AUTISM SPECTRUM DISORDER

(ASD): A GENERAL OVERVIEW

A PAPER PRESENTED BY:
OKEY-MARTINS NWOKOLO
Mphil/Ph.D student, Developmental Psychology Department UNILAG.
Programme Supervisor, Acceleration Therapy, Lagos.

E-mail:izuogu44@yahoo.co.uk
08039112839

Cell:

WHAT TO EXPECT
INTRODUCTION

WHAT IS AUTISM SPECTRUM DISORDER (ASD) ?

DIAGNOSTIC CRITERIA FOR PERVASIVE DEVELOPMENTAL DISORDERS (APA, 2000)

THE TRIAD OF IMPAIRMENT/SYMPTONS OF ASD

ADDITIONAL FEATURES COMMON WITH ASD
WHAT CAUSES ASD?
SOME FACTS ABOUT ASD
DETECTING ASD AT AN EARLY AGE
EARLY SIGNS TO LOOK FOR
OBSERVATIONS TO MAKE
MAKING A COMPREHENSIVE ASSESSMENT
INTERVENTION STRATEGIES
REFERENCES

 INTRODUCTION

The term autism is scary. It is replete with stigma, fear,

frustration and controversy. Stigma against persons and
families with autism. Fear for parents who are worried over the
future of their child diagnosed with autism and frustration for
parents and teachers who struggle daily with the challenging
behaviours and demands of supporting children with the
condition. The controversial image of autism is even more
serious and concerns professionals(including medical doctors)
differences in opinion regarding definition, causes presences,
intervention and cure.

This situations leaves parents even more confused. Yet , they

are interested in knowing more about their childs development
and pediatric practitioners in Nigeria need to better prepared
for this. The best thing you can do for these children and their
families is to keep abreast on current developments in the filed
and make informed decision about treatment.

WHAT IS AUTISM SPECTRUM DISORDER ?

Autism was first described by Leo Kanner of Johns Hopkins in 1943. He identified it as
a disorder with impairment in:
1. Reciprocal Social Interaction
2. Language and Communication development
3. Behaviour development.

Autism is actually a subtype of a class of disorders known as Pervasive Developmental

Disorder (PDD.) and there are 5 of these disorders.
1. Autism (Autistic disorder)
2. Asperger Syndrome
3. Retts disorder also called Retts syndrome
4. Childhood Disintegrative (CDD) Sometimes referred to as
Hellers syndrome
or disintegrative psychosis
5. Pervasive Development Disorder Not Otherwise Specified (PDD.Nos) sometimes
called a typical autism.

Although the term Autistic Spectrum Disorders (ASD) has gained acceptance and is
now used to mean the same thing as PDD, it is not yet an official diagnostic label.
This means that you cant find the term ASD in either the Diagnostic and Statistical
Manual of mental disorder (DSM. IV) or the world health organizations International
Classification of Disorder (ICD).

DIAGNOSTIC CRITERIA
SEE LEAFLET

THE TRIAD OF IMPAIRMENT

.SYMPTOMS OF ASD
LANGUAGE AND COMMUNICATION

Child may not babble, may be mute

The development of speech and language may be abnormal

delayed
or absent

May act as though deaf / or not respond when called by

name or even by gesture.

May echo or repeat words, phrases, sentences / or questions

over and over again echolalic speech.

Facial expressions and gestures may be unusual or absent

Incorrect understanding of speech . Words may be used

incorrectly

Production of speech may be unusual. A flat monotonous

tone or inappropriate variation is tone are of noted

Difficulties in initiating and or sustaining conversations.

BEHAVIOR AND IMAGINATION

Symbolic or imaginative play may be limited or absent e.g.
cannot play with a match box as if it is a car.
May be routine bound. Insist on sameness and resist change. Do
not tolerate change in routine or environment as this may cause
distress. E.g. changing his toy, school bag or position of furniture.
Inappropriate use of toys in play.
Morbid attachment to objects may hold onto a teddy for the
whole day.
Throw tantrums, screams often for no apparent reason.
A tendency to focus on minor or trivial aspects of things in the
environment, instead of being aware of the meaning of the
complete situation.

ADDITIONAL FEATURES
Odd response to sensory input e.g. covering ears.
Engaging in self injurious behaviors e.g. head banging, hand biting,
face/head slapping.
Stereotypical behaviors e.g. hand flapping, incessant rocking, jumping
up and down, aimless wandering.
Repetitive/compulsive patterns of behavior opening and closing door.
Repetitive lining of objects such as legos, finger twisting or curling.
Language and or social regression e.g. sudden loss of previous ability
to point, kiss, eye contact, etc.
Walking on toes
Sleep disturbances
Bizarre eating patterns food fads
Poor muscle tone e.g. clumsy with picking up small objects
No real fear of dangers may run into a moving car or put finger on a
burning gas.

WHAT

CAUSES

AUTISTIC

SPECTRUM

DISORDER?

No one has been able to answer this question precisely and conclusively.
The complex and pervasive nature of the disorder makes it even more
complicated to pin-point the exact cause or causes. It would appear that
ASD occurs as the result of varied and different biochemical causes and
presents as malfunctioning of the brain (ASA, 2003).

ASD is definitely NOT the result of bad parenting and children with ASD do
not just choose to misbehave. This had been the impression during 1950s.
Volkmar and Wielsner (2004) gave the following as evidence that autism
was a brain-based disorder:
The prevalence of seizures: As children with autism were followed over
time, it was clear that many of them went on to develop seizures.
The prevalence of neurological problems: Many children with autism exhibit
unusual features on neurological examination such as persistent primitive
reflexes(which are present at birth but typically disappear in children after
a few months).
The high rate of prematurity or other birth problems: Some studies have
reported that
children with autism are more likely to have had
complications during the pregnancy or after birth.
The association of autism with a number of medical conditions that are
known to affect brain development e.g. phenylketonuria, congenital rubella,
tuberous sclerosis, and fragile x syndrome. These associations are strongest
with fragile x syndrome and tuberous sclerosis but research is ongoing.

GENETICS AND ENVIRONMENTAL FACTORS

There is evidence that genetic factors are very much involved in
autism.Research on genetics of autism suggest that the predisposition
to develop autism can be inherited, and that a range of other problems
in language, learning, and social interaction might also be inherited.
There is currently much controversy and interest in the question of
whether the environment can cause autism.Some reports suggest a link
between immunizations or exposure to mercury in vaccines and autism.
My opinion in this matter would be that Nigerian professionals should
find out why many states in USA outlaw thimerosal. Also ,it may be
needful to reevaluate the quality of vaccines that our children are
getting in terms of ensuring that they are of the safest standards..and
not rejected commodities from the west and USA. Furthermore, we
might need to check or review the safety levels our current
immunization schedules.
The Center for Autism and Related Disabilities (CARD) listed many
biochemical factors that may be implicated in the etiology of autism,e.g.
allergens,leaky gut,vaccines, etc. More information can be obtained
from their website(see reference)

SOME FACTS ABOUT AUTISM

Autism is the third most common developmental disorder, following
mental retardation and cerebral palsy.
Autism as yet, has no known medical test or cure but is TREATABLE.
It occurs more in males than in females at a ratio of 4:1
It appears to have 2 forms:
(a) Infantile/static : In which case symptoms are present from
birth.
(b) Regressive : In this case, there is an actual loss of previously
learned skill. May present from fifteen months to two and half years.
Autism has no boundaries . It can affect anybody regardless of social
status, religion, country or creed.

NEED FOR EARLY DETECTION OF ASD

Early diagnosis and appropriate intervention leads to great
positive outcomes.Research has shown that the earlier the
intervention the better the prognosis.
Children do not simply outgrow ASD
It appears to be a deteriorating conditionsome describe it as
progressively degenerative.
The human brain is very plastic. Prior to age 5, major neural
networks are possible (Volkmar and Wiesner,2004). If a child
does not develop or use certain tracts in the brain during these
critical time limit, he may never fully do so. Obviously, children
between 6 and 10 or more do improve, but it is a slower
process, often requiring more effort to learn the basics
,and grow up developmentally. From personal experience, I
cant say that I have the same top hope for a patient who is 9
or 10 that I may have for a 2-4 year old.

EARLY SIGNS TO LOOK FOR

Although there are individual differences,some characteristics
appear to be universal among children with a high risk of
developing ASD.
Child does not babble or point at 12 months.
Child does not use single words at 16 months.
Child does not try to imitate words, scribbling
Child shows regression or loss of previously learned skill.
This may be language regression (e.g. stopped using words) or
social regression (e.g. stopped pointing, kissing, etc.)
Acts as deaf or does not respond to name when called
Avoids eye contact
Does not take interest in other children
Does not like to be swung, cuddled, or bounced on knees
Does not play appropriately with toys (e.g. cars) but only
mouths, fiddles or drops them.

OBSERVATIONS TO MAKE
During your observation of the child notice the following:
Does the child recognize your presence?
Does he respond toHello or a handshake?
Does he make eye contact
Does he point or follow your pointing
See the Checklist for Autism in Toddles (CHAT) at:
www.featnt.org/info/chattest.asp

COMPREHENSIVE ASSESSMENTS
If your suspicion of autism is still strong, you may consider more
specialized assessments by members of other disciplines. Service
providers such as Acceleration Therapy, Lagos, may be helpful as
well.
A comprehensive assessment will normally involve the following:
History
Medical Assessments
Psychological Assessments
Speech-Language Communication Assessment
Occupational and Therapy physical Assessments

Considering that the audience is made up of mostly medical

personnel, it might be necessary to outline some of the recommended
medical tests for Autism. There is no specific medical test for ASD.
However, once you have a suspicion of autism, you may want to run
some recommended tests to rule out other possible causes. Doctors
may check for:

Lead levels

Hearing
MRI scan
EEG- for possible seizures
Fragile x syndrome: 5-10% of children with ASD present with
fragile x.
Metabolic Screening: Some treatable metabolic disorders may
result in the manifestation of ASD.

Chromosomal Testing:

Immunological dysfunction: Allergens such as gluten and casein
may be affecting the childs behaviour

INTERVENTION STRATEGES
To date, (medically speaking) there is no cure for ASD. Behaviour and
Educational intervention approaches have proved beneficial to most children
on the spectrum. Research has shown that approaches such as ABA, which
offer structured intensive programming can be extremely helpful .
There are however, numerous other approaches which have been beneficial
for some people with ASD. Some of the techniques overlap but there are
basically two approaches: those that attempt to change the child and those
that attempt to change the environment for the benefit of the child. The
latter has gained more research acceptance.
Intervention techniques which have been found to be beneficial to people
with ASD, include:
Lovaas (ABA)
Specialized Education
Behaviour modification
Occupational therapy
Speech Language and communication therapy
Auditory integration
Relationship Development Intervention (RDI)
Picture Exchange communication system (PECS)
TEACCH (Treatment and Education of Autistic and Related Communication
Handicapped Children)

Sensory Integration
Vitamin therapy
Dietary modification etc
Option Institute (Son Rise Programme)
Drug treatments.

Autism is here with us. More and more children

are being reported to be on the spectrum. My
biggest wish today is that everyone here will
become an advocate for these vulnerable
children and families. We need to get parents out
of shame and denial. We need to campaign for
availability of appropriate services. We need to
educate the government and the public about
ASD, we need to get schools to open their gates
for our children.

REFERENCES

American Psychiatric Association (APA). 1994. The Diagnostic and Statistical

Manual of mental disorders. 4th ed. (DSM-IV) Washington D.C. APA
Autism South Africa (2003) My Child May be affected by Autism Spectrum
Disorder (information for parents).

CARD (2004) Biochemical Flowchart: http://www.centerforautism

.com /biological / biochemical/

Jordan, R. (1997). Education of Children and Young People with Autism

Birmingham

Volkmar, F.R, and Wiesner, L.G. (2004). Healthcare for Children on the
Autism Spectrum. Bethesda, Woodbine House.

Wing. L. (2003): The Autism Spectrum. A, guide for parents and

professionals.

Wing. L. (1993). Autistic Spectrum Disorders: An Aid to Diagnosis.

Wing, L., and Atwood. T. (1987). Syndromes of autism and atypical

development. In D. Cohen and A. Donnell an, editors. Handbook of autism
and pervasive development disorders. New York: John Wiley & Sons, 3-19.

THANKS FOR LISTENING

Yours in pursuit of hope and help for
children in Nigeria with ASD.