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April 9, 2003

Last modified April 9, 2003 - 12:25 am

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The mystery of autism

By SUZANNE KYDLAND ADY
Of The Gazette Staff

Billings psychiatrist Melinda Payne has noticed something about the parents of autistic kids. They often feel they've done something to cause the disorder, but nothing is further from the truth.

"People sometimes feel ashamed, and then they won't get help as soon," said Payne. "But the sooner the intervention, the better off both the kids and the family are."

The cause of autism, a disease which effects the social interaction and communication skills of children within their first three years of life, is still a mystery. While autism is a developmental disability caused by a neurological disorder in the brain, there are different theories surrounding its source.

"The causes are generally multiple," Payne explained. "Genetically, someone may be at a higher risk for it. A child can come into the world with a higher chance of having autism."

Some researchers think environmental factors -- anything from soil toxins to electromagnetic waves -- may trigger the disease in people who are genetically susceptible. The recent belief that certain childhood vaccines could be linked with autism is ongoing, although in 2001, the Institute of Medicine said there was no proof that the disorder is caused by the measles-mumps-rubella vaccine.
 

A defunct theory

Payne also mentioned that the "refrigerator mother" philosophy -- thinking which suggested cold, aloof moms could encourage autism -- is now defunct.

"Still, there's neither a cause nor a way to predict if a child is more at risk," she said.

According to the Centers for Disease Control and Prevention, forms of autism affect an estimated 1.5 million Americans. Statistics from the U.S. Department of Education show autism is growing at a rate of up to 17 percent each year, which means the prevalence of the disorder could reach 4 million people in the United States within the next few years.

Payne argues that incidences of autism over time are actually somewhat stable. But factors such as quicker diagnoses and less institutionalization could make those numbers seem higher.

Information from the Autism Society of America states cases of autism are consistent around the world, but the disease is four times more prevalent in boys than girls. Autism is a spectrum disorder, and the symptoms can vary from child to child.

The most important characteristic of autism is abnormal development of speech, Payne said, and that's why the disorder is often not diagnosed until the child is a toddler.
 

"But kids with severe autism aren't socially reciprocal, and people will know quite soon," she explained. "There's some newborns where you can tell right away. In others, parents don't pick up on it right away."

Other signs of autism include: Insistence on sameness, uses gestures or pointing instead of words, repeating words or phrases in place of normal, responsive language, prefers to be alone, may not want to cuddle or be cuddled, little or no eye contact, spins objects, over-sensitivity or under-sensitivity to pain, uneven gross/fine motor skills and not responsive to verbal cues.

There is no medical test to diagnose autism, but there are several early behaviors that may be tell-tale signs, according to the National Institute of Child Health and Human Development. If a baby: Does not babble or coo by 12 months; does not gesture by 12 months; does not say single words by 16 months; does not say two-word phrases on his or her own by 24 months; or has any loss of any language or social skill at any age, it could be a red flag.

Help is available for those kids and their families, Payne said. There are numerous sites on the Internet, including the Autism Society of America (www.autism-society.org).

"In Montana, parents can call STEP, the Lincoln Center offers testing and most schools have screenings," she said.
 

Asperger's Syndrome

Payne works closely with kids who have Asperger's Syndrome, a disorder which falls under the same umbrella of Pervasive Developmental Disorders as autism. She describes the disease as "more complex" and the children who have it "higher functioning, and generally, very capable."

The same type of symptoms typically apply to Asperger's patients, except they don't have the speech development problems that autistic kids do.

"They often have a narrow area of obsessive interest," Payne said. "I've worked with kids with Asperger's who know everything there is to know about railroads, or toilets or the Civil War. But they have no emotional thermostat -- most couldn't read social cues to save their lives."

Most people with autism or Asperger's have an overlapping problem with obsessive-compulsive disorder. That can include acts such as excessive hand-washing, double-checking or wanting things "just so."

Payne recalls one Asperger's patient who made himself go through an 84-step ritual before going to bed. The OCD can be treated with medication and psychotherapy, unlike autism or Asperger's.

"The main goal there is to target the symptoms that are the most disabiling, and find out what these children are really good at," Payne said. "These kids are unusual and you have to see what works for each child ... sometimes you just have to throw out the rulebook."

Copyright © The Billings Gazette, a division of Lee Enterprises.

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