QUE SABEMOS DEL AUTISMO

Professor Andrew Whitehouse leads the Autism Research Team at Telethon Kids Institute, working with children with autism and their families to reduce the disability associated with the disorder.

In this short video he shares his top ten things that everyone should know about autism spectrum disorder. — The Autism Research Team is a research centre at the Telethon Kids Institute.

A key aim of the Autism Research Team is to develop new and innovative ways to deliver autism therapy to ensure every child has the very best opportunities in life.

EARLY SINGS OF AUTISM TUTORIAL

¿Cómo se diagnostica el autismo? ¿Cuál es el tratamiento adecuado? ¿El TEA tiene cura? En este video el Dr. Rodrigo Morales Toquero nos responde a estas preguntas. Agenda una consulta 📲 🧑🏻‍⚕️Dr. Rodrigo Morales Toquero 🩺 Pediatra y Neurólogo Pediatra Citas: (222) 2252864 y (222) 2141444 WhatsApp (sólo mensajes) da clic 👉 https://wa.link/zam6v4 📍 Hospital Ángeles Puebla | Torre II de Especialidades piso 7 consultorio 3725

El Autismo no es un trastorno ni una enfermedad, es una condición. La principal causa del autismo son las vacunas. El gluten es un factor muy importante en el desarrollo del autismo. La homeopatía puede mejorar mucho e incluso curar el autismo. No. No te preocupes. No me he vuelto loco ni he perdido la cabeza.

Solo he empezado a soltar, una detrás de otra, algunas de las mayores estupideces que he oído sobre el autismo a lo largo de mi vida.

Si por algún extraño motivo, en algún momento de duda, preocupación, agobio, desesperación o debilidad, has llegado a dudar por un segundo si alguna de las historias de este tipo que circulan por internet, y por muchos grupos de Whatsapp, tienen algo de cierto, déjame que te lo aclare negro sobre blanco y de una vez por todas.

NO. No, no, y 1000 veces no. Supongo que entonces te acabarás preguntando, quién tiene tan poca vergüenza para inventarse estas mentiras para fomentar todos estos bulos por todos lados cuando lo único que pueden hacer, es perjudicar a las familias, y poner en serio riesgo, la salud de los propios chicos.

Pero mira, como dijo es torero, “Hay gente pa´ to´” No te preocupes porque en este video te voy a contar las principales mentiras que escucharás sobre el Autismo, y la verdadera explicación a muchas de ellas Hola, Soy Manuel Antonio Fernández, el Neuropediatra.

Experto en TDAH, Director del Instituto Andaluz de Neurología Pediátrica en Sevilla y de la web para familias elneuropediatra.es. Ayudo padres de niños con problemas como el TDAH a identificarlo y dar con el tratamiento y la terapia adecuados para resolverlo y normalizar al 100% su situación académica, personal, social y familiar de una vez por todas.

Si quieres ayuda en el diagnóstico o el tratamiento de tu hijo a cualquier edad, Ponte en contacto ahora mismo con nosotros para que analicemos tu caso y nos pongamos manos a la obra. Llama al 682 651 047 o escríbenos al mail recepcionista@elneuropediatra.es

LO INCORRECTO – Una nueva mirada hacia la discapacidad

Michael Wigler, a professor at Cold Spring Harbor Laboratory (CSHL) was surprised. A molecular biologist and geneticist, with a background in mathematics and medicine, he devoted two decades of his research career to studying the causes of autism. In the early 2000s, Wigler and his team revealed that a certain portion of autism cases have genetic underpinnings. One of the team’s goals was to elucidate the full extent of autism’s genetic causes in order to find clues to its treatment and prevention. The team thought they had a good theory, which they dubbed the “unified hypothesis,” but in 2017 that theory began to develop cracks. Now, the most recent findings produced by Wigler and his colleagues are not at all what they expected.

Based on theory, the team projected that affected siblings would share more genetic determinants inherited from their mothers than the fathers. But the findings showed the opposite. “In fact, we see a greater signal of sharing from the father than from the mother,” Wigler says. That parental gender surprise is a head-scratcher that the team has only recently been able to explain. “It’s a puzzle. And we do not like our solutions.”

A complex condition, autism afflicts 1 in 44 children in the United States, according to the Centers for Disease Control. It manifests itself in a multitude of symptoms, from social awkwardness to anxiety and repetitive behaviors to resisting change. This variability is the reason why it’s called an autism spectrum disorder or ASD. Where on the spectrum an individual fits matters greatly. Those who fall into the high end of the spectrum have better prospects—they are the high-functioning individuals who often have special abilities such as superior math skills or photographic memory, which help them cope with life challenges, such as social anxieties. At the low end of the spectrum are those with intellectual disabilities and those who don’t talk at all. It’s estimated that 31% of children with ASD have an intellectual disability, and an even greater number have problems with motor skills.

Gender has always been a big part of the conundrum. Boys are about four times more likely to be diagnosed with autism than girls. According to the statistics published by the Johns Hopkins Bloomberg School of Public Health, 1 in 34 boys has autism (2.97%) compared to only 1 in 145 girls (0.69%). Girls often have different symptoms than boys. For example, they tend to suffer more from anxieties rather than display repetitive behaviors, and because anxieties can be masked or overlooked by clinicians, a certain percentage of girls may end up being misdiagnosed. Instead of being placed on the spectrum, some may be diagnosed with psychiatric disorders, such as depression or anxiety, says Catherine Lord, a practicing clinician who focuses on autism and is a professor of human development and psychology at the University of California, Los Angeles.

Some women self-diagnose later in life, having grown up without a clue that they might be autistic. Despite the increased focus on autism in the past two decades, which has lifted some of the social stigma from the condition, that trend is rising, Lord says. “The number of self-diagnosed people who are female is increasing every day,” she says. “And it’s not so much true for males.” Brandy Schillace, editor-in-chief of BMJ Medical Humanities, author, and host of Peculiar Book Club podcast, self-diagnosed when she was an adult, after being told to “not be weird in public” for most of her childhood. “What makes autism a disability is not that you are broken, but that society disables you because it’s not built around your needs,” Schillace says.

Gender is a big part of the conundrum. Boys are about four times more likely to be diagnosed with autism than girls.”

It’s hardly surprising that society doesn’t cater well to the people on the spectrum. After all, the exact definition of autism is still evolving. It took decades for society to even recognize autism properly as a condition. For a good chunk of the 20th century, autism was viewed as childhood schizophrenia. People with autism had been classified as psychopaths rather than neurodiverse individuals. Even the modern-day definition of autism as a spectrum disorder is still developing. The current fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, described certain autistic features differently from its predecessor, DSM-4, a testament to the fact that scientists are still working to fully identify its nuances.

The underlying causes of the disorder had been equally puzzling, sometimes leading scholars in the wrong directions, such as pinning the blame on the children’s mothers for their “cold and unemotional parenting.” And without knowing what causes autism, physicians had—and still have—no means of preventing it or reducing its severity or risk of occurring. Just like with any other affliction, the path to mitigating autism lies in understanding where it comes from. If medics understand autism causes better, they would be able to design better therapies and potentially even better prevention.

That’s exactly what Wigler has been doing for the past 20 years. As the genomic methods matured on the brink of the millennium, he hoped to find the answers in the genes of people on the spectrum. But piecing these answers together proved just as complicated and nonlinear as the history of this puzzling condition.

A complex history of a complex disorder

The two people typically credited with the definition of autism are Hans Asperger, an Austrian physician who practiced in Vienna before and during World War II and Leo Kanner, a Jewish psychiatrist born in 1894 in Klekotiv, then in Poland and now in Ukraine, who later left Europe for the United States. Both began using the term “autism” in the 1940s. Asperger, for whom the Asperger syndrome is named, described the children he studied as “autistic psychopaths,” and as recent findings revealed, went on to collaborate with the Nazis on euthanizing patients that were deemed mentally unfit to exist in society. Kanner’s paper described his patients as not relating “in the ordinary way” to people or situations, and said their “behavior is governed by an anxiously obsessive desire for the maintenance of sameness.” He was the one who, at first, explained the disorder is caused by unemotional parenting, coining the term “refrigerator mother”—a view he denounced later.

It took decades for the autism research community to find out that neither man was the first to define and describe autism. A Ukrainian-born Jewish psychologist named Grunya Sukhareva beat them by about 20 years. She was just well hidden behind the Iron Curtain.

Sukhareva graduated from medical school in Kyiv in 1915 and worked at the city’s psychiatric hospital. A few years later, she moved to Moscow, where she worked at the Pedagogical Sanatorium School for children with special needs. Some of them were traumatized by the dramatic events of the time—World War I, the Russian Revolution and civil war. Others were noticeably different from their peers: They had social deficits, motor-skills issues, and preferred to play alone or interact with adults rather than kids their age. Sukhareva described one of the boys, a 12-year-old who read everything he could find and never played with toys, as an introvert “with an autistic inclination into himself.”

Children with severe challenges sometimes lived in the sanatorium for two to three years, taking school classes and physical education, and receiving social- and motor-skills training. In a 1925 paper, Sukhareva described six boys with “autistic tendencies,” chronicling their behaviors in finest detail, including the fact that some were gifted—one excelled at playing violin and another had an incredible memory for numbers. Her findings, along with other records of the clinical work, were published in Russian and a year later in a German journal, where her name was misspelled as Ssucharewa. The paper was not translated into English, so neither her term autistic nor her detailed observations reached English-speaking psychiatrists. The German-speaking Asperger and Kanner might have read it, although it’s hard to tell because neither one mentioned her name or referenced her in their own papers. The fact that the German version of her name had several typos likely didn’t help either.

Nearly 100 years later, another Russian-speaking psychologist, Irina Manouilenko, found the original 1925 volume while working on her dissertation at the Karolinska Institute in Sweden. She decided to compare Sukhareva’s descriptions with the modern-day standard definitions in the DSM-5, published by the American Psychiatric Association. She was surprised to see how spot-on Sukhareva’s descriptions were. Manouilenko published these comparisons in a 2015 paper, “Sukhareva—Prior to Asperger and Kanner.” What the DSM-5 depicts as deficits in “social interactions” and understanding relationships, Sukhareva described as “flattened affective life,” “lack of facial expressiveness and expressive movements,” “tendency toward abstraction and schematization,” and “keeping apart from their peers, avoiding communal games.” And, where the DSM-5 lists “stereotyped or repetitive motor movements,” “insistence on sameness,” “fixated interests,” and “sensitivity to sensory input,” Sukhareva’s notes speak of “talking in stereotypic ways,” being “pedantic,” with “strong interests pursued exclusively,” and sensitivity to noise or smell. Moreover, they were worded so simply that any parent or grandparent could understand them.

The simple hypothesis that the mothers passed a strong autism-causing variant didn’t stand the test.”

With the only diagnostic tools available to her being the keen power of observation, Sukhareva couldn’t pin down the causes of this strange disorder. Instead, she focused on helping these children improve their social and motor skills by interacting with others and taking classes in painting, woodwork, and gymnastics—until they were ready to transfer to regular schools. Remarkably, the basic foundations of the interventions she set up haven’t changed much over a century. Even some modern schools like Meristem, which prepare autistic young adults for an independent life and employment, in essence follow similar principles. Nonetheless, it took more than a few decades for diagnostic and analytical tools to mature enough for scientists to start chipping away at the puzzle.

Combing through the genes

Wigler’s interest in autism stemmed from his early life experiences. His girlfriend’s brother was different from every other kid he knew. “He never looked you in the eye, but he knew every baseball player and all the statistics of the baseball players, and that’s all he would talk about,” Wigler says. “He made a profound impression on me.”

Wigler didn’t know the boy had autism. Later, in medical school, Wigler learned about the condition and became curious about its causes. At first, he doubted it was merely hereditary, attributing it to mutations called de novo mutations—not present in parents but arising in their child. “What struck me about this kid was that he was so different from anybody else in the family so I thought from the beginning that autism was the result of a new mutation.”

In the 1980s, he became interested in a method called genome difference analysis. The method had proved useful in studying cancer causes, so he decided to look for new mutations in the genomes of people with autism. At the time, such methods didn’t yet exist, so his team published a paper describing the theory behind building such technology. Shortly after, at the end of the 1980s, Russian scientist Nikolai Lisitsyn, who had been working on a similar problem, contacted Wigler’s lab. Lisitsyn had managed to solve a particular technical problem, and, detecting his interest in fleeing a collapsing Soviet state, Wigler invited him over to work at CSHL. This collaboration laid the foundation for the future methods of genomic analysis Wigler’s lab would follow for years to come.

In the early 2000s, Wigler’s team got a chance to put their genome mining tools to the test. Child psychiatrist Susan Folstein, at Tufts New England Medical Center at the time, had put together the first small simplex (only 1 child affected) collection of genomic DNA from about 200 families with instances of autism. She passed her collection of genomic DNA to James S. Sutcliffe, an associate professor of psychiatry at Vanderbilt University who studies the genetic underpinnings of autism spectrum disorders. Wigler, who was looking for such collections, got in touch. After applying their genomic analysis methods to the samples, Wigler and his colleagues Lakshmi Muthuswamy and Jonathan Sebat showed that de novo mutations most certainly play a role.

The particular culprits were “copy number variations”—genetic glitches in which large chunks of the genome get deleted or duplicated. They looked as if someone had torn a piece out of the DNA string. “Your genome is a long string. It’s a ribbon. And if you were to cut out a piece of the ribbon and then tie it together, you’d be missing a large piece of your ribbon,” Wigler explains. “Some of them are really large, hard to miss with our new techniques, as easy as seeing a crater on the moon with a low power telescope.”

Notably, not all de novo mutations cause trouble. There are about 100 to 200 de novo mutations in the genome for every birth, Wigler explains, and most of them don’t affect anything. For example, genes involved in the sense of smell or the immune system function vary greatly between people, and some variants may even be advantageous. “There’s great tolerance and probably even positive selection for variation in these genes,” he explains. But other genes’ functions are so essential and specific that any changes would render the organism inviable or severely disadvantaged. The large copy number mutations are of that type, just too massive not to leave a mark. And they were clearly more abundant in children that had autism than in their neurotypical peers. The team showed that the copy number variations were responsible for a substantial number of autism cases. That finding opened new horizons, sparking hope that by sequencing the DNA of people with autism and looking for smaller sequence variants that alter gene function, researchers would be able to pin down the causative genes.

Previously, and still today, some scientists used more standard approaches, combing through collections of genomes for variants that might be common to people with similar disorders, a technique called Genome Wide Association Studies. One such collection was called AGRE for Autism Genetic Resource Exchange, an effort aimed to shed more light on familial autism, studying the multiplex families—those that had multiple siblings and multiple members affected. Another collection named the Autism Genome Project was composed of different groups across the U.S. and Europe and gathered information about affected siblings. “The idea was to see what regions of the genome are shared between affected individuals across large collections,” says Sutcliff. “And that effort failed to find loci strongly influencing autism incidence,” Wigler notes. “A very important failure, since it pointed to other causes, including new mutations.”

Consequently, the Simons Foundation followed the lead of Folstein, and created the Simons Simplex Collection, or SSC. The effort was led by Lord, an expert in diagnostic criteria. They amassed genetic samples from 2,600 families, where only one child affected was on the spectrum while no siblings or parents were. “With SSC there was hope to find the ‘core autism’—the mutation or set of genes specific to autism,” says Sutcliffe. By comparing the autistic child’s genome to the genomes of other family members, scientists aimed to pinpoint the genes that made this child different. Wigler worked closely with Lord to mine the SSC collection for answers and identify the genetic mishaps in children from families that did not have any other members affected. More recently, embracing the ideology of “strength in numbers,” the Simons Foundation launched SPARK, an ambitious ongoing effort to collect data from 50,000 families of any kind and, so far, has collected about 30,000.

Notably and somewhat strikingly, de novo mutations played out differently in boys versus girls. While boys with “comparable-size craters” succumbed to autism, the girls did not. “It took a larger hit to make a girl autistic than it took to make a boy autistic,” Wigler says. “That was one of the first indications that girls were resistant.” In their 2011 study, Wigler and his team explained that women have greater resistance to autism from genetic causes. The phenomenon became known as a female protective effect. “Female protective effect means that you need a higher load of mutations to rise to a phenotypically recognized autism spectrum disorder that can be clinically determined,” Sutcliff says.

Yet, as seminal as the findings were, overall they explained only about 30% of autism cases. Neither was it possible to identify that definitive “core autism” set of genes. “We had hoped that there was one, but the answer is ‘no, not really’,” Sutcliff says. “Today’s data doesn’t allow us to do that.”

The data is very hard to fit with standard genetic models.”

Aiming to solve the rest of the puzzle, Wigler’s team proposed the unified hypothesis of autism. They postulated that there must be other kinds of mutations that weren’t possible to see so easily. For example, these mutations may not be occurring together in the genome but are instead spread out across multiple genes in different places. They also hypothesized that these mutations would be transmitted largely from the mother because—while mothers were better protected as females—they still could carry the autism-causing variants and then pass them onto their children. “We made a unified hypothesis, stating that autism results from de novo mutations and is transmitted by the survivors of the de novo, namely the girls,” Wigler says.

Eventually, when there were enough large sample collections, with enough genome data, Wigler, in collaboration with Matt Wroten and Ivan Iossifov, both of Cold Spring Harbor Laboratory, and Kenny Ye from Albert Einstein College of Medicine, developed a method to test their hypothesis. Specifically, the team wanted to measure the genomic differences between siblings that were discordant for autism (meaning one has it and the other doesn’t) and concordant for autism (meaning both siblings have it). Overall, they applied the method to about 1,300 pairs of concordant siblings and 4,500 pairs of discordant siblings from the SSC, AGRE, and SPARK collections.

But the simple hypothesis that the mothers passed a strong autism-causing variant didn’t stand the test. “Surprisingly, we observed that the concordant siblings shared more of the fathers’ genomes.” Wigler says. “The more extensive sharing of paternal than maternal genomes contradicted our expectations that mothers will be the primary source of damaging variants in the high-risk multiplex families.” And that meant that there was more work to do: more hypotheses to formulate and prove.

Some hypotheses invoke complex genetics, and these might be correct, but Wigler and colleagues doubt it will be the full story. “The data is very hard to fit with standard genetic models,” he says. They already have some other ideas that might help explain the mystery. He and another Cold Spring Harbor Laboratory researcher, Tobias Janowitz, considered theories that the mother’s immune system plays a role, potentially impairing fetal development. Recent research supports such a theory. A 2017 study by Johns Hopkins Bloomberg School of Public Health team concluded that when pregnant mothers have fevers, their children’s risk of autism increases. A 2018 study by Columbia University researchers found that if a pregnant woman suffers a high fever in her second trimester, her child’s chances of developing autism increase by 40%.

Healthy pregnancies are a good start to reducing autism severity and risk.”

Michael Wigler, Ph.D.

The immune system can play an even greater role in the mother-father conundrum, Wigler thinks. For example, the father may be carrying an antigen—meaning a protein—that the mother’s body doesn’t like so it attacks it in the fetus. “The father may not be carrying an autism risk gene—just an antigen that the mother doesn’t like,” Wigler explains. “The kids who have autism, may be kids who’ve suffered from an immunological attack on them while they were in utero. Some portion of autism might not be caused by conventional genetics, but by the maternal-fetal conflict.”

While some genetic causes of autism, like the copy number variations, have become proven culprits, others will take longer to identify. A full list of autism’s genetic underpinnings might take years, if not decades, to put together, and it still may be incomplete. In the meantime, Wigler says, healthy pregnancies are a good start to reducing autism severity and risk. That involves parents and physicians. Doctors can monitor pregnancies better. They can intervene earlier. They can watch out for certain dangerous conditions that occur in pregnancies, such as preeclampsia—a problem related to the placenta. “There isn’t much we can do about genetic mutations yet, but we can work on the maternal-fetal conflict,” Wigler says. “If we could control that process better, we could have healthier babies and reduce autism risk.”

Written by: Lina Zeldovich, Science Writer | publicaffairs@cshl.edu | 516-367-8455

FROM https://www.cshl.edu/after-100-years-of-research-autism-remains-a-puzzle

Luz Raquel Padilla: la madre de un niño autista que fue quemada viva tras denunciar amenazas en México

• Marcos González Díaz
• Corresponsal de BBC News Mundo en México

22 julio 2022

«Ella se dedicaba por completo a cuidar a su hijo. Era su vida estar al lado de su hijo. Era muy alegre, con esa chispa que te hacía reír con sus ocurrencias. Muy buena amiga y buena madre comprometida».

Así recuerda Mily Cruz Díaz, coordinadora en Jalisco del colectivo Yo Cuido México, a Luz Raquel Padilla, brutalmente asesinada por un grupo de personas que la rociaron con alcohol y prendieron fuego en un parque de Zapopan, México.

La joven pertenecía a esta asociación -que aglutina a otras cuidadoras de personas dependientes- como madre de un niño con autismo en el que se enfocaba prácticamente las 24 horas.

Su asesinato provocó un gran impacto e indignación en México no solo por su brutalidad, sino por el hecho de que previamente ya había denunciado ante la policía y en sus propias redes sociales numerosas amenazas de muerte y agresiones por parte de vecinos de su edificio.

Pero, una vez más, ponerlo en conocimiento de las autoridades no evitó el ataque sufrido el sábado 16 de julio y que el martes 19, tras tres días de agonía con casi el 90% de su cuerpo quemado, acabara falleciendo.

Over the past few years, more and more people have asked themselves how they can create an autism-friendly environment. Architects have written about designing autism-friendly buildings and families have remodelled rooms to provide positive sensory experiences.

It is clear from listening to people who have an autistic spectrum condition that they can experience the world very differently to others. This can be both debilitating and empowering. In creating an autism-friendly environment we must try to reduce the negative effects of sensory differences and enhance the positive effects.

Every individual on the autism spectrum will experience the world differently from a sensory point of view; therefore, the points below are very generic and, where possible, attention needs to be paid to each individual’s preferences.

Questions we need to ask ourselves

Before we begin to remodel a room or design a building there are some questions we should be asking ourselves to help inform how we will go about making changes that will be positive for individuals with autism. Many of these questions entail assessing the existing environment and taking into account the seven sense indicators, as well as being attentive to the people who will be using the environment.

It is important when considering the questions relating to the senses to remember that people with autism can be either hypersensitive (receive too much sensory information) or hyposensitive (receive too little sensory information). They can also be both hypersensitive or hyposensitive, requiring less stimulus at times and more at others.

The questions we should ask ourselves when trying to create an autism-friendly environment deal with –

1. Visual sense (Sight)
2. Auditory sense (Hearing)
3. Touch and pressure sense
4. Olfactory sense (Smell)
5. Taste sense
6. Vestibular sense(Balance)
7. Proprioceptive sense (Space)
8. Who will use the space?
9. What the space will be used for?

Questions dealing with visual input

• What is the lighting like in the rooms, both natural and artificial?
• What colour are the walls?
• How many things are in the room that would require visual awareness/recognition?
• Are curtains, carpets and furnishings patterned?

Lighting plays a large part in the sensory experiences of many autistic people. We now know that fluorescent lights can be distracting to the point of debilitating for some people because they can see the lights flickering at 60 flashes per second (60Hz). Some fluorescent lights have a flicker rate of 120 Hz.

Natural lighting also plays a part, especially with sleeping patterns. One reason is that melatonin (a hormone which helps to regulate sleep/wake patterns). Usually melatonin rises during darkness and dips during daylight hours. If people with autism are experiencing sleep problems, one of the many strategies to try is to ensure that there is darkness during times of sleep.

Paying attention to colour is also important. Different colours have different effects on us. As an example, the colour red has the longest wave length and, therefore, can stimulate us and raise our pulse rate. Yellow also has a long wavelength and can stimulate. Light blues can calm the mind and aid concentration. Green can be restful. Think about the room you are designing – are you trying to create a stimulating environment or a calming one?

How cluttered or minimalist rooms are should also be taken into consideration. Many autistic people are particularly observant of every detail and can become overwhelmed by too much visual information to process. Others need more visual stimulation.

Patterned fabrics can be particularly distressing to some individuals with an autistic spectrum condition. Patterns can be distracting and overwhelming and can even cause visual distortion.

Questions dealing with auditory input

• Are there regular external sounds, such as traffic, children playing or building works?
• Are there regular internal sounds, such as clocks ticking, refrigerators humming, music?
• Is it possible to reduce external sounds from permeating to the inside?
• Is there a way of reducing sounds for each individual, such as earplugs?

Many people with autism tell us that they can hear sounds at many decibels above those others can hear. They can hear sounds that are a lot further away and the intensity of sounds can be deafening. They can be listening to rock music on high volume and still hear a conversation in the room next door.

Questions dealing with touch and pressure

• Is there an area that provides for different textures to be felt or stroked?
• Are there items to provide different feelings on the skin, such as sand or water?
• Are there items to provide pressure if needed, such as wooden massagers?

Some autistic people shun touch unless they are in control of it. Others need extra pressure to feel calm and safe and benefit from items such as weighted blankets if used appropriately. Some people need extra stimulation to feel, if they are particularly hyposensitive (filter out too much sensory information as opposed to too little).

Questions dealing with the sense of smell (Olfactory)

• Are there any smells outside of the room or building that permeate through the walls, windows or doors?
• Are there any smells from indoors that can cause distress, such as cleaning products, perfumed products or foods?

Some people with autism find smells so overwhelming that they cause extreme nausea. Some will even smell the product long after it has been removed from the room or cupboard.

Questions dealing with taste

In creating an environment where the sense of taste will be used, such as dining rooms, it is worth remembering that sometimes we can assume a distaste for a flavour when the distaste could be something else. It is possible that distaste can come from a discomfort from the texture of the food, or the appearance of the food. Questions to ask would be –

• Have we created an environment where choice is available and clear to see?
• Are choices of foods shown pictorially as well as in words?

Questions dealing with balance (vestibular) and space (proprioceptive)

• Are there opportunities for swinging?
• Are there opportunities to balance on beams or boards?
• Are there opportunities to bounce or climb?
• Are there opportunities for a person to sit with their backs against the wall?
• Are there opportunities to sit where a person can see the whole room?
• Are there quick exit routes?

Some autistic people find it difficult to have a sense of themselves in relation to the physical world around them. Rocking, swinging and balancing can help them gain a sense of self. Having too much room in front of them or behind them can cause anxiety if they need to have something directly behind them or in front of them to gain a sense of themselves. In addition, some people with autism experience anxiety if they cannot see what is happening or where sounds are coming from and they find this very disorientating.

Many people with autism need space around them and feel overwhelmed by crowds or clutter. They can feel hemmed in by corridors and need to know there is a quick escape route.

Who will use the space?

This might seem an obvious question to ask; however, it is important to think the answer through. The environment might need to be different for children or adults. You might also need to consider whether the same environment will be used by others who might have sensory differences, or by a group with very differing sensory needs. If there is a risk of sensory overload; is there somewhere else a person can go to escape from the overload?

What will the space be used for?

Some spaces are used for large groups of people, such as school halls or open-plan offices. Other spaces are for single use or small groups. Yet, other spaces are intended for transition, eg corridors or lifts.

Transition spaces can be difficult for people on the autism spectrum, because it can sometimes be difficult to move from one space to another or one activity to another.

Therefore, consideration needs to be made as to how to make transition spaces easier to deal with. Some questions you can ask are –

• Can there be a natural flow from one space to another without using a corridor? Are there less claustrophobic ways to go up or down a building than the use of lifts?
• If spaces are being used for large numbers of people, are there smaller spaces available for retreat if necessary?
• If spaces are small and intimate, are there opportunities to go easily to a more open space?
• Can you create a map of where individuals with autism seem to become most anxious? Are there alternative routes?

Conclusion

There are architects who specialise in designing buildings that are autism-friendly such as Maria Luigia Assirelli Dott. Arch (Rome) ARB, partner in GA Architects and Magda Mostafa, associate professor in the Department of Construction and Architebtural Engineering in Egypt. However, we can all play a part in providing an autism-friendly environment by taking into consideration sensory differences and the need for structure.

Although every individual on the autistic spectrum will have their own environmental needs, there are some general questions we can ask ourselves to create a physical environment that will reduce anxieties as opposed to increasing them. We need to pay attention to all seven of the senses – visual, auditory, olfactory, taste, touch, vestibular and proprioceptive. We also need to pay attention to space and how it is used.

Addressing everyone’s personal preferences will always be difficult; however, some thought and consideration can make all the difference to some.

by Manar Matusiak FROM https://livingautism.com/create-autism-friendly-environment/

Una de las actividades más relajantes para un autista es pasear, sin embargo a pesar de ser una actividad ludica sencilla no esta exenta de cietas medidas de precaución.

Lo primero es proveerse de una bolsa o mochila y al menos llevar agua, algo de comer que le guste y pequeñas ayudas como pañuelos, quiza algún objeto que le calme en una situación de más escitación y poco más.

Planificar un poco el itinenario es aconsejable, que tenga sitios de parada por ejemplo un banco para sentarse a la sombra si hace sol o sitios donde guarecerse si hay riesgo de lluvia.

Es ideal que desde el principio se creen cierta complicidad, por ejemplo, caminar juntos pero no de la mano, solo se da la mano cuando se va a cruzar una calle o cuando es necesario. Se debe caminar en paralelo anque si no es posible de puede combinar con uno delante y otro atras.

Cuidado con los peligros en las calles de la ciudad, respetar los semaforos para que se acostumbre a su significado de luces y sonidos.

Evitar sitios ruidosos o con mucha gente, si fuera así hay que buscar otro sitio por donde pasear.

Conviene repetir itinerarios pero que no sean unicos, combinarlos, variarlos, de modo que siendo conocidos no siempre se hace lo mismo, pero que incorporen un serie de paradas y constumbres como puede ser sentarse en una zona, tomar alli una fruta, etc.

No es adecuado que el trayecto sea muy largo e ir avanzando poco a poco.

También es adecuado tener un parque o zona de naturaleza para salir de la ciudad, hay determinados sitios que son de especial atractivo como cascadas, fuentes de agua, etc.

Diagnosis in Young Children

Diagnosis in young children is often a two-stage process.

Stage 1: General Developmental Screening During Well-Child Checkups

Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits, with specific autism screenings at their 18- and 24-month well-child visits. A child may receive additional screening if they are at high risk for ASD or developmental problems. Children at high risk include those who have a family member with ASD, show some behaviors that are typical of ASD, have older parents, have certain genetic conditions, or who had a very low birth weight.

Considering caregivers’ experiences and concerns is an important part of the screening process for young children. The health care provider may ask questions about the child’s behaviors and evaluate those answers in combination with information from ASD screening tools and clinical observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.

If a child shows developmental differences in behavior or functioning during this screening process, the health care provider may refer the child for additional evaluation.

Stage 2: Additional Diagnostic Evaluation

It is important to accurately detect and diagnose children with ASD as early as possible, as this will shed light on their unique strengths and challenges. Early detection also can help caregivers determine which services, educational programs, and behavioral therapies are most likely to be helpful for their child.

A team of health care providers who have experience diagnosing ASD will conduct the diagnostic evaluation. This team may include child neurologists, developmental pediatricians, speech-language pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists.

The diagnostic evaluation is likely to include:

• Medical and neurological examinations
• Assessment of the child’s cognitive abilities
• Assessment of the child’s language abilities
• Observation of the child’s behavior
• An in-depth conversation with the child’s caregivers about the child’s behavior and development
• Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

Because ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include:

• Blood tests
• Hearing test

The outcome of the evaluation may result in a formal diagnosis and recommendations for treatment.

Diagnosis in older children and adolescents

Caregivers and teachers are often the first to recognize ASD symptoms in older children and adolescents who attend school. The school’s special education team may perform an initial evaluation and then recommend that a child undergo additional evaluation with their primary health care provider or a health care provider who specialize in ASD.

A child’s caregivers may talk with these health care providers about their child’s social difficulties, including problems with subtle communication. These subtle communication differences may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. They also may have trouble forming friendships with peers.

Diagnosis in adults

Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety disorder or attention-deficit/hyperactivity disorder (ADHD).

Adults who notice the signs and symptoms of ASD should talk with a health care provider and ask for a referral for an ASD evaluation. Although evaluation for ASD in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about:

• Social interaction and communication challenges
• Sensory issues
• Repetitive behaviors
• Restricted interests

The evaluation also may include a conversation with caregivers or other family members to learn about the person’s early developmental history, which can help ensure an accurate diagnosis.

Obtaining a correct diagnosis of ASD as an adult can help a person understand past challenges, identify personal strengths, and find the right kind of help. Studies are underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of autistic transition-age youth and adults.