What is Autism?

Possibly many parents hear the term autism for the first time in life only when they have taken their
child for a medical examination. Still we find parents unclear about this condition and explanation
about AUTISM. Hence we consider that it is our primary responsibility to define what autism is. The
word autism - even before it was incorporated to identify this neuro developmental disability meant,
escape from reality. Individuals with classical autism exhibit three types of symptoms:
Socially Inappropriate interaction/behavior,
Problems with verbal and nonverbal communication and imagination,
Unusual or bizarre activities and interests.
You may find these qualitative behavioural abnormalities spread over the individual's functioning in all
situations, although they may vary in degree both between and within individuals. Most of these
children would appear as if they live inside a bubble in their own world shunning contact with the
people around them.
Characteristics of children with Autism
These are listed here to enable all parents to be aware and pick up warning signs early and act.
Prefers to be alone; aloof manner
Little or no eye contact,
Insistence on sameness; resistance to change,
Difficulty in expressing needs, and no single finger pointing.
Repeating words or phrases in place of normal, responsive language,
Laughing, crying, showing distress and tantrums, for reasons not apparent to others,
May not want to cuddle or be cuddled,
Unresponsive to normal teaching methods,
Sustained odd play, spins objects, inappropriate attachments to objects,
Apparent over-sensitivity or under-sensitivity to pain,
No real fear of dangers,
Noticeable physical over-activity or extreme under-activity,
Uneven gross/fine motor skills,
Not responsive to verbal cues; acts as if deaf although hearing tests are in normal range,
A word of Caution to parents
We emphasise that these standardised behavioural data are aimed at creating awareness but
not phobia. Having any of these features in itself is not indicative of autism, but warrants further
follow up and formal evaluation by a multi-disciplinary team. For example, in the
social/educational system of United States of America, all infants who exhibit developmental
deviations are closely observed and monitored with appropriate intervention until they are able to
reach a Yes or No category on a definitive diagnosis. This ensures that no child is left out in the
system and enables early intervention (where necessary) which is very crucial for prognosis.

This also raises the need to create awareness among the medical community (particularly
paediatricians) who have the potential to identify autism early. There is a need to not only
educate them but also sensitise them so that they can alter their practice to be more informed
about screening every child for developmental deviations. Although this runs the risk of raising
false alarms, it is better than a child with a deviation going unnoticed.
How early can autism be diagnosed?
Though parents and sometimes grandparents are usually the first to notice unusual behaviors in
their child, it might be a while before the family seeks a diagnosis. Well-meaning friends and
relatives sometimes help parents ignore the problems with reassurances that every child is
different, or she can talk but she just doesn't want to!, boys tend to talk late or I spoke late.
Unfortunately, these pacifying words only delay seeking help, resulting in delays in assessment
and treatment for the child. Behaviour scientists are trying to bring down the age of first diagnosis
to 18 months or younger. Early diagnosis is critical as research and our hands on experience
proves that earlier the diagnosis, better the prognosis.


How to proceed with diagnosis.
After initial identification, assessment by professionals who specialize in autism is necessary.
Such specialists include people with the professional titles of child psychiatrist, child
psychologist, developmental pediatrician, or pediatric neurologist.

Autism specialists use a variety of methods to identify the disorder. Using a standardized rating
scale, the specialist closely observes and evaluates the child in a variety of settings to assess
communication, play and social behaviour. Please note that no matter when the child is
diagnosed, it's never too late to begin intervention.


Are there any specific investigations?
This again is an area of confusion among parents. We emphasise that an accurate diagnosis can
only be made by observing the childs behaviour, communication, social interaction and
developmental milestones along with a standard questionnaire answered by the parents. There
are no objective medical tests for diagnosing autism.[For example you can diagnose, qualify &
quantify jaundice by testing the blood level of bilirubin. Such bio markers are yet to be identified
in autism].

Sometimes various investigations (such as EEG, metabolic screening, CT/MRI scans, BERA,
etc) are asked for to rule out the possibility of other potential disorders. However, it is advised not
to place too much emphasis on these investigations and their outcome, as they are rarely
conclusive; more over a sizeable money and precious time is lost in that process.
After diagnosis ?
The above said guide lines would help parents to identify and diagnose the child with the least
possible time delay. When the examination is done under one roof in an Institute specializing in
autism, less time would be lost and parents would be at peace. When parents learn that their
child is autistic, they realize that they have a child who may not live up to their dreams and will
daily challenge their patience.
Most people wish they could magically make the problem vanish.
Some parents deny the problem or fantasize about an instant cure. They may take the
child from one specialist to another, hoping for a different diagnosis.
However, it is important for the parents to eventually overcome their pain and deal with the
problem cherishing hopes for their child's future. Of course, accepting the diagnosis and living up
requires a lot of courage and family support. Some parents are luckier than others in this. But
remember the saying that Luck favors the brave

The next obstacle in the path is choosing the ideal intervention from the various types of
interventions, since we are lacking in a universally accepted credible treatment methodology.
Lack of a proper insight into the autism puzzle also adds on to the confusion of the parents. At
this stage it is worthwhile to give you a glimpse into the history of autism. From the time it was
identified in 1940s to almost till 1970 autism was identified as a psychiatric condition and treated
as such. For more than three decades, parents were crushed under Shame and Blame theory
of refrigerator mothers. The year 1964 saw the dawn of Autism Society of America and Autism
Research Institute. Pioneering work of Dr.Rimland laid the path for medical research. This was
the turning point in history of autism whence it came out of the psychiatric domain and scientific
explorations on organic damage to the brain in autism were begun. Over the years, with the
advent of technology and imaging techniques we have gained knowledge on the brains
involvement in the behavioral symptoms and the etiopathology behind the process.

Now in 2011 with all the available research data we can reasonably assure that parents can look
forward to the future with a positive mind set. The underlying biological basis of autism is better
understood and the concept of brain in autism being hardwired and untreatable is slowly melting
away. Now parents need not get emotionally shattered when somebody- without proper
knowledge- projects a negative attitude of impossible in autism. Bio medical treatment
techniques are beginning to show transformative results. But the fruits of these primary
research/clinical outcomes could be enjoyed only by knowledgeable parents. Knowledge would
empower the parents to utilize the process and get these children out of their bubble to live in
harmony with the outside world. Hence we have presented to you the state of the art evidence
based information about the newer concepts in bio medical treatment techniques promising
better behavior and cognition.
Understanding the biological basis of behavior in Autism...
The very limited success of conventional management techniques to date, suggest a
wider search for innovative and alternative methods. This has necessitated a new
platform where we essentially understand autistic behavior by studying the underlying
intermediary biological processes than by symptom by symptom approach.
Here is an explanation to make it clear. If you get angry very often at the work place -the
problem which you never had till recently- your doctor may prescribe a tranquilizer pill to
calm you down, it is a symptomatic approach. If he traces it to your constipation lack of
sleep and relieves your constipation and thereby the anger it is biological approach.
For average people like us, behavior is a matter of choice, control, and will. Though we
may like to watch the football match, we may turn off TV to complete some pending
officer assignment. We can use our inhibitory abilities to control anger and keep quiet for
the sake of workplace harmony. We, the so called normal individuals obtain all these
abilities -by default- due to the near normal connectivity/integration of the functional areas
of our brain and the neurotransmitters which process the sensory inputs [hearing, vision,
touch, taste. smell etc] to a proper output of emotion and activity.
This proper processing and integration of sensory inputs by the brain is the fundamental
functional unit of learning and behavior. Health and behavior is a product of perfect
biological harmony between brain-the upstream commander and downstream organ
systems.
The individuals with Autism lack this remarkable ability of Processing and integrating
Sensory inputs resulting in the various behavioral issues and lack of communication.
The spontaneous question in your minds could be why does the brain of these children
lack this ability to process input information, while we develop it by default?
We have a logical answer for this query...
Understanding the biological basis of behavior in Autism...
Why does the brain of these children lack this ability to process
input information, while we develop it by default?

We have a logical answer for this query...
It is understood with recent breakthroughs in genomics that Autism is a multifactorial neurological
disease with a very strong genetic component. These children possibly have
susceptible/vulnerable genes which are not strong enough and they succumb to environmental
toxins, which you and I may withstand. The resulting malfunctioning of genes affects the
molecular order. Ensuing molecular disorder results in long standing inflammation in their organ
systems. Through molecular signaling [information transfer through cellular mechanisms] the
brain is possibly secondarily affected.

This understanding has not come overnight. It has taken decades of dedicated research and the
postulate is arrived at after analysis of the most constructive discoveries as detailed below.
Irregular bowel habits, constipation and vomiting and food intolerance were observed in
many individuals with autism. In 1980s to 90s with the advent of flexible endoscopes,
many such children with ASD were subjected to endoscopy and found to have various
degrees of inflammatory lesions in the stomach duodenum-and colon. This discovery
was an eye opener as it gave the evidence of an organic basis for autistic behavior.
These children were suffering from unexpressed visceral pain as they are non verbal.
This could be one of the reasons behind their night time sleep disturbance and day time
altered behavior. [ Can you relate it to the time when you had a stomach problem and the
disturbed sleep].
Later research identified that the constant visceral pain could trigger sympathetic over
activity causing hyperactivity and inattentiveness.[Can you relate it to the unprovoked
anger you exhibited when you had headache for two days with indigestion]
Later 1990s, advances in molecular biology, genomics and techniques like
immunecytochemistry identified increase in tissue damaging chemicals called cytokines.
This led researchers to think that the inflammation not only causes pain but releases
chemical mediators which can cross boundaries and spread to different organ systems.
Most of the research data indicated that the primary organ system affected could be the
digestive system [Gut].
Recently inflammation of blood vessels (vasculitis) hypo-perfusion/hypoxia(Low oxygen
saturation) and neuro-inflammation were identified in key areas of brain in autism. Long
standing inflammation in the tissues of the digestive system, mast cell activation and
break down of the bloodbrain defense barrier suggest that symptoms of autism could be
intensified by chronic inflammatory molecules generated in the Gastro Intestinal tract.
All these painstaking research leads are pointing out to a model in which the
inflammation - molecular disorder in the downstream systems influencing the
molecular order of the upstream brain affecting processing and connectivity and
conceivably converging on to the autism profile.
Understanding treatment possibilities in Autism..
As mentioned earlier, the new era of biological approach to autism offers a hope that if the
health or activity patterns of brain tissue in autism could be improved, one might see
improved receptivity to behavioral interventions, and perhaps some spontaneous
amelioration of behavioral symptoms. [Various interventions in vogue are Occupational
therapy, special education, speech therapy, behavior modification approaches and art
therapy].

We postulate that in autism the functional areas of the brain are dormant due to the
inflammation/molecular disorder and they could be activated to functional efficiency by
treating the inflammation and restoring molecular order.

It is believed that dietary or environmental triggers affect the gut microbial flora and produce
damaging inflammatory chemicals [cytokines] on a chronic basis. Ensuing downstream
inflammation could signal upstream molecular unrest in the functional areas of brain,
ultimately affecting synaptic connectivity in susceptible individuals

Any treatment technique which can ameliorate the inflammation in the organ systems could
benefit these individuals.

It is proposed that by effectively treating the downstream inflammatory pathology we could
initiate reestablishment of upstream molecular order. Molecular order restored could activate
the dormant neuronal pools, improve connectivity, processing and restore functional
integration.

Gluten free casein free diet [GFCF], anti fungal drugs to treat colon are therapeutic measures
borne out of such postulates which link up gastro intestinal inflammation and behavior in
autism.
Our experience on this therapeutic hypothesis...
As mentioned in the opening statement of this booklet, whatever we have written here is based
on our hands on experience in treating children with autism since 2004 at our DOAST centre. We
present a glimpse of our transformative integrated therapy clinical program for autism, for the
sake of completion and to give you confidence.
The components of the Integrated therapy are medicines and dietary regulation and
techniques derived from the traditional Indian medical systems of Yoga, Ayurveda and
Siddha.
The therapeutic concept of these traditional systems is toxin elimination rejuvenation
and regeneration. This therapeutic concept is in complete synergy with the present day
technological understanding of chronic disease as cellular stress, molecular disorder,
cytokines and signal triggers between body and brain.
Clinical alleviation of painful GI symptoms and consistently associated improvement in
behaviour are observed outcomes in this intervention program. The clinical results are
consistently replicated proving the efficacy.
In this treatment guided research program, the observed improvements in behavior,
communication and cognition domains are non-invasive indicators of restoration of
molecular order and integration of the upstream neuronal pools.
The way forward in bringing ring tones on the silent screen...
Global society is burdened with children with autism getting added every day. We need to
help them right now and at the same time learn more about providing the most effective
help.

Day by day the scientific discoveries make us more aware of the complexity of autism. A
constructive approach is to see the enormous complexity as a gift, and move forward. The
inherent complexity directs us to move with humility about the limits to precise scientific
knowledge. We quote from Dr.Martha R.Herbert who works extensively on the biological
basis of autism and advocates that the brain in autism is not Hard wired Effective
response to crisis is a challenge we face in autism and in our planetary existence as well.
Our health and planetary problems will not wait for the perfection of our knowledge basewe
need to act now (Herbert 2006).

The above statement guides the direction in which treatment and research should
coordinate, educate and narrow disconnect between treatment and science. Dr.Martha
further states, that in research, Good becomes lost in the constant pursuit of the Perfect.
Instead, humility can allow us to seek the Good enough, which is much more practical than
grasping for unachievable perfection. You would have appreciated that in this booklet we
have identified the good enough information to utilize and move forward.

We have to learn from our present treatments, so that we can have better treatments in the
future. Understood in its real totality, this should mean a marriage of research with treatment,
with research improving beneficial treatments and treatment responses informing the
direction of research-Treatment guided research.

Treatment guided research based on genetic vulnerability to environmental triggers, within
the high performance environment of the human nervous system is a challenging paradigm
shift in the way we understand and manage autism.
It is promising to ensure smiles on the face of parents as rewards.

Dos and Donts for parents with children diagnosed with ASD
Dos
Do seek an early diagnostic confirmation,
Do accept the diagnosis and issues surrounding it at the earliest,
Do search for professional service providers in your vicinity, seek the help of an NGO
wherever possible.
Do share responsibility and devote time for management of your child between you
and your spouse. Maintain a healthy relationship between you and your spouse. Your
physical and psychological well being is very important for the health of your child.
Do explore newer treatment techniques after careful assessment and evaluation.
Provide a reasonable time for the child to adapt to a new training method before
calling it a success or failure.
Do join parent groups if available. They are the ultimate source of help and support.
Do believe in your strength and the ability to train your child positively.
Do maintain a diary about your childs day-to-day activities, progress or deterioration.
If possible video graph childs activities.
Do delay the next child.
Do plan economy judiciously, the training or treatment is long drawn.
Donts
Dont indulge in self-blame or blaming your spouse for the situation.
Dont bother too much about what others might think.
Dont blame others if you do not get assistance, learn to help yourself it is good in the
long run.
Dont get carried away by biased opinions on the web and new research drugs and
therapies, take the opinion of an expert when in doubt.
Dont jump into newer treatment avenues, drugs or magic remedies just because
they are very well campaigned for.
Dont run away from a new problem, face it courageously and overcome.
Dont consider your child as a liability. If you identify and cultivate his special interest,
he can be an asset.