Autism Spectrum Disorder

What is Autism Spectrum Disorder (ASD)?

The term autism spectrum disorders (ASDs) has been used to include the diagnostic categories autistic disorder, Asperger disorder, and pervasive developmental disorder–not otherwise specified. Recent estimates of the prevalence of ASDs are in the range of 6.5 to 6.6 per 1000, and paediatricians, therefore, are likely to care for children and adolescents with these diagnoses. (AAP, 2018).

What are the signs and symptoms of ASD                      

Some babies with ASD may seem different very early in their development. Others may seem to develop typically until the second or even third year of life, but then parents start to see problems.

ASDs, similar to other neurodevelopmental disabilities, are generally not “curable,” and chronic management is required. Although outcomes are variable and specific behavioural characteristics change over time, most children with ASDs remain within the spectrum as adults and, regardless of their intellectual functioning, continue to experience problems with independent living, employment, social relationships, and mental health.

Diagnosis of ASD

Doctors diagnose ASD by looking at a child’s behaviour and development. Young children with ASD can usually be reliably diagnosed by age 2.

Older children and adolescents should be screened for ASD when a parent or teacher raises concerns based on observations of the child’s social, communicative, and play behaviours. Diagnosing ASD in adults is not easy. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as schizophrenia or attention deficit hyperactivity disorder (ADHD). However, getting a correct diagnosis of ASD as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help.

The evaluation may assess:

  • Cognitive level or thinking skills
  • Language abilities
  • Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:

  • Blood tests
  • A hearing tests

The outcome of the evaluation will result in recommendations to help plan for treatment.

Management of Autism Spectrum Disorders

The primary goals of treatment are to minimize the core features and associated deficits, maximize functional independence and quality of life, and alleviate family distress. Facilitating development and learning, promoting socialization, reducing maladaptive behaviours, and educating and supporting families can help accomplish these goals. Ideally, interventions should help mitigate the core features of ASDs, which include impairment in social reciprocity, deficits in communication, and restricted, repetitive behavioural repertoire.

Physiological Changes

Children with ASDs often exhibit behaviours that result in feeding problems and, in turn, may impact nutrient intake. They tend to desire sameness in daily routines including eating the same foods that result in a diet that lacks variety. Additionally, disturbances in routine may lead to disruptive mealtimes, and, thus poor intake.

Other possible factors that may affect nutritional status include gastrointestinal (GI) complications as well as differences in metabolism and utilization of nutrients. GI complaints are common among children with ASDs. Diarrhoea, foul smelling stools, flatulence, abdominal pain and constipation are among the most commonly reported GI problems. Adams et al. found that children with more severe cases of ASD reported more GI symptoms.

Nutritional Interventions:

Antioxidant Supplementation

Researchers have begun to explore metabolic abnormalities that may be present in children with ASDs. Specifically, imbalances of some metabolic biomarkers related to oxidative stress and DNA methylation have been noted. James et al. reported decreases in methylation and antioxidant capacity with subsequent increases in oxidative stress in children with AD.

Similarly, Other studies found decreased antioxidant and methylation capacity in children with AD when compared to groups of unaffected siblings and controls. Increased oxidative stress in children with AD can lead to cellular damage and altered epigenetic expression. Thus, exploring these imbalances and investigating nutritional interventions that may normalize these metabolic pathways may be a critical component in treating AD. However, several factors may influence the nutritional

Severe autism has been linked to low levels of certain nutrients (vitamins B3, B6, C, calcium, iron and zinc). Good nutrition is important as poor diet can affect mood, learning and sleep. People with autism may have difficulty with sleeping. Healthy foods give the brain and body the nutrients that they need in the right amounts

Gluten and Casein Hypersensitivity

Gluten is a protein found in wheat, rye and barley and foods made from them, for example bread, pasta, biscuits and breakfast cereals. Casein is a protein found in cow, goat and sheep milks and foods made from them, for example cream, yoghurt and cheese. Hypersensitivity to these proteins may worsen mood, behaviour and communication in some individuals with autism.

Precursor for Dopamine & Serotonin

Children with autism spectrum disorder (ASD) have urinary metabolites suggesting impairments in several pathways, including oxidative stress, inflammation, mitochondrial dysfunction, and gut microbiome alterations.

Many studies have shown a positive correlation with low levels of few amino acids like tryptophan and tyrosine and ASD severity. Few amino acids are responsible for the production of serotonin and dopamine which help to keep ASD conditions slightly more controllable.

Sulforaphane, a supplement with indirect antioxidant effects that are derived from broccoli sprouts and seeds, was recently shown to lead to improvements in behaviour and social responsiveness in children with ASD.

Sugar

Although sugar has not been implicated for behavioural effects in children, the benefits of decreasing sugar consumption (such as dental health and nutridense foods) must be emphasized.