Autistic child playing alone
Keywords:
Autism, neurodevelopmental disorder, intellectual disabilities, pollutants, neurotransmitters, Nigeria.
Introduction.
Autism among Nigerian Citizens What is autism? What causes autism among Nigerian citizens? Does autism exist in Nigeria? The brain of a person with autism. Normal developmental stages in communication and social interactions from birth to 3 years. What intellectual disabilities do people with autism have? How does the person with autism behave? What mental and other neurological health issues can occur with autism among Nigerian citizens?
What is autism?
Autism is one of the neurodevelopmental disorders that start in childhood. By being a developmental disorder, it means that the problem or deficit begins at the child’s developmental period.
Developmental periods are age targets where certain behaviors or capabilities are possible. So developmental age periods are targets periods in childhood, which could be from birth to eighteen years.
These developmental stages target the physical, learning or cognitive, language and behavior.
The problems in autism affect communication and social interactions which starts quite early in the developmental period of the child. These problems the children have, can be noticed at different areas of their functioning, at home, at school, etc. There may or may not have problems with reasoning, solving problems, or learning.
Even though these issues start quite early in life, they may not be noticed by the parents or caregivers. And the baby may seem to be developing normally, until the toddler ages of between 2 years to 3 years. Some developmental achievements maybe acquired until the toddler age. But when the child gets to this toddler age, even the little achieved, are easily lost. Autism is a lifelong challenge.
Areas of severity:
There are actually three levels of severity.
Level 3 –
This shows severe problems in verbal and non verbal communication. Speech maybe present, but the words are not understood. Behavior is inflexible, with restrictive and repetitive behaviors. Inflexible behavior means that the person is unable to change his or her behavior when circumstances change. Restrictive behavior the person’s interest, thoughts, focus and actions are limited. And some of his or her actions are done repeatedly.
Level 2 –
Has marked issues in verbal and non verbal communication. The person can make simple sentences. And the behavior remains inflexible.
Level 1 –
This was once called high functioning autism. In this type, there some noticeable difficulties, especially when support is not available. Social behaviors maybe present, but they may seem odd and they are not able to make friends. What is meant by social behaviors, are interactions one has with other people. They also may not be able to easily change from one task to another.
They can make full sentences and engage in communication. But they have difficulties with initiating conversations and changing topics.
What causes autism among Nigerian citizens?
Autism is due to the combination of gene and environmental factors. Genes are things that we inherit from our parents. They are part of our DNA. So it runs in the family.
It is important to know that one environmental factor alone, is not enough to bring on autism. It would require many environmental factors working together, or combining with genetic factors to bring up autism.
GENETIC FACTORS.
Specific genes:
There is actually no specific gene that is known as autism gene. Autism is due to a combination of genetic defects, that is mutations or polymorphisms in certain areas of the gene. Mutation is a permanent change in the part of the DNA, which are many a times harmful.
It is more common with children that have the Fragile X gene. There is a gene called fragile X messenger ribonucleoprotein 1 (FMRI 1). This gene is necessary for the production of a protein needed for brain development. Sometimes, this gene is unable to make the protein, due to mutation.
There are also mutation at chromosome 15. This chromosome is also needed for brain protein formation. Chromosomes are also made up of DNA.
Neurotransmitters issues:
There are problems with neurotransmitters in the brain. Neurotransmitters are brain chemicals through which brain cells communicate with each other.
These neurotransmitters include Gamma Amino Butyric Acid (GABA), glutamate, serotonin, dopamine, norepinephrine, acetylcholine, etc.
Environmental factors.
Pregnancy and birth trauma issues:
Labour and delivery issues –
Trauma or injury to the baby head during labor and delivery are risk factors to the development of autism. But it should be noted that one form of birth injury may not be enough to predispose to autism. Birth traumas are quite high in Nigeria. These cause deprivation of oxygen to the baby’s brain, thus can cause autism among Nigerian citizens.
Prolonged labor and delivery are risk factors. These are quite high in Nigeria. This is because of the stigma associated with delivering by cesarean section.
Low birth weight babies, distressed babies in the womb, and those with low apgar scores after birth are at risk. Apgar score, is a standard assessment score which the health care provider calculates when a baby is born. To calculate it, the health care provider looks at and rates certain factors on the baby. These include the baby’s skin colour, heart rate, respiratory rate, reflexes and muscle tone. Rating it, rates the health of the baby at birth. The higher the rate, the healthier the baby. And the lower the rate, the less healthy the baby.
Pregnancy issues –
Transverse lie of the baby in the womb, breech presentations and multiple births are also risk factors. Transverse lie occurs when the baby in the womb positions itself horizontally. Breech presentation, is when the baby attempts to come out of the womb with its buttocks or legs.
Meconium aspiration occurs when the baby in the womb defecates and inhales the substance into its lungs. This could be a risk factor for development of autism.
Anemia of the baby after birth, and even maternal anemia are risk factors Anemia means lack of enough blood.
Jaundice in new born and even incompatible blood types between baby and mother are risk factors. Blood type incompatibilities include A.B.O. blood groups and Rhesus factor.
Severe maternal illness in pregnancy is a risk factor. Examples are diabetes in pregnancy, obesity during pregnancy, bacterial and viral infections. These infections include measles, mumps, chicken pox, etc.
Even preeclampsia and excessive maternal bleeding during pregnancy and after delivery are risk factors. Preeclampsia, is an illness that can occur in a pregnant woman. It comes with high blood pressure, swelling of the legs, face and hands with protein in her urine. And it comes with damaged internal organs.
Premature separation of the placenta from the womb is a risk factor for autism. A prolapsed umbilical cord can predispose to autism. A placenta is the end of the cord that attaches the baby to the mother’s uterus or womb. So when it separates from the womb early, the baby will not get enough nutrients and oxygen.
Children conceived less than 2 years, or more than 6 years, from the previous child, are at risk of autism.
Exposure to pollutants –
When a pregnant mother is exposure to toxins like smoke, pesticides, etc. these are risk factors. Even exposing the newborn baby to these can affect the baby’s brain.
Pollutants can come from as air pollution. The air pollution can come from traffic, factories, firewood, waste incinerations, and even noise. Noise can cause stress.
The toxins include, pesticides, like chemicals used in the farm. Also pesticides used to spray insects in the homes are culprits. Pesticides are sold as insecticides, herbicides, fungicides, rodenticides (used to kill rats, etc.), fumigants, etc.
The toxins can be detected in fruits, vegetables, grains, and even breast milk. They can also be inhaled or pass through the skin.
Metals include lead, mercury, arsenic, etc. The load does not have to be too high to cause harm. Mercury can be seen in water, fish, soil, etc. Lead can be gotten from paints and infants that live in old dilapidated houses are at high risk.
Age of parents:
Advanced age of parent(s) is a risk factor. Elderly parents is a risk factor.
So children from mothers 36 years and above are at risk. While children whose fathers are 40 years and above are at risk.
For the elderly mothers, there is high risk of having obstetric complications, especially that due to problems with the uterus. Problems with the uterus include muscle issues and reduced blood supply.
Then, for the fathers and mothers, there are mutations in the sperms and ovum (egg) respectively.
The use of medications in pregnancy:
Using certain medicines during pregnancy can predispose the baby to developing autism. But it actually depends on the time of pregnancy or gestational age. Example of medicines includes, anticonvulsants, i.e. medicines that treat epilepsy. These medications are also used to stabilize mood.
The use of some herbal remedies by the pregnant woman can also be risk factor for autism. In Nigeria, some women use herbal medicines to treat or prevent vomiting in early pregnancy, known as morning sickness. Some women also use herbal remedies to keep the weight of their baby small, while in the womb. In Nigeria, some herbal medicines contain lead, mercury, and 100% heavy metals which can be toxic.
Some research studies have also implicated parents with alcohol abuse, as risk factors for autism in offspring. And some research also document that a father who abuses cannabis can produce an offspring with autism.
Does autism exist in Nigeria?
Many people are unaware that autism disorder can be found among Nigerian citizens. Knowing the exact number of children and adults living in Nigeria with autism is an uphill task. This is due to stigma, derogatory comments and ignorance which compels parents to lock these people in their homes. So the figures published, may not reflect the true numbers.
The prevalence of autism among children attending private special schools in the southeastern part of Nigeria is 11.4%.
Among children who attend immunization programs in Lagos state, the prevalence is 14.8%.
Among children in the community suffering from neurodevelopment disorders, the prevalence is 34.5%.
In normal mainstream schools in the southeast, the prevalence is 2.9%.
In northwest Nigeria, the prevalence among children attending a tertiary hospital is 1.4%
The brain of a person with autism.
Brain anatomy issues:
In autism, there is problem with the development of the brain from an early age. Thus autism is known as a neurodevelopment disorder.
Due to low oxygen in the brain of the developing fetus, many parts of the fetal brain are negatively affected. Even the areas, which are responsible for decoding facial expressions, the use of eye contact and joint attention, are not functioning well.
There are also abnormal brain activities, as well as abnormal brain structure and growth. These abnormal brain growth messes up the normal brain cell connections. These are worse in the 1st and 2nd years of the child’s life. The areas of the brain important for thinking, planning, and judgment, etc. are negatively affected. These same areas are also responsible for emotions, social function, language, etc.
In early life of the child with autism, there is excessive brain growth, but this is followed by reduced brain growth in the cerebral areas. This excessive initial brain growth makes the heads of some of the children with autism, slightly bigger than it should be. But this increase in the size of head is not seen in adolescents due to the later decrease in the size of the head. Large head size is a pointer to the severity of autism.
The corpus callosum that connects the two parts of the brain has issues and it is smaller than normal. So a problem arises with the communication of both sides of the brain.
The issues at the corpus callosum, and the cerebella white matters of the brain, cause the restrictive and repetitive behaviors in autism.
There are also issues with brain cells migration and connecting with each other.
Issues with neurotransmitters and hormones:
Neurotransmitters are chemical in the brain that enables different parts of the brain to communicate with one another. There is actually problems with the neurotransmitters, especially between the excitatory and inhibitory types.
Oxytocin, known as a love hormone, that enable us to have social connectedness, is low in autism.
In the development of autism, serotonin, a neurotransmitter, is low in the brain. Serotonin is needed in brain development and in mood regulation. So, when low, it can predispose to autism. This is more probable when there is also a low oxytocin.
There is dopamine dysfunction in different parts of the brain, leading to social deficits seen in autism. Dopamine is also a neurotransmitter.
Normal developmental stages in communication and social interactions from birth to 3 years.
It is important to know what to expect from a normal developing child. This will help to detect early enough when something is going wrong. Below are the communication and social development from birth to three years.
Communication development:
From birth to 3 months –
Within this developmental period, the baby cries, coos, responds to sounds and voices.
By 3 to 6 months –
They can babble, and respond to conversation by making sounds.
From 6 to 12 months –
He/she continues to pay attention, and responds to conversations by making sounds. They understand simple words and respond to simple commands.
From 12 to 18 months –
Can point to things of interest, shake head to say ‘no’, wave and tries to repeat words spoken by others. At this stage, the child may say the word ‘mama, or dada.’
Then from18 to 24 months –
They can communicate by using up to 5 to 10 words, and combines words with gestures. Can imitate simple words and actions. Can respond to yes or no questions, by head gestures. Continues to repeat words heard, etc.
From 24 to 36 months –
Can name objects in pictures. Understands the words me, you and my. Can use two word phrases.
Their vocabulary increases to 3 word phrase and can know up to 300 words. Up to 50% of what the child says is understood by the caregiver. And child can understand the words ‘mine and yours.
Social development:
From birth to 3 months –
He or she should be able smile, make eye contact and be able to pay attention.
Then from 3 to 6 months –
The baby can respond to his/her name. A baby at this stage can reach out for objects and recognize familial faces. Interacts more intentional with people with play.
He/she responds to affection and is able to show happiness and sadness. Will even imitate facial expressions.
From 6 to 12 months –
At this stage, they may begin to refuse being carried by strangers. This is called stranger anxiety. They can copy simple playing methods
Can play with favorite people, etc.
From 12 to 18 months –
They can hug, kiss and helps caregiver in putting toys away. Can recognize self in the mirror or in pictures. Gets upset when separated from parent or caregiver. Can easily get frustrated and upset and throw tantrum. Begins to show empathy by knowing the feeling of others, e.g. can comfort another child crying or a sad caregiver. Wants to be the centre of attention and applauded often.
They begin to assert themselves more and move about more independently. But they can leave the caregiver only for brief moments.
From 18 to 24 months –
Shows anger by throwing tantrums. Separation anxiety starts to reduce at this stage. The child enjoys spending time with siblings and can play with other children, but still spends time playing alone. Children do pretend play and enjoys listening to stories.
Between 24 to 36 months –
Begins to recognize other people’s feelings, and ask a lot of questions. They can easily respond to your questions with short sentences. At this stage, they can go on short errands and help in simple chores.
Plays more with other children. Children are a bit possessive, especially with toys, clothes, etc.
What intellectual disabilities do people with autism have?
It is documented by research that between 40% to 70% of children diagnosed with autism, have Intellectual Disability (ID). Intellectual disability occurs when there is a below average intellectual functioning. This occurs with an IQ of less than 70.
Some of people with autism, have IQ of between 70, 75 and above. But those at the level 3 autism, have lower IQ scores of less than 70.
Actually, there are different IQ documentations of people living with autism. But in general, 57% have IQ below 85 and 43% are above 85.
A recent study documented by CDC, documented that about 60% of persons with autism have average, or above average IQ. This is because, those with lower IQs are easily diagnosed with autism. But those with autism and higher IQ are easily missed. Their high intelligence mask their autism.
Children with co-occurring autism and ID, have present with more tantrums and other behavioural and learning issues. And they have more difficulties in verbal and nonverbal communications. While those with higher IQ, have less melt downs and less behavioural issues.
How does the person with autism behave?
In Childhood:
In the area of communication –
It is important to know that some children with autism do not speak at all. While some speak with limited ability. More than half of the children with autism in Nigeria have problem with speech.
From birth to six months is the time for developing eye contact and babbling. But for babies who may later develop autism, even though they start out with eye contact and babbling, these communication skills reduce over time.
From 7 – 12 months, children who will later develop autism concentrate less, and respond to conversation less often. They respond to their names much later. They do less of pointing at things of interest, etc.
The children who are between the ages of 13 to 18 months, who will later develop autism, develop word usage much later than those who do not have autism.
By 18 to 24 months, children who may later develop autism will develop word usage much later than normal children. And this could be by an average age of 36 months.
From 24 to 36 months, the child with autism does not know the difference between mine and yours. And some may misuse pronouns.
Social development –
From birth to 6 months.
Most of the development is delayed. Smiling back at the caregiver or mother comes much later and some may have expressionless face. It is even difficult to get the baby look at you.
At the age of 6 to 12 months.
These children may not play or have limited play with caregivers or mothers. Even stranger anxiety is delayed and the children show less fear with strangers.
Between the ages of 12 to 18 months.
Self-recognition is delayed at this point. These children do not show empathy. They easily throw tantrums often. They cannot adjust to sudden changes, and this can provoke tantrums. For example, the same route to school must be taken each day and any sudden change of route can be met with the throwing of a tantrum. So they prefer routines.
By the age between 18 and 24 months.
These children prefer playing alone, as opposed to other children who do not have autism. Pretend play develops much later and the child with autism does more of functional play. Functional play is done by using the toy just as it is designed. Many children living with autism do not do symbolic play and for those that do, the play is limited. They initiate social interactions only when in need. And they have odd ways of playing with toys, like lining them up. They also get involved with repetitive plays, like switching off lights continuously, spinning self round and round or walking on toes.
By the ages between 24 to 36 months.
Children with autism do not know the difference between something that is mine and something that is yours, so they can easily give up their possessions.
In Adulthood:
Skills:
People living with autism tend to concentrate on specific details, rather than seeing the bigger picture. And because they have difficulties in abstract thinking, they can excel in things that require focusing on details.
So they have good level of meticulousness and precision, so they can succeed in jobs that require strict organization. For example in stores that requires products to be organized and arranged properly.
They have special interests in arts, so such people are very creative. And they excel in the areas of arts, music, because they find joy in expressing themselves via such media. Since many are good in arts, have good memory, pay attention to details, they are good in graphic arts. And some are also good in data processing.
Yes, some have exceptional memories. This is to the point that some can remember the calendar date of a day in a past year.
Some are good problem solving because they have good memory and think outside the box. This is better done with visual cues. But if the problem solving has to do with abstract thinking, they have problems with it.
Some people living with autism are good in mathematics. These involve the high IQ, students with autism. This is because they use the visual areas of their brain.
So these individuals are good in computer jobs, accounting, engineering, etc.
People living with autism are also good in jobs that requires punctuality, honesty and abiding to rules. They are also good in freedom fighting.
What mental and other neurological health issues can occur with autism among Nigerian citizens?
Persons living with autism, are at a high risk of having other mental and neurological health issues. These neurological health issues include Attention Deficit Hyperactivity Disorder (ADHD), and seizures.
They can also develop mental illnesses such as depression and anxiety from their adolescent age. This is due to the problems they have with communication and socializing.
And yes, Obsessive Compulsive Disorder (OCD), is quite common with persons having autism. This is because the two conditions share the same things that cause them.
Persons with autism have an increased risk of having schizophrenia. This is because they share common genetic issues.
