Looking at Autism Spectrum Disorder

  • The history of autism as a diagnosis starts in 1943 when Leo Kanner described his cases.
  • In 1944, Hans Asperger published his thesis, describing aberrant behaviour in his cases. Asperger Syndrome has been recognised as a separate diagnosis since then, but this is about to change with the new diagnostic criteria according to the DSM V. 
  • In the 1950s autism became known as the “refrigerator mother” syndrome. This opinion was finally changed with the publication of the Autism Twin Study in the Journal of Child Psychology in 1977.
  • Dr Bernie Rimland’s publication on Infantile Autism also played a role to discard the mother’s emotional role as an etiological factor, as he described the neural theory of behaviour.
  • Ivor Lovaas became a pioneer in behavioural therapy, which today is researched widely and has been proven to be invaluable in the management of the disorder.

Secondary features of autism include:

  • gastro-intestinal disease;
  • food allergies;
  • immune disorders;
  • sensory dysregulation
  • motor skills development problems;
  • developmental speech- language disorders;
  • mood disorders;
  • disorders in sleeping and eating;
  • hypo- and hyperactivity; and in 10% of children
  • savant skills.

Co-morbid diagnoses related to autism include:

  • epilepsy;
  • infantile spasms;
  • Tourette syndrome;
  • AD(H)D;
  • OCD;
  • PKU;
  • Encephalitis, etc.

Certain genetic conditions can also present with Autism features:

  • Rett Syndrome;
  • Down Syndrome;
  • Fragile X;
  • Williams Syndrome;
  • Tuberous Sclerosis;
  • SOTOS Syndrome;
  • Rubinstein-Taybi Syndrome; and others.

Autism does not seem to be a purely genetic problem, nor does it seem to affect one brain module alone. It is not a brain-specific disease. Recovery and improvement cannot always be qualified or classified.

Treating the underlying gastro-intestinal disease is important in a major group of children on the Autism spectrum, as their behaviour can improve dramatically. Presentation of gastro-intestinal disease is complicated and unique in this group of children.

A group of children on the Autism spectrum present with either a history of recurrent infections, abnormal response to infections or chronic immune dysregulation.
Autism commonly presents as a multifactorial neurometabolic disorder of genetic expression. Disturbed endocrine markers are often seen in autism. Inborn errors of metabolism can also often present as autism, but are treatable.

The treatment of autism therefore involves a holistic approach which ranges from dietary intervention and supplementation to medication.

Treating developmental disorders requires a multidisciplinary approach. There is no magic bullet. Biomedical treatment offers unique benefits in conjunction with other interventions.