Autism

India is home to about thousands of people with Autism and the disability has been on a rise since the last few years. According to statistics by the Centers for Disease Control and Prevention (CDC), one in every 88 children today is born with Autism Spectrum Disorder (ASD) against a ratio of one in 110 a few years back.

 

What is Autism?

Autism Spectrum Disorders are enduring and persistent neuro-developmental disorders characterized by a triad of impairments seen in children. Autism Spectrum Disorder (ASD) is a term used to describe a group of complex neuro-developmental disorders that have been brought under one umbrella term in DSM-V. Types of autism includes- autistic disorder, childhood disintegrative disorder, pervasive developmental disorder- not otherwise specified (PDD- NOS) and Asperger Syndrome.

ASD affects the normal brain functioning and cause impairments or delays in social interaction, cognition, communication and language along with repetitive behaviour, unusual interests in objects and behavioral issues caused by a combination of factors that adversely affect the development of brain. The autistic symptoms are usually noticed before the age of 3 years in children, although in many cases it may be noticed at a much older age. Despite normal physical appearance, their daily functioning, executive skills and a host of other aspects are affected. Recognizing these signs and an early intervention can help these children lead a near normal life. A comprehensive assessment of children with autism is required with several professionals working in tandem in order to pinpoint the deficits in the child using several assessment methods.

Autism Causes
No certain known cause of autism has been established so far. There are multiple reasons that can be held accountable for the occurrence of autism in a child. Over the last five years, a number of rare gene changes or mutations have been recognized that may have a link to autism.
Genetic factors are thought to be one of the most significant causes for autism spectrum disorders. However, most cases of autism seem to be caused by a combination of autism risk genes and environmental factors influencing the early brain development. These factors may affect at different stages of life- before birth, at the time of birth or after birth.

Pre-natal factors:

  • Chromosomal abnormalities and spontaneous gene mutations- a change in the structure of the genes.
  • Maternal complications during pregnancy- hypertension, diabetes, obesity, bleeding and use of psychiatric drugs in the mother during pregnancy
  • High testosterone levels in the amniotic fluid and prenatal exposure to ultrasound waves.
  • Prenatal stress consisting of exposure to life events or environmental factors that distress an expectant mother.
  • Advanced age of either parent.

Perinatal factors:

  • Low birth weight.
  • Gestation duration.
  • Hypoxia during childbirth

Postnatal factors:

  • Environmental factors like exposure to drugs, toxins, infections, certain foods or heavy metals.
  • Gastrointestinal or immune system abnormalities.

Autism Symptoms
Children with autism display a wide range of symptoms with varying severity. These symptoms can be categorized into three domains- social interaction, communication skills and stereotypical behaviour and other unusual behaviours.
Listed below are some of the signs and symptoms of autism:
Social skills:

  • Deficits in social-emotional reciprocity
  • Abnormal social approach and failure of normal back-and-forth conversation
  • Reduced sharing of interests, emotions, or affect
  • To failure to initiate or respond to social interactions.
  • Poor eye contact, no response to his/ her name, prefers to stay aloof
  • Deficits in developing, maintaining, and understanding relationships
  • Difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
  • Avoids touch or seeks more physical touch for example hugging, kissing, etc.

Communication skills:

  • Deficits in nonverbal communicative behaviors used for social interaction and lack of facial expressions
  • Poorly integrated verbal and nonverbal communication
  • Deficits in understanding and use of gestures
  • Delayed development of speech and language skills
  • Has difficulty in understanding or expressing his/her own feelings
  • Repetitive words or sentences over and over again (echolalia)
  • Irrelevant speech i.e. gives unrelated answers to questions

Unusual interests and stereotypical, repetitive behaviour:

  • Stereotyped or repetitive motor movements
  • Lining up toys or flipping objects
  • Insistence on sameness, inflexible adherence to routines, or ritualized patterns.
  • Highly restricted, fixated interests that are abnormal in intensity or focus
  • Strong attachment to or preoccupation with unusual objects, excessively circumscribed or preservative interest.
  • Absence of pretend play
  • Hyper- or hyporeactivity to sensory input
  • Unusual interests in sensory aspects of the environment
  • Apparent indifference to pain/temperature
  • Inappropriate object use.
  • Unusual fears or dislikes, e.g. cutting nails, flowers\
  • Poor eye-hand coordination

Other symptoms:

  • Increased hyperactivity
  • Affected executive skills
  • Self - injurious behavior like head banging, biting oneself, etc.
  • Aggressive behavior towards others like biting, scratching, pulling others hair, throwing objects, etc.
  • Throwing temper tantrums, unusual mood or emotional reactions
  • Lack of safety consciousness
  • Odd sleep and food habits, for example; may have disturbed sleep or may not eat food items which are white in color, etc.

Autism Treatment
Currently, there is no existing, permanent treatment for autism. The management of autism involves a multi-disciplinary approach that focuses on the deficits in a range of domains.
OCCUPATIONAL THERAPY:  It focuses on the acquisition of skills like eating, bathing, grooming, dressing etc. that facilitates independence in activities of daily living that are pivotal for the self-growth of a child. In addition to this, OT also comprises of activities that focus on various aspects related to autism including hyperactivity, fine and gross motor abilities, attention etc. It also incorporates sensory integration therapy (SI) that helps in reducing the sensory issues children with autism commonly face.
PSYCHOLOGICAL INTERVENTION:  It entails Behaviour therapy, in particular ABA, which primarily makes use of behaviour modification to teach autistic kids adaptive behaviours that enhance and improve the quality of their life. It can also be used for modification of disruptive behaviours often reported in autism including self-injurious and aggressive behaviour. Psychological intervention also helps children with autism to regulate their emotions by educating them about the ways of dealing with them. Executive functioning is another aspect that is incorporated in it.
SPEECH THERAPY:
Speech therapy incorporates enhancement of communication skills and further use of meaningful language as a way of expression.

SPECIAL SCHOOLS: Schools designed for individuals with autism comprise of a comprehensive program attending to a variety of facilities ranging from vocational training, adaptive skills, cognitive functions and communication skills.

ARTS-BASED THERAPY: Art is a form of expression that requires little or no verbal interaction which could open doors of communication for a child with autism. It Increases the ability to manage sensory issues (problems with stickiness, messy activities etc.), improves fine motor skills, improves social skills. Dance therapy facilitates rhythm, facial expressions, body language. Music as an accompaniment adds to the therapeutic effects. Art therapy in groups can have additional benefits of improving interaction skills and communication.

PLAY THERAPY: Children with autism use toys in a very inappropriate manner; for example tasting, banging or spinning them. Their play behaviors are also very repetitive. They often lack the ability to pretend play (e.g. dressing up a doll, or pretending to be a teacher) or imitate others. Play therapy increases self-efficacy and autonomy, develops new and creative solutions to problems, develop respect and acceptance of self and others, learn to experience and express emotions, cultivate empathy and respect for thoughts and feelings of others.

FAMILY COUNSELLING AND PSYCHOEDUCATION: Psycho-educating the family members of an individual with autism is one of the essential aspects of treatment. It entails providing information about the condition, the severity, the implications and the way ahead. It also includes addressing the expectations of family members, their emotional stability and caretakers’ burden.
MEDICAL MANAGEMENT:
Medication in autism is given to reduce certain moderate to severe symptoms such as mood swings, aggressive behavior, hyperactivity, etc. It is also advised to address the co –morbid conditions like OCD, depression, gastrointestinal problems, sleep disturbances, etc.
DIET AND NUTRITION:
Often the nutritional status in Children with autism remains compromised. They usually have vitamin A, vitamin B – 6, vitamin B-12 and folic acid deficiencies. This could be due to many reasons like difficulty to swallow and digest many foods items, sensory problems like food preferences, diarrhea, constipation, frequent infections, bloating and gastrointestinal (GI) pain. Hence, an alteration in the diet with respect to the nutritional requirement after assessing the other aspects like the swallowing and digestive ability is necessary so as to improve the quality life of the patient.

ANIMAL-ASSISTED THERAPY:
Animal-assisted therapy (AAT) is a type of therapy that involves an animal with specific characteristics, becoming a fundamental part of a person's treatment. It increases attention span, helps to overcome sensory defensiveness, enhances problem-solving skills, helps the child learn about unconditional love, helps the child to relax and maintain a better state of mind, helps building and maintaining social skills.

STEM CELL THERAPY FOR AUTISM
Currently, there is no proven cure yet for Autism and it requires a continual lifelong management. The conventional interventions facilitate development and learning, promoting socialization, self awareness, reduction in maladaptive behaviors and educating and supporting families.

These, however, do not provide a permanent treatment and do not address the core neuropathology associated with autism. However, recently, stem cell therapy has made a major breakthough in the field of autism and other neuro-developmental disorder as it directly focuses on the neurological repair.

Researchers and doctors are now looking at regenerative therapy using stem cells as potential therapy for children showing symptoms of autism. The idea that stem cells possess the capability to multiply in many cells and form specialized cells different from the mother cell can help in repair of the damaged brain tissue forms the basis of this idea. Stem cells have the potential to repair the affected neural tissue at the molecular, structural and functional level. They are known to address the core of neuropathology of autism with the help of their unique paracrine regulatory functions that are capable of regulating cell differentiation, tissue and organ repair, and anti-inflammatory actions in the recipient. This repairs the underlying brain damage which can also be objectively seen on PET CT scan of brain along with functional improvement in these children.

As a treatment form, it is extremely simple, which involves the child getting only 2 injections and has not been associated with any significant irreversible neurological complications. Stem cell therapy, therefore, has the probability to produce better clinical improvements, as compared to earlier methods.
The NeuroGen Outcome:-
At NeuroGen BSI, we have successfully treated over 150 cases of Autism. We have published the world’s first clinical study on the effect of stem cells in autism in 32 patients in the International Journal “Stem Cell International.” The path breaking results observed through this study has demonstrated the safety and efficacy of stem cell therapy.

Schematic representation of clinical improvements after cellular therapy in autism

Post stem cell therapy, doctors have observed reduction in hyperactivity, abnormal stereotypical behavior, reduction in self stimulatory behavior, improvement in eye contact, attention span, speech, communication skills and social interactions. This helps to integrate these children into society and to help them be independent.
These functional enhancements that have been seen in our patients can be co-related with the improvements in the brain metabolism as well that is observed in the PET-CT (Positron emission tomography- computerized tomography) scans of the patients.

Objective Radiological evidence of improvement after stem cell therapy in autism:


Intrathecal autologous stem cell therapy is a safe, feasible and effective treatment strategy for children with Autism. Stem cell therapy along with a well designed rehabilitation program can help to improve the quality of life of these children.

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