Autism Spectrum Disorder (ASD) - Research Paper Example

?INTRODUCTION Autism Spectrum Disorder (ASD) Autism spectrum disorder (ASD) is a congenital condition occurring in children more frequently than diabetes, spina bifida, or Down syndrome. The defining characteristics of ASD include 1) labored social interaction, 2) impaired use of words and gestures in communication, and 3) inconsistent patterns of behavior interests, and activities. In itself, ASD is already difficult to manage in society because of the wide spectrum of symptoms that it encompasses. It may manifest readily after birth or later on in the patient’s childhood. It is thus possible that the treatment procedure varies from one patient to the other (National Institute of Mental Health, 2009). Because the illness affects the social facets of the patient, house members suffer as much as the patients do. ASD patients seldom seek comfort, and prefer being alone. Some ASD patients remain mute throughout their lives. Ironically, some find it difficult to control emotional outbursts and aggressiveness. Because they cannot use nor understand other components of communication such as tone of voice or facial expressions, it is difficult to let others know what they need. ASD and Other Health Concerns A significant number of pediatric patients with ASD also have an associated medical condition. Because an estimated 3.4 of 1000 children, ages 3-10 years, are afflicted with ASD, whether or not the special health care needs of these patients can be provided by the state is a valid concern. Different researches have described ASD as neurobehavioral difficulties associated with 1 or more co morbidity such as epilepsy, gastrointestinal problems, depression, anxiety, and sleeping disorders. Based on the findings of the 2005-2006 National Survey of Children with Special Health Care Needs, 5.6% (n=2, 088)of children with special health care needs (n = 535, 000), aged 3-17 years, are autistic. In 2003-2004, autistic children have significantly higher prevalence of depression or anxiety problems, and behavioral or conduct problems. Systemic problems such as respiratory ailments, skin and food allergies were also reported (Gurney et al., 2006). The same is yet to be stated in the 2005-2006 survey. Because ASD affects behavior and social interaction, it is understandable why it is often associated with brain problems. Results of ASD studies using postmortem and MRI analyses show that ASD affects the cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem. The occurrence of seizures among ASD patients have been noted in the studies of. If not controlled, it will lead to. More serious neurological abnormalities prevalent among ASD patients are fragile X syndrome and tuberous sclerosis, from which 1 out of 4 ASD patients suffer (National Institute of Mental Health, 2009). On the other hand, autism did not seem to increase the risk for diabetes or asthma (Gurney et al., 2006). A much more valid concern is that, as Kogan et al. (2008) found out, autistic children with special health care needs (SCHN) are significantly more likely to have less access on health care. According to the survey, factors that contribute to this poor management of autism-SHCN include sex, with autism-SCHCN occurring more likely in boys than in girls, and poverty. The medical condition is thus not alleviated in such cases because the affected households cannot afford special health care such as medical homes and specialty care. These households have large out-of-pocket expenses, and they always encounter problems on caring for their ASD-SHCN house member. Sometimes, it becomes difficult to make ends meet because, as much as they need to work to carry the financial demands of caring for an ASD patient, parental involvement in the treatment is usually the key to a treatment’s success (National Institute of Mental Health, 2009) Objectives of the Study Based on the findings of previous researches, it is thus the hypothesis of this study that autistic children are more vulnerable to other illnesses. To prove this, a survey was conducted among households with autistic pediatric patients to identify which health concerns do ASD patients usually suffer from. In line with this, a standardized plan will then be formulated based on what parts of the body need attention from the health care provider. It is the aim of this research to develop an easy-to-follow, efficient algorithm that can be used both by parents/guardians and health care providers. In the future, the results of this study can be used to instigate further efforts on providing an efficient standardized care for ASD patients. METHODS An interview was conducted among parents of children diagnosed with ASD. They were asked whether their autistic children had any of the following: eczema, food allergies, seizures, asthma, epilepsy, depression, ear infection, and sleep problems. Data were presented as percent of children with ASD. RESULTS In an interview conducted among the parents of 19 autistic children, the findings were as follows: Table 1. Occurrence of certain health conditions in 19 children afflicted with autism spectrum disorder (ASD). Health condition percent eczema 37% food allergies 88% seizures 94% asthma 42% epilepsy 47% ear infection 65% sleep problems 84% Among the eight health conditions being studied, seizures, food allergies, sleep problems, depression, and ear infection occurred in more than half of the 19 autistic patients who underwent the interview. DISCUSSION Underlying Causes of ASD Although no single, independent factor has been proven to cause autism, many studies have implicated several parental characteristics and obstetric conditions in ASD. Advanced paternal and maternal age is a significant risk factor. Studies in Australia, Denmark, and US have established at least 1.5 relative risk of women ages 35 years and older to give birth to a child with ASD. The probable mechanism underlying the causative effect of paternal and/or maternal age on ASD is the increased occurrence of genetic mutations due to replication errors and defective DNA repair mechanisms. Among older individuals, these chromosomal defects accumulate and affect several chromosomes. Because many chromosomes are already affected, it is understandable why such mechanism can cause a disorder, with a wide range of phenotypic manifestations, such as ASD (Kolevzon et al., 2007). Expecting parents should also watch out for abnormal gestational age and intrapartum hypoxia, especially when their ages are not optimal for child-bearing. Lack of oxygen usually occurs during Caesarian delivery, threatened abortion, and vaginal bleeding. Among the brain regions highly susceptible to the adverse impacts of hypoxia, the hippocampus and lateral ventricles are the ones shown to be greatly affected among patients with ASD. Four studies have identified an Apgar score of less than 7 as predictive of ASD (Kolevzon et al., 2007). If such conditions were present during the pregnancy, ASD screening should be performed as soon as possible. Interestingly, Kolevzon et al. (2007) did not find any significant correlation between intrauterine growth retardation and ASD. ASD-Associated Ailments There has been growing evidence that a certain phenotype of ASD is highly associated with gastrointestinal ailments. Wakefield et al. (2002) further described this type of ASD as having similarities with hepatic encephalopathy. Their study found that in a number of cases in which ASD presents later in childhood, the developmental regression is accompanied by gastrointestinal symptoms such as abdominal pain, gastrointestinal inflammation, esophageal reflux, diarrhea, and constipation. Several studies have already suggested that dietary-derived opioid peptides such as gliadmorphine from wheat gliadin and B-caseomorphine from bovine casein may have been absorbed. Once available in excess systemically, these opioids may affect the central nervous system. In addition, they exert motor and secretory activity of the gastrointestinal tract, and increasing the gastric emptying time, resulting to abdominal spasms, pain, and constipation. The accompanying allergic reaction to food might have also been caused by the abnormal immune response occurring at the gastrointestinal mucosa. In gastrointestinal inflammation found among ASD patients, increased levels of CD8+ T cells were detected. As such, food allergies manifested by ASD patients may be of Type IV or cell-mediated. Based on the studies gathered, the ASD-associated heath issues are not secondary to autism. Rather, the risk factors that causes ASD may have caused the other illnesses as well. Other neurological disorders such as seizures, epilepsy, and sleep disorders go with ASD, because it is primarily a nervous system defect. For example, disruption of electrical activity of the brain, as what happens during seizures and epileptic attacks, occur in almost all cases of neurological lesions, such as autism. Some ASD-associated health issues, on the other hand, might have actually caused autism, just like how gastrointestinal inflammation and opioid surplus causes both neurological and gastrointestinal problems. Probable Management of ASD-SHCN One of the easiest ways to prevent additional health problems with autism is the early detection of ASD. Correcting communication deficits is integral to the success of treating ASD or any disease associated with it. Applied behavioral analysis (ABA) has been widely used to reinforce desirable behaviors and reduce undesirable ones. Effective communication between the ASD patient and the health care provider is necessary to determine whether other non-ASD health issues are present. It is thus not surprising that for autistic children that do not receive adequate treatment for their ASD, the assigned health care providers are sometimes not aware of the patient’s other health concerns. Because a lot of patients with ASD sustain food allergies, many diets have been developed to help the child cope with their condition. A gluten (wheat protein)-free, casein-free diet has been found to be beneficial. This is based on the hypothesis that several cases of ASD and its associated gastrointestinal problems were caused by opioids derived from casein and wheat protein gliadin. To aid in digestion, a single dose of secretin has also been suggested. However, there are still a number of researches trying to establish its effects on ASD-related gastrointestinal problems (National Institute of Mental Health, 2009). Several studies have also suggested the use of omega-3 fatty acid for ASD patients. The use of this diet is based on the fact that neural tissue contains a lot of docosahexanoic acid (DHA), an omega-3 fatty acid. However, its effects on ASD is yet to be established (Bent et al., 2009). CONCLUSION Most of the parents of the ASD patients interviewed for this study reported the occurrence of seizures, food allergies, sleep problems, depression, and ear infection. It is thus confirmed that ASD patients indeed suffer from other ailments. Early diagnosis is critical in the management of ASD. Screening should be performed, especially when risks factors such as old paternal/maternal age and hypoxia were encountered during the pregnancy. The first step in the management of ASD-SCHCN is improving the communication skills of the patient. This helps both the patient and the care provider to relay messages of other health issues that the patient may have sustained. In cases wherein ASD is associated with gastrointestinal upsets, it may be helpful to try several diets. Most promising is the gluten-free, casein-free diet, because it prevents the opioid excess that may cause or even aggravate autism. References Bent, S, Bertoglio, K, and Hendren, RL. 2009. ‘Omega-3 Fatty Acids for Autistic Spectrum Disorder: A Systematic Review‘. J. Autism Dev. Disord. 39(8). pp. 1145-1154. Gurney, JG, McPheeters, ML and Davis, MM. 2006. ‘Parental Report of Health Conditions and Health Care Use Among Children With and Without Autism‘. Arch Pediatr Adolesc Med. 160. pp. 825-830. Kogan, MD, Strickland, BB, Blumberg, SJ, Singh, GK, Perrin, JK and van Dyck, PC. 2008. ‘A National Profile of the Health Care Experiences of and Family Impact of Autism Spectrum Disorder Among Children in the United States, 2005-2006‘. Pediatrics. 122(e). pp. 1149-e1158. Kolevzon, A, Gross, R and Reichenberg, A. 2007. ‘Prenatal and Perinatal Risk Factors for Autism: A Review and Integration of Findings‘. Arch Pediatr Adolesc Med. 161. pp. 326-333. National Institute of Mental Health. 2009. ‘Autism Spectrum Disorders: Pervasive Developmental Disorders‘. Available at: http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental-disorders/index.shtml Wakefield, AJ, Puleston, JM, Montgomery, SM, Anthony, A, O’Leary, JJ, and Murch, SS. 2002. ‘Review Article: the Concept of Entero-colonic Encephalopathy, Autism and Opioid Receptor Ligands’. Aliment. Pharmacol. Ther. 16. pp. 663-674. Read More