in, and I hope you don’t mind that I have done this (ie do it over a couple of weeks).

Alrighty then, let’s get started!

 

What is autism?

Autism gets a great deal of attention (good and bad) in mainstream media.  Everyone thinks they know someone with it (whether it be formally diagnosed or not) and we often hear people say that they feel that “[they are] autistic” themselves.  There is an enormous amount of misinformation out there and hence also fear, about what this condition is, how children are affected and what it means for a person’s life.

Let’s try to set this straight shall we?

Autism is a term used to describe a developmental condition where the affected person has impairment in the everyday functioning (in their job/at school or in other aspects of their daily lives) due to substantial difficulties with social interactions and communication, as well as restricted interests and repetitive behaviours. This can be associated with inflexibility (of attitude; ie a general stubbornness) and the need to stick to routines, and/or over/under-reactivity to sensory stimuli in the environment.

The term “Autistic Spectrum Disorder (ASD)” recognises that in different people, these characteristics can manifest in various combinations with varying severity (that is, they occur on a spectrum).

 

How common is it?

According to the AMA (Australian Medical Association) position statement on ASD (2016), there is no reliable data about the occurrence of ASD in Australia.  Our estimates are based on data in similar countries like the United States and the United Kingdom, although estimates used in Australia tend to be on the more conservative side.  In the US, a prevalence of about 1.5% is reported in children [1], whereas in the UK it is reported at about 1% [2] (so this is the prevalence that tends to be reported in Australia).

This means about 1 in every hundred children is affected by ASD – or in real terms, maybe one child in every 3-4 classrooms in schools.  It occurs almost 4 times more commonly in boys than girls.

 

What causes autism?

There are many factors that might increase the risk of a child having autism but exactly why autism happens is still unclear to us.  Research has suggested that it might come from abnormalities in parts of the brain that interpret sensory input and help us to process and use language.[3]

Some risk factors include:

  • A strong family history of autism
  • Older mothers and fathers
  • Exposure of the mother to certain drugs or chemicals during pregnancy (eg alcohol, antiepileptic medications)
  • Rubella

There is NO EVIDENCE to show that vaccinations cause autism (even though they are commonly blamed).

 

What does it look like (ie what are the signs and symptoms?)

The two things that all children with an Autistic Spectrum Disorder have in common (regardless of the severity of the condition), are difficulties relating to and communicating with other people (social skills), as well as restricted or repetitive patterns of behaviour.  Symptoms of autism typically appear during the first 3 years of life although some parents report signs in their children noticed from birth.

There are MANY symptoms and signs that are associated with autism, and it is important to know that

  • not all of them need to be present for a diagnosis
  • just because someone has some symptoms/features, doesn’t mean that they have autism

In fact, it would be true to say that everyone on earth would have at least one or more of the features associated with ASD – even though only around 1 in 100 people would meet full criteria for a formal diagnosis.

ASD can also occur alongside other medical conditions like epilepsy or associated with a chromosomal abnormality (eg Cornelia de Lange syndrome (CdLS), Tuberous Sclerosis, Fragile X syndrome).[4]

The symptoms and signs of autism can look different in different individuals, and they present in varied ways depending on the child’s age and how severely they are affected.

 

Here is a list of some signs of ASD.  It is not exhaustive, but is designed to paint a picture of the difficulties that someone with the diagnosis might have.  

 

Communication

Children with ASD might:

  • as a baby make little noise/babble
  • have delayed or no spoken language (often first noticed at age 2-4 years)
  • repeat words or phrases out of context or use an odd tone of voice or accent
  • have difficulties understanding even simple instructions
  • as they get older, fail to recognise body language or other social cues
  • not understand inferential language, sarcasm or be unduly literal in their understanding of what is said to them.

 Social skills

Children with ASD commonly are unable to see things from another person’s perspective.  For example, if someone hurts themselves and cries, they may not understand why the person is upset.

They might also

  • lack empathy or emotion
  • be disinterested in interactions with their peers or adults
  • have poor eye contact
  • lack imagination when playing, instead displaying repetitive or ritualistic play (eg lining toys up, sorting them into colours etc)
  • not respond when their name is called or if they are spoken to
  • not point to things or use gestures
  • fail to share enjoyment or interests – for example they might not bring a toy to show their parent

Restricted interests and repetitive behaviours

Children with ASD may:

  • have an obsessive interest in certain objects or subjects – for example, a child might know all about the names and types of dinosaurs as well as obscure facts about them or, they might carry an object, however unusual (eg a coat hanger) around with them everywhere.
  • be very rigid in following routines and be unreasonably upset by changes in that routine
  • focus narrowly on an object – for example locking and unlocking a door, flicking a light switch on and off
  • play in a meaningless or repetitive way with a toy or object eg spinning the wheels on a toy car rather than driving it
  • display repetitive or unusual body movements – for example hand-flapping, toe-walking or body rocking

Sensory behaviours

Children with autism might

  • be overly sensitive to sensory input (eg certain noises, the sensation of grass or sand under their feet)
  • be under-sensitive to sensory input (eg have a very high pain threshold)
  • seek sensory input – for example they might like spinning themselves around in circles until they are dizzy, or sniff/smell everything around them; lick things

 

Okay… I think that might be enough for today – yah?  Plus I gotta go cook some yummy dinner for my dad (who is ACTUALLY coming around for dinner tonight (I think he comes over one in every 10 times I ask him to) – Nasi Lemak, my first attempt).

Next week, we’ll discuss the different TYPES of autism (and present and past classification systems), how it is diagnosed, WHO can diagnose it (in Australia) and how it is is best managed/treated.

 

Sit tight for the next exciting installment!!

 

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

 

 

 

 

REFERENCES

[1] Christensen DL, Baio J, Braun KV et al.  Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2012. MMWR Surveill Summ 2016;65(No.SS-3)(No.SS-3):1-23

[2] Brugha TS, McManus S, Bankart J, Scott F et al.  Epidemiology of Autism Spectrum Disorder in Adults in the community in England. Arch Fen Psychiatry 2011;86(5):459-465

[3] < https://www.webmd.com/brain/autism/understanding-autism-basics#3>

[4] http://raisingchildren.net.au/articles/autistic_disorder_signs_and_symptoms.html

[5]  http://www.autismawareness.com.au/diagnosis/who-can-diagnose/

[6] https://ama.com.au/position-statement/autism-spectrum-disorder-2016

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