Notes from the Nurse, July 2011

By OCUUC posted Wednesday, July 20, 2011, 1:41 pm

What I learned about Autism

The most interesting workshop I attended at my recent nurse practitioner conference was on autism spectrum disorder (ASD) in children. I want to share some of the key points with you in this column.

ASD is manifested by impaired socialization, delayed or unusual communication, and repetitive behavior patterns. There are many completely different causes, but all seem to be related to genetics. How the mutations occur is another question. Researchers are investigating a possible viral cause among several others.
There is a full spectrum of symptoms and degrees of severity from extremely mild to disabling
Statistics: 1 in 91 people in the US are affected (2009), occurrence is 4-5 times higher in males, recurrence rate within families is 10-15%
Those affected with ASD use their eyes differently, looking at the mouth rather than the eyes. It is harder for them to look and listen at the same time. They have a heightened sense of hearing, smell, and touch.
Multiple genetic changes are involved; girls seem to be protected by having 2 X chromosomes. (normal genes on one chromosome protect against abnormal genes on the other; since boys have only one X, they are more vulnerable)
Developmental screening is very important throughout the first 2 ½ years of life. Early intervention can make a huge difference in helping children and families learn to cope with ASD, and in fact improving the outcome. With a proper program, the brain will actually grow more normally. The reason ASD is often not diagnosed until after 18 months of age is that a different set of genes is activated at that point in development. It is only then that certain behaviors or the lack of them become obvious. The sad thing is that the average age of diagnosis is still 8-9 years. (Side note: the brain is not fully mature till age 24 years!)
Signs to watch for: no big smiles by 6 months, no back and forth sharing by 9 months, no babbling by 12 months, no gestures by 18 months, no words by 16 months, no 2 word meaningful phrases by 24 months, loss of skills at any age.
Behavioral Signs (more than one or two of these): hour long tantrums more than once a day, doesn’t know how to play with age appropriate toys, gets stuck on things over and over, persistent toe-walking, unusual attachments to parts of toys or objects, lines things up, odd movement patterns, extremely oversensitive to certain textures or sounds, very uncooperative
Special educational, occupational, speech therapy, social storytelling, physical activity that helps integrate the senses (e.g. horseback riding) are all techniques that actually help create new brain connections.
There are medications that can help with various aspects of ASD. There is no cure.
Vaccines do NOT cause autism!!

What can you do? If you are close to children of family and friends, a daycare provider or teacher, be alert to the possibility of ASD if there is a delay in normal development. If you are concerned, the parents probably are too, but are fearful and/or in denial. All parents compare their children to others. This is a subject to be very gently broached. Excellent resources can be found at www.autismspeaks.org and www.ninds.nih.gov/disorders/autism As a parent, insist on your health care provider’s doing appropriate developmental screening as recommended by the American Academy of Pediatrics.

Adair Small, Congregation Nurse, nurseocuuc dot org (nurseocuuc dot org)