Health

Guess Which Quality Kids with Autism Share?

An intriguing theory may guide diagnosis and therapy — and help struggling families

Monika Ingram of Fredericksburg, Virginia, knew something wasn’t quite right when her eight-year-old son began exhibiting oppositional defiant behavior at school.

“I understood him and his moods, but he was confused at school and it was very overwhelming,” Ingram told LifeZette. “He would leave the classroom and just wander the halls, and that didn’t seem right for a bright child who loved to learn.”

At this same time, Ingram noticed similar behavior from her second, third, and fourth child. She took parenting and anger management courses to make sure she wasn’t the source of the problems. After doing some reading on autism spectrum disorders, she decided to take her children for psychological evaluations.

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Sure enough — all of them tested positive for Asperger’s syndrome.

Ingram said this diagnosis forced her to change completely her expectations for what her family would look like. Five of her six children have now been diagnosed with Asperger’s. Although she has adjusted to their needs, initially it was a struggle to understand all the sensory issues that accompanied this disorder.

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Going grocery shopping was especially difficult. When her husband was deployed to Afghanistan, Ingram took all of her children to the grocery store with her. Inevitably, one of them would disappear every time.

“They were overwhelmed by the store — it was large and bright and confusing, and they would go hide someplace small and dark,” she said. She had to buy the most broken-in jeans from the thrift stores so the fabric would be as soft as possible, and she learned very quickly to remove any tags.

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Sensory overload is just one of several common symptoms that accompany autism spectrum disorders. Other symptoms include ongoing social problems — such as difficulty communicating and interacting with others — a tendency toward repetitive behaviors, and difficulty with motor skills.

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Many of these symptoms seem, at a glance, to be disparate, unconnected manifestations of a disorder that researchers are still trying to understand. It is now 30 years since scientists really began to distinguish autism as its own disorder, distinct from schizophrenia.

However, despite 30 years of research, scientists have yet to discover the underlying cause for autism. It could occur as a result of certain genetic variations, but it could also occur as a result of environmental factors. The chances of a child developing autism increase, for example, with premature birth.

[lz_bulleted_list title=”A Child’s Early Signs of Autism Spectrum Disorder” source=”http://www.nationalautismassociation.org”]Low to no social skills|Avoidance of, or resistance to, physical contact|Repetition of words or phrases|No response to own name|Avoidance of eye contact|Wants to be alone|Gets upset by minor changes|Has obsessive interests[/lz_bulleted_list]

The array of symptoms and causes can be baffling to scientists. But recently a group of researchers at Massachusetts Institute of Technology and at Massachusetts General Hospital Institute of Health Professionals (MGHIHP) came together to review more than 100 studies of autism performed within the last three decades. They reached a surprising hypothesis: All of the different manifestations of autism could be considered an impairment of predictive abilities.

Dr. Pawan Sinha, professor of neuroscience at MIT and a lead author on the paper, told LifeZette, “Even though superficially these symptoms look very different — one would not think that crossing the road would have much to do with interacting socially — there are foundational principles that underlie these domains.”

He continued: “In interacting with children with autism and hearing from parents about what kinds of conditions are challenging and what makes life easier, a theme that comes up over and over again is the need for structure, which is just another way of saying that they are making things as predictable as possible.”

Impairment of prediction may not seem very serious at first, but it can yield an extremely confusing perspective. The authors state, “With compromised prediction skills, an individual with autism inhabits a seemingly ‘magical’ world wherein events occur unexpectedly and without cause. Immersion in such a capricious environment can prove overwhelming and compromise one’s ability to effectively interact with it.”

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This may be why one of the most common indications of an autism spectrum disorder is the insistence on sameness and routine. Annie Cardinaux, project coordinator at the neuroscience lab at MIT, told LifeZette, “A lot of parents and teachers report that children want to do things the same way each time. They go through the lunch line and if the forks are in a different place, they have a complete meltdown. Many children who struggle with autism benefit from having predictable routines that meet their threshold for change.”

Monika Ingram found this to be true in her own experience. “My children didn’t understand that when I cut my hair I was still the same person until they heard me speak,” she said.

When Ingram picks up her father — whom she suspects also struggles with Asperger’s — from the airport, he says, “You’ve got to stop changing your hair.”

Dr. Margaret Kjelgaard, professor of communication sciences and disorders at MGHIHP, was a lead author on the study and incidentally is a mother to an autistic child. She says that the teachers at her son’s school try to manage the need for routine by creating visual schedules for the kids so that they can predict each part of their day. They also manage the sensory overload by giving each of the children noise-cancelling headgear.

Although this unifying theory of autism is just that — a theory — it is the first lens through which each of the disparate symptoms can seem truly united.

“We don’t want to overstate the importance of the piece because it’s a theory and has the possibility of being wrong,” Dr. Sinha explained. “That being said, we are excited about the possibility of how the theory can guide new kinds of diagnostic tools.”

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For instance, instead of clinicians testing the manifestations of autism, they could test their patients’ ability to predict events. Assessing prediction itself would be simpler than trying to measure the broad spectrum of social skills and relying on parents to report their children’s skills accurately.

“Instead of targeting the various manifestations, we would target the core,” said Dr. Sinha. He predicts that this kind of intervention would have broader applications — it would help address both social skills and motor abilities at the same time.

Intervention for children on the autism spectrum is already promising. Ingram, whose three oldest children have now reached adulthood, has worked tirelessly with intervention programs to help her children succeed.

“We knew that childhood would not be where they had their shining moments in life, so we worked hard to prepare them for adulthood,” she explained.

Her three oldest children have all graduated from high school at the top of their classes, some of them with college credits already in tow. They all play musical instruments — and they all have received their Eagle Scout award.

Researchers hope that the exploration of the new theory about predictive abilities may help change the childhood path for many. Cardinaux explained it this way: “The goal of therapy and intervention is to help children with autism gain the skills that they might not gain alone while also helping them embrace their uniqueness.”

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