Patterns in Autism

All of my patients are interesting and important, however out of the 7 children whom I examined last Wednesday, the most unusual were two sets of identical twins.

The boys, Adam and Alex, first presented to me about a year ago as three year-olds with classical signs in all three domains (social, speech, and behavior), though Adam was more “with it” than his brother.  They both were begun on regimes to improve their health and well being and improve energy utilization, plus continuing traditional therapies through the educational system. They have both improved markedly, though Adam continues to make more rapid progress than his brother. In fact, Adam appears all but typical at this time, with only slight delays in speech and language. An interesting aside, their younger sister is definitely not ASD, but loves to flap and jump when she is excited – mimicking what she had observed in her older brothers.

This was the first time that I was seeing Cara and Carly, and it was positively fascinating because one of them has autism, and the other one, well, seems to have escaped it. Their stories are similar to the boys in that they had developmental delays (late crawling and walking) plus delayed speech that led to an ASD diagnosis by 2-1/2 years of age. The parents got help with S&L, OT, PT, PLUS a bunch of ABA. After 6 months, Cara appears neuro-typical (though she is the one with more G-I symptoms) and Carly has made remarkable progress.

So, you have to think, what’s different, and what’s the same? What is it within the families, between each twin, and between the two sets that gives a clue to what is going on with infantile autism? I am aware that I am not the only doctor to think of this – twin studies are ongoing in search of answers through this channel. That research will discover much more than these clinical observations, I would hope. Back to these patients; historically and medically there are few apparent differences. The most obvious similarity that I was able to ascertain was the common element of chronically challenged G-I tracts in ALL of the kids.

Here are two sets of identical twins exhibiting behaviors that lead one child to have an ASD diagnosis, and the other to other to appear to be more amenable to therapeutic interventions. How could that be? Well, anyone who is friends with a set of identical twins will tell you that many of them are not the same – even as infants. One is fussy while the other is calm, one child seems to catch on better and another seems to be better at sports. Their genes are the same yet the manner in which each child reacts to the environment is different. It really is NOT that surprising then, that sometimes, infants “on the fence” for developing a medical disorder can fall one way or the other depending on a variety of known and unknown forces.

Think of it, there are more autoimmune diseases now than ever before. Asthma is increasing, as is Lupus (SLE) and thyroid disease. Then, there are the disorders which are possibly associated with immunity such as Multiple Sclerosis, Alzheimer’s Disease and many cancers. Some of us get these disorders, others seem to escape them. And children nowadays, for no apparent reason at all, are experiencing an epidemic of childhood autism.

What do we learn from this, young Padawan?
I think that we ALL might be just one or two chemicals away from disaster.

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