The Earliest Findings in Autism

Problems abound throughout the gastrointestinal system of many ASD patients. Of the eleven originally-described autistic children (8 boys and 3 girls), Dr. Kanner noted:

Donald… was breast fed, with supplementary feeding, until the end of the eighth month; there were frequent changes of formulas. “Eating,” the report said, “has always been a problem with him. He has never shown a normal appetite…

Richard…  mother began to “train” him at the age of 3 weeks, giving him a suppository every morning “so his bowels would move by the clock…

Paul… vomited a great deal during his first year, and feeding formulas were changed frequently with little success…

Barbara… nursed very poorly and was put on bottle after about a week. She quit taking any kind of nourishment at 3 months. She was tube-fed five times daily up to 1 year of age…

Herbert… vomited all food from birth through the third month. Then vomiting ceased almost abruptly and, except for occasional regurgitation…

Alfred… For the first two months, “The feeding formula caused considerable concern…

Charles… developed an obsession about feces, would hide it anywhere ( for instance, in drawers), would tease me if I walked into the room… he is still not toilet trained. He never soils himself in the nursery school, always does it when he comes home. the same is true of wetting. He proud of wetting…

John… The father said: “The main thing that worries me is the difficulty in feeding. That is the essential thing… During the first days of life he did not take the breast satisfactorily. After fifteen days he was changed from breast to bottle but did not take the bottle satisfactorily. There is a long story of trying to get food down…

See a pattern there? Apparently, not the same one as Dr. Kanner, who focused on faulty parenting. Perhaps surprisingly, he also noted the delayed motor responses, “According to Gesell, the average child at 4 months of age makes an anticipatory motor adjustment by facial tension and shrugging attitude of the shoulders when lifted from a table or placed on a table.” This was a common skill that his patients seemed to lack. All of this from the father of modern child psychiatry.

That was 1943. The public is often fed media stories proclaiming “breakthrough” discoveries of the “earliest signs of autism.” Recent articles have reported on MRI scans, head lag, and new parental concerns indicating earlier diagnosis, Many books have been written on the subject and screening kits are available. Even my description of core hypotonia is simply another early sign of motor weakness.

The earliest signs were detailed in the earliest literature. Feeding problems and low tone either leading to developmental delay or presenting as signs and symptoms of it, have been written about for 70 years. Yet, little progress has been made towards a more precise diagnosis; let alone etiology, effective treatment, prognosis or prevention of this modern epidemic.

Earlier diagnosis can lead to earlier interventions and improvement. A thorough evaluation with a high index of suspicion will help identify even more at-risk youngsters. Increasing the number of diagnosed children should boost research funding.

Let us hope that the focus shifts towards making a more precise diagnosis and assigning successful interventions to the various presentations of this condition. I fear that the new language of the DSM 5.0 and a continuous stream of debates about whether there are more cases of ASD interfere with such progress. Furthermore, thinking that autism is hard-wired and not subject to medical intervention often frustrates treatment efforts.

So, for now, doctors such as myself working with families such as our patients will just have to do it ourselves.

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