NEURO-IMMUNE DYSFUNCTION SYNDROMES (N.I.D.S.)
Autism (Disease, Disorder, or Syndrome?)
and its Connection to ADD/ADHD, CFS/CFIDS
Autism as classically defined was and is a devastating disorder.
It was a severely incapacitating disability that in the past was
relatively rare. It occurred in approximately 1-2 infants per
10,000 births. Autism was/is characterized by Primary Alterations
in Social Interaction and Speech Delay, with additional abnormalities
including the need for sameness, abnormal habits and rituals, lack
of imaginative play including toy usage, and many children exhibit
a craving for sensory stimulation (usually vestibular) including
spinning, hand-flapping, etc.
By definition, "autism" had an early onset before 30 months of age
(now extended to 36 months under DSM IV), while disorders appearing
later in life have been thought to be symptomatically different from
"autistic handicap" conditions. Publications over the last 13 years
have cast some doubt on these relationships. While the rationale for
an age limit for the onset of autism has been discussed, it has been
pointed out that there is no firm evidence that similar or identical
syndromes might not develop in older children.
Recent discussions have focused on the differentiation of "Autism"/
"Autistic Syndrome" into Autism that is congenital (including "classic"
Kanner Autism, Neurologic Disorders and Medical Disorders associated
with Autism such as Tuberous Sclerosis, Phenylketonuria, Congenital
Rubella, Down's Syndrome, etc.) vs. Acquired or "Regressive" onset
(perhaps the largest group of these children).
Acquired should apply to any child with normal birth and development
to 6-8 months of age, certainly 10-12 months of age. These children
then "regress" to various degrees into the current "labels" of Autism,
atypical Autism, Autistic Spectrum, Autism/PDD, etc. The authors would
propose that many/most/all of this group of children, if thought of as
Acquired or "Regressive" Autism, will likely fall under the medical
category "N.I.D.S. (Neuro-Immune Dysfunction Syndromes)," and need to
be thought of immediately as a medical illness, that is potentially
treatable and changeable.
It is essentially over this last decade that this type of "Autistic
Regression" or "Atypical Autism"/PDD has appeared in large numbers.
It is worth noting, that at the same time, i.e. s/p 1980, "quiet"
ADD, "mixed" ADHD, and other cognitive dysfunctions have received
new focus and attention among children and adolescents. Children
suffering from this new "Autistic" disorder generally appear normal
in the first 12-18 months of life, even later. They do not present
signs or symptoms pediatricians or neurologists would find significantly
atypical. These children create an inconsistency with previously
held beliefs that 70-80% of autistic children are mentally retarded.
They crawl, sit up, walk, and usually hit normal motor milestones
on schedule. Up until the age of onset, they are affectionate and
appear to have above average intelligence.
Children with this "autistic regression" may begin to develop some
speech but then, without warning, cease to progress, or begin to
regress. Suddenly, these children become withdrawn. They are
quiet sometimes and hyper at other times. Often self-stimulatory
behaviors (i.e. arm flapping, rocking, spinning, or head banging)
may develop. Over time, some manifest symptoms that are both
similar and atypical to children previously diagnosed as "Autism".
What was once a relatively rare disorder is now twenty-forty
(or more) times more likely to occur. Before, "autism" was 1-2
per 10,000 births. Now current statistics suggest a frequency of
20-40 per 10,000 births (rates of 80 per 10,000 or higher have
been suggested). If a large part of this increase is accountable
as late onset/autistic regression, then our understanding and
approach to these children has got to change, evolve rapidly, or
we may forever lose them. The key becomes the concept we may
lose potentially very bright, highly productive individuals, not
children started off brain damaged, or likely retarded.
Most researchers did not look for "medical" answers to autism
because they felt this was a disorder that was untreatable medically.
Without the technology to understand these children, pediatricians
and pediatric psychologists fell into the concepts of "bad
parenting", childhood psychosis/schizophrenia, classifying "Autism"
as a developmental/"psychological" disorder. Treatment for this
affliction was primarily left in the hands of psychologists and a
Autism though is still treated mainly by psychologists and psychiatrists.
If not a "psychiatric" disorder, its "biological" component deserves
medical intervention. Researchers are now just beginning to understand
the medical origins and implications of potential therapies for these
As noted, in the past, "Autism" has been associated with medical
disorders such as Tuberous Sclerosis, PKU, Congenital Rubella and
others. In these circumstances, one sees "autism" caused by a
known disease process. To this date, these remain rare disorders.
Currently, it appears we may be looking at a large number of
children, who start off normally without any of the usual stigma
or developmental characteristics of a "congenital" disorder, and
yet stop progressing (normally) or "regress" into an autistic
disorder. It is in this subgroup of children, that it may be
necessary to think in terms of "Autism" as a disease process,
rather than a developmental disorder.
Members of the board include:
Dr. Nancy Klimas, University of Miami immunology research
specialist and member of the NIH Advisory Committee
Dr. Ismael Mena, nuclear medicine and neuroimaging research
authority, Santiago, Chile
Dr. Bruce Miller, Harbor General UCLA neurologist, a leader
in central nervous system dementias and the application of
Dr. Audrius Plyoplis, pediatric neurologist and pioneer in
Dr. Michael Goldberg, Clinical Staff UCLA, pioneer in
immune work in CFS/CFIDS, ADD/ADHD, Autist/PDD