QUESTIONS YOU NEED TO ASK
The Autism Spectrum – Questions & Answers
What is Autism?
Autism is a developmental disorder relating to interaction and communication, expressed in two main categories:
|1. Marked impairment of social interaction with others (lack of eye contact, or low level eye contact, lack of participation in enjoyment).
|2. Restricted repetitive and stereotyped patterns of behavior and rituals (obsessive repetition of actions or movements).
Is there a known cause for the development of Autism?
Demystifying the etiology of autism is a scientific task that has undergone many fluctuations over the last few decades. Although there is substantial research evidence concerning the influence of genetic factors, broader consideration today relates to the epi-genetic field that also includes consideration of environmental factors.
At present it is still impossible to isolate the genetic-environmental and neuro-developmental factors involved in neurological or metabolic aspects of the disorder.
Has there been an increase in the frequency of Autism in recent years?
In the early 1980s, international statistics indicated that there were 2 cases of autism per 5,000 children.
In the 1990s, with the extension of the DSM-IV (American Psychiatric Association Diagnostic Manual) criteria for the definition of Pervasive Developmental Disorders (PDD), the range of cases included within this category also broadened and the frequency was estimated as 2 cases per thousand children.
The addition of Asperger’s Syndrome to this category also dramatically increased the frequency of cases.
Simultaneously, the level of awareness concerning these disorders rose, diagnostic tools were enhanced, and the age of diagnosis was greatly reduced.
In 2014 the prevalence of the phenomenon of autism reached epidemic proportions: one case per eighty (1:80) children in the USA; one per one hundred (1:100) in Israel.
How and where is Autism diagnosed?
In the past decade, diagnosis has been conducted with the help of internationally accepted tools.
- The common tool, appropriate for toddlers 2 years old, is ADOS-T 3.
- The common tool for the age of 1.5 years to 2 years is the M-CHATT
A recent novel tool to assess infants under the age of 18 months is the Early Scale of Pre-Autism Scale (ESPASI), which was developed at the Mifne Center. In Israel, the following professionals are exclusively qualified to make the diagnosis:
- Developmental Pediatricians
- Child psychiatrists
Diagnoses are made in the Child Development Stations of the various health funds and hospitals. Each hospital in Israel has an institute for child development, nevertheless the queues for appointments at these institutes are lengthy and months are often wasted waiting for diagnosis.
Sometimes, the alternative of private diagnosis by an experienced expert may be advisable in order not to lose precious time for early treatment.
When can Autism be first diagnosed?
“Symptoms are typically recognized during the second year of life, but may be seen earlier than 12 months” (DSM-5)
In recent years, there has been a significant reduction in the age at which autism is diagnosed. In Israel, children are usually diagnosed between the ages of 1.5-2 years old, yet even this age may be too late.
- It is important to diagnose babies under the age of 1.5 years.
- It is important to note that the diagnosis at this stage does not indicate autism, but rather a developmental disorder that may point to a pre-autism stage, since symptoms are not yet clear at this age, and caution should be applied to this diagnosis.
What is the advantage of such an early diagnosis?
Treatment in infancy is advantageous because of the plasticity of the brain at this stage.
In the first two years of life the most accelerated growth of neurons takes place in the brain. These neurons are built into a complex web of cells that controls the baby’s sensory-emotional-cognitive regulation.
A baby that avoids contact with others is often a baby experiencing sensory-overload, and is unable to contain this flood of stimuli.In emotional development that influences social inter-personal capabilities, the involvement of neurological and neuro-chemical systems affect regulation.
Treatment through stimulation in measures appropriate for the baby’s needs can amend the baby’s regulative abilities and the entire development of a baby with communication development difficulties.
How is it possible to know that this is a case of Autism?
Babies are born with the ability to bond and create attachments, and this can already be discerned from the age of three months. When a baby does not make contact, or does not show an interest in its surroundings, it is first necessary to negate medical problems (sight and hearing). Only once these possibilities have been negated, testing for an attachment and communication development disorder should be considered.
Not every attachment and communication development problem will develop and become autism, but every autistic state begins with an attachment and communication development problem!
Are there professionals who claim that diagnosis cannot be made at such a young age?
Over many years, when parents of children with autism were interviewed for therapeutic purposes and asked when they first noticed that their child’s development was somewhat inappropriate, they would mostly provide one of two responses.
- ‘Our child developed normally until the age of one year and then a regression occurred.’
- ‘I felt from the beginning that something was not right with my baby but, everyone told me that I was just a hysterical mother.’
Most mothers have good intuition concerning their infants, and it is wise to listen to them. In many cases if they wait for a distinct diagnosis, the window of opportunity may be missed.
It is also important to take into account that an anxious mother radiates her stress to her baby, and this creates a vicious circle that, instead of contributing positively to the situation, actually exacerbates it.
A study conducted over the last decade in the Mifne Center concerning early treatment intervention for autism investigated 110 children who were diagnosed between the ages of 2-3 years with autism, using a retrospective analysis of video recordings of the first months of their lives (before suspicion arose concerning developmental difficulties).This study enabled the Mifne staff to identify eight signs relating to the characteristics of a bonding and communication development disorder during the first year of life that can in certain cases assist early detection of a pre-autistic stage.
In the end, it is the baby and not the diagnosis that must be treated.
What are the early signs and characteristics of a communication development disorder or Pre-Autism?
- Resistance to eat/feed
- Lack of direct eye contact with people
- Lack of reaction to the voice or presence of a parent
- Withdrawal from parental touch (or touch of any other person)
- Delayed motor development
- Accelerated growth of the circumference of the head in relation to its starting point
It is important to note that each of these symptoms may indicate another disorder unconnected to autism, it is therefore imperative first and foremost to conduct medical examinations, to negate these possibilities.
What can be done when there is reason to suspect a communication development disorder?
As noted above, the baby’s medical condition should be examined before testing for a communication development disorder. Tests provided by the mother-and-baby clinics are important but the nurses at these clinics should not be expected to be able to identify a communication problem during a short visit.
- Parents who sense that something is not normal in their baby’s development should therefore turn to a child development pediatrician.
- Parents need to know that even if the doctor calms their doubts, it would be advisable for the doctor to reexamine the baby again after a short period of time.
- Parents must assert their rights to see experts in this field. The gift of time granted by early diagnosis may sometimes be critical to the baby’s future appropriate development.
This is the result of many years of research carried out at the Mifne Center.
The issue of vaccinations is sometimes questioned. Is there a connection between vaccinations during infancy and Autism?
Current studies have not found any connection between the vaccination of infants and autism.
In the late 1990s, a study was published in the UK concerning the connection between vaccinations and autism, supposedly due to the mercury components of the inoculation cocktail. Some years later it was discovered that the research findings had been intentionally deceptive and that the researcher was prosecuted and admitted committing the fraud. Nevertheless, the findings had already stirred up a storm among parents and professionals.
It is possible that babies with a sensitive predisposition may in rare cases be harmed by vaccinations, suffering from high temperature, seizures or neuro-physiological damage unconnected to autism. Babies should not receive an inoculation if they are ill, suffering from a cold, or have a high temperature.
A control group for the effects of inoculation can be found in Israel in the ultra-orthodox Jewish community that does not usually allow vaccination. This group does not exhibit a lower incidence of autism than the general population of Israel.
Sensory Regulation is a prevalent term - what does it mean?
One of the central problems involved in autism is the lack of integration between the systems responsible for sensory regulation, cognition, emotion and perception.
In the past there was a perception that autism involved sensory deprivation. Today we assume that it actually involves a sensory overload that may cause confusion and anxiety.
In infancy it is still possible to influence sensory regulation through controlled stimulation according to the baby’s needs. One of the prevalent problems involving the difficulties in regulation is an eating problem.
When is it possible to identify an eating problem that is not just a chance refusal to eat?
During the first months of neuro-physiological regulation in an infant’s life, feeding serves as a central tool in the infant’s ability for physical, emotional and cognitive self-regulation.
Many infants diagnosed on the autism spectrum exhibit eating disorders. Disruptions in eating habits develop as a result of a lack of sensory and emotional regulation.
Many infants refuse to transition from liquids to solid foods. Often they exhibit fear concerning the texture or color of a particular food, the sensation that it causes in the mouth, its disappearance due to swallowing and the act of chewing that alters the state of the food’s mass. Where has the food disappeared to? This issue is related to phobias characteristic of autism. Later there may also be a direct association with the fear of bowel movements in the toilet.
Eating habits also have special meaning within the nuclear and extended family systems. Eating and feeding are a primary component in the creation of reciprocal family relationships. The assumption is that due to the primary nature of the need for eating and the communicative elements that it involves, basic anxieties are exacerbated forming obsessive cycles, spreading to other areas of functioning.
In cases of autism, eating disorders are universal. Research over many years at the Mifne Center, examining children from Israel and from other countries, indicated a consistent correlation between improvement of eating habits, improvement of functional behavior and improvement in other areas of development.
As the child is exposed to a gradually more varied range of foods and begins to be more flexible in taste, there is a corresponding widening of the baby’s interest in their surroundings, varying methods of play and pleasure within inter-personal relations.
What can be done to improve eating habits?
Parents become tense when their baby does not eat, and anxiety may grow and become a central issue.
It is important to understand that the eating difficulty – after medical problems have been negated – stems from a combination of a lack of sensory regulation and anxiety, and so tension must be reduced in order to help them to deal with the difficulty.
The most prevalent problem encountered by parents is the transition from liquid to solid foods that occurs for most babies at the latest at age one. Sometimes this process takes more patience. Meals should be pleasurable. The baby has to adapt gradually, but it is important not to succumb to the difficulty.
Giving up is the easy way out for both parents and baby, but this makes it even more difficult to assimilate change and may become a chronic eating problem.
It is important to know:
- An infant who is sensitive to food does not attempt to try new foods if he is not hungry.
- No child starves himself to death, so it is preferable to miss one or two meals, and not to rush to provide a bottle instead of solids.
Since this process is not easy for parents, it is wise to have the supervision of a professional expert in eating disorders.