Abstract: Autistic disorder comes under pervasive developmental disorders. An early onset condition that is characterized by delay and deviance in the development of social communication and other skills. This article deals with the diagnostic criteria, general management and homeopathic approach in treating this disorder.
Autistic disorder (more recently described as ‘mind blindness’) is a neurological and developmental disorder that usually appears during the first three years of life. A child with autism appears to live in its own world, showing little interest in others and lack of social awareness. Action for Autism (AFA) shows that one in every 500 Indian infants is suffering every year from autism.
According to DSM-IV TR, Autistic disorder is classified as one of the pervasive developmental disorders (PDD’S). Autistic disorder is characterized by a qualitative impairment in the verbal and non-verbal communication, imaginative activity and reciprocal to social interactions that develops before the age of 3 years. Other neurological disorders that can co-ordinate with autistic disorder are seizure disorders, tuberous sclerosis and fragile X-syndrome.
As early as 1867, Henry Maudsley, a psychiatrist noted a group of young children with severe mental disorders, who had marked deviation, delay and distortion in their development. In 1943, Leokanner in his classic paper ‘Autistic disturbances of affective contact’ coined the term ‘Infantile Autism’ and provided a clear and comprehensive account of the early childhood syndrome. Therefore, Autistic disorder is historically termed as ‘Early Infantile Autism’ or ‘Childhood Autism’ or ‘Kanner’s Autism’.
Prevalence: Autistic Disorder is believed to occur at a rate of about 8 cases/10,000 children (0.08%) in India and 2–30 cases/10,000 all over the world.
Age of onset: The onset is before the age of 3 years, although in some cases, it cannot be recognized until the child is much older.
Sex distribution: Autistic disorder is 4–5 times more frequent in boys than in girls. Girls with autism are more likely to suffer more severe mental retardation.
Genetic factors: The higher concordance is in monozygotic twins than dizygotic twins (36% versus 0%). Siblings of autistic children show a 2% prevalence of autism (50 times over expected prevalence). About 15% of siblings have delay in learning (usually language or speech disorder), mental retardation or physical defects.
Perinatal factors: Maternal bleeding after the first trimester, perinatal asphyxia and meconium in the amniotic fluid have been reported in the histories of autism more often than in the general population.
Postnatal factors: Postnatal neurological infections such as meningitis, encephalitis, congenital rubella, cytomegalovirus, phenylketonuria and inborn errors of metabolism — tuberous sclerosis and neurofibromatosis are associated with autism. Males with autism have been found to be the products of longer gestational age and were heavier at birth. Females with autism are more likely to be post-term pregnancies.
Medical factors: About 2–5% appears to have fragile X-chromosome syndrome. Seizure disorder appears in 35–50% by 20 years of age. Low IQ is associated with higher incidence of seizures, social impairment, self-multilatory and bizarre behaviour.
Psychodynamic and parental influences: kanner described the parents of autistic children as intellectual, obsessive, socially reserved, cold and emotionally detached (so called ‘refrigerated parents’).
Bio-chemical factors: About 1/3rd of autistic children have elevated serotonin levels, significance of which is unclear and the cause is unknown. In some autistic children, there is a high concentration of homovanillic acid (metabolite of dopamine) in the CSF. Some evidences indicate that the symptom severity decreases the 5-HIAA (5-hydroxy indole acetic acid) — a metabolite of serotonin.
DSM-IV-TR Diagnostic Criteria for Autistic Disorders
- A total of six (or more) items from 1, 2 and 3 with at least two from 1 and one each from 2 and 3.
- Qualitative impairment in social interaction, as manifested by at least two of the following:
- Marked impairment in the use of multiple non-verbal behaviours such as eye-to-eye gaze, facial expressions, body postures and gestures to regulate social interaction
- Failure to develop peer relationships appropriate to the developmental level
- Lack of spontaneous seeking to share enjoyment, interest or achievements with other people for e.g. a lack of showing, bringing or pointing out objects of interest)
- Lack of social or emotional reciprocity
- Qualitative impairments in communication as manifested by at least one of the following:
- Delay or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime)
- In individuals with adequate speech but with marked impairment in the ability to initiate or sustain conversation with others
- Stereotyped and repetitive use of language or idiosyncratic language
- Lack of varied, spontaneous make-believe play or social imitative play appropriate to the developmental level
- Restricted, repetitive and stereotyped patterns of behaviour, interest and activities as manifested by at least one of the following:
- Encompassing pre-occupation with one or more stereotyped and restricted patterns of interest that is abnormal either in the intensity or in focus
- Apparently inflexible adherence to specific and non-functional routines or rituals
- Stereotyped and repetitive motor mannerisms for e.g. hand or finger flapping, twisting or complex whole body movements
- Persistent pre-occupation with parts of objects
- Delays or abnormal functioning in at least one of the following areas with onset prior to mage 3 years:
- Social interaction
- Language as used in social communication
- Symbolic or imaginative play
- The disturbance is not accounted for by Rett’s disorder or childhood disintegrative disorder.
The primary management is through ‘intensive behavioural therapy’ starting before 3 years of age, applied at home as well as in the school focusing on speech and language development and good behavioural control.
Important principles of the educational approach that can be applied at school are:
- Teaching one–on–one using primary rewards such as food as motivation
- Teaching in small increments with repetition
- Using total communication in teaching with a range of techniques such as spoken language, symbols and visual tools
The principles of behavioural modification programs that can be applied at home by the parents are:
- Identifying the manageable problems
- Finding a reward that works for the child
- Trying to modify the behaviour consistently by giving behavioural therapy
The gluten and casein–free diet is more useful in treating autism. It helps in slight modification of the behaviour.
Homeopathic paediatrician should be a very careful observer, noticing every detail of the child and parents, their behaviours and attitudes. His observation should be based on sound principles and not on hypothetical theories.
A proper history taking and physical examination of the child is important. The history should be divided into two parts:
- History of the mother
- History of the child
History of the mother
Most of the illnesses seen in a child in the initial few years of his life are directly or indirectly linked to the mother’s physical and emotional states during conception, pregnancy or labour.
History of the child
It is very important to identify the ethnicity or genetic factors, as environmental and social characteristics influence a disease process. He should also enquire about the developmental milestones.
A quick assessment of delayed milestones:
- Absence of social smile by 2 months
- Lack of head stability by 4 months
- Unable to recognize the mother by 6 months
- Inability to sit without support by 8 months
- Inability to crawl by 9 months
- Inability to stand without support by 9 months
- Inability to walk without support by 18 months
- Lack of pincer grip by 12 months
- Absence of babbling speech by 12 months
- Inability to make any meaningful sentence by 3 years
During physical examination, the neuro-developmental reflexes should be assessed:
- Early detection of these problems in children not only helps us to arrest the further damage of the child but also helps in the treatment. It is found that these children at lesser age respond well to the treatment. Constitutional treatment with co-operative parents helps to nib in the bud.
- Before starting the homeopathic treatment, an evaluation of the child on an autism rating scale (ARS) is must. Periodical assessments are also necessary to interpret the improvement.
- Quite often, a series of medicines need to be prescribed in a sequence by carefully studying the emerging symptomatology from time to time.
Repertorial Analysis — Synthesis Repertory
- Mind – AUTISM
- Mind – AUTISM – children; in
- Mind – TACITURN
- Mind – COMPANY – aversion to
- Mind – SADNESS – company – agg.
- Mind – RESERVED
- Mind – QUIET, wants to be
- Mind – SOLITUDE – desire for
- Mind – COMPULSIONS
- Mind – COMPULSIVE DISORDERS
- Mind – LOOKED AT – cannot bear to be looked at
- Mind – UNSOCIABLE
- Mind – HYPERACTIVE CHILDREN
- Mind – SPEECH – affected
- Mind – SPEECH – inarticulate
- Mind – INDIFFERENT
- Mind – SENSITIVE – noise, to
- Mind – SENSITIVE – light, to
- Mind – SENSITIVE – touch, to
- Mind – SENSITIVE – mental impression, to
- Mind – RESTLESSNESS
- Mind – IMPATIENT
- Mind – TALKING – indisposed, to
As we are well aware of the fact that homeopathy treats holistically. There is no single remedy for a disease. The constitutional remedy selected on the basis of the symptoms of an individual cures successfully. However, the Homoeopathic Materia Medica offers a number of remedies covering symptoms of autism. The symptoms with reference to the Materia Medica of commonly indicated remedies are as follows:
Absent minded and dreamy children, who are deeply engaged in their fancies and award, both mentally and physically. Dependent on others. Mental retardation with stereotypical or self-injurious behavior. Neurological or behavioural problems in children after being punished teased or scapegoated by peers or family members. Involuntary convulsive rolling or pendulum like movements of the eyeballs from side to side, which is relieved only during sleep.
Dwarfish mentally and physically, infantilisms, where memory is weak and the child seems inattentive and stupid. He does not learn to play or walk and may approach a state of borderline mental retardation. Regression of milestones especially speech. Wants to lie down. Chilly patient; takes cold easily, always inattentive in the class; can never concentrate on anything.
Children, who have been born to the mother, who, during pregnancy had a strong history of fright or had disappointment love, difficulty in concentration, epileptic convulsions, gigging constantly and an extreme difficulty in making contact with the child. Mental and physical development of the child arrested. Rage, restless, sensitive to noise and aversion to company.
Chilly patient; takes cold easily. Fair, fat and flabby with large head, distended abdomen, red face and cold feet. Head sweats profusely while sleeping. Sour smelling child. Slow development of milestones. Craving for indigestible things, aversion to meat and milk. Always wants to be magnetized.
Thin and delicate looking children with fine skin and dark complexion or ‘café au lait’. Light coloured eyes with pigmented moles, strong family history of cancer, tuberculosis and other chronic illness. History of excessive parental control. Passionate, sensitive to reprimands, ailments after vaccination, extremely sensitive to all impressions.
Hot patient, poorly nourished, great emaciation while eating well, craving for salt, aversion to bread and fatty things. Plays alone. Irritable and cross. Cries when spoken to. Awkward; drops things from nervous weakness. Ailments from sudden and abrupt separation from parents. History of mental depression in the mother during pregnancy.
Hot patient. Red and puffed face. Hot perspiration all over the body except lower limbs. Marked sensitiveness to noise. Painlessness of complaints. Behavioural and neurological problems that arise after the death in the family or frightening experiences where fear remains for long.
Abusive, angry and rude children, who tend to insult their parents and throw things at people in anger. Dissatisfied and deviant child. Malicious. Cannot be tackled by parents or authority.
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