What is autism and how is it treated?

Autism is a group of brain development disorders that have a variety of manifestations. The hallmark of autism is the disability to interact normally with others using both verbal and non-verbal communication skills.

Essentially, autism interferes with the affected person’s ability to communicate, interact socially, and behave normally in social situations.

Autism affects children of all nationalities and races

girl holding cards

A cinematic depiction of a person with autism spectrum disorder can be seen in the Academy Award-winning movie Rain Man (1988) starring Dustin Hoffman as “Ray” and Tom Cruise as his brother “Charlie.”

In 2013 physicians decided to collectively call the variations and subtypes of autism (including Asperger syndrome) “autism spectrum disorder.” There is no current way to detect autism spectrum disorder in-utero (prior to birth). There is no cure for autism spectrum disorder.

autism puzzle

Autism spectrum disorder is characterized by any one or any combinations of the following:

Difficulties with social interactions
Difficulties with verbal and non-verbal communication
Intellectual disabilities
Difficulties with motor coordination
Sleep disturbances
Gastrointestinal problems
Engagement in repetitive behaviors

Interestingly, a significant portion of people with autism spectrum disorder is extremely skilled with respect to one or more areas involving visual skills, art, music, problem-solving, memory skills and mathematics. In many cases, they harbor savant (highly gifted) skills.

Autism spectrum disorder probably begins in early brain development, but the outward manifestations become apparent between the ages of one and four. Although the development of all children can vary significantly, early detection can lead to early intervention and treatment, which can dramatically affect outcomes and the quality of life for persons with autism spectrum disorder.

autism awareness

Improved outcomes are seen with increased learning skills, communication skills, and social skills. Doctors say that the warning signs can be seen as early as one year of age.

Over three million persons are affected with autism spectrum disorder in the United States. Somewhere between one and two percent of all children are affected with autism spectrum disorder (approximately one in 60 births). Boys are approximately four times more likely to be affected with autism spectrum disorder than girls.

Scientists have discovered that the incidence of autism spectrum disorder has been increasing over the past few decades. It is unclear if the increased diagnosis rate is a result of better diagnostic criteria or environmental factors or both.

According to the AdCouncil, AutismSpeaks, and the Mayo Clinic, early warning signs include:

No large smiles or other warm, joyful expressions by six months or after that
No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months
No babbling by 12 months
No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
No words by 16 months
No meaningful, two-word phrases (not including imitating or repeating) by 24 months
Any loss of speech, babbling or social skills at any age
Fails to respond to one’s name when called
Performs repetitive movements such as rocking, spinning or hand-flapping
May be extremely sensitive to light and loud sounds or noises
Engages in ritualistic and repetitive behaviors and may become extremely annoyed if the routine is disrupted
Rarely makes direct eye contact
Does not like to be touched or cuddled or hugged
Does not engage in imaginative play behaviors
May not have a normal pain response
Strange vocal tones and patterns
Delayed speech or loss of speech
Strange or very limited food preferences
Difficulty expressing feelings or emotions
May become very disruptive in social situations

It is important to become familiar with these and other developmental milestones for toddlers. If a parent or caregiver suspects anything amiss, they should talk to their pediatrician about a simple screening test called the “Modified Checklist for Autism in Toddlers.”

The exact diagnosis needs to be made by a physician experienced with autism spectrum disorder. Even though there is no cure, early diagnosis and intensive intervention can improve learning abilities and behavior and increase the ability to interact socially with others. If you suspect a child has autism spectrum disorder, check with your doctor immediately for a screening examination.

What causes autism spectrum disorder?

The exact cause is not fully understood, but it is generally accepted that the cause is usually a combination of genetic mutations and environmental factors that affect early brain development.

These environmental factors include but are not limited to advanced parental age, conditions that decrease available oxygen to the developing baby, maternal illness during pregnancy, and lack of certain vitamins including folic acid. It should be noted that any one of these does not cause autism spectrum disorder, but rather a complex combination of these with the background of genetic predisposition.

Additional risk factors for autism include:

Being male (the male-to-female ratio for autism is 4:1)
Certain other genetic conditions (including, but not limited to, Fragile X syndrome, Tuberous sclerosis, Rett’s syndrome and Tourette’s syndrome)
Pre-term birth
History of other family members with autism

After exhaustive research, doctors state emphatically that there is no connection between developing autism and receiving childhood vaccines. Earlier reports linking vaccinations and autism have been completely debunked.

How is autism treated?

Every person with autism spectrum disorder is unique. As a result, every treatment plan should be customized. The goal is to improve learning skills, attention, behavior, and ability to interact socially.

The treatment will involve the entire family, physicians, teachers and skilled therapists. Both behavioral and medicinal treatments may be required, and the treatment program’s goals will evolve as the child grows. There are many great educational programs available for a person with autism spectrum disorder from toddlers to adults.

The best improvement in autism spectrum disorder symptoms is directly related to early diagnosis and behavioral intervention. Many people with autism spectrum disorder who receive appropriate intervention and guidance will live independent, rich and rewarding lives.

All persons with autism spectrum disorder deserve the opportunity to live meaningful, productive and enjoyable lives with gratifying relationships. With a better understanding of autism spectrum disorder and interventional support programs, those affected by autism spectrum disorder are living fulfilling and remunerative lives.

For more information, visit AutismSpeaks.org.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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Understanding Bipolar Disorder and treatment

My sister told me that a well-known signer, Demi Lovato, announced that she has Bipolar Disorder. What is Bipolar Disorder?

Bipolar disorder is a mental health disease where a person’s mood can cycle back and forth between periods of low activity/depression and periods of mania/high activity. These emotional periods can be looked at as two opposite “poles” of emotion,” hence the term “bipolar.”

In the past, the condition was called “manic-depression” and this term is still used, but not as commonly as bipolar disorder. Bipolar disorder is a chronic medical condition. Like other chronic medical conditions, (e.g. high blood pressure) the goal is to manage and control, not cure. Many cases can last years or even a lifetime. Fortunately, there ae excellent treatments for bipolar disorder that dramatically affect the quality of life for those who suffer with bipolar disorder.

Incidence

Bipolar disorder is very common. In fact, over three million cases are diagnosed in the U.S. every year. It can occur at any age, but most commonly it is seen in ages 15 and 60. It often starts in late adolescence.

Diagnosis

The diagnosis must be made by a certified doctor, preferably a psychiatrist, primary care physician or psychologist. There are no lab tests to make the diagnosis. There are also several subtypes of bipolar disorder that will not be delineated in this article.

Depressive episodes

Patients may feel intensely sad, experience a strong sense of hopelessness, and feel extremely sluggish. The patients may feel low energy, low motivation and feel extremely worthless. They may have trouble concentrating and focusing and making decisions.

They may experience significant appetite changes, which may cause dramatic weight changes, and they may have periods of uncontrollable crying. They tend to focus on negative themes and may isolate themselves from others. Depressive phase patents may require more or even less sleep (insomnia). Patients may stay in bed for days and even contemplate death or suicide.

Manic episodes

During this phase patients experience high levels of energy and require very little sleep. They may become quite productive. Patients often describe feeling especially confident, very hopeful, and intensely excited. Often spectacular and unrealistic plans are made.

Patients can develop rapid speech, have an increased sexual drive, and are more prone to abusing drugs and alcohol. Decisions can be made both impulsively and rapidly, but not always with good outcomes causing a hallmark of bipolar disorder: poor judgment.

Bipolar Disorder may cause their mood to be elevated and joyful at one moment but rapidly change to being angry, irritable, aggressive and hostile. Patients with bipolar disorder, during a manic phase, can experience delusions (believe in things that are not true) and hallucinations (see things that are not really there). The term ‘hypomania’ is used for the manic state without hallucinations or delusions.

Cycling between depression and mania

Although most periods of mania or depression can last days to weeks, some periods of depression and mania can last for months and even years. Depressive and manic episodes may not always cycle back and forth. One emotional state may repeat itself several times before cycling to the other polar state. There are often periods of ‘normalcy’ between cycling to either the depressive of manic states.

Treatment

Treatments are designed to alleviate symptoms and include (usually in combination):

Prescription medications
Support groups
Psychotherapy
Cognitive behavioral therapy
Family therapy
Psychoeducational therapy
Hospitalization

One of the most important items to acknowledge is that some patients with bipolar disorder may become suicidal during the depressive state. If someone has depression (for any reason), it is important to recognize the warning signs of suicidal risk and make sure help is obtained immediately.

Warning signs include:

Talking about death
Loss of participating in activities that were normally enjoyed
Weight change
Isolation
Crying spells
Giving away personal items
Focusing in on negative or morbid themes
Acting recklessly
Increased drug/alcohol use

Demi Lavato was extremely courageous in publically acknowledging the successful treatment of her bipolar disorder. In fact, she is not alone, hundreds of well-known people have bipolar disorder as documented here: https://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder.

Remember, bipolar disorder cannot be cured, but there are many excellent treatments that can dramatically improve the quality of life and alleviate symptoms of both mania and depression. If you suspect that you or a loved one has bipolar disorder, call you primary care doctor today and get help. It could very well save a life.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

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