Christopher Gillberg, MD of the University
of Goteborg, Sweden spoke at one of the national ASA conferences
on what should be included in a diagnostic work-up for Autism.
To make an accurate diagnosis of autism certain
things must be done:
1) A family history must be obtained. The
doctor will want information on any genetic disorders that have
been found in other family members: autism, Asperger's Syndrome,
learning problems, tuberous sclerosis, neurofibromatosis and mental
retardation, for instance. Instead of asking if anyone in the family
has autism or Asperger's Syndrome, the doctor should describe behaviours
he/she is interested in without implying that the family is strange.
The child's medical records and information on the course of the
mother's pregnancy and te birth of the child are important.
2) There has to be a detailed physical examination
of the child and many times this is not done. Some conditions such
as tuberous sclerosis, may be indentified by a careful examination
of the skin, for instance.
3) The doctor should do a general, age appropriate
medical and neurodevelopmental examination.
4) There should be a psychological evaluation
by a clinical psychologist who understands autism and what tests
are appropriate for the child's age and development.
5) The laboratory work-up should include:
- a chromosomal analysis, especially for
the Fragile X syndrome.
- either an MRI or CAT-scan to determine
the presence, for instance, of tuberous sclerosis, neurofibromatosis,
or the hypomelanosis of Ito.
- a cerebral spinal fluid examination to
identify a deteriorating brain problem.
- an auditory brain stem response, to identify
a brain stem dysfunction. Preliminary evidence suggests that some
children with a brain stem dysfunction cannot tolerate music so
it is useful to know this.
- an ophthalmological examination, so that
glasses can be prescribed, if necessary, at an early age when
they are more likely to be tolerated. Also, tuberous sclerosis
and intrauterine afflictions of various kinds can be disproved
with an ophthalmologic examination.
- a hearing test.
- a blood test for phenylalanine, uric
acid, pyruvic acid and evidence of a herpes infection.
- a 24 hour urine examination for a metabolic
screen, and the level of uric acid and calcium.
Except for the possible exception of the
auditory brain stem test, these procedures should be required for
all children thought to have autism, under the age of 12 years,
unless the cause of the autism is already known. For adults some
of these tests should be performed, depending on the physical appearance,
general course of the disorder etc.
This is an excerpt of an article that was
placed in the Spring, 1992 issue of The Advocate - the newsletter
of the Autism Society of America Inc.
MYTHS and FACTS CONCERNING
|Autism is an emotional disturbance
||Autism is a lifelong pervasive developmental
disorder with impaired development of the neurological system.
|There is cure for it, or people grow out
||People do not grow out of autism. Autism
is a lifelong disorder but the manifestation of symptoms
may change over time.
|Poor parenting causes autism.
||Parents do NOT cause autism.
|Everyone with autism behaves in the same
||People with autism are individuals with
strengths and weaknesses unique to them.
|Children with autism just need more love
and a good spanking.
||Autism is not caused by a lack of love
and is not cured by punishment. Parents need support to
manage difficult behaviours with structure and consistencty.
|People with autism have to be in special
programs for the autistic.
||Individually designed programs best meet
the needs of the person with autism. They should be learning,
living and working in settings where there is ample oppurtunity
to communicate and interact with others who have the skills
|Supplied by the Geneva Centre, Toronto,
ON, May 1994.
STEREOTYPIC (SELF STIMULATORY)
Stereotypy or self stimulatory behaviour
refers to repetitive body movements or repetitive movement of
objects. This behaviour is common in many individuals with developmental
disabilities; however it appears to be more common in autism.
In fact , if a person with another developmental disability
exhibits a form of self stimulatory behaviour, often the person
is also labelled as having autistic characteristics. Stereotypy
can involve any one of all the senses. We have listed the five
major senses and some example of stereotypy.
||staring at lights, repetitive blinking,
moving fingers in front of the eyes, hand flapping.
||tapping ears, snapping fingers, making
||rubbing the skin with one's hands or with
another object, scratching.
||rocking front to back, rocking site to
||placing body parts or objects in one's
mouth, licking objects.
||smelling objects, snfifing people.
Researchers have suggested
various reasons for why a person may engage in stereotypic behaviours.
One set of theories suggests that theses behaviours provide
the perosn with sensory stimulation. (i.e., the person's sense
is hypersensitive). Due to some dysfunctional system in the
brain or periphery, the body craves stimulation; and thus, the
person engages in these behaviours to excite or arouse the nervous
system. One specific theory states that these behaviours release
beta-endorphins in the body (endogenous opiate-like substances)
and provides the person with some form of internal pleasure.
Another set of theories states
that these behaviours are exhibited to calm a person (i.e. the
person's sense is hypersensitive). That is, the enviroment is
too stimulating and the person is in a state of sensory-overload.
As a result, the individual engages in these behaviours to block
out the over stimulating environment; and his/her attention
becomes focussed inwardly.
Researchers have also shown
that stereotypic behaviours interfere with attention and learning.
Interestingly, these behaviours are often effective positive
reinforcers if a person is allowed to engage in these behaviors
after completing a task.
There are numerous ways to
reduce or eliminate stereotypic behaviours, such as excercise
as well as providing an individual with alternative, more socially-appropriate,
forms of stimulation (e.g., chewing on a rubber tube rather
than biting one's arm). Drugs are also used to reduce these
behaviours; however, it is not clear whether the drugs actually
reduce the behaviours directly (e.g., providing internal arousal)
or indirectly (e.g., slowing down one's overall motor movement).
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