UNDERSTANDING AUTISM
Autism is a disease, disorder, or syndrome, which typically appears in the first three years of life. Autism affects functions of the brain, interfering with reasoning abilities, communication, and social interaction. Some children with autism never speak while others start talking later than typical children. Those who speak often have difficulty with conversational skills. They often avoid eye contact and have difficulty understanding social cues. Autistic children do not tend to exhibit symbolic play in a typical way and some engage in repetitive, and at times self-abusive behaviors. Autism affects four times as many boys as it does girls. Autism is different for each child.
As of today there is no medical test that can determine if your child has autism or is on the “autistic spectrum”. A diagnosis of autism can be determined by a professional observing your child’s behaviors. Each child is different and therefore will not behave the same as other autistic children. However, there are some generalizations that are useful in helping determine if a child has autism. The following observations are taken from many different parents that have autistic children. When reading the list below, please keep in mind this is just a generalization and should not be used to determine if your child has autism. Some parents of autistic children will answer “yes” to many of theses questions, while others may only answer “yes” to a few. Autism ranges in its degree of severity. If there is any doubt, please take your child to be assessed by a professional.
- have “selective” hearing, meaning sometimes he responds to you, but often does not?
- have a language development delay?
- like to open and close doors repeatedly, or watch lights or fans?
- flap his hands or twirl/move his fingers near his face?
- tantrum frequently and at times for no obvious reason?
- hate getting his hair or nails cut?
- repeat over and over, word for word what is said to him, or what he hears on videos/TV?
- line up toys or objects?
- have a high pain threshold?
- eat only a few specific foods and craves sugar or salt?
- not ask for help when needed?
- seem to look off into nowhere or “zone out”?
- watch the same video over and over again?
- run or pace back and forth?
- not have words or skills that he once had?
- avoid eye contact?
- rock, spin, jump, or bounce often?
- twirl string or paper clips?
- have a distended abdomen, profuse sweating, or excessive thirst/urination?
- hate buying new shoes?
- cover his ears or seems overly sensitive to sounds, light, odors, or touch?
- have consistent difficulty sleeping or getting to sleep?
- act extremely fatigued, passive, restless, or hyperactive?
- play next to other children, but not with them?
- seem to be unaware of danger?
- not point his finger?
- have a difficult time with transitions or change?
- turn cars over and spin the wheels?
- fixate on trains, other topics, or parts of objects?
- have chronic diarrhea and/or constipation?
- have dark circles under his eyes, red cheeks or earlobes?
If your child has any of the above behaviors, we urge you to see your Doctor and school district to obtain an autism screening. The earlier a child is diagnosed and treated, the better the chance of recovery from autism. If it is discovered that your child has autism, PDD (pervasive developmental disorder), or Aspergers Syndrome, use this web site as a tool to help you help your child become the best that he or she can. Feel free to e-mail us with any questions you may have.
UNDERSTANDING SEIZURES
A seizure results from a temporary electrical disturbance in the brain. Epilepsy is simply the term used for anyone that has had two or more unexplained seizures occurring more then 24 hours apart. Epilepsy is considered a disease, while seizures are the symptoms. Unfortunately, autism and epilepsy are common as coexisting diseases. Approximately 20-30% of autistic individuals will develop seizures at some point in their lives. Certainly there is a connection between the two, one that science has yet to discover.
There are many types of seizures, but for simplistic purposes only a few will be discussed. Febrile seizures occur generally in infants, and result from a rapid increase or spiking of a fever. It is the rapid rise in temperature, not the temperature itself, which brings on this type of seizure. For the most part, these seizures are not dangerous and most doctors believe this type of seizure does not cause any long-term harmful effects. While scary to witness, these seizures require little treatment.
Generalized seizures are categorized mainly by tonic-clonic (grand mal), or absence (petit mal) seizures. Grand mal seizures occur when a person has their entire body contract or flex all their muscles at once (the tonic phase). Then the body will jerk and twitch (the clonic phase) as the person shakes. Drool or foaming of the mouth can occur. The person may moan or make unusual noises and perhaps lose bladder control. The seizure generally last less than one minute and is followed by a post-ictal state in which the person usually sleeps. Petit mal seizures are often viewed as “zoning out” or starring spells, which usually last five to fifteen seconds. The person is still conscious, unlike the grand mal seizure, but is unable to answer questions or move. This person usually recovers quickly and may be unaware the seizure took place. If the electrical activity spreads to impair the person’s level of consciousness, then the seizure is termed complex partial. Or if the seizure causes convulsions, then the name partial seizure with secondary generalization is used. Please visit other web sites to learn more about the many other terms used.
Most people with epilepsy are treated with anti-epileptic drugs (AED). For easily controlled epilepsy, a Neurologist may be a good choice to use as the individual’s doctor. However, for those people that are unable to get their seizures under control, or for someone simply looking for another opinion, an Epileptologist should be consulted. It would be prudent to seek a pediatric doctor in either case if the patient is a child. Studies vary as to the success of seizure control from medication. The best studies, in terms of success of medication, state approximately 70% of people with epilepsy will gain control of their seizures using medication. The other 30%, by necessity, will be forced to try other methods. The goal with medication should be seizure control with minimal or no side effects. Some medications work well to stop seizures, but can have very negative side effects that can cause the person to switch medications. Parent surveys from the Autism Research Institute have shown that Tegratol and Depakote were rated the most effective drugs in controlling seizure activity and improving behavior. It would obviously be smart to try these two drugs first in treating seizures with a person with autism. Note however, that all medications work different in different individuals. Thus, some seizures and behaviors are made worse by these same medications. The newest medication available in the US is Onfi. This drug has been available in other countries for many years, but only about two years in the US. Like other medications, it will be helpful for some, but work poorly for others. Medication is but one choice of treatments to attempt. If medication fails, or the side effects are too significant, there are other options.
The first logical option to try if medication fails would be the Ketogenic diet. Perhaps the Ketogenic diet is even the first step to try, before medication. Most doctors would disagree with that statement, but it is certainly an option. The Ketogenic diet, in simple terms, is a very high fat, low protein, and low carbohydrate diet. The body produces ketones from this diet, which many believe to have an anti-seizure protective measure in the brain. The diet is calorie restrictive so the person does not gain a lot of weight. Studies have been extremely promising thus far for this treatment. It should be noted that this diet MUST be done under the direct care of a doctor AND especially a good dietician. This is not a diet to try without medical supervision. If an autistic child is already on the GFCF diet, then the transition to this diet should be relatively easy for both the parents and the child. This treatment has been used successfully since the 1920’s. After the movie “First Do No Harm” with Meryl Streep came out some years ago, the diet treatment has become a mainstream medical practice. Many doctors do not have the facts right on this diet and as such, do not recommend it until all other treatments have been exhausted. Even though younger children seem to benefit more from the diet, even adults can attain seizure control from the Ketogenic diet. More studies need to be done so we can learn more about this treatment option and its variations.
If medication and the Ketogenic diet are unsuccessful, then the next step that should be explored should be the Vagus Nerve Stimulator (VNS) or surgery. Surgery can be a good option, but only for certain patients. Various factors must be present for surgery to be considered. There are a few different surgical options that are performed for the control of seizures. The VNS therapy is similar to a heart pacemaker; in that a small device is implanted into the patient’s chest (or in the case of some children, the back) and electrical impulses are sent to the vagus nerve. Scientists are unclear as to why the VNS works, but many people have had positive results from this anti-seizure treatment. Doctors use the rule of “thirds” to explain the success rate of this device. 1/3 have significant improvement, 1/3 have moderate improvement, and 1/3 see no changes. Most people that benefit will still need to take medication while using this device.