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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

MYTHS

FACTS

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 of autism. 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 way. 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 they lack.
   

 

Supplied by the Geneva Centre, Toronto, ON, May 1994.

STEREOTYPIC (SELF STIMULATORY) BEHAVIOUR

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.

Sense Stereotypic Behaviours
Visual staring at lights, repetitive blinking, moving fingers in front of the eyes, hand flapping.
Auditory tapping ears, snapping fingers, making vocal sounds.
Tactile rubbing the skin with one's hands or with another object, scratching.
Vestibular rocking front to back, rocking site to side.
Taste placing body parts or objects in one's mouth, licking objects.
Smell 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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