Dr. Hanes Swingle, associate professor of pediatrics at the University of South Alabama College of Medicine, said autism spectrum disorders are a group of complex developmental disorders that include autism, Asperger’s syndrome and Pervasive Development Disorders – Not Otherwise Specified (PDD-NOS).

“Autism is a pattern of behavior that has a neurological basis,” Dr. Swingle said. “It is a disorder of neural connectivity, where there are disruptions in neural organizations, neurotransmitters, and synapses – or connections between brain cells.”

According to Dr. Swingle, criteria for autism include restricted interests and repetitive behaviors, as well as impairment in social interaction and communication.

Restricted interests and repetitive behaviors include encompassing preoccupations that are abnormal in intensity or focus; inflexible adherence to nonfunctional routines or rituals; repetitive motor mannerisms; and persistent preoccupations with parts of objects.

Impairment in social interaction includes impairment in nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures; failure to develop peer relationships; and lack of spontaneous sharing of enjoyment, interests or achievements.

Impairment in communication includes delay or total lack of spoken language; impairment in the ability to initiate and/or sustain a conversation; repetitive use of language; and lack of varied, spontaneous make-believe play.

Dr. Swingle said it is important for parents to be aware of the common red flags for autism:

  • No babbling, pointing or gestures by 12 months of age
  • No single words by 16 months of age
  • No spontaneous 2-word phrases by 24 months of age
  • Loss of language or social skills at any age

Common behavior problems seen in children with autism include meltdowns, ADHD, OCD, anxiety, aggression, sleep problems, and extreme food selectivity.

According to Dr. Swingle, autism is not due to one cause. “Medically, we have identified multiple conditions that lead to autism,” he said. “Twenty-five percent of children with Fragile X syndrome, the most common inherited cause of mental retardation, meet criteria for autism. Fifty percent of children with tuberous sclerosis – a rare condition associated with unique skin findings, seizures, tumors and mental retardation – have autism.

Dr. Swingle said drugs, chemicals, pollution, and cultural changes may also be contributing to the rise in autism.  

“A survey from 1990 reported that children in the United States spend 93 percent of their time indoors, which is undoubtedly a much higher figure than the pre-air-conditioning and pre-television era,” Dr. Swingle said. “This results in increased exposure to indoor air pollutants and puts children at risk for vitamin D deficiency.”

Vitamin D is a natural anti-oxidant important in DNA repair and directly affects brain development and immune function. The main source is from synthesis in the skin following exposure to sunlight.

According to Dr. Swingle, TV viewing is associated with delayed language development in young children. “The more the TV is on, the less children speak,” he said. “Exposing infants and young children to TV can result in language delay, hyperactivity and inattention, and increased aggression – all common behaviors in children with autism spectrum disorders.”

In addition, delayed childbirth may contribute to the rise in autism. “Autism risks increase with the age of the father,” Dr. Swingle said. “Over the past 30-40 years, there have been a lot of changes in our culture and delayed childbirth is one of those.”

Studies show that the risk of having a child with autism increased by more than 5-fold when fathers were over 40.  

According to Dr. Swingle, applied behavioral analysis is the most effective treatment for autism spectrum disorders. He recommends the following local services – The Little Tree Preschool, Woody’s Song, and the Learning Tree, Inc.

For more on these services, visit http://www.learning-tree.org/index.html.

Dr. Swingle recently gave an overview of autism spectrum disorders at the April Med School Café lecture. To view the lecture in its entirety, click here.

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