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Autism Spectrum Disorder

 

 

 

 

Eli Grover

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Cal State
Dominguez Hills

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Abstract

Autism
Spectrum Disorder (ASD) is a neurodevelopmental disorder in which the
development of the central nervous system is disturbed. This disorder is
present in early childhood and is defined by deficiency in social behavior
including communication and repetitiveness. ASD is a multi-factorial disorder
that varies pervasiveness, severity, and onset; it affects 1% of the
population, although males are diagnosed more often than females. One prominent
characteristic such as sex steroid and testosterone, has wide-ranging influence
on phenotypic variability related to autism. Emerging neuroimaging evidence
also supports a role for fetal testosterone affecting individual differences in
structural and functional brain development in directions congruent with
patterns of sexual dimorphism, and in brain regions known to develop atypically
in autism and other sex-biased developmental psychopathologic conditions. Specific
parts of the brain are usually affected in how neurons trigger different
deficits to ASD. The Diagnostic and Statistical Manual of Mental Disorder
(DSM-5) puts Autism in these categories Asperger Syndrome, childhood
disintegrative disorder, and pervasive developmental disorder as part of ASD. A
diagnosis for ASD includes looking for intellectual disability and language impairment,
which is common to autism.

 

 

 

 

 

 

 

                                                            Problem
Statement

According
to Autism Speaks, they estimate Autism prevalence is increasing 1 in 68
children, (1 in 42 boys and 1 in 189 girls in the United Stated), making boys
five times more likely than girls to have autism. Although there is no known
cure for autism, it can be detected and diagnosed as early as 18 months in some
cases. Out of those children who are diagnosed with Autism, one third will
remain non-verbal and around one third will have an intellectual disability.
Much of the focus regarding ASD characteristics are based on certain medical
and mental issues which are a mutation or deletion of genes in a child’s
chromosomes which do not appear in the parent’s chromosomes. The more obvious
signs tend to appear between 1 and 2 years of age, and frequent health issues
accompanying autism include; gastrointestinal disorder (GI), Seizures, sleep
disturbances, attention deficit, hyperactive disorder (ADHD), anxiety, and
phobias. People who have a desire to become parents should consider genetic
testing before having children. Families will benefit from knowing what
biological and environmental effect increase the chance of having a child with
Autism Spectrum Disorder.                                

                       

 

 

 

                       

 

 

 

Literature
Review    

Genetic and Environmental Factors

Biological
research has shown that genetic and environmental factors contribute to a major
role in the development of ASD. There isn’t no single factor that explains the
trends in the pathology of autism. Autism affects males more than females.
Research done by (Garber K Neurosciences 2007), he conducted a study on Turner
syndrome, which showed a comparison with autism that impaired social
interaction is impacted where the X chromosome was inherited from the mother.
He then came up with the conclusion that the gene locus related to cognitive
behavior is in the X chromosome with the males. Genetic disorders that cause
mental retardation and are closely related to autism is fragile X syndrome.
This syndrome does appear more in females, these symptoms affect the brain and
body with mental retardation, facial characteristics, attention deficit,
hyperactivity, hypoesthesia, and emotional instability (SüdhofT.C. and neurexins 2008). These factors play a major
role in the developmental state of autism, and chromosomes are going to play
and decide what role is being taken into our bodies. Chromosome X which occurs
for males plays its major role in this syndrome.

            A highly controversial subject with Autism’s
is associated with vaccinations.  Routine vaccines for measles, mumps,
rubella, diphtheria, pertussis, and tetanus have long been claimed to increase
chances of Autism (Roberts W, HarfordM. Immunization and children at risk for
autism. Paediatr Child Health. 2002). None of
these environmental factors of MMR vaccine has drawn particular attention since
the study conducted by Wakefield et al 2007. The University of Norway proposed that the MMR vaccine may be a
causative factor in the development of autism spectrum disorder. Since
this initial publication, immunization remains controversial for some parents
and the uptake of the MMR vaccine has fallen in some countries, despite much
discussion regarding the safety of MMR, a lack of evidence for an association
between MMR and autism, and the risks of insufficient protection against wild
measles virus infection. Studies on Autism in California have demonstrated no
correlation between increased rates (Wakefield and Murch S.H 1998). No
increased risk for autism for children who had been vaccinated with a thimerosal-containing
pertussis vaccine compared with children who had been vaccinated with the same
pertussis vaccine formulated without thimerosal. Therefore, more common
research leads to be believe that there is no correlation between the vaccines
and autism.

 

Brain Development and Speech

Autism
has been linked to many changes of the developing brain. Children who are
growing to adults must develop a very important aspect of life, speech.
Children who fail to develop
language comprehension, sophisticated
expressive and receptive language as a toddler may be the early signs of early autism
(Fenson et al., 1994). Toddlers who will eventually develop autism, will miss
or are slow to achieve this important milestone that only occurs in our childhood.
In fact, delay in language is reported as the strongest and earliest red flag.
Infants demonstrating the ability to discriminate phonemes within the first
weeks of life, and can’t recognize their own name at 4 months will also
discriminate familiar from unfamiliar words by 7 months. This neural
abnormality must begin early in development in babies that will eventually show
autism. (Eimas et al., 1971; Werker and Lalonde, 1988). Babies are ready to
speak a language from birth, or even when they are inside the utero. Around 2
years old, children develop verbal transmission skills. One area of the brain
located were the temporal lobe and parietal lobe meet in the left hemisphere is
the Wernicke’s area, where language comprehension is dealt with. Another part
of the brain located in the same region as Wernicke is the Broca’s area, where
speech articulation is dealt with exclusively. Both sides of the brain develop
very alike, the left hemisphere outgrows the other by the age of 5 in 95% of
the time, and speech area in the right hemisphere starts being used for other
purposes, like gestures. According to research findings by (Rita Carter University of California Press. Berkeley
and Los Angeles, California 1999), right-handed people use their frontal lobe
on the left side of the brain to carry verbal transmissions, and the one on the
right side of the brain to understand others’ feelings through non-verbal
transmissions such as facial expressions, body movements and tone of voice.

 Broca’s area is located forward of Wernicke’s
area, on the side of the frontal lobe. It is located adjacent to the part which
controls motor areas such as the jaw, the pharynx, the tongue and the lips.
When there’s damage to Broca’s area, people simply cannot speak, even though
they may understand what is being said to them and know exactly what to say.
What comes out of their mouth are only fragmentary words, making them sound
like a sentence from a telegram. People can develop a speech disorder called
“Wernicke aphasia” it occurs when there is damage to Wernicke’s area. People
can still work with their speech, meaning they will only struggle with part of
speech. What comes out their mouth is, mostly an enumeration of meaningless
words, in which incorrect words and mere sounds, take the place of proper
words, not making any sense. Since they do not understand what they are saying
themselves, they cannot get a grip on their speech, and they are not even aware
that they are making no sense. This is because speech itself is managed outside
of Wernicke’s area of the brain.

 There is a bridge called the “Insula” to
connect these two speech areas of Wernicke and Broca. This is a hidden expanse
of cortex that lies within the great enfold, known as the Sylvian fissure, that
divides the temporal and frontal lobes. Where there is damage to this
surrounding area, many speech disorders occur. For example, people cannot
repeat what they have just heard when there is something wrong with the connection
of these two areas. This is because words heard (recorded in Wernicke’s area)
can no longer reach Broca’s area, where speech is dealt with. Children who
develop autism have affects in both areas of Wernicke and Broca. children with
autism show weaker activation in brain regions that process and recall sounds
of words than controls do. A neurodevelopmental condition like ASD interferes
with language development because it alters the way the brain responds to
environmental input. In the typical developmental process. Early in the
developmental process, according to (Bates, 1993; Friederici, 2005; Smith &
Yu, 2008) a child with a typically developing brain can differentiate speech
from non-speech, discriminate words within a stream of connected speech, relate
the words to objects and actions in the environment, discriminate sentences
within continuous discourse, relate the meaning of one word to another word. That
being said having a developing Wernicke area and Broca area is very important
for children who are diagnosed with autism, due to the fact they will struggle
making complete sentences or having a full-on conversation. Having therapy at a
young age improves language skills for the developing lobes of the brain.

The Hippocampus and ASD

Taking into consideration that people with autism suffer from
different medical issues, some of which affect their brain, it has largely been
speculated that the hippocampus is an underline key to behavior dysfunctions.
According to the American Journal of Neuroradiology, MRI’s were acquired
through a study, from children with two different degrees of autism. While the
third category were children with no autism. Their findings were that the
hippocampal- shape in children with autism were related to the degree of intensity
of the illness. The children with autism showed signs of alterations in both
the hippocampus and subiculum. Children with severe forms of autism appeared to
have more prominent deformations in the hippocampus. In the article from the
American Journal of Neuroradiology, adults with epilepsy shared similarities in
MLT structure with the children who had autism. Although 38% of children with
Autism Syndrome will develop a seizure disorder during their infancy or teenage
years, they are not related. A person can have seizures and not have autism.

Rojas et al. (2004) conducted a study to determine whether
the parents of children with autism showed the same changes in structures.  For the study, Rojas performed Magnetic
reasoning imagining (MRI) scans on 17 biological parents of children with
autism, 15 adults with autism and 17 adults with no personal or family history
with autism. The results of this study showed that after all scans were
compared, it was noted that the parents of children with autism had a
similarity with the adults that have autism. The left hippocampus was larger in
both the autistic adults and the parents of autistic children. The left side of
the amygdala was smaller in the same two groups compared to the group who have
no personal or family history of autism.

Cognitive
function and Chemical Unbalance

            Gamma-aminobutyric acid (GABA) is a neurotransmitter that helps
send messages between the brain and the nervous system. GABA is produced inside
brain cells with the help of glutamate, and its function is to act as an inhibitory
neurotransmitter, which blocks nerve impulses. Glutamate is an excitatory
neurotransmitter, and when it’s bound to adjacent cells, it has an impulse to
fire and send nerve impulses. Without GABA, nerve cells fire too often, causing
an unbalance in the body and brain. Many disorders like panic attacks, seizures,
and conditions like addiction, headaches, Parkinson’s syndrome, and cognitive
impairment are all related to low levels of GABA (Atkins Robert, Dr. Atkins’ Vita-nutrient solution, Simon
& Schuster). Gamma-aminobutyric acid helps the transmission of nerve
impulses from neuron to neuron. The less GABA that’s in the body, the more
nerve transmissions occur, this is what it feels on what having too much coffee
does to the body. (Louzada PR, Lima AC, August 2004). This chemical play’s a
major role in individuals who have autism. In a study done by William Gaetz a
professor of radiology at the University of Philadelphia showed that brain
scans of children with autism have less GABA in brain regions related to sound
processing and motor control. His study helps explain why many people with
autism are hypersensitive to loud noises or have motor impairments. His
technique used a vivo magnetic resonance spectroscopy (MRS), which measured the
concentrations of brain chemicals. Therefore, he was able to see the brains of
children with autism, and saw they lacked enzymes that help produce GABA. They
also have less GABA in the motor cortex and auditory cortex, which would
explain the sound process that occur in their brain. His studies also found
that these children have delayed brain responses to sounds, and abnormal brain
waves in the cortex. These cortical oscillations dependent on neurotransmitters
of which GABA produces. (Gaetz W. Et al. Neuroimaging 2013). People with autism
have trouble filtering irrelevant sensory information, which inhibition in the
brain plays a major role. Research has suggested that reduced GABA activity in
the brain plays in producing autism hallmark symptoms. MIT and Harvard
Neuroscientist conducted a study regarding GABA. In this study, Harvard
Neuroscientists explored an optical task called a binocular rivalry. During the
time of study, researchers showed each participant one image per eye, two
different images. Binocular rivalry requires brain inhibition and has been
shown to be more difficult for people with autism. In order to see the images,
the brain must switch back and forth between input from the right and left eye.
For the participants, it may look like the two images are attenuating in and
out, as input from each eye takes its turn inhibiting. Caroline Robertson found
that “non-autistic adults switched back and forth between the images nine times
per minute, and one of the images fully suppressed the other about 70 percent
of the time”.  Caroline Robertson also
found that autistic adults switched back and forth only half as often as non-autistic
subjects, and one of the images fully suppressed the other only about 50
percent of the time. Once the study was finished the researchers then measured
GABA activity using a technique known as magnetic resonance spectroscopy. Caroline
Robertson states that “non-autistic participants with higher levels of GABA
correlated with a better ability to suppress the non-dominant image”. In most
autistic participants, there was no relationship between performance and their
GABA levels. Caroline Robertson suggests that GABA is present in the brain but
does not perform its usual function in autistic individuals (Caroline Robertson
2015).

Drugs for Specific Types of Autism

            Autism
affects children in different ways, although most of them have the same
symptoms. Receiving treatment will be based on the type of autism. Behavioral
therapy is usually the first line for treatment, with pharmacological medicine
added to help patients function in their daily activities. Autism brakes down
to three categories; autistic disorder, Asperger’s syndrome, and pervasive
developmental disorder. The first category of autism is also known as classical
autism. According to (Autism Support of
West Shore 2017), this spectrum disorder has language delays, social and
communication challenges, and unusual behaviors and interests. Intellectual
disabilities are also very present. Having this classical autism is the more
severe of the three categories.

Some
symptoms of this type of autistic disorder have problems being touched by other
people, have restricted and repetitive behaviors, have many sensory overloads,
and most likely will have issues communicating, whether is verbal or
physically. Most types of autism share the same symptoms, but in the classical
autism these symptoms are more severe than most and are the most common to
have. The second type of autism is Asperger’s syndrome. One of the milder types
of autism spectrum disorder. Common symptoms people experience is the same as
the other types of autism, only with Asperger’s they tend to be less mild.
Usually, people with have behaviors that aren’t common and that may be weird to
others, and of course the most common with autism is having social challenges.
These symptoms are the most difficult for people with Asperger’s. Problems with
language and intellectual disability don’t affect those with Asperger’s.  The last type of autism is Pervasive
development, this is also called “atypical autism.” This type meets the
characteristics for the other two types, but not most of them. Those who have
PDD-NOS (Pervasive Developmental Disorder-not otherwise specified) experience
milder symptoms or fewer symptoms. Those with PDD-NOS only suffer from social
and communication challenges. People tend to be the highest-functioning
autistic types and simply do not fit into any of the other categories or types
of autism spectrum disorders. Some of the same medications may be taken for all
types of autism, depending on the severity of the symptoms.  Sertraline
is a serotonin reuptake inhibitor, and it was shown to improve separation
anxiety in an 11-year-old girl having Asperger’s syndrome. (Hollander E, Soorya L, Chaplin W, et al. 2012). Two other
types of medications for autism include risperidone and aripiprazole. Risperidone
is an antipsychotic medication, that helps by changing the effects of chemicals
in the brain. Risperidone also helps schizophrenia in adults and children who
are at least 13 years old. It’s also used to treat symptoms of irritability in autistic
children who are 5 to about 20 years of age. Aripiprazole is also an
antipsychotic medication. It works by making new chemicals in the brain. Aripiprazole
is given to children 6 years or older who symptoms of autistic disorder that
include irritability, aggression, mood swings, temper tantrums, and self-injury
(Bhardwaj A, Agarwal V, Sitholey P (2005).

 

 

Discussion

            Children
with ASD develop differently, and not everyone will have the same symptoms; in
fact, some may not show any symptoms at all. Most children with autism can
speak clearly, while others may not be able to speak at all and may mumble
words. These behaviors complicate diagnosis and treatment for those with ASD.
Based on a diagnosis, this progress will affect treatment at differing rates.
According to Dr. Annabel Marsh (2007), “Children with ASD face more challenges
transitioning to school, particularly with social interaction. Further
development and implementation of specific school-based interventions is needed
in order to assist children with autism to maximize their success in starting
school”. While not every child is born ready for school, Waddington and Reed
(2009) showed that children with ASD are less ready for school on an
emotional level rather than their peers. Children with ASD appear to have more
externalizing behaviors and self-regulation difficulties that affect their
school engagement and relationships with teachers. School-based behavioral
interventions on ASD, appear to improve cognitive, language and daily living
skills, but have less impact on socialization and peer inclusion. Some
therapies that help children with autism in school would be Applied Behavior
Analysis, and Present study. In ABA-based therapies, (Lovaas, 1987) found that
47% of the children with ASD who received long-term ABA therapy achieved levels
of normal intellectual and educational functioning in their classroom as
compared to only 2% of those children with ASD in a control group. Other
studies have also found similar improvement rates for children in ABA-based
therapies as compared to those who participate in a control groups (Scheinkopf
& Siegel, 1998). The effectiveness of ABA seems to get children on track if
introduced at an early age of childhood.

 

Diagnosis

It
is important to have a child evaluated by professionals who know about autism.
Speech-language pathologists may diagnose autism in only the aspects that
concern in the language barrier. Professionals like pediatricians,
neurologists, occupational therapists, physical therapists, and developmental
specialists, among others. Speech-language pathologist play a key role because
problems with social skills and communication are often the first symptoms of
autism. There are a number of tests and observational checklists available to
evaluate children with developmental problems. The most important information comes
from parents and caregivers who know the child best and can tell the SLP and
others all about the child’s behavior.

Conclusion

Autism
Spectrum Disorder is complicated to understand, there’s still much research to
be done to have a definitive answer on what causes Autism. It is difficult to
identify and recommend intervention and preventative practices for ASD.
Research shows that ASD develops from environmental and genetic factors. Some
individuals prefer therapies to help with their behavior, social and education,
but to some medication is a good alternative to balance brain chemicals and
help them on their everyday life. Having different therapies and medications is
helpful in allowing individuals with ASD to cope and thrive despite their
diagnosis. Research on ASD continues to expand and scientist keep learning
about the disability, the more research the closer scientist are to finding a
cure to Autism.

 

 

Bibliography

University of California, Berkeley, 4511 Tolman
Hall, Berkeley, CA, 94720, United States Behavioral Intervention Association,
2354 Powell Street, Suite A, Emeryville, CA, 94608 United States

Hideo Matsuzaki, Keiko Iwata, Takayuki Manabe, Norio Mori Journal
of Central Nervous System Disease First Published February 22, 2012

 

Marsh, A., Spagnol, V., Grove, R., & Eapen,
V. (2017). Transition to school for children with autism spectrum disorder: A
systematic review. World Journal of Psychiatry, 7(3), 184–196.

 

Ring, M., Derwent, C. T., Gaigg, S. B., &
Bowler, D. M. (2017). Structural learning difficulties implicate altered
hippocampal functioning in adults with autism spectrum disorder. Journal Of
Abnormal Psychology, 126(6),

 

Gaetz, W., Bloy, L., Wang, D., Port, R. G.,
Blaskey, L., Levy, S. E., & Roberts, T. P. L. (2014). GABA estimation in
the Brains of Children on the Autism Spectrum: Measurement precision and
regional cortical variation.

 

Rita Carter: MAPPING THE
MIND. University of California Press. Berkeley and Los Angeles, California.
1999

 

Study finds altered brain chemistry in people
with autism

Anne Trafton | MIT News Office, Caroline
Robertson 2015 – http://news.mit.edu/2015/altered-brain-chemistry-autism-1217

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