Parks medical legal consulting presents-autism

Parks Medical-Legal Consulting Presents:
What is Autism? Diagnosis, Treatment and Care
By Paul Parks RN-Legal Nurse Consultant
© 2010 PMLC

What is autistic disorder?
Autistic disorder (also called autism) is a neurological and developmental disorder that usually appears during the first three years of life. A child with autism appears to have difficulty interacting with others, showing little interest in others, and a lack of social awareness. The focus of an autistic child is a consistent routine and includes an interest in repeating odd and peculiar behaviors. Autistic children often have problems in communication, avoid eye contact, and show limited attachment to others.

Autistic Disorder
Autism can prevent a child from forming relationships with others (in part, due to an inability to interpret facial expressions or emotions). A child with autism may resist cuddling, play alone, be resistant to change, and/or have delayed speech development. Persons with autism may exhibit repeated body movements (such as flapping hands or rocking) and have unusual attachments to objects. However, many persons with autism may demonstrate proficiency in some areas (i.e., counting, measuring, art, music, memory).

What causes Autism?
The cause of autism is not known. Research suggests that autism is a genetic condition. It is believed that several genes are involved in the development of autism. Research studies in autism have found a variety of abnormalities in the brain structure and chemicals in the brain, however, there have been no consistent findings. One theory is the possibility that autistic disorder is a behavioral syndrome that includes several distinct conditions. However, parenting behaviors are not the cause or a contributing factor to the cause or causes of autism.

Who is affected by autism?
Approximately 3 to 6 out of every 1,000 children born are diagnosed with autism. Autism is more prevalent in boys than girls, with four times as many boys affected than girls.

What are the symptoms of Autism?
The following are the most common symptoms of autism. However, each child may experience symptoms differently. Symptoms may include: difficulty with social interactions, this may include parents
may show a lack of interest in, or rejection of, physical contact. Parents may describe autistic infants as "unaffectionate." Some autistic infants and children are not comforted by physical contact.
avoids making eye contact with others, including parents

Autism Symptoms
fails to develop friends or interact with other children
difficulty with communication
is delayed or does not develop language
once language is developed, does not use language to communicate with others effectively

Symptoms Continued
has echolalia (repeats words or phrases repeatedly, like an echo)
uses stereotypical or idiosyncratic language
presence of repetitive or stereotyped patterns of behavior or interestshas repetitive motor movements (such as rocking and hand or finger flapping)
is preoccupied, usually with lights, moving objects, or parts of objects

Symptoms May Resemble Other Conditions
apparent hypersensitivity to certain noises
has rituals
requires routines which may be nonfunctional or excessively rigid
may have preoccupations or highly restricted patterns of interests
The symptoms of autism may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is Autism Diagnosed?
For the first time, standard guidelines have been developed to help identify autism in children before the age of 24 months. In the past, diagnosis of autism was often not made until late preschool-age or later. The new guidelines can help identify children with autism early, which means earlier, more effective treatment for the disorder.

Guidelines
The standardized guidelines were developed with assistance from 11 different organizations including the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatrists, and American Academy of Neurology. According to the guidelines, all children before the age of 24 months should routinely be screened for autism and other developmental delays at their well-child check-ups. Children that show developmental delays and other behavior disorders should be further tested for autism.
By screening children early for autism, those diagnosed with the disorder can receive appropriate educational and behavioral treatment.

What Are The Guidelines?
The standardized guidelines developed for the diagnosis of autism actually involve two levels of screening for autism. Level one screening, which should be performed for all children coming to a physician for well-child check-ups during their first two years of life, should check for the following developmental deficits:

Developmental Deficits
no babbling, pointing, or gesturing by age 12 months
no single words spoken by age 18 months
no two-word spontaneous (non-echolalic, or not merely repeating the sounds of others) expressions by age 24 months
loss of any language or social skills at any age

Screening for Autism
The second level of screening should be performed if a child is identified in the first level of screening as developmentally delayed. The second level of screening is a more in-depth diagnosis and evaluation that can differentiate autism from other developmental disorders. The second level of screening may include more formal diagnostic procedures by clinicians skilled in diagnosing autism, including medical history, neurological evaluation, and genetic testing. Other tests may be ordered if indicated.

Genetic Testing
Genetic testing involves an evaluation by a medical geneticist (a physician who has specialized training and certification in clinical genetics), as there are several genetic syndromes which may cause autism, including Fragile-X, untreated phenylketonuria (PKU), neurofibromatosis, tuberous sclerosis, Rett syndrome, as well as a variety of chromosome abnormalities. A geneticist can determine whether the autism is caused due to a genetic disorder, or has no known genetic cause. If a genetic disorder is diagnosed, there may be other health problems involved.

Genetic Testing
The chance for autism to occur in a future pregnancy would depend on the syndrome found. For example, PKU is an autosomal recessive disorder with a reoccurrence risk of one in four, or 25 percent, chance, while tuberous sclerosis is an autosomal dominant disorder, with a reoccurrence risk of 50 percent.

Cases without a Genetic Cause
In cases where no genetic cause for the autism is identified, there is still a slightly increased chance for a couple to have another child with autism, with ranges averaging from 3 to 7 percent. The reason for this increase over the general population is thought to be because autism may result from several genes inherited from both parents acting in combination, in addition to unknown environmental factors. There is no action/inaction known that parents could have done, or did not do, to cause autism to occur in a child.

Treatment For Autism
Specialized behavioral and educational programs are designed to treat autism. Behavioral therapy is used to teach social skills and cognitive (thinking) skills. Behavior modification is also useful in reducing or eliminating maladaptive behaviors. Individualized treatment planning for behavioral therapy is important as autistic children vary greatly in their behavioral needs. Intensive behavior therapy during early childhood and home-based approaches training and involving parents are considered to produce the best long-term outcomes for children.

Special Education
Special education programs that are highly structured focus on developing social skills, speech, language, self-care, and job skills. Medication may be helpful in treating some symptoms of autism in some children. Mental health professionals provide parent counseling, social skills training, and individual therapy. They also help families identify and participate in treatment programs based on an individual child's treatment needs. Specific treatment will be determined by your child's physician based on:

Basis for Treatment
your child's age, overall health, and medical history
extent of the disorder
your child's symptoms
your child's tolerance for specific medications or therapies
expectations for the course of the disorder
your opinion or preference

Symptoms Vary
Autism (or ASD) is a wide-spectrum disorder. This means that no two people with autism will have exactly the same symptoms. As well as experiencing varying combinations of symptoms, some people will have mild symptoms while others will have severe ones. Below is a list of the most commonly found characteristics identified among people with an ASD.

Autistic Characteristics
A person with autism may often miss the cues we give each other when we want to catch somebody's attention. The person with ASD might not know that somebody is trying to talk to them. They may also be very interested in talking to a particular person or group of people, but does not have the same skills as others to become fully involved. To put it more simply, they lack the necessary playing and talking skills.

Engaging with Others
A person with autism will find it much harder to understand the feelings of other people. His/her ability to instinctively empathize with others is much weaker than other people's. However, if they are frequently reminded of this, the ability to take other people's feelings into account improves tremendously. In some cases - as a result of frequent practice - empathy does improve, and some of it becomes natural rather than intellectual. Even so, empathy never comes as naturally for a person with autism as it does to others.

Area Affected by Autism

Causes Explored
Genetic errors. Researchers have discovered a number of genes that appear to be involved in autism. Some may make a child more susceptible to the disorder; others affect brain development or the way brain cells communicate. Still others may determine the severity of symptoms. Each genetic error may account for a small number of cases, but taken together, the influence of genes may be substantial. Some genetic errors seem to be inherited, whereas others occur spontaneously.

Possible Causes of Autism
Environmental factors. Many health problems are due to both genetic and environmental factors, and this is likely the case with autism as well. Researchers are currently exploring whether viral infections and air pollutants, for instance, play a role in triggering autism.

Vaccines as a Possible Cause
One of the greatest controversies in autism centers on whether a link exists between autism and certain childhood vaccines, particularly the measles-mumps-rubella (MMR) vaccine and vaccines with thimerosal, a preservative that contains a small amount of mercury. Though most children's vaccines have been free of thimerosal since 2001, the controversy continues. To date, extensive studies have found no link between autism and vaccines.

Coping and Support
Raising a child with autism can be physically exhausting and emotionally draining. These ideas may help:
Find a team of trusted professionals. You'll need to make important decisions about your child's education and treatment. Find a team of teachers and therapists who can help evaluate the options in your area and explain the federal regulations regarding children with disabilities. Make certain this team includes a case manager or service coordinator, who can help access financial services and government programs.

Coping and Support
Take time for yourself and other family members. Caring for a child with autism can be a round-the-clock job that puts stress on your marriage and your whole family. To avoid burnout, take time out to relax, exercise or enjoy your favorite activities. Try to schedule one-on-one time with your other children and plan date nights with your spouse — even if it's just watching a movie together after the children go to bed.

Education and Seeking Others
Seek out other families of autistic children. Other families struggling with the challenges of autism can be a source of useful advice. Many communities have support groups for parents and siblings of children with autism. Learn about the disorder. There are many myths and misconceptions about autism. Learning the truth can help you better understand your child and his or her attempts to communicate. With time, you'll likely be rewarded by seeing your child grow and learn and even show affection — in his or her own way.

Statistic's

Statistics

Conclusion
Autism is a terrible disease. It usually comes on suddenly and leaves you and your child with a lifetime of challenges. Each of us deals with the aftermath in our own way. Our initial instincts are often to finding causes and placing blame. These may be important, but not nearly as important as helping your ASD child get better.
As you now know, there are many different roads to ASD. You will probably never know the exact road your child took, and may feel frustrated and powerless without a scapegoat or an exact diagnosis.

Your Choices
You can counter these feelings by getting the information you need to understand your child's disease. This is information you rightly should expect to get from the medical professionals you have come to trust with your own health. However, with ASD, you are stuck with a stark and scary choice; you can settle for medical management of your child's symptoms or take the lead in figuring out what is actually wrong with them and work to make them better. Symptom management is the easier choice - eventually they will get a handful of prescriptions and will be accommodated by medical and educational institutions.

Additional Resources and Links
Overviews :Autism(Mayo Foundation for Medical Education and Research)
Autism(National Institute of Neurological Disorders and Stroke) - Short Summary
Autism Overview: What We Know(National Institute of Child Health and Human Development) - PDF Also available in Spanish
Autism Spectrum Disorders (ASDs)(Centers for Disease Control and Prevention)
Pervasive Developmental Disorders(National Institute of Neurological Disorders and Stroke) - Short Summary

Latest News
One Percent of U.S. Children Have Autism(12/18/2009, Reuters Health)
Brain Imaging Sheds Light on Social Woes Related to Autism(12/18/2009, HealthDay)
Working Intensely Early on May Help Autistic Kids(11/30/2009, HealthDay)
Parent Training Complements Medication for Treating Behavioral Problems in Children with Pervasive Developmental Disorders(11/20/2009, National Institute of Mental Health)
More News on Autism

Diagnosis/Symptoms
Diagnosing & Evaluating Autism: Part 1(Center for Autism & Related Disabilities) - PDF Also available in Spanish
Diagnosing & Evaluating Autism: Part 2(Center for Autism & Related Disabilities) - PDF Also available in Spanish
Learn the Signs. Act Early(Centers for Disease Control and Prevention) Also available in Spanish

Treatment
Autism: Education(Autism Society of America)
Autism: Treatment Options(Autism Society of America)
Positive Behavior Support (PBS)(Center for Autism & Related Disabilities) - PDF
Treatments for Autism(Autism Speaks)

Alternative Therapy
Alternative Treatments for Autism(Autism Speaks)
Autism: Learning Approaches-Complementary Approaches(Autism Society of America)
Rehabilitation/Recovery Understanding Autism: Occupational Therapy(American Occupational Therapy Association) - PDF
CopingAustism through the Lifespan(Autism Society of America)
Life with Autism: Stress on Families(Autism Society of America)

Related Issues
Autism Spectrum Disorders and Stuttering(Stuttering Foundation of America)
Autism: Safety in the Home(Autism Society of America)
Choosing Professionals & Coordinating Services(Center for Autism & Related Disabilities) - PDF Also available in Spanish
Facts for Parents about Autism and Vaccine Safety(American Academy of Pediatrics)
Individualized Education Plans (IEPs)(Nemours Foundation)

Clinical Trials
ClinicalTrials.gov: Autistic Disorder(National Institutes of Health)
ClinicalTrials.gov: Child Development Disorders, Pervasive(National Institutes of Health)
Genetics: Autism and Genes(National Institute of Child Health and Human Development) - PDF Also available in Spanish
Genetics Home Reference: 16p11.2 deletion syndrome(National Library of Medicine)
Genetics Home Reference: 2q37 deletion syndrome(National Library of Medicine)
Learning about Autism(National Human Genome Research Institute)

Research
Autism Research(Centers for Disease Control and Prevention)
Autism Research at the NICHD(National Institute of Child Health and Human Development)
Lack of Eye Contact May Predict Level of Social Disability in Two-Year Olds with Autism(National Institute of Mental Health)
NICHD Autism Research(National Institute of Child Health and Human Development)
NIDCD Panel Proposes New Benchmarks for Gauging Language Development in Children with Autism(National Institute on Deafness and Other Communication Disorders)
Science News about Autism(National Institute of Mental Health)
Tuberous Sclerosis Moves toward Drug Therapy, Offers Clues to Epilepsy and Autism(National Institute of Neurological Disorders and Stroke)

Organizations
National Center on Birth Defects and Developmental Disabilities(Centers for Disease Control and Prevention) Also available in Spanish
National Institute of Child Health and Human Development
National Institute of Mental Health
National Institute of Neurological Disorders and Stroke Also available in Spanish
National Institute on Deafness and Other Communication Disorders
Law and Policy: Your Child's Rights(Autism Speaks)

THE END
This has been a Parks Medical-Legal Consulting Presentation
www.parksmedicallegal.com
paul@parksmedicallegal.com
Research: http://legalrnblog.com
This material may notbe copied without permission from this publisher.
“integrating medicine and law”
© 2010 PMLC

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