ASA SB | Checklist for Autism in Toddlers (CHAT)

OTHER CONDITIONS RELATED TO AUTISM
(Excerpts from an article about autism  by Tina Iyama, M.D.)

Seizure Disorder
An EEG is an "electroencephalogram," a test that records electrical activity of the brain through wires attached to the scalp. Seizures are caused by abnormal electrical activity that can often be identified by the EEG. Different patterns mean different things and are best interpreted by neurologists. Seizures do not indicate any one specific neurologic disorder; they are seen in many children with developmental delays, in children with no learning delays and in children with autism.

About 30% of children with autism also develop seizures during their lifetimes. Two or more seizures that are not typical "febrile seizures" or "fever seizures" mean that your child has epilepsy. This may also be referred to as a "seizure disorder." All children with nonfebrile seizures or complicated febrile seizures should see a neurologist and have an EEG done.

You may have read about the "Landau-Kleffner Syndrome" and a variant that was written about in association with autism. The original Landau Kleffner syndrome referred to school-aged children who lost language skills and developed seizures, but who did not have any autistic characteristics. Several authors wondered if this process happened in young children, whether autistic development would result. This was then written about in conjunction with "electrical status epilepticus of sleep" and led to the recommendations for 24-hour video EEGs. This did not turn out to be useful for the vast majority of children who had it done. If abnormalities of sleep were identified, treatment did not alter the course of their emerging autism. Treatment with anticonvulsants would be expected to treat identified seizures and not the autism.

Hypotonia
Muscle tone refers to the amount of tension that is normally present in all of our muscles. While awake, most people have a normal amount of resistance to having their joints moved. It is neither too easy nor too hard to move a normal arm or leg. Hypotonia refers to "decreased muscle tone," a looseness or floppiness either of the limbs or the body. Hypotonia can be caused by disorders of the brain, nerves or muscles. If a child has normal knee-jerk reflexes and has good strength in the muscles themselves, then the hypotonia is caused by differences in brain function. The brain does not send the correct balance of messages to the tendons and muscles, leading to this feeling of looseness. This looseness can affect the quality of a child's movements.

Many, but not all, children with autism have some degree of low tone. They may be late in sitting up or late in walking. They may be clumsier in their movements than other children. They may have difficulty holding a pencil. Some metabolic disorders are associated with hypotonia, and so if your child is hypotonic, then certain lab tests might be recommended. One confusing thing often happens regarding tone. Your child's therapist says your child is hypotonic, but the neurologist or other physician says his tone is normal. Is one right and the other wrong? No—they are looking at two different aspects of tone. The therapist notes a mild amount of low tone that can nevertheless affect a child's movement. The neurologist is looking for the amount of low tone that indicates a neurologic disease. Generally, the neurologist will look for a greater degree of low tone before describing it as "hypotonia." They are both correct, but looking for different things.

Sensory Integration Deficits

Children with autism seem to use their senses differently than typically-developing children. They may perceive the world somewhat differently and their use of their senses may be clues as to the way they process these experiences. Children may be over or under-reactive to a sensation. Usually, children with autism have a high pain threshold but are overly sensitive to sounds. A vacuum cleaner can be frightening and painful. Children may look at objects out of the corners of their eyes or have strong preferences for certain textures. They may seek out small, tight spaces or wrap themselves tightly in blankets. This difference in processing may be related to brain abnormalities, possibly to the abnormalities in the cerebellum, a part of the brain that takes in some of these sensory signals. A part of a child's reaction to sensations, however, may be tied into the generally high level of anxiety that is often present. Anxious children may be frightened by unexpected sounds or touch, and control over these sensations may reduce anxiety. We have no idea which comes first, the anxiety or the processing problem, or something else altogether.

It is clear that these differences are common in children with autism. They are symptoms of autism and not a separate diagnosis. What is not clear is what can be done about them or how effectively they can be treated. Pediatric occupational therapists have shown the most interest in this area and we await the data to support treatment of sensory integration disorders.

Hyperlexia

Hyperlexia refers to the ability to read words far above one's ability to comprehend. The ability to read depends on several skills. One must be able to recognize letters and patterns of letters that form words. One must also be able to comprehend the meaning of those words. Children with hyperlexia can read words, but struggle with comprehension. For reasons that we do not understand, many children with autism spectrum disorders are very, very good at learning the names of letters and numbers and then at reading words and spelling them. This process of "decoding" is an important beginning in learning to read. Children as young as 18 months of age may start identifying letters and numbers. Some children may be reading and spelling words by 2 or 3 years of age. Parents are appropriately delighted. It is only called hyperlexia if the child does not understand the meaning of the word they can read. For example, if a child could spell "xylophone" but not be able to identify a picture of one, this is hyperlexic. Primary grade children may understand labels or concrete stories, but struggle as the material gets more abstract.

Children with autism who are hyperlexic generally have better outcomes than children with autism who cannot decode in this way. The struggle for parents and teachers is to work to attach meaning to the words the child can read.