Guest: Dr. Jane M. Charles - Pediatric Genetics & Development
Host: Dr. Linda Austin – Psychiatry
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin and I am talking today with Dr. Jane Charles, who is a Developmental-Behavioral Pediatrician. Dr. Charles, let’s talk about the autistic spectrum disorder. Can you explain what that means?
Dr. Jane M. Charles: The spectrum refers to severity of symptoms. All of the autism spectrum disorders have common symptoms. Actually, there are three disorders; autistic disorder, Asperger disorder, and pervasive developmental disorder, not otherwise specified. But all three have common symptoms and deficits in three areas. The deficits are in communication, so it’s in the language; language delay in particular or odd or unusual use of language. The second area is in social reciprocity or social interaction, being able to relate to people appropriately, and the third area is in perhaps stereotypical behaviors or unusual behaviors and or what we call limited interest, so when they are overly focused in one particular type of interest. In autistic disorder, you have deficits in all three of these areas. So, you have deficits in language, social interaction, and unusual behaviors and Asperger disorder is a little bit different. The key to Asperger disorder is that you cannot have language delay in order to receive the diagnosis of Asperger disorder. So, in general, in Asperger disorder their children have developed normal milestones for language and such that by age three, they should be using short sentences. Now, sometime they may have some strange use of language, but they should not have language delay. The big key for Asperger disorder is the lack of social reciprocity or lack of understanding of give and take conversation and they also have unusual interests, very limited interest, and can be overly focused on very odd subjects.
Dr. Linda Austin: What is the third entity?
Dr. Jane M. Charles: The third category is called pervasive developmental disorder, not otherwise specified and we call it PDD-NOS. It is a confusing term and it’s a little difficult to understand, but the best way to understand PDD-NOS is to think of it as when you don’t quite meet all the criteria for autistic disorder. So, basically it is a mild form of autism and you still have deficits in the three areas of communication, social interaction, and unusual behaviors, but to a much lesser degree than a child with autistic disorder; that’s what PDD-NOS is. Now, the services and the interventions for all three autistic disorder, Asperger disorder, and PDD-NOS are about the same. So, in a way, it doesn’t make that much difference whether what you are diagnosed with because we are going to all treat at the same way anyway
Dr. Linda Austin: So, in other words, these are not black-white, but there are shades of grey and every child is a little different with a different array of strengths and weakness.
Dr. Jane M. Charles: Exactly, it’s very good way to put it.
Dr. Linda Austin: And so you do your best to describe that, but in the end, it’s not so important exactly how you describe it as I would imagine as to how you craft a therapeutic program for that child.
Dr. Jane M. Charles: Right.
Dr. Linda Austin: Can you describe what some of those therapeutic interventions are?
Dr. Jane M. Charles: The first thing, we try to get kids involved with a speech therapy to try to catch them up on their language. We also use occupational therapy because children with autism spectrum disorders frequently have fine motor issues. So, they are very young, it maybe buttoning, tying shoes, snapping, using utensils, and then as they get older they may have difficulty with writing. Children with autism spectrum disorders also have a difficulty with an area called sensory integration.
Dr. Linda Austin: I am sure that’s a big topic, but can you describe a little bit of what sensory integration problems manifest themselves as?
Dr. Jane M. Charles: Children with autism have difficulty organizing the input that they have received from the environment. So, they have difficulty coordinating sounds. They have difficulty organizing movement, the way their bodies move through space. They have difficulty tolerating and organizing and interpreting touch, temperature, and making sense of what kinds of sensory inputs they are receiving from the environment. It’s very common issue in children with autism. So, one of our therapies that we do is sent children to occupational therapist where they receive sensory integration therapy. This is also -- it’s not -- sensory integration issues are not limited just to people with autism. You can have sensory problem and not have autism as well, but this is one component that we feel very strongly about having it treated pretty early on. An example, you may have heard about children with autism covering their ears a lot even if it’s a sound that would not bother you. They have difficulty going in auditorium or movie-theaters, where there is a lot of echoing and they may start screaming and run out with their ears covered. They may have difficulty tolerating having their clothes on and they may want their clothes off all the time or the other way around, they may have difficulty tolerating and having any clothes off and they want all their clothes on. They may not be able to walk barefoot at all. I have one patient, who put all of the clothes that she owns on because she is craving kind of a depressor type of feeling. Then, she goes and lays under her mattress. So, these are kinds of things that are very comforting to people with autism and I think it helps them to organize themselves and kind of make sense of what’s going around them.
Dr. Linda Austin: I guess one way to think about that is that something about the way the brain does or does not filter out sensations is off, so that they are either amplified or diminished in a way that is disturbing.
Dr. Jane M. Charles: Exactly.
Dr. Linda Austin: Or maybe, if you think about the way that we must all constantly modulate that or modify that, so that you walk into a room, you may smell something and you accommodate to that, get used to it very quickly or block out a sound, that process is off in those kids.
Dr. Jane M. Charles: Yes.
Dr. Linda Austin: Very basic mechanism. Let’s talk some about Asperger. Often times, kids don’t get that diagnosis until later. I would guess because they may speak fine and it may be a little harder to diagnose. What’s a typical presentation of those kids?
Dr. Jane M. Charles: Often, they are very socially awkward. They don’t have friends. They don’t understand how to approach another child and start a conversation. They also often have a particular focus subject that they are really focused on and refuse to talk about anything else and they don’t understand when the people get bored listening to them. For example, I had a patient once, who was very focused on everything about the United States. He could draw a picture of the United States with every state in it accurately freehand. Then he wanted to tell you all kinds of facts about the United States. Now, this was a young man who was in high school and when Michael Jordan was a big basketball player in college or in the Pro, I think he was in the pro and so I tried to engage him on what I thought would be a pretty typical conversation for a kid in high school and yet he totally was clueless about my trying to engage him and instead persisted on telling me, which state had the most native Americans, which was the smallest state, and on and on to the point where I was pretty bored with it and yet people with Asperger disorder don’t pickup on social cues to understand that they need to stop their conversation and move on to something else.
Dr. Linda Austin: And is that also a spectrum disorder. In another words, as you are describing this, I can think of people I know, who may have never been clinically diagnosed or treated but just aren’t very skillful socially. People, who don’t talk at meals, maybe very bright, maybe mathematically-scientifically inclined, but really have trouble with engaging in with empathy.
Dr. Jane M. Charles: Yes. In fact, it is considered as spectrum on the spectrum and even if they don’t meet criteria for a diagnosis, they can still have a lot of the same symptoms and they often as you said follow scientific and mathematical types of subjects and in career such as engineering and in fact we often see children with autism, who have parents who are engineers or computer programmers and all and if you think about it, these are subjects where the parent doesn’t have to engage a lot with other people while they are working and it’s very different for example then going into sales where you would have to be very social.
Dr. Linda Austin: So, in another words, this can run in families it sounds like this.
Dr. Jane M. Charles: Yes, very much. Autism spectrum disorders can run in families. That’s part of why we get a big history, family history to try to see if there are other people on the family that may have had for example obsessive compulsive -- been diagnosed with obsessive-compulsive disorder or an uncle or father, who was odd or kind of corky or didn’t engage, didn’t like to do social things with the neighbors. Only about 10% of the time can we actually find an etiology or a reason for why a child has autism and usually it’s a genetic disorder. So, we do, do genetic testing on every time we make a diagnosis of a child with autism, just to try to pick up in that small percent to see if the child might be one of the small percent that has a genetic disorder that is commonly expressed as an autism spectrum disorder.
Dr. Linda Austin: Dr. Charles, thank you very much.
Dr. Jane M. Charles: Thank you.
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