Early diagnosis key to treating autism

The challenge of treating autism lies in identifying the disorder at an early age.

"The sooner the diagnosis, the better outcome you are going to have," said Lewes pediatrician Dr. Jay Ludwicki.

He said parents should rely on children's well checks to diagnose symptoms, which generally present themselves by 15 and 18 months and as early as 12 months. Those symptoms can range depending on the degree of the neurological disorder, which affects the functioning of the brain.

Ludwicki, who's formerly of Pittsburgh and moved to the area in 1997, said autism is characterized by three main factors: the lack of social interaction skills, the lack of communication skills and the presence of repetitive activities, such as walking circles around a room and banging utensils.

He said there are several chromosomal defects that come together to show characteristics of autism. There are different types of impairment from mild, commonly diagnosed as Asperger's Syndrome, to severe.

"It is very diverse. That is probably the biggest problem," Ludwicki said.

He said he uses the Denver Developmental Screening for children at well checks, or routine visits when children are healthy.

One indicator would be "Is the child pointing, indicating things they want," he said. If several indicators show abnormal development, then he said, physicians can use more intense screenings designed to identify disorders.

"Not every kid is going to articulate real well at 15 to 18 months, but they will pick up nonverbal communication with parents and others around him," Ludwicki said, therefore absence of pointing may be a sign.

Other indicators may be not making eye contact, not showing reciprocal emotion and not being able to follow simple tasks like 'Throw this in the trash.'

"They don't play with toys. They line up toys. Later, they count toys. They don't make transitions easily from one activity to another," Ludwicki said, further explaining characteristics of the disorder.

He said his first step after determining a child is autistic is to refer the family to a pediatric neurologist and a pediatric psychologist. Some children with autism have co-morbidities, Ludwicki said, or other health problems such as anxiety disorder, depression, ADHD or obsessive compulsive disorder. Those problems can be treated with medication. For autism, there is no cure.

"My job is to get them to the neurologist and make sure they don't have other co-morbidities they could be treating," Ludwicki said.

He said more evidence points to genetic factors as causing autism and related disorders, classified as an autism spectrum, than environmental factors. He said vaccines are often blamed for causing autism, but studies have disproved that theory. (For information on that, visit the American Academy of Pediatrics Web site at www.aap.org.)

"It presents at that age" when vaccines are given, Ludwicki said, "so people always look back at a vaccine and say, 'It must have been the vaccine that caused it.'"

"It has a lot to do with brain disorganization," Ludwicki said.

He compared the development of an autistic child's brain to a tree that wasn't pruned. Research shows that autistic children lack the protein glutamate that prunes the brain, or organizes white matter.
Early diagnosis key to treating autism - Delaware Coast Press - delmarvanow.com

The Age of Autism: Donald T. and Fritz V.

By DAN OLMSTED
BALTIMORE, April 29 (UPI) --

They were born within four months of each other, Fritz V. in June of 1933 and Donald T. that September. Fritz was born in Austria, Donald in Mississippi, but they had a surprising amount in common.

Unfortunately.

When Donald was taken by his beleaguered parents to Johns Hopkins University in 1938, he acted like no 5-year-old that famed child psychiatrist Leo Kanner had ever seen.

"He learned my name," Kanner recounted decades later, "but he would never see me if he met me because he would never look up enough and had enough eye contact to recognize faces. ... Also, while he spoke, it was not for communication, and if in order to satisfy his needs some communication was needed, he would not be able to distinguish between 'I' and 'you,' rather echoing religiously some of the things that he was interested in.

"For instance, if he wanted his milk, he remembered constantly that his mother always asked him, 'Donnie, do you want your milk?' And his way of asking for milk was 'Donnie, do you want your milk?' Well, this was only a part of some of his peculiar behavior."

Yet, strangely, by age 2 1/2 he could name the presidents and vice presidents of the United States backwards and forwards and recite the 25 questions of the Presbyterian catechism.

Fritz made an equally vivid impression on Hans Asperger, the pediatrician who first saw him in 1939 at age 6 in Vienna. Asperger described him as "a highly unusual boy who shows a very severe impairment in social integration. ... His gaze was strikingly odd. It was generally directed into the void."

In school, "He quickly became aggressive and lashed out with anything he could get hold of (once with a hammer). ... Because of his totally uninhibited behavior, his schooling failed on the first day. ... Another strange phenomenon in this boy was the occurrence of certain stereotypic movements and habits."

As with Donald, "The content of his speech was completely different from what one would expect of a normal child," Asperger said of Fritz. "Only rarely was what he said in answer to a question."

Weird, but he started speaking at 10 months and soon "talked like an adult."

Donald T. and Fritz V. -- their last names were never given -- have endured in medical literature because they are firsts. Donald was the first to confront Kanner with the behaviors that he later named "autism." Fritz was the first case study of what came to be known as Asperger's Disorder. Both conditions are now classed in the official U.S. guide to mental problems as Pervasive Developmental Disorders, and are also called Autism Spectrum Disorders.

Autism derives from the Greek word for self, "autos," as in autobiography.

Most experts think the disorders are related, with autism the severe manifestation; Asperger's is sometimes referred to as "autism lite" or "a dash of autism" and is differentiated by a lack of delay in language development.

Kanner's study of Donald and 10 other children was titled "Autistic Disturbances of Affective Contact," and was published in the journal "Nervous Child" in 1943. Asperger called his study of Fritz and three other children "'Autistic Psychopathy' in Childhood;" it was published in the "Archiv fur Psychiatrie und Nervenkrankheiten" in 1944.

Kanner described autism's defining features as "extreme aloneness and a desire for the preservation of sameness."

"The children seemed to live in a static world in which they could not seem to tolerate any kind of change introduced by anybody but themselves," Kanner said in a 1972 speech, "and even that didn't occur very often."

"The autist is only himself," Asperger wrote, "and is not an active member of a greater organism which he is influenced by and which he influences constantly."

Kanner and Asperger did not collaborate on their studies. Nor did either predict the deluge that would follow: In the United States, a reasonable estimate is 30 or 40 children out of every 10,000 are diagnosed with autism, and another 30 or 40 are diagnosed with other Pervasive Developmental Disorders, including Asperger's.

This leads to a simple but significant question: Was it coincidence the first few cases of these strikingly similar disorders were identified at the same time, by the same term, in children born the same decade, by doctors thousands of miles apart?

Or, is it a clue to when and where autism started -- and why?

The question reflects a huge, and hugely important, debate. If autistic children always existed in the same percentages but just were not formally classified until the 1940s, that would suggest better diagnosis, not a troubling increase in the number of autistic children.

If, however, autism had a clear beginning in the fairly recent past (a past so recent that Fritz and Donald could both be alive today at age 71), then the issue is very different. That would suggest something new caused those first autism and Asperger's cases in the early 1930s; something caused them to increase, and something is still causing them today.

This ongoing series will look for answers by tracking the natural history of autism around the world -- a road less traveled than one might think. For example, Asperger's study was not translated into English until 1994 -- a half-century later -- and still is not easily available. Actually reading Asperger's account of Fritz V. makes you realize the severity of his disorder and its similarity to classical autism.

"The reader of Asperger's first paper cannot fail to be impressed by the close similarities to Kanner's case descriptions and the relatively few differences," wrote British psychiatrist Lorna Wing in the 1994 anthology "Autism and Asperger Syndrome," which includes the first English translation. Translator Uta Frith noted, "By a remarkable coincidence, Asperger and Kanner independently described exactly the same type of disturbed child to whom nobody had paid much attention before and both used the label autistic."

Both said autistic children were impossible to miss.

"Once one has properly diagnosed an autistic individual one can spot such children instantly," Asperger said.

"It is a unique syndrome," Kanner said, "and almost photographically not identical, but similar."

Kanner was clear he never saw an autistic child until he met Donald T. in 1938 -- 17 years after he got his medical degree in Berlin, on his way to becoming one of the world's leading psychiatrists, to whom the toughest cases were often referred "all the way to the great Hopkins," as he jokingly put it.

In fact, his landmark 1943 paper begins, "Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits -- and, I hope, will eventually receive -- a detailed consideration of its fascinating peculiarities."

Markedly, uniquely different: The great psychiatrist at the great Hopkins was convinced he was seeing something new.

Next, a look at the oldest of Kanner's patients, the one whose birth might mark the start of the age of autism. Her name was Virginia S.

This article is one of seven in a series UPI published earlier this year.

The Age of Autism aims to be interactive with readers and will take heed of comment, criticism and suggestions. E-mail: dolmsted@upi.com
The Age of Autism: Donald T. and Fritz V.

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Unlocking the door to autism - One family chronicles its struggles and triumphant journey

By Linda Maraldo

Correspondent - Chicago Suburban News

The crowd at a local 2003 Little League All-Star baseball game was particularity excited about one player, a rookie who was leading the league in hits that year.
"What a sweet swing!"
"Who is that kid?"
"A rookie? I can't believe it! You're kidding!"
Those were the comments Rhonda Brunett heard about her son, Jordan, while walking through the crowd that summer day.
"It was like a miracle. They were talking about my child," she said.
Rhonda and Rick Brunett of Carol Stream never put limits on their son, Jordan, a sixth-grader at Jay Stream Elementary School in Carol Stream, but there was a time when he couldn't follow directions let alone play All-Star caliber baseball.
Jordan is autistic, a complex developmental disorder that affects social and communication skills. He was diagnosed at age 3.
To educate others about autism and the reality of raising an autistic child, Rhonda published "From Autism to All-Star" in the fall of 2004 by Specialty Publishing Co. in Carol Stream. The book includes observations and personal journal entries from Rhonda as well as excerpts from friends, family members, teachers and parents.
Rhonda actually began writing a journal while pregnant with Jordan, intending it to be a gift for him once he was older.
"I never intended to make my journal a book until I saw familiar tendencies in my friend's son and said, 'I can't let this happen, I have too much information, I have to get the word out,' " recalled Rhonda, stressing early intervention with autistic children is crucial.
Rhonda knew her journal had documented the warning signs and the efforts that helped Jordan assimilate into grade school, become socially interactive and a star baseball player.
"'From Autism to All-Star' is to be shared with parents and teachers to educate them, with (the) hope that my experience will give others hope and strength," Rhonda said.
Warning signs
For a new parent or someone who has not been around many children, not recognizing red flags is not understanding what you are seeing, Rhonda explained.
"Autistic children often develop normally through the first few years. Then they begin to display certain behaviors. It was confusing," said Rhonda.
For example, she would ask herself why Jordan could memorize all the presidents, but could not verbalize: "Mommy, I want a cookie."
Jordan played with toys differently. Instead of racing his toy cars on the ground, he would pass them before his eyes as if he were taking their picture. He also could be found running around the block 10 times or staring at a car tire for 40 minutes.
He paced endlessly, fixated on objects and showed repetitive movements. Jordan was "tirelessly repetitive," according to Carla Crosby, a friend of the Brunett's. Jordan couldn't communicate, which led to frustration which then led to tantrums.
"I don't know what is wrong and I don't know how to handle it," Rhonda wrote in her journal. She often felt very alone. "It's hard for the average person to understand what it's like to raise an autistic child," she wrote.
By 3 years old, Jordan was having problems if he was pulled from a routine. "A broken routine for Jordan made everyone who was involved in Jordan's day difficult, including Jordan," wrote his godfather Mike Muro in "From Autism to All-Star."
The Brunetts heard comments about his behavior from family members, but it was Crosby who suggested Rhonda take Jordan to a neurologist. Rhonda brought a video that showed Jordan's idiosyncrasies to the neurologist and Jordan was diagnosed with autism.
Taking action
Rhonda knew almost nothing about autism, only what she had seen in the 1988 movie, "Rain Man," and what she read in two nonfiction books on the subject.
Rhonda instinctively did some things right, such as the constant use of flash cards. But she also took the advise of others. "I did whatever anyone suggested: the doctors, the teachers, friends," she said.
Neurologist Charles Swisser of Children's Memorial Hospital in Chicago told the Brunetts by third grade Jordan would lose most of the outward signs of autism. "Keep the Kool-Aid jug full," Swisser told them, referring to the many children who wanted to hang out with Jordan.
Even if Jordan wanted to play alone, he needed to be with children. Autistic children will mimic other children, so they will learn by having playmates around them.
Rhonda took Swisser's advice and surrounded Jordan with playmates.
"We were blessed with a wonderful neighborhood family of children who loved Jordan and treated him like another brother," said Rhonda.
Autistic children need consistency, much attention and socialization. Jordan had to be taught social skills, how to share toys and play with other children. Rhonda explained they had to take the toy away from Jordan and deal with the tears or tantrums and try again until he learned he had to share. Absolutely everything is a process, she added.
Autistic children also need encouragement and positive feedback. They are sensitive to loud sounds, so yelling at them does not help, said Rhonda.
One of Rhonda's goals for her son was to teach him compassion, which she showed him first-hand. The way to teach respect is to give it, she said.
Breaking ground
Rhonda was not afraid to write she was tired or frustrated in her personal memoir. One particular breakdown she had convinced her that Jordan's school needed to provide him with a full-time aid.
On Jordan's first day of school in the Individual Evaluation Program in Community Consolidated School District 93, Rhonda could not get her son dressed. He would not cooperate and Rhonda found herself outside crying. A neighbor ended up getting Jordan ready for school.
"I thought I was a terrible mother. I couldn't control my kid," Rhonda said.
"It was maybe this state of mind dealing with Jordan and his difficulties that made me demand a full-time aid for my son," Rhonda wrote in her book.
One in 50 families daily will have a child diagnosed with autism, and Joan Huchthausen, assistant superintendent of District 89, confirmed teachers are seeing an increase in children with autistic tendencies and Asperger's disease, a mild form of autism. Huchthausen stressed parents are the first and life-long teachers, and schools cannot do everything.
Rhonda said it is important the teachers know the autistic child's positive characteristics and set the tone to prevent classroom bullying. Autistic children process information slower than other children, which is why it is important for them to have an aid to keep them on track, she pointed out.
Rhonda developed a method she calls the triangle of constant communication with the classroom teacher, speech teacher and herself, so there is triple reinforcement to Jordan's learning.
To educate more teachers about autism, Rhonda, her friend Wendy Williams, who has a child with Asperger's, and teachers from District 93, created a PowerPoint presentation, to help teachers recognize the red flags and develop appropriate teaching strategies and suggestions for the classroom.
While transferring her journal to manuscript, memories of Rhonda's own unpleasant school experiences started to surface, which motivated her to make a difference.
"I had a hard time understanding concepts. I couldn't focus. I would space out. I barely made it through school. I just struggled through school," she said.
Rhonda suspects she had attention deficit disorder long before it was recognized. "I was pushed through the system. I didn't learn a lot. I said, 'I'm not going to let that happen to my kid.' I wanted Jordan to enjoy school," Rhonda said.
Where are they now?
Rhonda said teaching or helping other children is something she is thinking about for the future. She has already given presentations at Roosevelt University in Chicago, to special education teaching students, and in the future she will target regular classroom teachers.
Jordan continues to learn. Rhonda and his speech teacher are working to expand his conversational level by having Jordan discuss newspaper articles.
Learning is still hard work. Now after an intense day at school where he needs all of his energy to focus on learning, Jordan will play ball to relax.
"We tried to let Jordan be Jordan, never wanted to change him but bring him to a position where he could interact socially," his dad, Rick, added.
For information about "From Autism to All-Star," autism information or support groups, visit www.autism2allstar.com.