Unit V: Medical Intervention & Alternative Therapies

1. Role of Medical Professionals

2. Medication: Symptomatic approach for hyperactivity aggression SIB, Preservation, Anxiety seizures, Sleep disorders

3. Alternative Therapies - Diet therapy, Megavitamin therapy, Auditory Integration Therapy, Music & Movement Therapy, Ayurveda, Yoga & Adaptive Physical Education, etc

4. Challenges & limitations of medication

5. Role of teachers

 

 

 

 

 

1. Role of Medical Professionals

A number of medical specialists can be helpful in treating various aspects of autism, including: 

2. Medication: Symptomatic approach for hyperactivity aggression SIB, Preservation, Anxiety seizures, Sleep disorders

Currently, there is no medication that can cure autism spectrum disorder (ASD) or all of its symptoms. But some medications can help treat certain symptoms associated with ASD, especially certain behaviors.

NICHD does not endorse or support the use of any medications not approved by the U.S. Food and Drug Administration (FDA) for treating symptoms of autism or other conditions.

Healthcare providers often use medications to deal with a specific behavior, such as to reduce self-injury or aggression. Minimizing a symptom allows the person with autism to focus on other things, including learning and communication. Research shows that medication is most effective when used in combination with behavioral therapies.

The FDA has approved the use of some antipsychotic drugs, such as risperidone and aripripazole, for treating irritability associated with ASD in children between certain ages. Parents should talk with their child's healthcare providers about any medications for children with ASD.

Other drugs are often used to help improve symptoms of autism, but they are not approved by the FDA for this specific purpose. Some medications on this list are not approved for those younger than 18 years of age. Please consult the FDA for complete information on the following listed medications.

All medications carry risks, some of them serious. Families should work closely with their children's healthcare providers to ensure safe use of any medication.

Healthcare providers usually prescribe a medication on a trial basis to see if it helps. Some medications may make symptoms worse at first or take several weeks to work. Your child's healthcare provider may have to try different dosages or different combinations of medications to find the most effective plan.

Families, caregivers, and healthcare providers need to work together to make sure that the medication plan is safe and that all medications have some benefit.

 

3. Alternative Therapies - Diet therapy, Megavitamin therapy, Auditory Integration Therapy, Music & Movement Therapy, Ayurveda, Yoga & Adaptive Physical Education, etc

People with ASD often may repeat behaviors or have narrow, restricted interests. These types of behavior can affect eating habits and food choices, which can lead to the following health concerns.

Caring for a child with ASD can be challenging on many levels, and healthful eating is no exception. For children with ASD, a nutritious, balanced eating plan can make a world of difference in their ability to learn, how they manage their emotions and how they process information. Because children with ASD often avoid certain foods or have restrictions on what they eat, as well as difficulty sitting through meal times, they may not be getting all the nutrients they need.

Two most common dietary concerns in ASD:

·      Restricted/Obsessive Diets

·      Using diet as a treatment for ASD ("Biomedical Interventions").

Restricted/Obsessive Diets

Many children with ASD have selective eating that goes beyond the usual 'picky eating' behaviour seen in most children at specific developmental stages. These types of self-limiting diets are usually a direct result of the disorder. The diet may be limited to as few as 2 or 3 foods.

Common Feeding Concerns include:

·      Difficulty with transition to textures (especially during infancy)

·      Difficulty accepting new foods

·      Restricted intake due to colour, texture, packaging and food temperature

·      Difficulty with meal time preparation e.g. specific plate and cutlery, positioning of food on a plate

·      'Continually eating' rather than having mealtimes

Strategies for dealing with Selective Eating

·      Most children do best when meal times are the same time, place, situation every day

·      Use visual timetables and visual schedules. Written timetables or picture symbol schedules detailing when and where they will eat, what will be eaten and the type of behaviour expected at meal times makes mealtimes more predictable and a less anxious occasion for the child.

·      Whilst children should not be restrained, seating that encourages staying at the table can be helpful.

·      Establish as calm and comfortable environment as possible

·      Some children eat more when they have a video or music on, whilst for others this may be too distracting.

·      Work to broaden the variety of a child's diet expanding on already accepted food groups e.g.: different types of bread

·      Do not assume that the child will automatically refuse a food in a new environment e.g. they may eat fish fingers at granny's but not at home.

·      Setting small goals in stages will allow the child step by step to reach a larger goal e.g. before encouraging a child to eat vegetables, they may need to learn to accept a small amount on their plate first. The amount may be as small as a pea but this allows the child to remain secure within the environment they are familiar with.

Changes in dietary intake will be a slow process and not all strategies will work for each child. Behaviour modification needs to be tailored to each individual child and family situation.

Knowledge of the composition of different foods, alternative substitutes and supplementation is the expertise the dietitian can bring to ensure the child has an adequate diet. Reassurance and advice during these critical periods of growth is a valuable use of dietetic resources. Special diets ("Biomedical Interventions") and ASD

The amount of information available via the Internet, books, parent networks and other organisations to parents of children with autism, can be overwhelming and often contradictory. Interest in the use of diet and vitamins as a therapeutic approach for autism is high. "Biomedical Interventions" are often advocated to parents of children with autism and there are often anecdotal reports of dramatic improvements. Although diets are a popular treatment for ASD there is a lack of consistent and good quality scientific evidence to support their recommendation as a treatment for ASD symptoms. The following is a brief overview of several of the most common dietary "treatments", focusing on approaches for which there is peer-reviewed research available. Peer -reviewed research is scientific, academic work which has been evaluated by others working in the same field (Oxford Dictionary of English, 2nd Edition).

1.Gluten Free Casein Free (GFCF) Diet

This is the most popular and best known dietary intervention. The theory behind the treatment:

It has been suggested that people with ASD have a gut which is abnormally "leaky". The poorly digested casein and gluten leak into the bloodstream where these "opoid-like" proteins interfere with the normal functioning of the nervous system, affecting mental function and behaviour. (The "Opoid" theory). It is therefore proposed that by eliminating foods containing gluten and casein from the diet, autistic behaviours may be reduced. 7776 evidence:

Well-respected independent reviews of the evidence have found it to be inconclusive and the GFCF diet cannot be recommended as a standard treatment for autism due to the limited data available.

2.  Exclusion of Phenolic compounds and foods high in salicylates

The theory behind the treatment:

This is linked to the findings of a small sample of children with ASD having impaired levels of enzymes needed to breakdown compounds in foods high in salicylates and phenolic compounds resulting in raised levels of neurotransmitters such as serotonin, which may affect behaviour. 77e evidence:

There is no evidence to suggest that avoiding these foods is beneficial.

3.  Exclusion of Food Additives

The theory behind the treatment:

It is believed that people with ASD cannot tolerate a range of additives, including Aspartame, MSG, artificial colours (e.g. sunset yellow (E110), tartrazine (E102), carmoisine (E122), Ponceau 4R (E124)) and sodium benzoate (E211) resulting in adverse affects on their behaviour. 77e evidence:

While the avoidance of particular additives is very common, there has been little good quality research on the affect of food additives on people with ASD.

4.  Yeast Free Diet

The theory behind the treatment:

It is believed that a "leaky gut" in people with ASD, may be caused by an overgrowth of yeasts in the gut, following treatment with antibiotics. This then results in behavioural symptoms of ASD, allergic reactions or increased susceptibility to allergies. The theory is that by eliminating dietary yeasts these symptoms can be prevented. 77e evidence:

Yeast overgrowth in the gut is usually treated by prescribed medications and there is no evidence that eating less dietary sources of yeasts helps.

5.Supplements

Vitamin and mineral supplementation, e.g. Vitamins A, C, B6, Magnesium, Zinc The theory behind the treatment:

People with autism may have abnormal or impaired metabolic or biochemical processes and high doses of vitamins or minerals may be needed to correct for this. 77e evidence:

Well respected, independent reviews of the evidence that supplementation with vitamins and minerals is beneficial, have found it to be inconclusive. Supplements can be costly and it

should also be noted that sometimes the suggested doses exceed the safe upper limit for adults and little is known about long term high doses in children.

6.  Fish Oils and other supplements rich in omega 3 fats

The theory behind the treatment:

Omega-3 fats play a key role in brain development and function. Imbalances or deficiencies of essential fatty acids may contribute to a range of behavioural, learning difficulties or neurodevelopmental disorders such as ASD. 7776 evidence:

While there is some evidence that omega 3 supplements improve other neurodevelopmental disorders such as learning difficulties, mood disorders and in children with developmental co­ordination disorder (DCD) there is not enough evidence available in the case of ASD. Fish oil supplements can be quite costly and more autism-specific research is required to add to our knowledge in the area, since we don't know enough about their longer term use and any associated health risks, or if the effects of supplements are greater than achieved by eating a healthy diet, as recommended for the general population.

7.  Probiotics and Enzymes

Probiotics can be taken as powders or as yoghurt drinks and there are also numerous digestive enzyme products aimed at people with ASD. 77e evidence:

There is no research currently available to indicate that probiotics have any therapeutic benefit in ASD. In addition, there is no evidence that enzyme preparations have a useful role in ASD. Safety and Biomedical Interventions

Despite the fact that there remains as yet, insufficient evidence to confidently recommend any of these biomedical interventions for the treatment of the condition, there are often many anecdotal reports of dramatic improvements available, which can be compelling enough to persuade parents to embark on this process.

There may be the perception that dietary change is safer than using medications, however, these dietary interventions are not without potential hazards. Elimination of foods containing gluten and casein, eg, in the CFGF diet is a significant change and could be nutritionally imbalanced, leading to nutritional deficiencies or poor growth, while little is known of the autism-specific effects of high doses of vitamins, minerals and fish oil supplements in children. It is therefore important to consult a Consultant Paediatrician, General Practitioner or Dietitian before commencing on any dietary intervention.

A qualified dietitian, eg, can discuss the implications of the diet for the individual patient weighing up potential benefits with the difficulties they are likely to face. They are likely to recommend that any intervention be undertaken on a trial basis initially, and can provide guidance to ensure a logical approach is undertaken during this trail period, so that as far as possible, the effect of the diet is clear and objective, while at the same time safeguarding its nutritional adequacy.

Megavitamin therapy

Megavitamin therapy is the use of large doses of vitamins, often many times greater than the recommended dietary allowance (RDA) in the attempt to prevent or treat diseases. Megavitamin therapy is typically used in alternative medicine by practitioners who call their approach orthomolecular medicine.

There are several reasons to suspect that children on the autism spectrum may not be getting sufficient nutrients, including chronic diarrhea or constipation, gastrointestinal inflammation, and a tendency to restrict food choices.  In addition, the possibility exists that children with autism do not break down or process the nutrients they do consume in expected ways.

Mega-vitamin therapy and other nutritional supplements are commonly used to treat children with ASD. Recent studies show that over 30% of parents are giving their children extra Vitamins C and B6, and over 25% are using essential fatty acids and magnesium. Other nutritional supplements reported in use by more than 10% of parents include Vitamin A, mega-vitamin therapy (non-specific), DMG (dimethylglycine), and L-glutamine.  The rationale for use and the expected benefits of many of these supplements vary, as does the evidence supporting them. In regards to maintaining a general state of good health, the use of a daily multi-vitamin is widely accepted and supported for children with ASD, especially given the self-restricted diets many of these children consume. Vitamin therapy and nutritional supplements beyond this, however, are not fully supported and need to be further studied.

VITAMIN C

Children with ASDs have not been found to suffer from a severe lack of Vitamin C.  Any beneficial impact its use may have for children on the spectrum is therefore not due just to making up a vitamin deficiency. What, then, might its effect be? There are several possibilities. Vitamin C, also known as ascorbic acid, is believed to influence the functioning of the human body and brain in many ways, including regulation of cellular immune function; as an antioxidant; and via its impact on the neurotransmitter dopamine.

VITAMIN B6 AND MAGNESIUM COMBINED THERAPY

The use of large doses of vitamin B6 (pyridoxine) was first reported to improve speech and language in children diagnosed with "autism syndrome" in the late 1960s.   Over the next three decades, a variety of studies were conducted in attempts to show that children with autism significantly improved on a regimen of Vitamin B6 with magnesium. (Magnesium was added to counter negative side effects that can come with large doses of Vitamin B6, such as irritability, hypersensitivity to sound, and bed-wetting.) Most of these reported positive outcomes, and called for more research to be conducted.   At least two studies found that children with autism had high levels of B6 in their blood -- evidence that their bodies were not efficiently converting the vitamin, and providing a reason why more B6 might prove helpful. 

DMG

Dimethylglycine (DMG) is not a vitamin, per se, but is sold as a nutritional supplement. It has been suggested that DMG is an immune enhancer in addition to being "metabolized in the liver, ultimately to glycine, an excitatory neurotransmitter."    Although DMG has been widely used to treat children with ASDs, the two double-blind, placebo controlled studies conducted to test it did not show it to be effective.   These were very small studies, however. Considering the large numbers of parents treating their children with DMG, and the repeated claims of effectiveness (especially in the areas of speech and behavior) made in the parent-advocacy literature over a great many years,  more research is warranted.

ESSENTIAL FATTY ACIDS (OMEGA 3)

Essential fatty acids, which make up about 20% of the dry-weight of the brain, are now believed to be crucial to the brain's optimal functioning. Called "essential" because they cannot be manufactured by the body, but must be acquired through the diet, these fatty acids have a major influence on a variety of biochemical processes involving the neurons, or nerve cells, in the brain. They can therefore impact both thought processes and behavior.   In addition, they are believed to help modulate the immune system  -- an interesting fact, considering that we now know some kind of immune dysfunction may well be involved in autism. 

 

Auditory Integration Therapy

Auditory integration therapy (AIT) was developed as a technique for improving abnormal sound sensitivity in individuals with behavioural disorders including autism. Other sound therapies bearing similarities to AIT include the Tomatis Method and Samonas Sound Therapy.

Practitioners of Auditory Integration Training (AIT) say that it can reduce:

These difficulties can cause discomfort or confusion in autistic children.

Some practitioners also claim that AIT can help to improve speech and language difficulties and other core features of autism.

Pioneer Dr. Alfred Tomatis (1920–2001), an internationally known otolaryngologist and inventor, adapted electronically modified music by Mozart to target diverse disorders such as auditory processing problems, dyslexia, learning disabilities, attention deficit disorders, autism, as well as sensory integration and motor-skill difficulties. His successor, Dr. Guy Berard, also an accomplished Ear, Nose and Throat (ENT) specialist, developed the current educational approach. Berard believed that behavioural and cognitive problems often arose when an individual perceived sounds in a “differential” manner. This, he said, happens when individuals perceive certain frequencies far more acutely than other frequencies. Sounds thus appear to that person in a “distorted” manner. This often leads to difficulties in comprehension and behaviour. Berard’s objective was to reduce “distorted” hearing and hypersensitivity of specific frequencies, so that after Auditory Integration Training (AIT), ideally all frequencies could be perceived equally well. The individual would than be able to perceive environmental sounds, including speech, in a normal fashion.

Today, children and adults with learning difficulties, attention deficit disorders, dyslexia, autism, and pervasive development delay have benefited from Auditory integration Training (AIT). An estimated 20% of the population suffer from distortions in hearing or sensitivity to certain sounds. This can contribute to inappropriate or anti-social behaviour, irritability, lethargy, impulsivity, restlessness, high-tension levels, as well as problems with language and reading. Improvements reported after receiving Auditory Integration Training (AIT) include more appropriate affect, expression and interaction; better articulation and auditory comprehension; and an overall increase in academic and social skills.

Who are potential candidates for Auditory Training?

Those who have sensitivity or distortions in the auditory system are candidates for Auditory Integration Training (AIT). Signs may include sound sensitivity, tuning out behaviour and auditory processing difficulties. They may exhibit the following behaviours:

What changes may result from Auditory Integration Training (AIT)?

Reported changes in client’s behaviour following Auditory Integration Training (AIT) have included:

·       increased attention to auditory input,

·       improved social behaviour,

·       increased interest in communication,

·       better eye contact,

·       improved articulation,

·       improved auditory comprehension

·       overall improvement in academic skills.

·       Reduction of sensitivity to sound impulsivity, aggressive behaviour, echolalia, distractibility and temper tantrums.

Music & Movement Therapy

Founded by Joanne Lara, Autism Movement Therapy is an established movement and music method for teaching individuals with autism. 

AMT offers an innovative, energetic and structured approach that stimulates the brain, aids sensory processing, develops communication and motor skills and addresses behaviours associated with ASD, all while having fun!

Reflecting a growing interest in the brain-body connection and incorporating Positive Behaviour Support strategies, AMT is an exciting approach which complements other therapeutic techniques for children on the autistic spectrum and has children meeting and achieving their speech, social and academic goals.

Music-based interventions are effective treatment tools for individuals with ASDs because they harness the musical strengths of this population while alleviating their impairments. We are offering three different reasons that make music-based interventions particularly attractive for individuals with ASDs. First, musical training may help address the various core autism impairments in joint attention, social reciprocity, and non-verbal and verbal communication, as well as comorbidities of atypical multisensory perception, poor motor performance, and behavioral problems. Second, children with ASDs find musical activities enjoyable, perhaps due to their enhanced musical understanding (Heaton, 2003). Children with autism have enhanced pitch perception abilities compared to typically developing children, for instance, enhanced pitch memory, labeling (Heaton, 2003), and discrimination (Bonnel et al., 2003). Therefore, clinicians and special educators often use music-based activities in school settings to engage children with ASDs (Hess et al., 2008). Third, music-based activities can be non-intimidating experiences wherein a child with ASD spontaneously explores various musical instruments, with the trainer joining in and copying the child's actions. Children with ASDs have difficulties with direct social engagement; hence, socially embedded group musical activities provide excellent opportunities to engage in predictable and comfortable interactions with social partners (Darrow and Armstrong, 1999; Allgood, 2003). In this review, we first provide evidence for the multisystem effects of musical experiences in facilitating various skills in children with autism, other neurological populations, and healthy individuals. Next, we discuss the critical elements of music-based activities and the popular music therapy approaches used in ASDs and other pediatric developmental disorders. Finally, based on the current literature, we provide recommendations for clinicians and clinical researchers working with children with autism including ideas for assessment and treatment.

 Ayurveda, Yoga & Adaptive Physical Education

Autism otherwise called as autism spectrum disorders (ASD) is one among the major concern of health sector worldwide. This is considered as a developmental or neuro developmental disorder which affects physical, mental and social development of a child and it is lifelong. This affects a child’s ability to behave in a society. With its holistic and authentic approach, Ayurveda gives new hope in management of ASD. Combination of panchakarma therapies, medhya aushadhas with yoga and diets will improve quality of life of autistic children to a great extent. 

Disorders like autism are considered as sahaja vyadhi according to Ayurveda which means diseases appearing from birth itself. These diseases arise due to factors transferred from parents and it can be considered as genetic disorders.

Prevention

Ayurveda believes prevention of disease is more important than curing. For autism prevention can be achieved through three stages such as prevention before consumption, during pregnancy and after delivery.

Prevention before consumption include detoxification of shareera through panchakarma chikithsa, rasayana seva,manovikara niyanthrana(controlling emotions of mind) etc. Panchakarma help in evading impurities of body(vitiated dosha).Through rasayana chikithsa regeneration of healthy tissues occurs which help in production of healthy sperm and ovum.

Prevention during pregnancy include proper diet and activities mother. manovikara niyanthrana (controlling unwanted emotion) is more important in this period. 

 

Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting an average of one in 37 children, and these conditions led to increase in the estimates from 13.6% to 16.8% (Suresh, 2018; Arora et al., 2018; Baio et al., 2018). The awareness and diagnosis of ASD, along with the limitations of current therapies, has necessitated more research for better treatments to improve lifelong outcomes and the dissemination of educational programs to the autism community. In the past decade, many researchers have investigated the effects of yoga on markers of impairment of social interaction/communication, stereotyped behavior, and sensory dysfunction.


To review the role of yoga through the following parameters among children with ASD:.

1.     Musculoskeletal function : Handgrip strength

2.     Cardiovascular function : Heart rate and blood pressure (BP)

3.     Neurological function : Reaction time

4.     Behaviors : Sensory processing, motor execution, social interaction, communication, and cognition.

Impaired musculoskeletal function

Kern et al. (2013) examined that children with ASD have significantly poorer handgrip strength as compared with neurotypical children. The evidence has shown musculoskeletal dysfunction or poor function that affects muscle tone, gross motor function and posture, balance, gait pattern, and neuromuscular coordination as found in twisting a bottle cap. Handgrip dynamometer is a valid tool for measuring overall muscle strength and suggests that children with ASD have muscle weakness. If such physical impairments include fine and gross motor problems (Provost, Heimerl & Lopez, 2007), movement/motor skill deficits (Green et al., 2009), dysfunctional posture and muscle tone (Jong, Punt, Groot, Minderaa & Hadders, 2011), hypotonia (Ming, Brimacombe & Wagner, 2007), balance problems (Minshew, Sung, Jones & Furman, 2004), and gait pattern differences (Calhoun, Longworth & Chester, 2011) reflect the issue of general physical condition in muscle weakness of children with ASD. Hardan, Kilpatrick, Keshavan & Minshew (2003) added that handgrip strength was significantly weaker in children with ASD. Bhat, Landa & Galloway (2011) stated that one of the earliest motor signs of an ASD may be weakness in pronation and supination as in turning a doorknob or twisting a bottle cap and also added that abnormal muscle tone in children with ASD may play a role in the limitations of activities of daily living. Anecdotal reports and limited research suggest that children with ASD are weaker in muscle strength. Thus, the functional effects of muscle weakness in children with ASD could be widespread.

Role of yoga in musculoskeletal function

There are few studies which show that yoga helps in improving musculoskeletal function. Dinesh et al. (2014) studied that pranayama improved handgrip strength and handgrip endurance by decreased autonomic arousal in healthy volunteers. Mandanmohan, Lakshmi, Kaviraja & Ananda (2003) demonstrated that yoga practices improve lung function, strength of inspiratory and expiratory muscles, as well as skeletal muscle strength and endurance. Bhavanani, Udupa, Madanmohan T & Ravindra (2011) reported that both fast and slow Surya Namaskar increase isometric handgrip strength and handgrip endurance. It is suggested that yoga can be introduced to autism population to improve muscle strength and overall health.

Impaired cardiovascular function

The perceived cardiovascular factors in children with autism are lowered cardiac vagal tone and no standard stimulus strengths. This factor influences autonomic response that leads to social, emotional, and cognitive dysfunction. Giblin, de Leon, Smith, Sztynda & Lal (2013) identified autonomic activity as a predictive tool for cognitive decline and reported that higher sympathetic drive may benefit calculation and memory skills while being detrimental to judgment, comprehension, orientation, attention and language ability. Rushmer (1972) analyzed that the stimulation of arterial baroreceptors at every heartbeat is enough with above 45 mmHg of mean arterial pressure, ejection pressures of the heart. Changes in arterial pressure induce the changes in cardiac cycle intervals (Julu, Kerr, Hansen, Apartopoulos & Jamal, 1997), so in autism the cardiac vagal tone is low, and Keele, Neil & Joels, 1982; Guyenet et al., 1996; and Jordan (1995) reported that cardiac vagal tone (amount of vagal efferent activity to the heart) relies on the degree of stimulation to arterial baroreceptors.

Role of yoga in cardiovascular function

Ming et al. (2005) incited against the statement of provoked autonomic responses to socioemotional stimuli (Hirstein, Iversen & Ramachandran, 2001; Palkovitz & Wiesenfeld, 1980). According to Ming et al. (2015), it requires standard stimulus strengths, which are difficult in children with ASD because of their uncooperativeness. Several evidences suggested that yoga increases parasympathetic nervous system (PNS) and gamma-aminobutyric acid (GABA) activity, which leads to improvement in cardiac function (Streeter, Gerbarg, Saper, Ciraulo & Brown, 2012).

Impaired neurological function

Several studies on histopathological, structural imaging, and head circumference in autistic children have shown increased brain volume; neuronal growth dysregulation; and associated abnormalities in specific neural sites of cerebellum, medial temporal lobe, and frontal lobe. Helen (2006) & Waldie & Saunders (2014) added neurological impairments related to deficits in interpersonal interaction such as problems remembering and identifying people; the inability to perceive social cues; and misunderstanding nonverbal cues such as gestures, facial expressions, and speech prosody as seen in children with ASD. The problem in the frontal cortex and the circuits leading to and from the frontal lobe is associated with neural level of executive functions. This includes planning, attention, social reciprocity, working memory, problem-solving, task switching, verbal reasoning, mental flexibility, monitoring of actions, and inhibitory control. Inhibitory control allows tolerating dominant responses or ignoring distracting stimuli in order to give an appropriate response, whereas in autism it inhibits or stops performing an appropriate action that leads to social inappropriate behavior, sometimes extreme emotional outburst (Waldie & Saunders, 2014). However, to avoid these characteristics in autism, where the inhibitory circuitry is underactivated (Kana, Keller, Minshew & Just, 2007), the inhibitory control requires neuronal synchronization of frontal lobe (anterior cingulate gyrus and middle cingulate gyrus) and posterior areas of the brain such as the striatum, basal ganglia, and the insula.

Kana et al., 2007; Cherkassky, Kana, Keller & Just, 2006; and Murias, Webb, Greenson & Dawson, (2007) found that cortical connectivity between frontal and posterior regions have been abnormal resting state in individuals with autism. Children with ASD have social difficulties involving eye contact, reciprocal interactions, and responding to emotional cues. Dawson et al. (2002) suggested that the ventromedial prefrontal cortex and the medial temporal lobe make up a brain system specialized for social processing that is deficient in autism, impairing facial processing ability, reducing attention to faces, and leading to difficulties with theory of mind, language, and social skills.

Role of yoga in neurological function

Yoga therapy may help in inherently building the ability to exchange information to and fro through all senses that make a meaningful response, integrating senses in central nervous system and enabling function of attention, emotion, cognition, coordination, arousal levels, and autonomous system (Betts & Betts, 2006; Khalsa, Amen, Hanks, Money & Newberg, 1999; Segal et al., 2010; Orme-Johnson, 2006; Orme-Johnson, Schneider, Son, Nidich & Cho, 2006; Zeidan et al., 2011; Newberg, Wintering, Khalsa, Roggenkamp & Waldman, 2010).

4. Challenges & limitations of medication

Before deciding whether medication is right for your child, it’s important to talk with your child’s doctor about what the medication does and what its side effects are.

Aggressive behaviour
Risperidone can help reduce aggressive behaviour in autistic children. It belongs to a group of medications called atypical antipsychotics.

The side effects of atypical antipsychotics include:

Less common side effects include:

Anxiety and obsessional behaviour
Selective serotonin re-uptake inhibitors (SSRIs) can help reduce anxiety. These medications can sometimes also reduce children’s obsessional behaviour, although more research is needed into how well these medications help with repetitive behaviour.

The most common side effects of SSRIs are:

Teenagers and grown-ups can experience sexual dysfunction with SSRIs.

Recently doctors and scientists have started to worry that people taking SSRIs might think about hurting or even killing themselves, particularly if they’re younger than 25. If these feelings happen, it’s almost always within the first couple of weeks of starting the medication, so you need to watch your child carefully during this time.

Hyperactive behaviour
Stimulants like Ritalin and Concerta are prescribed to help children with attention deficit hyperactivity disorder (ADHD). They can also reduce hyperactive behaviour in some, but not all, autistic children. This might allow children to concentrate on a task for longer and think more before they act.

The main side effect of these medications is lower appetite. This can mean that children using them might not gain enough weight, or might even lose weight.

Other possible side effects include:

Seizures
Up to one-third of autistic people have seizures at some stage in their lives. Some autistic people have a lot of seizures. Some autistic children will be diagnosed with epilepsy.

Seizures can usually be treated effectively with anti-epilepsy medication. There are many different anti-epilepsy medications, so the best one for your child depends on the type of seizures your child has. It also depends on any other problems your child has or other medications they’re taking.

Side effects vary with different anti-epilepsy medications. Common side effects include:

Sleep problems
Melatonin maintains your circadian rhythm, which is your internal 24-hour clock. Your circadian rhythm helps to control when you fall asleep, how long you sleep and when you wake up.

Melatonin can help people who have trouble sleeping – for example, because of jet lag or shift work. It can also help with sleep difficulties in autistic children.

Side effects of melatonin include nausea and headaches.

Tics
Several different medications can help reduce tics. These medications include atypical antipsychotics and noradrenergic agents like clonidine. Clonidine can also help lower hyperactive behaviour.

The side effects of antipsychotics include:

The side effects of clonidine include feeling very sleepy. People might also experience low blood pressure or heart rate. Clonidine is also very dangerous if your child takes too much.

 

5. Role of teachers

Children diagnosed with autism are on the increase, so knowing how to teach these children and which strategies to use, is extremely important. Listed are some tried and true strategies that will ensure that every autistic child receives the best education possible.

These strategies can be implemented both in a classroom and at home.

1.     Create an environment that is not over stimulating. The child will do better if there is no loud music playing in the background, as it distracts an autistic child from concentrating.

2.     Create a structured environment with predictable routines. This is where the picture schedule so often used in autistic classrooms comes into play. The daily routine should be the same from day t day, only differing for special occasions. At such times, an appropriate picture representing that event should be placed on the child's schedule.

3.     Give fewer choices. If a child is asked to pick a color, say red, only give him two to three choices to pick from. The more choices, the more confused an autistic child will become.

4.     Select repetitive motions when working on projects. Most autistic classrooms have an area for work box tasks, such as putting erasers on pencils or sorting colors into colored cups.

5.     Keep voice low and clear when teaching. Autistic children become agitated and confused if a speaking voice is too loud. Excess talking between staff members should be kept to a minimum.

6.     Limit physical contact. While this is a good strategy for all children, autistic children cannot properly interpret body language and touch, so minimal body physical contact is best

7.     Allow students to stand instead of sit around a table for a class demonstration or for morning or evening meeting. Many children do better when allowed to stand. Many rock back and forth and this allows them to repeat those movements while still listening to teacher instruction.

8.     Encourage and promote one to one interactions with students to promote social skills. Since autistic children have a problem with social skills and appropriates social behavior this is very important. Opportunities for social interaction might have to be structured at first, but with practice, they will start to understand social interactions.

9.     Eliminate stress. Again, the autistic child needs to learn in a calm and quiet classroom. IF staff members are experiencing too much stress, leave the classroom until you feel better. Autistic children pick up on emotions very easily.

10.For visual learners, be sure to use signs and pictures, such as the pictures from the Board maker program. This is the beginning of communication skills for these children.

These ten suggestions should help in educating the autistic child with less stress and in a more focused environment taking into account their limitations.