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Autism Spectrum Disorder-A Paediatric Dentist's Perspective

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Autism Spectrum Disorder-A Paediatric Dentist's Perspective :O p e sm n A ti c u c A e s s Autism - Open Access Berman, Autism Open Access 2015, 6:1 DOI: 10.4172/2165-7890.1000158 ISSN: 2165-7890 Perspective Article Open Access Journal Autism Spectrum Disorder-A Paediatric Dentist’s Perspective Marvin H Berman* Bridle Lane, Bannockburn, Illinois 60015, USA *Corresponding author: Berman MH, 1 Bridle Lane, Bannockburn, Illinois 60015, USA, Tel: (847)295-9393; E-mail: [email protected] Rec date: September 02, 2015; Acc date: December 14, 2015; Pub date: December 21, 2015 Copyright: © 2015 Berman MH. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction the lack of babbling or meaningful gesturing, repetitive hand flapping, failure to respond to their name, excessive single word usage without Most recent reports published by the Autism and Developmental spontaneous phrases, an aversion to hugging or touching, and Disabilities Monitoring network under the auspices of the Centres for difficulty in making eye contact. All of these symptoms and others may Disease Control and Prevention predict that one in every 150 children be mild, or severe enough for parents to seek professional advice, will suffer from some kind of autistic spectrum disorder (ASD), with a hoping for a remedy [8,9]. 4-to-one prevalence of boys over girls [1]. The etiology of ASD is currently unknown, and there is no known cure [2]. In a 2009 study The American Academy of Pediatrics recommends a well-child involving phone conversations with 78,000 parents of US children who screening for ASD at 18 to 24 months of age using formal autism were identified by a health professional as having an ASD, the screening tests [10]. Its most recent policy statement suggests that prevalence of ASD amongst 3 to 17 years old was estimated to be as “early identification of developmental disorders is critical to the well- high as 1:100 [3].This article discusses the diagnosis, etiology, and being of children and their families. Further, it is recommended that clinical aspects of ASD that are pertinent to dental professionals who developmental surveillance be incorporated into every well child visit treat these patients. and any concerns be addressed promptly. The sooner the disorder is identified, the soon-er that interventions can be instituted” [11]. Statistics The definitive diagnosis of ASD is usually made by pediatricians, psychologists, or psychiatrists who institute a process of analysis which The alarming rise in the statistics of ASD and the multifaceted involves a developmental and clinical history, tests for cognitive efforts of parent-led advocacy groups has put the ASD issue front and function, and assessment of receptive and expressive language skills. centre for scientific researchers, healthcare providers, educators, and Evaluation of each of these components requires a great deal of time the broad expanse of society [4]. Bombarded with news reports and patience, especially if the child is very young or is reluctant to concerning a host of social and health issues, the sheer mass of global cooperate. Pervasive developmental disorders, Asperger’s syndrome, statistics becomes an impersonal and overwhelming blur. In the case of Rett syndrome, and childhood degenerative disorders are all autism, the statistics have taken on real meaning with a palpable considered a part of the ASD group, but the distinction between the relevance and challenge for the dental profession. various entities is not always clear. Whether the statistics represent an increased incidence of autism or Pervasive developmental disorder-Not otherwise specified whether society has simply become more aware of the condition (or both) is a matter of conjecture. There is also the question of whether The diagnosis of pervasive developmental disorder is made when the parameters for labelling a child autistic have become so broad that some autistic symptoms are evident but the entire set of criteria is not the alarming statistics are distorted [1,5,6]. However, there is no present. Generally these children are higher functioning, have fewer question that those who actively work with children are encountering communication problems, and often respond very positively to patients with increasing frequency that have been diagnosed with interventions. autistic disorders. Dentists treat very young patients in an up-close, Asperger’s syndrome personal atmosphere where communication is absolutely essential. Often, dentists may be the first healthcare providers to recognize that a This condition (named for Hans Asperger) is one of the higher one or 2-year-old child has some type of extraordinary pervasive functioning forms of ASD and is distinctive because these children behavioral disorder that a parent, fearing the worst, may have generally speak with clarity and have the ability to have normal suspected instinctively and emotionally but never faced objectively. In conversations [12]. Some authorities prefer to consider Asperger’s many instances the idiosyncratic behavior is mistakenly attributed to syndrome separate and apart from autism. A definitive diagnosis or immaturity or the “terrible 2s.” differentiation may be nearly impossible to establish. Persons with Asperger’s think very literally without subtlety or nuance…concrete Diagnosis rather than abstract. They may speak obsessively about a particular subject of special interest to them and be reluctant to move on to ASD is a “catch-all” term that refers to a highly variable range of another topic. Their ability to socially interact is noticeably impaired, neurodevelopmental disorders observed in young children [7]. therefore establishing or maintaining friendships with their peers is Currently, there are no empirical biological tests (e.g., blood tests or negatively impacted [13-15]. brain scans) for ASD that are reliable. Parents, caregivers, teachers, or healthcare workers may notice some aberrant behaviors, language Rett syndrome delays, odd speech patterns, or mood swings that indicate a need for a Rett syndrome is a degenerative disorder, which has its onset in consultation with various specialists. By the time a child has reached infancy, and all of the autistic symptoms are more severe in nature 24 months of age, 80% of parents of children with an ASD are noticing Autism Open Access Volume 6 • Issue 1 • 158 ISSN:2165-7890 Autism Open Access Citation: Berman MH (2015) Autism Spectrum Disorder-A Paediatric Dentist’s Perspective. Autism Open Access 6: 1000158. doi: 10.4172/2165-7890.1000158 Page 2 of 6 both physically and mentally. The etiology is thought to be a genetic definitive awareness of where his body is in space. In the more severe mutation, predominately affecting girls. The self-infliction of pain, situations, various chew toys or gloves are employed in an attempt to nonverbal temper tantrums, lack of speech, and lack of interest in their mitigate the physical damage [27,28]. Dentists should not confuse the surroundings are often accompanied by severe physical limitations as self-infliction of pain as a sign that they can treat these patients well. The condition is rare but devastating [16]. without local anaesthetic. These patients do feel pain, but their interpretation of that external pain is unclear. Some autistic authors History and Nature of Autism have related that the self-infliction of pain gives them a “sense of reality.” Autism, as an entity, was first described by Hans Asperger in 1938 [17]. Leo Kanner of Johns Hopkins first used the term “autism” in the It should be noted that the variations in symptoms and behavior modern sense in the 1940s, referring to it as “early infantile autism” make accurate diagnosis of the various ASD entities very difficult. One [18]. child may be nonverbal, using gestures or screams, whereas another child may talk incessantly and compulsively about a favorite subject. Based on the Greek word “autos,” meaning “self,” autism was This kind of behavior should not be mistaken for a lack of intelligence. extrapolated to mean “alone, preoccupied with self, a withdrawal into Many of these children have surprising powers of observation and private fantasy,” the kind of self-isolation where any stimulation from hidden talents despite their seeming inability to relate socially to the the outside world may be an intrusion [19]. everyday world. “Autistic savants” exhibit these characteristics to the The diagnosis of ASD is based on both testing and behavioral extreme [22]. observation of an extensive list of characteristics such as impairment of social interaction and communication, restricted interests, and focus Etiology and repetitive behavior. These characteristics become more evident The etiology of ASD is an enigma. Highly regarded researchers are when in the course of treating these children clinicians observe the of the opinion that there is probably more than one cause since the lack of eye contact, echolalia (repetition of the last word you say), self- disorder can have such disparate manifestations. Genetics, infliction of pain, addiction to a specific routine and sometimes expert environmental poisons, neurologic psychopathy, dietary deficiencies, recall of complicated minutiae out of context with the moment. About and allergies have all been implicated [5]. At one time the villains were 30% to 50% of these children do not develop natural speech patterns thought to be “refrigerator moms,” referring to mothers who were not [20,21]. able or willing to bond with their newborn babies [29]. The theory was In some instances children affected by ASD will possess an amazing that a mother’s coldness toward her infant could cause that child to aptitude for music or art beyond the average, but at the same time they retreat from the world. may be incapable of managing the more mundane tasks of everyday Hypotheses revolving around allergies, food poisoning, vitamin life, such as dressing themselves, brushing their teeth, etc.
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