What is Autism?

By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar  www.whelehans.ie

Autism is a neurodevelopmental disorder characterised by impaired social interaction, verbal and non-verbal communication, and restricted and repetitive behaviour.

Whilst on its own, autism is not a learning disability or a mental health problem, some people with autism will have an accompanying learning disability, learning difficulty or mental health problem. Globally, autism occurs in 1-2 per 1000 people, with males five times more likely to be affected than females. It is suspected that the number of adults living with the condition is vastly underestimated.

Autism is a spectrum condition. This means that while all people with autism share certain difficulties, the condition affects each person differently.  Autism spectrum disorder (ASD) is characterised by:

·         Persistent deficits in social communication and social interaction across multiple contexts;

·         Restricted, repetitive patterns of behaviour, interests, or activities;

·         Symptoms must be present in the early developmental period (typically recognized in the first two years of life);

·         Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

Causes

Causes remain largely unknown. It is generally accepted that it is caused by abnormalities in brain structure or function. Evidence suggest complex genetic factors play a part in some forms of autism but there is no single cause.

Risk factors

Factors thought to increase the risk of developing ASD, known as ‘risk factors’, can usually be divided into five main categories:

• Genetic factors – certain genetic mutations may make a child more likely to develop ASD.
• Environmental factors – during pregnancy. Some suggested environmental factors include being born before 35 weeks of pregnancy (premature birth) and exposure to alcohol or medications such as sodium valproate (a medication sometimes used to treat epilepsy) during pregnancy.
• Psychological factors – people with ASD may think in certain ways that contribute towards their symptoms.
• Neurological factors – specific problems with the development of the brain and nervous system could contribute to the symptoms of ASD.
• Other health conditions – certain health conditions associated with higher rates of ASD.

Some myths about Autism (dispelled!)

There are many myths and misconceptions about autism.  Here are some of them. Autism:

….. is the childhood form of schizophrenia

Some early researchers believed that autism was the childhood form of schizophrenia. However we now have evidence that autism is completely distinct from schizophrenia, with different causes and effects.

….. is caused by a lack of maternal affection

Professor Bruno Bettelheim believed that autism was caused by a lack of maternal affection. This led to the concept of the ‘refrigerator mother’ i.e. a mother who was emotionally distant. This theory has since been disproved. There is now evidence that autism has nothing to do with lack of affection from parents. Most mothers and fathers of children with autism are extremely caring and loving parents.

….. is caused by the MMR vaccine

The idea that autism is caused by the MMR vaccine was first suggested by Dr. Andrew Wakefield in a research study published in 1998. However this study has since been shown to be seriously flawed and fraudulent. There have been many studies which show that there appears to be no causative link between the MMR vaccine and autism.

 

….. can be cured

Autism is a lifelong condition. Symptoms can be managed and with the right support a person can have a normal and productive life.

Symptoms and signs

Typically, symptoms of Autism spectrum disorder (ASD) first appear during infancy or childhood, and generally follow a steady course without remission. About half of parents of children with ASD notice their child's unusual behaviours by age 18 months, and about four-fifths notice by age 24 months.

 

The Journal of Autism and Developmental Disorders states that failure to meet any of the following milestones indicates autism is likely:

·         No babbling by 12 months.

·         No gesturing (pointing, waving, etc.) by 12 months.

·         No single words by 16 months.

·         No two-word (spontaneous, not just echolalic (just repeating what someone else said)) phrases by 24 months.

·         Any loss of any language or social skills, at any age.

Once diagnosis is made then there are recognised protocols and systems in place to help children with ASD and their families manage and flourish. For the purpose of this article I will look specifically at Autism and adults as there is less written about autism after childhood. Some people with ASD grow up without their condition being recognised, sometimes through choice.

 It is never too late to be diagnosed with ASD. Getting a diagnosis of autism (including Asperger) can be a really positive step. A lot of adults say their diagnosis has helped them to understand why they find certain things difficult, and also why they are especially good at some things.

Treatment

If you receive a formal diagnosis of autism, the person making the diagnosis should share information from the assessment with your GP. With a proper diagnosis, adults with ASD, in conjunction with other specialist health professionals, come up with a treatment plan. ASD patient may be able to access local autism support services, if these are available in their area. Autism is a spectrum, so every individual’s needs are very different and they will respond differently to different forms of therapy or intervention.

 Range of services currently listed via HSE, although not consistently or available everywhere

•        Residential care ranging from campus-based settings to high, medium and low support community housing to individual supported living.

•        Respite/Home Support/Outreach. 

•        Day Service Programmes ranging from autism-specific to programmes within Intellectual Disability, Physical/Sensory Disability and Mental Health Services. 

•        Rehabilitative & Vocational Training

•        Employment Supports

•        Behavioural Therapy

•        Mental Health Supports

•        Family Support 

•        Autism-Specific Education/Training for Professionals working with ASD clients.

Medical

Being a neural disorder, autism cannot be treated through medicines. However, people with autism display higher incidences of a range of both mental health and physical conditions than those who do not have autism. This includes the likes of depression, anxiety, bipolar disorder, diabetes, gastrointestinal disorders, epilepsy, insomnia, high cholesterol, high blood pressure and obesity.

So, in relation to medication, it is vitally important that the correct support and treatment for ASD patients, ie planning, environment, education, learning etc is in place to minimise any potential adverse effects relating to the conditions above. The reasons people with autism have higher incidences of these mental and physical problems is not fully understood.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

Migriane: Foods to Avoid

Food additive triggers
Additives like flavour enhancers, sweeteners and preservatives can all lead to migraines.  They include monosodium glutamate (MSG) which can cause a condition known as “Chinese restaurant syndrome”; one of the main symptoms of this is headache. MSG is present in packet soups, Oxo cubes, soy sauce, certain crisps, sauces and Chinese restaurant food. Always check the food label to identify if a food contains MSG.  Aspartame (sweetener) is present in diet fizzy drinks, sweets, sugar free foods and diet foods, it can cause headaches and in severe cases migraines. So many of us buy diet or sugar free foods and think “healthy”; but for a migraine sufferer these foods can trigger an attack.

Sodium nitrate can also trigger your migraine. It’s present in processed foods and is used primarily in cured meats to prolong their shelf life. When sodium nitrate is consumed in food it causes the body to produce nitric oxide, this is a gas which expands the blood vessels.  This can then result in an individual becoming more susceptible to a migraine.

Sulphites are present in dark alcoholic beverages, but they are also present in dried fruits, apricots, figs and prunes; this preservative has been known to trigger migraine in some. Sulphites are also present in citrus fruits like lime and lemons.

How to identify a food trigger

Food can be a trigger for only 20% of migraine suffers and can be wrongly blamed for an attack in the majority of cases. In order to identify what is really causing your migraine you need to refer back to you food diary. It’s important to also note that if a certain food does trigger a migraine, it may not be the only contributing factor. Fasting or skipping meals can bring on a migraine so eat little and often. If you wish to identify a triggering food then an elimination diet may be the best solution.

Elimination diet

To identify what foods may be triggering your migraine, an elimination diet may be one solution. Unfortunately in order to identify the triggers you may need to follow this diet for a number of weeks. This will give your body time to adjust to a new way of eating. It’s only a temporary diet as it can be very unbalanced. When the migraines have stopped or are not as regular then you can start to reintroduce other food groups into your diet.

Reintroducing foods

When reintroducing food, do it one day at a time and one food at a time. For one whole day start with a food you suspect is the least likely to cause a migraine and eat that food a number of times in the day. So if you are testing citrus fruit, then have an orange for breakfast, snack on grapefruit and add lemon juice to your water. The following day you need to revert back to your elimination diet and follow it again for an additional 48hours before testing a second food. Continue this process until you find the problematic food group. The common migraine trigger foods such as dairy, caffeine etc. should be added back into your diet last.

Avoiding foods

Continue your regular diet and eliminate all foods from the particular food group. If you suspect dairy to be causing your migraines’ then avoid, milk, cheese, yoghurt, cream and all dairy foods stuff. If you achieve relief with the avoidance method then reintroduce the food to ensure your theory is correct. Once you discover what food is triggering your migraine you need to determine how much of that food you can consume, everyone’s therapeutic index is different some people can tolerate a little while some people cannot ingest that food at all.

If you are avoiding any food/food group for some reason, you should consult a nutritionist. A Nutrition consultation can help identify food triggers, recommend an elimination diet, and formulate meal plans. Alternative foods may need to be introduced to ensure you are not missing out on essential nutrients. Also consider that food may not be the only triggering factor so do not eliminate a food unless you are sure it is exacerbating the symptoms of migraine.

Upcoming Migraine Talk

Whelehans Pharmacy in conjunction with Migraine Association of Ireland is hosting a Migraine Information evening on Tuesday June 23^rd at 7pm in the Greville Arms Hotel in Mullingar. Admission is free. Speakers on the night will include Dr. Martin Ruttledge, Consultant Neurologist from the Beaumont Migraine Clinic. Dr Ruttledge is one of the top neurologists in the country, and the top when it comes to migraine and headache. There will be other speakers including Nutritionist Aisling Murray and Pharmacist Eamonn Brady and help and advice from Migraine Association of Ireland on the night. Call the Whelehans Pharmacy at 04493 34591 for more information or to book a place.

Aisling Murray has a Bachelor of Science in Nutrition and offers a one to one specialist nutrition service at Whelehans Pharmacy. Call Whelehans at 04493 34591 for an appointment

Migraine Ireland Helpline is 1850 200 378 (ROI) or 0844 826 9323 or Email info@migraine.ie. Expert information at www.migraine.ie

This article is shortened. For more detailed information on migraine, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

Migraine and tyramine rich foods

People with migraine are often told to avoid chocolate, cheese and red wine as these are known triggers for migraines. These foods may not be the biggest cause or trigger for migraines for many, but they have an influence for some people living with migraine.

Is this only a myth?

Some consider the influence of the likes of chocolate, cheese and red wine on migraine to be a myth. However studies indicate that a type of amino acid called tyramine in these foods is a potential trigger for migraines for some people. Experts are still trying to understand how tyramine can trigger migraines. One explanation is that tyramine can cause nerve cells in the brain to release the chemical norepinephrine. This produces a chain reaction resulting in constriction (narrowing) of blood vessels in the brain followed by re-bound dilation (expansion) of these vessels which results in the type of throbbing headache pain often associated in migraine. Thus I would advise that anyone living with migraine eating these products in caution; if they trigger migraine then they should avoid; if they find they don’t trigger migraine attacks then they continue to enjoy.

Influence of fat

Amines are more readily absorbed when fat is present, which may be a reason that chocolate and cheese seem to trigger attacks more than other foods and why fried foods and dairy products are implicated by some in migraine attacks.

Foods known as migraine triggers include:

Chocolate; Cheese and other dairy products; Citrus fruits like oranges and lemons; Caffeine (tea and coffee); Alcohol (especially red wine and some beers); Pork; Onions; Marmite; Wheat.

Foods rich in protein have higher levels of tyramine if they have been stored for a long period of time or if have not been kept cold enough. This can explain why aged and fermented foods are sometimes seen as culprits when it comes to triggering migraine. These include the likes of aged cheeses, smoked fish, cured meats and some types of beers.

Food craving prior to migraine

Some people find they experience food cravings, such as a craving for cheese, up to 48 hours before an attack (during the prodromal stage…see later). Some experts reckon these craving are the reasons these foods are sometimes mistaken as triggers. Eating a suspected food trigger on a migraine-free day will help you to ascertain if it is a real trigger or whether it is simply a food craving that acts as a warning of an impending migraine

What is the prodromal phase?
Several hours before the migraine begins (and sometimes up to 24 hours before) many with migraines experience unusual sensations. This is known as the prodromal phase. They may feel:

·         Energetic and excitable

·         Depressed

·         Irritable

·         Thirsty

·         Cravings for certain foods

·         Sleepy, with frequent yawning

·         Need to urinate more

 

Many who experience migraines recognise the prodromal phase and know a migraine is on the way so they know to take action to prevent an attack (eg) rest, avoid stress, avoid bright lights, avoid certain foods, take preventative medication, etc. 

Weekly weigh in clinic

Currently, Nutritionist Aisling Murray Bsc Nutrition is offering a weight loss program in Whelehans Pharmacy where your BMI and waist measurement is calculated and she checks your weight weekly. You get tips and motivation weekly to help you lose weight all at a great weekly rate of €10 per week.

 Whelehans Nutrition Service

Whelehans nutritional service is a private one to one advice service with our nutritionist Aisling Murray. Aisling’s areas of interest include weight loss management, nutrition education and food intolerance. Our nutrition service offers you the chance to change your life in a positive way by focusing on your overall wellbeing as well as the chance to follow up on your progress.

Migraine Ireland Helpline is 1850 200 378 (ROI) or 0844 826 9323 or Email info@migraine.ie. Expert information at www.migraine.ie
 

Headache? ….but which one?

As we build towards our “Migraine Event” at the end of June, over the coming weeks we will be outlining through these pages information regarding the management of migraine.
One of the most important steps in the successful management of migraine is in diagnosing that it is actually migraine which is the cause of the headache. Migraine is quite distinct from other headache types in how it presents and in how an episode evolves, attacks and subsides. Let’s look at the three most common “primary” types of non-migraine headache (secondary being headaches caused by other medical conditions)
Tension Headache
The most common type of headache is tension headaches and is usually caused by stress, poor posture or inadequate lighting. Often beginning in the afternoon or early evening of a stressful day and presenting as a “band like” or “pressing” sensation at the front of the head, they can last from one to six hours.
With tension headache, pain tends to be bilateral (both sides of head), constant and with no other symptoms as opposed to migraine which is usually confined to one side of the head, together with other identifiable symptoms. 
For most, treatment with an analgesic (paracetamol, aspirin or ibuprofen) will usually take care of it. Engaging in self-management activities such as regular exercise, regular eye breaks from your computer at work, sensible eating habits and learning stress management techniques can all lead to a reduction in tension headaches.

Chronic Daily Headache

Different from tension headache, which is episodic in nature, Chronic Daily Headache (CDH) refers to any headache that occurs on at least 15 days per month with each at least four hours duration. Currently affecting 4-5% of the population (and growing) variants of CDH can significantly affect an individual’s ability to function at work, at home and socially.

There are three distinct types:-

Chronic Tension Headache
Typically affects those with a history of ordinary tension headache……and whilst similar, it occurs on at least 15 days per month. Whereas tension headache is usually related to individual situations, chronic tension headache tends to be provoked by more enduring ongoing personal situations, i.e. job issues, family and relationship problems, grief, depression

Chronic (Transformed) Migraine

Diagnosed if you have migraine on 15 or more days a month over a period of at least six months. Over time, people with this diagnosis may experience an additional daily or almost daily headache. As the frequency of these headaches increases, there is a corresponding decrease in actual headache pain along with other migraine symptoms.  The down side of this perceived relief is that the headaches become less responsive to treatment. Other effects include depression and sleep disturbance,

Medication Overuse Headache

This is caused by the overuse of medication, taken primarily to alleviate headache. In the main this relates to analgesics (paracetamol, codeine, aspirin or ibuprofen) although can also occur with migraine attacking drugs (triptans). Those most commonly affected are those with a history of tension headaches or migraines that have become more frequent or severe over time. They take medication to gain relief from the pain, only to find the headache returning once the drugs have worn off. Sufferers then take more medication to alleviate continued pain, pain eases, drugs wear off, pain returns etc. (a vicious circle!). Once in this spiral, the only way is to break the cycle completely is through withdrawal. This is best achieved through consultation with your doctor. Typical withdrawal side effects can be worsening headaches, nausea and anxiety for a couple of weeks.

 Cluster Headache.

This is a rare (approx. 1%) but very severe headache found six times more commonly in men and usually begins in late 20’s or early 30’s. Typically, attacks begin in the middle of the night. Primary symptom is a severe stabbing pain affecting one side of the head. The side affected can vary between attacks but only in very rare cases would it affect both sides of the head at the same time. The duration of an attack can be between 15 minutes and up to 3 hours. Attacks come in clusters (hence the name) and can occur several times a day over a period of weeks or even months. After each cluster though, attacks can disappear for months or years.
A cluster attack can be distinguished from a migraine attack in that with cluster headache the person is agitated during an attack or unable to sit or lie at peace or find relief though sleep.
During an attack, other symptoms may occur such as red or watery eyes, runny nose, nasal congestion, facial sweating. In addition, a sufferer’s eyes may be affected with constriction of the pupil or drooping or swelling of the eyelid. Cluster headache has been described by some medics as “the most painful event that can happen a person” which emphasises the severity of the condition.
Whilst the cause is unknown, suspected trigger factors include alcohol, tobacco, irregular sleeping patterns, and stress and decreased blood oxygen levels. The most common treatment for cluster headache is the inhalation of pure oxygen and is only successful if the mask fits perfectly without leaking. The three “primary” types of headache I’ve described are the most common non-migraine headaches. There are other types of headache, i.e. those relating to sinus problems, over exertion especially exercise. These are known as secondary headaches.  

Upcoming Migraine Talk

Whelehans Pharmacy in conjunction with Migraine Association of Ireland is hosting a Migraine Information evening on Tuesday June 23^rd at 7pm in the Greville Arms Hotel in Mullingar. Admission is free. Speakers on the night will include Dr. Martin Ruttledge, Consultant Neurologist from the Beaumont Migraine Clinic. Dr Ruttledge is one of the top neurologists in the country, and the top when it comes to migraine and headache. There will be other speakers including Nutritionist Aisling Murray and Pharmacist Eamonn Brady and help and advice from Migraine Association of Ireland on the night. Call the Whelehans Pharmacy at 04493 34591 for more information or to book a place.

Migraine Ireland Helpline is 1850 200 378 (ROI) or 0844 826 9323 or Email info@migraine.ie. Expert information at www.migraine.ie