Autism - Psychiatrist Point of View

We are now going to discuss Autism, by Dr. Les Linet. Linet: Hello. I am a board certified psychiatrist, a board certified general adult psychiatrist and also in child and adolescent psychiatrist too. In talking about Autism, what I would like to do first is to explain it the way it is. it's not just speech delay or mental retardation, it's something like fever. Fever doesn't necessarily tell us the diagnosis, it's a symptom. When we make diagnosis especially in psychiatry, we make it syndromely, by that I mean, it has to have basically taste, the color, the shape, the size, odor of an elephant, and not a big mess. It's got fluffy ear, fluffy ears and trunk and enough things, than we have a diagnosis. So, Autism involves an impairment in the social brain. When human beings first arrived on this planet, they had some problems to solve, reproduction, sleeping and eating. But as we all know all the other animals they've already solved that problem, the big deal about being human, was dealing with the most treacherous, dangerous creature that had ever existed on the planet, and that was our fellow homosepians, and that's really where the social brain came in. You had to become a psychologist, you had to be able to get a beat on the other person, you get a feeling for them. I think a nice example just to get to started is, a boy I saw who went to high school who was artistic and had a football rally, beginning of the season. The Cheer leader came out and he said things like, does anybody think that ZOOZOO high school can beat us, and my patient stood up, and raised the reasons why he thought the other school is going to win. He completely missed a meaning, a social meaning of the experience, and he heard the question as a technical question. He thought which team was better. So what's involved in Autism is largely difficulty in relating, we see symptoms such as poor eye contact, when speech is not terrible paired, we also see problems with intimation, there is a feel -- we all have this. When we talk to somebody and when you are relating to somebody, there are nuances. So there maybe use of words, both in -- difficulty in also repeating words. They don't -- patients with Autism don't have a good feel for relatedness. There is another example; this is of a famous, relatively famous person, named Temple Grandin, who is autistic, a high functioning autistic individual dealing with Asperger syndrome. She has a doctorate and has done work in the humane slaughter of cattle, because cattle do get upset when they are lined up and they see the cattle in front of them killed. So she designed a very humane, a much more human way of doing this so that very next victim doesn't see that previous one. But when people visit her, she has learned a correct way to meet people. She will take your coat, she will offer you tea or something like this, but you get the feeling that she has learned it, and just really not there. She is very bright, but she doesn't know how to do things. She also has said that she - it took her a long time to adjust with her dog and a cat. This is something a little child normally has no trouble with. She has learned to look at the tail, the wagging tail of the dog. it's, a little harder to explain - I don't know that I will be really be able to explain, it's an interesting aspect of this illness - in a moment, where otherwise quite intelligent. But in addition to in which the difficulty was related, there often are language problems, and there is often difficulty in shifting from one task to another or shifting in a new environment -- we often call this insistence on saying this. Kids with Autism often are - will become preoccupied by water riding or -- in the old days when we had record players, they often just watched the record going around. It maybe - we don't necessarily understand this, it maybe that there are just more comfortable with non human activities, so they can become involved in this. People are too complicated, and you will never know what to expect from a person. Another - interesting thing, as per individuals in high functioning, autistic individuals look upon a character in the original Star Trek series, is Mr. Spock, has a kind of high functioning autistic person. Mr. Spock, is logical, he doesn't have emotions. And there is an episode -- it started when it start to -- actually it's involved an alien entering the space craft and killing a crew member and Captain Kirk is somewhere else , not on the ship, so Spock is in command, he orders to abandon the ship, and the crew wants to retrieve the dead crew member, and Spock says, this is not logical, we have to save ourselves, and the episodes concludes with his saying when it comes to emotions, human beings are not rational. So, again that's the disorder itself when there is a high function, they can be quite logical, rational, but they do have difficulty with the nuances of social interaction, and one of the important issues is to recognize that, that aspects of this syndrome may not be the syndrome, I mean, speech and language delays can be simply there, they don't have to be autistic. There is expressive language disorders, people who have - who can understand but after they got to communicate, and there are receptive language disorders towards - there is a significant impairment in understanding speech. Cognitive difficulties can be mental retardation and some severe mental and retard people often do, look some what autistic, because they do have something to call them relating, but they often are affectionate, and their parents often can love them. In Autism, it's hard -- because you don't get feedback, it's hard, for parents do get this feeling of love with the child. Speaker: Would you say an autistic child's most biggest hallmark is that you have poor commutation skills with the people? Linet: A kind of - it's in understanding other people. If we don't make a mental map, we can't reach those mind, but we use our own way of feeling and understandings to project into somebody else how they may feel. So if we see some rolled up in a ball on the sidewalk, we sort of imagine what they must be going through. Speaker: If I had a young child that was about to years old, not speaking, but is trying to communicate with emotion, actions - maybe not speaking, but try to communicate in other ways, would that be kid - can be labeled autistic, or at risk at Autism, or just a speech delay kid? Linet: I would think speech delay. Speaker: What would make you say to the parent if she discussed it with you that this kid could be autistic, what else would you be looking for? Liner: Well, the example that you gave, was the child was trying to communicate, trying to relate - so that is not what we see in Autism. What we see in Autism is a child may take his parent's hand and use it as a tool, use the parent and parent's height and arm to reach something that the child wants, but he/she uses the parent like a tool. There is a communication, but it's a very different kind of communication, it's really hard, the way we use tools or particularly talk to tools. We treat tools as instruments and an autistic individual may communicate through a parent in more along those line, rather than you have to say. Speaker: If you suspected the child be autistic, is there any therapies that can be done to a child, that can help him get through life more easily? Linet: Well, there are conditions that are - have a much better prognosis, Autism is a difficult condition to have, and it basically is a life long problem. As the child matures, there is a tendency for them to want relationships, but they often have not developed the skills and may, not only not develop them, but may have difficulty developing that, because there is impairment in the social brain. But sometimes, they do function better. Well, the prognosis is best when there is good language development and good intelligence. 75% of autistic individuals have mental retardation, that's another obstacle in the development. So if you don't have mental retardation, you have a better chance. Speaker: So you would recommend at a young age, the kid