Center for Autism and Related Disorders, Philippines

Professionals for Autism Foundation Inc.

Autism Spectrum Disorders are lifelong neuro-

Developmental disabilities with onset before

36 months characterized by impairments

in reciprocal social interaction, impair-

ments in communication skills &

stereotyped behaviors, interests, and

activities. The terms autism (from autos the

Greek for self) and autism spectrum disorder

are often used interchangeably and refer to

three of five disorders known as Pervasive

Developmental Disorders (PDD).

The 3 “autism spectrum disorders” are:

• Autistic Disorder,

• Asperger ’s Disorder, and

• PDD-NOS (Not Otherwise Specified).

The other PDDs, which are less common, are:

• Child Disintegrative Disorder and

• Rett ’s Disorder.

Source: National Autism Society, UK

Autism indeed has many faces and these are just a few that illustrate the clinical heterogeneity of the condition. Recently, the more appropriate term that best describes this developmental disability would be “Autism Spectrum Disorders” (ASds) or the Pervasive Developmental Disorders (PDDs) – to reflect this broader spectrum of clinical characteristics. The autism spectrum, in fact, runs the gamut from people with multiple and profound disabilities to those with mild and manageable differences.

ASDs are not rare and affect nearly 1 in every 150 children. Nowadays many general pediatricians and physicians are bound to see and care for these children. With recent heightened public awareness through media and internet, more and more parents are likely to seek help when they find “red flags” in their child’s development. Some of these “red flags” or early markers include the following: no smiles or other warm joyful expressions by 6 months or thereafter, no back and forth sharing of sounds, smiles or other facial expressions by nine months or thereafter, no babbling by twelve months, no pointing, showing, reaching or waving by 12 months, no word by 16 months, no two word meaningful phrases by 2 years and any loss of speech or babbling or social skills by any age. (Source: “Could it be Autism?” by Nancy Wiseman) Although these signs do not necessarily mean a child has autism or any developmental disorder, they are reasons for concern and for further professional evaluation.

What does it mean to have an ASD? The new Diagnostic and Statistical Manual of Mental Disorders, 4^th edition, Text Revised (DSM-IV-TR) which defines all known mental disorders for the purpose of diagnosis, describes six characteristics of ADSs. To qualify for a diagnosis, a person must have 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).

1. Qualitative impairment in social interaction, manifest by at least two of the following:

A. Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures and gestures, to regulate social interaction

B. Failure to develop peer relationships appropriate to developmental level

C. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by lack of showing, bringing, or pointing out objects of interest)

D. Lack of social or emotional reciprocity.

2. Qualitative impairment in communication, as manifest by at least one of the following:
1. Delay in, or total lack of the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. Stereotypes and repetitive use of language or idiosyncratic language
4. Lack of varied, spontaneous make-believe, or social imitative play appropriate to developmental level.

3. Restrictive repetitive and stereotypic patterns of behavior, interests, and activities, as manifested by at least one of the following:
1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
2. Apparently inflexible adherence to specific nonfunctional routines or rituals.
3. Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting or complex whole-body movements)
4. Persistent preoccupation with parts of objects.

Aside from the above, the person has delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

1. Social interaction
2. Language as used in social communication
3. Symbolic or imaginative play

Further, the disturbance is not better accounted for by Rett’s Disorder (a neurodevelopmental disorder) or Childhood Disintegrative Disorder (characterized by late onset [>3 years] developmental delays).

Source: National Institute of Mental Health, 2004

The diagnosis of ASD is done by a medical professional with support from physical, occupational, speech therapists and educator. Ideally, everyone involved with a diagnosis should have significant experience with ASDs, their treatment. While there is no established cure for autism, there are many “treatments”. Many medications are used to treat problems associated with ASD. Majority of the children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics, such as Risperidone. The primary goals of treatment are to maximize the child’s ultimate functional independence and quality of life by minimizing the core features of ADSs, teaching social and behavioral skills, reducing maladaptive behaviors and educating and supporting families. Prognosis depends on several factors. Poorer outcomes are associated with lack of functional speech, mental retardation, seizures and presence of co-morbid psychiatric disorders. Better outcomes include early identification resulting in early enrollment in appropriate intervention programs with successful inclusion in educational and community settings. It is hoped that in the near future, new research findings will help identify causes and arrange the necessary interventions that is better than what is available today.

Resources: The reader is referred to the following for more information:

Philippine Society for Developmental and Behavioral Pediatrics (PSDBP) or call hotline number 8248899 Mon to Fri from 9am to 5pm.

Alexis L. Reyes is an Associate Professor of Pediatrics UP College of Medicine and President of the Philippine Society for Developmental and Behavioral Pediatrics.

AB is a 3 year old boy who has delayed speech. He does not answer or turn his head when his name is called but his response is immediate when TV commercials are shown. As an infant, he seemed fine and was a happy child but as he turned one, he became more aloof and less inclined to respond to his parents’ attempts at social interaction.

CD at 9 years of age was odd. He had no friends and spent most of his time drawing. He was in fact quite preoccupied with making illustrations of different churches. He knew by heart the patron saint of each church and could describe in detail some of their lives.

EF at 24 is a very efficient tour guide. He begins and ends his tour exactly on time. He could rattle off historical trivia and he regularly collects information on the different heroes and heroines of the Philippines. His other passion is to surf the internet for “sick animals” who he wanted to either adopt or help adopt.

GH at 35 could only use a few gestures to communicate and had to be supervised by her parents most of the time, as she would tend to escape from the house or run away from them when they were in the mall. She was quite aggressive as a young child and often hit herself or bit her hands when she was excited or happy.

Alexis S. Reyes M.D. FPPS, FPSDBP

The Many Faces of Autism

What are Autism Spectrum Disorders?