Subject: Re: Is he Autistic?
Forum: The Neurology and Neurosurgery Forum
Topic Area: Autism
Posted by CCF Neuro[P] MD, RPS on November 03, 1998 at 13:13:32:
In Reply to: Is he Autistic? posted by Angelina Thio on November 02, 1998 at 05:10:27:

MRI Examination Report:
Clinical History : Big head. Delay development. CT showed megalencephaly.
Imaging Protocol: SE T1 sagittal 5/1.5; SE T1 axial 5/1.5; FSE PD/T2 axial 5/1.5; FSE T2
coronal 5/1.5
Imaging Findings:Thickened cortex with relative paucity of underlying white matter was noted over the temporo-parietal regions bilaterally. Suspicious hyperintensity was noted in the posterior white matter bilaterally; ?gliosis.
Otherwise, no abnormal signal intensity lesion or mass lesion was noted in the brain. No obvious cleft to suggest the presence of schizencephaly was noted. The corpus callosum was well formed. No midline shift was detected. The lateral ventricles were mildly prominent. Prominence of the nasopharyngeal soft tissues was noted which probably represents enlarged adenoids. Signal intensities were noted within the right mastoid and right maxillary sinus, ?inflammatory changes.
Impression: Thickened cortex with relative paucity of underlying white matter over both
temporo-parietal regions. Features could represent some form of bilateral focal cortical dysplasia.

Since then, I make him go for all those Speech therapy, Occupation therapy, phycotherapy. I managed to put him in special educational program. At the same time he began to act 'violently' such as beating people, biting and recently he learn to struggle the baby. he had ear infection too. He is slow in everything.

Some of the examples are:

He can't hold a scissors properly and can't cut anything.
He can't walk without this right hand bending upwards,he can't walk single step up a stair.
He also can't walk down a stair case without holding to something.
He had to walk with right leg first and put both legs on the same step before proceed with right leg again.
He can't jump.
He can't answer questions ( He talk like a parrot ----repeating everything you said).
He also will have saliva flow out when ever he is excited, angry, happy, sad and so on.
He can't blow his nose, can't control bladder and bowel.
He don't understand dirty ( He ate his stool and drink the water from toilet bowl).
His hand can't move in co-ordination.
He paid too much attention in advertisement ( TV).
He will hold on to anything long and began to move his head to and for and repeat for hours. He likes car and especially bus and final. Nothing else can attract him more.
He don't eat vegetable at all.
He is always being 'bullied' in school.
He does improved and he actually showed positive improvement that surprised the therapist. He has being tested to had a developmental age of 38 months when his chronological age is 4 years and 5 months.
He had little eye-contact with everybody except me.
He enjoyed story books that has huge colorful pictures.
He can read a lot as he has good memory.
He can write single character, small and capital letters and also some Chinese characters.
He can feel hot and cold.
He loves to play with the computer and especially 'Sesame street's Elmos'.
He can't throw or catch a ball.

That's part of my self introduction of him.

I've read the 'Autism Symptom Checklist' and found that he is something like Autism. The local doctor didn't offer any advice and I'm in a lost of what he is suffering. Thus I really hope somebody out there can give me a piece of advice on whether he is an Autistic child or not.
Below is the Check list and I'll put a YES behind of the item if he has that symptom.

Difficulty in mixing with other children YES
Insistence on sameness; resists changes in routine YES
Inappropriate laughing and giggling
No real fear of dangers YES
Little or no eye contact YES
Unresponsive to normal teaching methods YES
Sustained odd play YES
Apparent insensitivity to pain YES
Echolalia (repeating words or phrases in place of normal language) YES
Prefers to be alone; aloof manner YES
May not want cuddling or act cuddly
Spins objects
Noticeable physical overactivity or extreme underactivity YES
Tantrums - displays extreme distress for no apparent reason
Not responsive to verbal cues; acts as deaf YES
Inappropriate attachment to objects YES
Uneven gross/fine motor skills; (May not want to kick ball but can stack blocks) YES
Difficulty in expressing needs; uses gestures or pointing instead of words YES

By the way, my boy had a very large head ( head circumference is 57 Inch).

Please help me. Please tell me whether my boy is Autistic or not. And how can I find out if he is in case you also not sure.

Wishing everybody best of health. Thanks for all advice and sorry for my long letter.

With all my heart,


Angelina Thio

Dear Angelina:

Sorry it has taken me so long to respond. First, you may look into the possibility that your first son has dyslexia, it is a learning disorder that has some of the same features as you describe. The conception of letters seems to be off therefore there is a problem with reading. Things can be done to help him and he should do fine once treatment and altering his learning environment begins. Your second son sounds like he does have autism. I can see that there are a few people on the forum who have sons and daughters that sound like your son. Let me first give you a brief description of the spectrum of Pervasive Developmental Disorders, of which autism is one form. As you read the description, you will find that your son fits some but not all the descriptions given, and this is normal for all autistic children do not have all the characteristic. This is a clinical diagnosis, meaning that there is not a biological marker or test that will say your son absolutely has autism or any other pervasive developmental disorder. The MRI suggests that your son has neuronal migration problem, called cortical dysplasia. Here the developing neurons didn't migrate to the correct position in the brain. This leads to those neurons functioning at less than optimal. The decrease in white matter underneath the cortical layer is the myelin surrounding the projections form the neurons not present in normal quantities. This can mean that there are fewer axons (projections for the neurons) or fewer oligodendrocytes (the cell that myelinates the axon) or a combination of both. Likely, in your son's case it is a combination of both. What was the cause is probably unknown or you would have been told, ie. infection, infarction, hypoxia, etc. It sounds like this is not a progressive disorder or your son would likely be worsening. This is likely the reason for his physical problems you mentioned.

Pervasive Developmental Disorder is the name for a group of disorders diagnosed in children with unusual behavior and development, including probelms in one or more basic processes of social, language, motor, sensory, affect or cognition. Children with autisic disorder are often diagnosed in infancy or early childhood and are usually well recognized by the physician and other health professiona. Rett's disorder is found in females and is a specific form of PDD that occurs after age 6 months and is felt to be a degeneratiive neurologic disorder with signs that mimic autistic disorder. Childhood disintegrative disorder is used for children who have the symptoms of autism but who do not show difficulties until after at least 2 years of normal development. Children with the other forms of PDD, Asperger's disorder and PDD-NOS are often more difficult to dianose accurately. Autistic disorder is the most "classic" of this category of disorders. Autistic disorder has been well described and validated and is generally diagnosed in early childhood. The majority of children with autistic disorder have delays in cognitive funcition, with up to 75% having IQs within the mentally retarded ranges. Nevertheless, some children with autistic disorder have average or above average cognitive functioning or exceptional ability in specific areas. Children with autistic disorder show characteistic early impairment in social interaciton and communication along with a restrictive range of interests, delayed play skills, and stereotyped behaviors. At young ages, children with autism generally have difficulty with social skills and the "give and take" of social play. They often prefer to be alone or with close family members. When they do seek out peers, they may be rejected or act inappropriately. As they move into the schoolage years, they continue to have social difficulties and seem to have problems empathizing with peers. These children are oftern teased or ignored by peers and may be viewed by age-mates ad "different or odd". Impairments in thinking/cognitive processing are common and may include perseverative, rigid, or ritualistic thinking, as well as very personal interpretations of situations. It is typical for such children to be very set in their activities and to have significant difficulty changing routines. Communication skills may be impaired and they often have problems with the social component of language as well as with intonation and prosody. Many have a history of language delay and may require speech and language therapy for articulation oron higher order communication problems such as pragmatic language, problem solving, or abstract reasoning. Speech may also include some autistic-like behaviors such as echolalia or unusual speech patterns. Overreaction to tactile sensations are common, and some chldren seem to have a very high or very low threshold for pain. There may also be unusual or idiosyncratic reactions to noises, tastes, or smells. Children may seem awkward or clumsy from an early age and may be somewhat behind peers in motor development (even with normal MRIs). They may engage in stereotypic motor behaviors such as rocking or spinning in early life. They may also become fascinated by touching certain objects or by movements and engage in them repetitively. Written language problems in later school years are frequently noted. Affective or emotional functioning problems appear to arise in two areas: 1) the understanding of emotions in self and others and 2) the regulation and expression of emotions and feelings. It is oftern difficult for a child to show empathy for others, even though he or she may intellectually understand that the other party has been hurt.

Psychological and educational evaluation are generally necessary to identify specific cognitive and academic strengths or weaknesses as well as to identify and target those behaviors that may benefit from intervention. Special educational accommodations may be necessary for many children to achieve appropriately in the classroom. Adjustments may be necessary for learning disabilities, cognitive delays, language probelms, perceptual-motor delays, or behavior/emotional disabilities.

Also, let me give you the E.mail address of the Autism Treatment Center of America for more information: sonrise@option.org. There is also a clinical trial of using secretin to treat autism being kicked around the NIH. It hasn't started yet but there was a call for applications.

Given the list of what your son behavioral characteristics and what I have given you in general terms, I would say that your son has autism. I would seek out help in all the areas of his deficits, learning, behavior, physical therapy, occupational therapy, etc. As a pediatric neurologist, I would also suggest keeping in close contact with him or her to follow his neurological state.

Sincerely,

CCF Neuro:Pediatrics MD, RPS

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