Autism - Understanding the disorder

    Autism is a lifelong developmental disability which affects a person’s     ability to communicate, play and socially interact with others and     understand language. Autism usually appears as developmental delays before     age three and is more prominent in males, with a male female ratio of 4:1.

    In the Diagnostic and Statistical Manual (DSM-IV), these diagnostic categories     are under the heading of “Pervasive Developmental Disorders (PDDs).” The     disorders are defined by deficits in three core areas: social skills,     communication, and behaviors and/or interests. Types of autism spectrum     disorders, or PDDs, include:
    • Autistic Disorder
    • Asperger Syndrome
    • Childhood Disintegrative Disorder
    • Rett Syndrome
    • Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

    All these disorders are characterized by different degrees of impairment in     communication skills, social interactions, and restricted, repetitive and

stereotyped patterns of behavior. Children with autism spectrum disorders may be non-verbal and antisocial, as in the case of many with “classic” autism, or Autistic Disorder. On the other end of the spectrum are children with a high-functioning form of autism characterized by idiosyncratic social skills and play, such as Asperger Syndrome. Two out of every three children with Autistic Disorder are mentally impaired; mental impairment is most frequent at the severe end of the spectrum. Children with Asperger syndrome have normal development.

Treatment for people with autism should include early diagnosis to increase the child’s chances for success; speech therapy; occupational therapy – fine motor and co-ordination problems; behaviour therapy and appropriate Education Placement.

UWI’s Research on Autism

While there is much research on autism in developed countries, there is very limited information available on the epidemiology of autism in developing countries. As the high prevalence of this condition is now considered a worldwide public health epidemic, studies from developing countries are particularly important in the quest for identifying underlying causes, which could lead to reduction in prevalence and/or severity and impact of this condition.

Professor Maureen Samms -Vaughan and colleagues from The University of the West Indies have done several studies on autism, which have been published as abstracts or full papers. These studies have looked at the effects of the environment on autistic spectrum disorder in Jamaica, Obstetric complications and autism in Jamaican children, Maternal stress associated
with raising Autistic children in Jamaica and The role of early childhood professionals in the early identification of autistic disorder.

The study on The effects of the environment on the autistic spectrum disorder in Jamaica conducted by Hall and Samms–Vaughan et al (2001) investigated the possibility that an environmental trigger interacting with a genetic component causes autism. It examined the relationship between environmental pollutants or toxins, like mercury and autistic disorder. In this study no association was found between living close to possible environmental toxins, use of household chemicals and autism during pregnancy.

Roberson, Hall et al (2001) examined Obstetric complications and autism in Jamaican children, this study explored the relationship between obstetric and perinatal history and the diagnosis of autistic disorder in Jamaican children. This study found that mothers of autistic children had higher rates of complications during labour and pregnancy and a larger percentage of autistic children were either born prematurely or late. The study also found that mothers of autistic children tended to be older and had fewer children. These findings are in keeping with previous research in developed countries.

Maternal stress associated with raising autistic children in Jamaica was a study by Siles and Samms–Vaughan (2001) which investigated the correlation between levels of stress and raising an autistic child in Jamaica. They found that there was
an association between raising an autistic child and maternal stress but this depended on the severity of the autism.

Samms–Vaughan and Franklyn–Barton (2008) examined the role of early childhood professionals in the early identification of autism. This study found that even though there was maternal concern about language development at an early age, identification and diagnosis was made more than twenty–four months after. In comparison with developed countries, mothers of autistic children in Jamaica identified developmental concerns at about the same time of 21.3 months, but there was significantly greater delay in Jamaican parents obtaining a diagnosis, 43.8 months for Jamaican children and 37.2 months for children in the USA. Late diagnosis impacts on the receipt of early intervention services, which is known to improve outcome.

The following recommendations were made:
• Primary health care professional and educators should be educated about autistic spectrum disorder (ASD).
• The general public should be educated about the milestones for child development and the “red flags” for developmental delays for which assistance should be sought by the parent.
• General practitioners and early childhood paediatricians should listen carefully to parental concern.

Current research

The University of the West Indies is collaborating with the University of Texas Health Science Centre at Houston (UTHSC –H)) on a study entitled “Epidemiological Study of Autism in Jamaica.” The study is funded by National Institutes of Health (NIH) and Fogarty International Center (FIC), and is investigating how genetic and environment factors interact and may cause Autism Spectrum Disorders. The long term goal for the project is to develop a large scale population – based Autism Spectrum Disorder (ASD) study in Jamaica. Currently the team is conducting a pilot age and sex matched case-control study aimed at:
• Examining whether exposure to mercury, lead, arsenic and cadmium contribute to the development of autism.
• Assessing the role of genes and their interactions with the heavy metals like lead and ASD.
• Assessing demographic and socioeconomic and lifestyle parental factors (e.g. smoking and drinking) for their impact on the development of autism.

The research process involves collecting information be questionnaire, including:
• Socio-demographic information and family history.
• A dietary and environmental exposure questionnaire.
• Biological samples (saliva, hair and blood) to test for genes and heavy metals.

The study will run for two years and will enroll 150 previously diagnosed autistic children and 150 matched controls, between the ages of 2 and 8 years. The study began enrollment in December 2009 and so far 41 cases and 21 controls have been enrolled.

Further information on this study may be obtained by contacting the UWI research team at 619-0707.