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Over the past two to three decades, we have seen significant advances in the diagnosis and treatment of autism. The term autism is rarely used today. It has been replaced by three letters: ASD, or Autism Spectrum Disorder. Experts who decide on terminology believe that it is a better description of reality, as this situation is indeed characterized by a range of presentations and seriousness.
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ASD occurs during early brain formation and the current incidence appears to be around 1 in 54 children. Male children are four times more likely to be infected than female children. Accurate and timely diagnosis of ASD requires a huge amount of resources. It can become very costly and the demand for early care often exceeds the capacity to provide this care. Thus, prevention can be a way of reducing the incidence and overall cost of a condition that has become more prevalent in the last 20 years. Although the exact cause remains unknown, we continue to discover more possibilities. A recent article in Pediatrics, the official journal of the American Academy of Pediatrics, identified toxic chemicals as one of the possible causes of autism. Researchers, led by a team at Johns Hopkins University, argue that we need to be more concerned about the neurotoxicity of certain toxins.
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The role of lead as a neurotoxin has historically been one of the first red flags. Since lead was discovered as a neurotoxin, thousands of other environmental chemicals and toxins have been discovered. When it comes to ASD, the role of toxins that cause damage in the early development of the brain requires more in-depth research. In animal models, there is a greater degree of certainty that toxins play a role as a cause for ASD. Scientists have found that exposure to air pollution during pregnancy and early infancy, at levels commonly found in large cities, is associated with autism. Exposure of pregnancy to pesticides may also increase the risk of ASD. In particular, organophosphates and organochlorides have been involved.
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Chemicals known as endocrine disruptors have also been implicated in the association with higher risk of ASD. Phthalates, a ubiquitous chemical, cause a decrease in testosterone. According to the study, Johns Hopkins is involved in the etiology of autism. The authors of the research work agree that the dance between genes and the environment remains very complex, but they also suspect that the role of genes has swelled and the role of the environment remains underestimated. To show the complexity of this “dance”, the researchers looked at more than 10,000 chemicals and how they can affect genes and genetic pathways. They found that 4,428 chemicals interact with one or more of the genes associated with autism.
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They argue that, as with other conditions involving multiple factors, it is very likely that the interaction of genetic variants and environmental factors will contribute to a significant percentage of ASD. What the authors seem to suggest is that we know there is smoke and therefore there must be fire, but at the moment, the extent of the fire is uncertain. more research is needed. Governments, meanwhile, should not allow new chemicals to enter the market unless they have been tested for developmental neurotoxicity. The regulation must be based on data obtained through appropriate research. More funding is needed to improve the quality of current research. More collaboration needs to be established between different silos of researchers and a full commitment needs to be made to identify the offensive toxins. This task will remain as difficult as changing the direction of a large ocean – it will take a long time and a deeper level of defense.
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The good news is that we know how important it is to ensure taking folic acid supplements from the beginning of each pregnancy. In this way, the impact of toxic chemicals can be significantly improved. In another article, also published in Pediatrics, researchers from the Mayo Clinic in conjunction with the Institute of Autism and Developmental Medicine in Pennsylvania and the College of Medicine at Baylor University in Texas wondered if we might have underestimated the IQ of children with ASD. The quality of their research was impressive – it included a large cohort based on population. The interesting conclusion is that there is an increased average to above average IQ among people with ASD. The data suggest that almost half of people with ASD have an average or higher IQ. Mayo Clinic experts express concern that if IQ tests are not performed on children with ASD, children with an average above-average IQ will not be identified. This failure can have long-term adverse effects, such as failure to develop meaningful relationships and inability to maintain employment. Dr. Nieman is a community-based pediatrician in a private practice. He is a writer, marathon runner and former president of the Alberta chapter of AAP.
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