By: Catherine Joachin
What is autism spectrum disorder?
Autism spectrum disorder (ASD) is an umbrella term that encompasses various developmental disabilities (American Psychiatric Association, 2013). This diagnosis covers different levels of autism, including Asperger syndrome and pervasive developmental disorder, which were both considered separate conditions under the previous iterations of the Diagnostic and Statistical Manual of Mental Disorders (Cleveland Clinic, 2023). Characteristics of autism spectrum disorder include social communication difficulties, poor social awareness, poor interaction skills and a preoccupation for restricted or repetitive behaviors (Centers for Disease Control and Prevention, 2022). These traits generally appear in early childhood, but autism can be diagnosed at any age (National Institute of Mental Health, 2023). Symptoms can also vary with respect to age, verbal and intellectual ability and disorder severity, but people with ASD tend to struggle with:
* Establishing and maintaining eye contact
* Engaging in reciprocal social interaction
* Adopting context appropriate social behavior.
* Coping with changes in routine
* Maintaining age-appropriate friendships
* Discerning and acting on gestures and non-verbal social cues
(World Health Organization, 2019)
Individuals with autism spectrum disorder also tend to show heightened interest in specific areas and little to no interest in activities unrelated to said areas (American Psychiatric Association, 2013). Lesser characteristics include delayed language, motor and cognitive skills, hyperactive and/or inattentive behavior, epilepsy and seizure disorder as well as unusual fear, emotional and mood responsiveness (Centers for Disease Control and Prevention, 2022).
Autism spectrum disorder can present itself with a comorbid intellectual development and/or language impairment (World Health Organization, 2019). Being female also represents risk factor for autism. Diagnosis for autism spectrum disorder generally includes medical exams, assessments, as there is no regulated distinctive instrument that can be used to identify the condition.
There is no standard treatment for autism spectrum disorder; however, structured interventions can improve target abilities in social interaction or behavioral deficits (National Library of Medicine, n.d.). Certain treatment procedures having been flagged as ineffective or harmful (e.g. secretin injections, ceasing vaccinations, chelation), but skill learning strategies tend to be beneficial (Eunice Kennedy Shriver National Institute of Child Health and Human Development, 1998; National Health Service, 2022)
While statistics vary significantly, prevalence of epilepsy rates in individuals with ASD range from 4 to 38%. In children, this co-occurrence is associated with intellectual disability and lower socioeconomic status (Richard, Scheffer & Wilson, 2017; Durkin & Yeargin-Allsopp, 2018).
The etiology of autism spectrum disorder is unclear, but research suggests that a combination of environmental and genetic factors could be at play. Supporting this link, recent identical twins studies have report between 64 to 91% chance of both twins having ASD (Tanai et al., 2008; Tick et al., 2016). No form of autism is caused by the administration of vaccines.
Autism spectrum disorder and epilepsy
Approximately 30% of individuals with either ASD or epilepsy are affected by the other disorder. However, in spite of evidence suggesting that prevalence rates in either population is higher than in the general public, combined epilepsy and autism is frequently left undiagnosed. In cases where autism-consistent difficulties succeeded epilepsy onset, delayed emergence of developmental deficits might hinder the likeliness of receiving an ASD diagnosis (Holmes, Sawer & Clark, 2021).
Studies have suggested that epilepsy and autism spectrum disorder rely on some of the same neurobiological networks, independent of the presence of an intellectual disability (Bozzi, Provenzano & Casarosa, 2017; Richard, Scheffer & Wilson, 2017; Specchio et al., 2022). Emerging research in this area hopes to facilitate the development of diagnostic instruments and therapeutic strategies that could improve the prognosis of individuals affected by this comorbidity (Jeste & Tuchman, 2015; Su, Chi, Lin & Yang, 2016; Specchio et al., 2022). Animal studies have already identified models to explore the neural mechanisms underlying combined ASD and epilepsy symptomology by measuring observable behavior in rodents experiencing epileptiform brain activity (Gilby, 2008; Lewis et al., 2018).
In terms of treatment outcomes, there is currently not enough evidence supporting the benefits of drug treatment in people with both epilepsy and ASD (Tuchman, 2000; Hirota et al. 2013). Contrastingly, behavioral interventions such as Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) report higher well-being levels and quality of life and yield positive results in terms of behavioral and mood outcomes in participants with epilepsy, providing promising therapeutic recommendations for individuals affected by ASD symptoms and epileptiform activity (Mannion & Leader, 2014).
In conclusion, autism spectrum disorder and epilepsy are highly co-occurring conditions who together often go under diagnosed. Despite there being no cure for these disorders, further research on their association can provide beneficial care and management strategies for people affected by this comorbidity.
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