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 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.
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.
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.
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.
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.
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