PUBLIC HEALTH AND ENVIRONMENT

AUTISM
INTRODUCTION:
Autism is a developmental disorder characterized by difficulties with social interaction and
communication, and by restricted and repetitive behavior. It is defined by the presence of
abnormal and/or impaired development that manifests before the age of three years.
Parents usually notice signs during the first three years of their child's life. These signs often
develop gradually, though some children with autism reach their developmental milestones at a
normal pace before worsening.
In 2018 the CDC determined that approximately 1 in 59 children is diagnosed with an autism
spectrum disorder (ASD). Boys are four times more likely to be diagnosed with autism than
girls. Most children were still being diagnosed after age 4, though autism can be reliably
diagnosed as early as age 2.

TYPES OF AUTISM:
 Asperger’s syndrome
 ADHD (Attention deficit hyperactive disorder)
 Pervasive developmental disorder not otherwise specified
 Autistic disorder
 Rett syndrome
 Childhood disintegrative syndrome
 Fragile X syndrome
 Down syndrome
 Tuber sclerosis
 Neurofibromatosis

CHARACTERIZATION:
Autism or autism spectrum disorder is a group of disorders with common disabilities in three
key areas:
I. Social awareness and interaction:
Unusual social development becomes apparent early in childhood. Autistic infants show less
attention to social stimuli, smile and look at others less often, and respond less to their own
name. Autistic toddlers; for example, they have less eye contact and turn-taking, and do not
have the ability to use simple movements to express themselves, such as pointing at things.
However, they do form attachments to their primary caregivers.
Children with high-functioning autism suffer from more intense and frequent loneliness
compared to non-autistic peers, despite the common belief that children with autism prefer to
be alone. Making and maintaining friendships often proves to be difficult for those with autism.
There are few systematic studies, of aggression and violence in individuals with ASD. The
limited data suggest that, in children with intellectual disability, autism is associated with
aggression, destruction of property, and meltdowns.
II. Language and other communication skills:
Autistic children do not develop enough natural speech to meet their daily needs. They are
prone to babbling and are prone to repetitive gestures or various word combinations as a result
of their speech impairment. However Joint attention and teaching allows them to communicate
through various hand gestures like pointing at object so they can convey their messages as
much as possible.
III. Imaginative play (Variable interests and behaviors):
People with autism are reported to have problems with imaginative play. They may experience
lack of creativity and fantasy in thought process. They usually rely on imitation i.e. understand
and imagine situations they are exposed to as compared to creating their own imaginative state
of mind on their own.
Some autistic children may exhibit echolalia. An estimated 0.5% to 10% of individuals with ASD
show unusual abilities, ranging from splinter skills such as the memorization of trivia to the
extraordinarily rare talents of prodigious autistic savants. Many individuals with ASD show
superior skills in perception and attention, relative to the general population in order to
improve their social and communication skills they are taught through various creative methods
such as getting them to identify things through color coding, outdoor activities etc.
This is why most autistic children excel at artistic activities like painting, music, drawing skills,
computer skills etc.
IV. Repetitive behavior:
 Stereotyped behaviors: Repetitive movements, such as hand flapping, head rolling, or
body rocking.
 Compulsive behaviors: Time-consuming behaviors intended to reduce anxiety that an
individual feels compelled to perform repeatedly or according to rigid rules, such as
placing objects in a specific order, checking things, or hand washing.
 Resistance to change: for example, insisting that the furniture not be moved or refusing
to be interrupted.
  Ritualistic behavior: Unvarying pattern of daily activities, such as an unchanging menu or
a dressing ritual. This is closely associated with sameness and an independent validation
has suggested combining the two factors.
 Restricted interests: Interests or fixations that are abnormal in theme or intensity of
focus, such as preoccupation with a single television program, toy, or game.
 Self-injury: Behaviors such as eye-poking, skin-picking, hand-biting and head-banging.
No single repetitive or self-injurious behavior seems to be specific to autism, but autism
appears to have an elevated pattern of occurrence and severity of these behaviors.

CAUSES OF AUTISM:
I. Genetic factors:
In some of the cases autism is said to be hereditary. However, in recent years the reason
behind autism seems to be more complex. Complexity arises due to interactions among
multiple genes, the environment, and epigenetic factors which do not change DNA sequencing
but are heritable and influence gene expression. Many genes have been associated with autism
through sequencing the genomes of affected individuals and their parents.
II. Prenatal environment:
Maternal bleeding after the 1st trimester and meconium in amniotic fluid can lead to autism in child.
Maternal nutrition and inflammation during preconception and pregnancy influences fetal
neurodevelopment. Intrauterine growth restriction is associated with ASD, in both term and preterm
infants. Maternal inflammatory and autoimmune diseases may damage fetal tissues, aggravating a
genetic problem or damaging the nervous system.

Exposure to heavy pollution is also said to be a cause as heavy metals in the atmosphere, upon entering
the body can harm the fetus’s central nervous system. Further, experts have already known that
mercury, lead, arsenic, polychlorinated biphenyls (PCBs), and toluene are toxic to humans and cause
neurodevelopmental disorders. Thus, it would not be surprising if we found that a chemical or
combination of chemicals did cause or dramatically increase the risk of ASD

III. Biochemical factors:

Mitochondrial dysfunction, characterized by elevated plasma lactate is common in autistic
people. Mitochondrial diseases are long-term, genetic, often inherited disorders that occur
when mitochondria fail to produce enough energy for the body to function properly. Around
7.2% autistic people have mitochondrial dysfunction which can be due to the mother suffering
from adverse drug affects during pregnancy, infections or other environmental causes.

I. Psychosocial factors:
 Parental rejection
 Family stress
 Traumatic experiences in childhood
 Faulty communication patterns
  Schizophrenic parents/ Parents suffering from various mental disorders
 Inadequate social parenting leading to “Mind Blank”
COMORBID CONDITIONS:

 Epilepsy
 Anxiety disorders
 Minor physical anomalies
 Intellectual disability
 Metabolic defects such as phenylketonuria
EPIDEMOLOGY OF AUTISM:
ASD averages from a ratio of 4.3:1 male to female ratio. The number of children to have autism
have increased dramatically since the 1980s.
The Centers for Disease Control’s Autism and Developmental Disabilities Monitoring (ADDM)
Network reports that in 2014, approximately 1 in 59 children in the United States (1 in 37 boys,
and 1 in 151 girls), has been identified with an autism spectrum disorder (ASD).
Attention has been focused on whether the prevalence of autism is increasing with time. The statistics
have risen steadily from 1996 to 2007. Reports of autism cases per 1,000 children grew dramatically in
the U.S. from 1996 to 2007. It is unknown how much, if any, growth came from changes in autism's
prevalence.

The number of reported cases of autism increased dramatically in the 1990s and early 2000s, prompting
investigations into several potential reasons. The true frequency of autism has increased and is doing so
rapidly.

MANAGEMENT:
The main goals when treating autistic children are to lessen their deficits. Expose them to a loving and
understanding environment in order to make it easier for them to pick up things socially as a result of
cognitive thinking and impersonation of habits. Families and educational systems are the main resources
for treatment as they allow gradual development in social skills among many others. Applied behavior
therapy, speech and language therapy, social skills therapy and occupational therapy helps as well.

REFERENCES:
https://www.psychologytoday.com/intl/blog/caring-autism/201809/what-causes-autism-
spectrum-d
o https://www.longdom.org/open-access/environmental-influences-on-biochemistry-in-
autism-spectrum-disorder-2165-7890.1000e123.pdfisorder
o https://www.appliedbehavioranalysisprograms.com/faq/what-are-the-biological-causes-of-
autism/