Autism is a pervasive developmental disorder in children characterized by the disruption and delays in cognitive, language, behavior, communication and social interaction.
With the method of diagnosis is almost certainly a growing number of children were found affected by autism will increase rapidly. Number of persons with autism more worrying given until now the cause of autism is still mysterious and a matter of debate among experts and doctors in the world. Autism is a disorder that is influenced by the multifactorial. But so far there is still not clear exactly on the causes and risk factors.
In these circumstances, prevention strategies that do not yet optimal. So that the current prevention purposes may be limited only to prevent the disruption that occurred not more serious, not to avoid the incidence of autism.
The word autism comes from the Greek "auto" means self ditujukanpada someone who shows symptoms of "living in his own world". In general, persons with autism to ignore the sound, sight or incident that involves them. If no reaction is usually the reaction is not appropriate to the situation or even no reaction at all. They avoid or unresponsive to social contact (sight, touch, affection, play with other children and so on).
Use of the term to persons with autism was first introduced by Leo Kanner, a psychiatrist from Harvard (Kanner, Autistic Disturbance of Affective Contact) in 1943 based on observations of the 11 persons who showed symptoms of difficulty dealing with others, isolate themselves, unusual behavior and a strange way of communicating.
Autism can terjadipada all communities rich and poor, rural town, educated or not, and in all ethnic groups and cultures in the world. Yet children in developed countries generally have the opportunity diagnosed early to allow management of an earlier with better results.
The number of children affected by autism increase. In Canada and Japan reached a 40 percent increase since 1980. In California alone in 2002, concluded there were 9 cases of autism per-day. With the method of diagnosis is almost certainly a growing number of children were found affected by autism will be even greater. The amount mentioned above is very worrying given until now the cause of autism is still mysterious and a matter of debate among experts and doctors in the United States dunia.Di mentioned autism occurs in 60,000 to 15,000 children under 15 years. Other literature mentions autism prevalence in the 10-20 cases of 10,000 people, some even say 1 in 1,000 children. In the UK in early 2002 even reported the incidence of autism has increased very rapidly, about 1 in 10 children suspected of suffering from autism. Comparison between males and females was 2.6 - 4: 1, but girls are exposed will show more severe symptoms. In Indonesia with a population of 200 million, up to now has not known the precise number of persons but the estimated number of children austima can reach 150-200 thousand people.
The cause of autism is not known with certainty. Some experts say autism is caused due to multifactorial. Some researchers have revealed the biochemical disturbances, other experts argue that autism is caused by psychiatric disorders / mental. Other experts argue that autism is caused by a combination of the wrong foods or environmental contamination of toxic substances that cause damage to the colon that cause problems in the behavioral and physical, including autism.
Some theories are based on several scientific studies have been presented to find the cause and the occurrence of autism. Some theories of the causes of autism are: Genetic (heriditer), Opioid excess theory, theory Gulten-Casein (celiac), kolokistokinin, Vasopressin and oxytocin theory, metilation theory, theory of immunity, autoimmune theory and food allergies, blood Substance attacker germ theory to the Myelin Protein the basic theory of infection because the vaccine virus, Sekretin theory, theory of gastrointestinal disorders (Hipermeabilitas Intestinal / Leaky Gut), Aspartame exposure theory, the theory of vitamin deficiency, certain nutrients and minerals Protein orphanin theory: Orphanin
Table 1. Some theories of the causes of autism
1. Genetic and heriditer
2. Opioid Excess Theory
* Opioid-like element
* Lack of enzyme dipeptidyl peptidase
* Dermorphin And Sauvagine
* Opioids and secretin
* Opioids and glutathione
* Opioids and immunosuppression
3. Gluten / Casein Theories And Celiac disorder Relations
* IgA urine
* Theory of Gamma Interferon
* Theory of Sulfate Metabolism
5. Oxytocin and Vasopressin
7. Immunity and Food Allergy Autoimmune Theory
8. Germs into the blood Substance attacker Base Myelin basic protein
9. Because viral infection theory Vaccination
10. Theory Sekretin
11. Theory of gastrointestinal disorders (Hipermeabilitas Intestinal / Leaky Gut)
12. Exposure to Aspartame
13. Vitamin deficiency, certain mineral nutrients
14. Orphanin Protein: Orphanin FQ / NOCICEPTIN (OFQ / N)
Although exposure to heavy metals (mercury) occur in every child, but only a small proportion who experience symptoms of autism. This may be related to genetic theory, one of which related to the theory Metalotionin. Some studies found children with autism seem to find any interference metalotionin netabolisme.
Metalotionon is the main system owned by the body in detoxifying mercury, lead and other heavy metals. Each heavy metals have different affinities terhada metalotionin. Based on the affinity of mercury has an affinity with the most kuar terhadam metalotianin than other heavy metals such as tenbaga, silver or zinc.
Based on several studies that have reported the experts indicate that metalotianin disruption caused by several things, among which are: Zinc deficiency, excessive amount of heavy metals, deficiency of cysteine, regulation element malfunctions Metals and genetic disorders, among others, the genes forming netalotianin
The debate is happening lately revolves around the possible causes of autism are caused by childhood vaccinations. British researcher Andrew Wakefield, Bernard Rimland of America to conduct research on the relationship between vaccinations, especially MMR (measles, mumps rubella) and autism. Many other studies conducted with larger populations and broader ensure that MMR immunization does not cause autism. Some parents of children with autism are not satisfied with such denials. Jeane Smith even an American citizen to testify before the U.S. Congress: autistic disorder in this country has become epidemic, he and many parents of children with autism penderta believe that their children are affected by autism is caused by a reaction from the vaccination.
Research in large numbers and wide certainly more trustworthy than the reports of some cases which are relatively meaningless in general. However, research specifically on persons with autism, did show a relationship even though not a cause and effect ..
Many of the experts do the research and stated that the seeds of autism has existed long before the baby is born even before vaccination. The disorder is confirmed in observations of several families with autism genes. Patricia Rodier, embryologist from America that the correlation between autism and birth defects caused by thalidomide concluded that brain tissue damage may occur at the beginning of 20 days during the formation of the fetus. Other researchers, Minshew found that in children who are affected by autism part of the brain that controls memory and emotion centers becomes smaller than in normal children. This study concluded that impaired brain development has occurred in the third semester of pregnancy or at birth.
Karin Nelson, an American neorology investigate conduct of the brain proteins from blood samples of newborns. Four samples of protein from normal infant has a protein content of a small, but the next four samples have high levels of protein that was later found that infants with high levels of this brain protein developed into autism and mental retardation. Nelson concluded that autism occurs before birth.
Currently, health experts in the country are increasingly concerned with autistic disorder in children. So the study of autism is rapidly increasing and growing. Previously, autistic disorders are considered only as a result of treatment of an authoritarian parent to his son. Advances in technology allow it to conduct research on the causes of autism is genetic, and metabolic neuroimunologi. In May 2000 researchers in America found a pile of protein in the brains of newborns who later developed into a baby boy with autism. This finding may be key in finding the primary cause of autism that can be taken to prevent it.
CLINICAL MANIFESTATIONS AND DIAGNOSIS
Autism is a pervasive developmental disorder in children characterized by the disruption and delays in communications, disruptions in play, language, behavior, feelings and emotional disorders, social interaction, feelings of social and sensory disturbances in feelings.
Disruption in verbal and nonverbal communication include language skills is delayed or totally unable to speak. Using words without plugging in the usual sense digunakan.Berkomunikasi by using body language and can only communicate within a short time. Words can not understand another person ("the language of the planet"). Do not understand or do not use words in appropriate context. nEkolalia (mimic or parroting), mimicked the words, sentences or songs without knowing what it means. He talks like a robotic monotone. Talk is not used for communication and flat imik
Disruptions in the field of social interaction include disorders refuse or avoid face to face. Did not look back when called, so often thought deaf. Feeling unhappy or reject a hug. If you want something, pull the hand nearest the person's hand and hoping that person do something for him. Not share the excitement with others. When playing away even when approached. When he wants something interesting hands of others and expects it to do something for her hand.
Disruption in the playing of them is playing a very monotonous and weird as catenate soap into a single row of long, rolling on the toy cars and watching carefully for a long time. There is a certain attachment to objects such as paper, pictures, cards or roll, continue to be held taken anywhere he goes. When the happy one toy does not want another toy. Did not like dolls, but prefer a less interesting objects such as bottles, rubber bands, batteries or other objects not spontaneous / reflex and can not imagine the play. Unable to mimic the actions of her friends and could not start the games are temples temples. Often pay attention to his own fingers, a rotating fan or the wind that moves. Ritualistic behavior that often occurs is difficult to change daily routines, such as when play had to do a certain sequence, when traveling to go through the same route.
Seen from the symptoms of conduct disorder is often regarded as a child who likes neatness must put certain things in place. Hyperactive children can be seen for example when it enters the house for the first time he came, he would open all the doors, walking up and down, running around aimlessly. Repeating a particular motion (moving his hand like a bird flying). He also frequently self-harm such as hitting your head or banging his head on the wall. Can be very hyperactive or extremely passive (quiet), sit face-to-eye with a blank stare. Angry for no good reason. Very, very concerned with one thing, idea, activity or person. Unable to show common sense. Can be very aggressive to others or himself. Cognitive disturbances of sleep, eating disorders and other behavioral disorders.
Feelings and emotional disturbances can be seen from the behavior of his own laughing, crying or angry for no apparent reason. Often raging out of control (temper tantrums), especially if they do not get something to be desired. Often raging out of control (temper tantrums) when the appetite is not acquired, can even become aggressive and destructive .. Unable to share feelings (empathy) with other children
Disturbances in sensory perception include feeling sensitive to light, hearing, touch, smell and taste (tongue) from from mild to severe. Biting, licking or kissing a toy or any object. When you hear a loud voice, covered their ears. Cried every time her hair washed. Could feel uncomfortable when given a particular outfit. Dislikes palpation or hug, if carried often degenerate or break away from the hug. Dislikes palpation or hug, if carried often degenerate or break away from the hug.
Diagnosis of autism is not easy because it requires precision, experience and may need a long time for observation. So far not found a clinical test that can instantly diagnose autism. Autism diagnosis is through clinical diagnosis rather than laboratory tests. Autism disorder is diagnosed based on DSM-IV. Many of the signs and symptoms of autism such behavior caused by a disturbance in addition to autism. Clinical examination and other investigations may be needed to ensure the possibility of other causes.
Because the cause of autism is multifactorial, so are many factors that cause mempengaruhi.Sehingga many theories have been proposed by many experts. It is difficult to ensure a sharp autistic disorder risk factors. Risk factors compiled by the experts based on the many theories that have grown autris causes. There are a few things and circumstances that make the risk of autistic children become larger. With the known risks of course can be taken to prevent and intervene early in children who are at risk. As for some of these risks can be diikelompokkan in some periods, such as the period of pregnancy, childbirth and infant age periods.
PERIOD OF PREGNANCY
Development of the fetus in pregnancy is very much influenced him. Growth and development of the brain or nervous system of the brain occurs very rapidly in this period, so that everything disturbance or disruption in the mother must be very influential. Disturbances in this brain will affect the future development of children's behavior and later, including the risk of autism.
Some of the state of mothers and babies in the womb to be more aware of autism are able to develop into an infection during labor, especially viral infections. Peradarahan during pregnancy must be considered as a state that could potentially interfere with fetal brain function. Bleeding during pregnancy is most often due to placental complications, including placenta previa, abruptio placentae, vasa previa, circumvallate placenta, and rupture of the marginal sinus. These conditions resulted in impaired transport of oxygen and nutrients to the baby that resulted in disturbances in fetal brain. Bleeding early in pregnancy is also associated with premature birth and low birth weight. Premature and low birth weight also seems to pose higher risks for the occurrence of autistic behavior is another potentially dangerous use of drugs taken, smoking and stress during pregnancy especially the first trimester. The presence or Maternal Fetal Atopy Atopy, which is an allergic condition in the fetus caused by entry of allergens through the mother. According to the writer's observation, this can be seen the movement of baby movement oesefagial reflux (hiccupps / hiccups) is excessive in the womb is especially true at night. Kedaaan suspected in the baby's digestion and its activity is affected by certain causes, including allergies or other toxic substances during pregnancy.
Urinary tract infection, high fever and depression. Wilkerson et al have been doing research on the history of pregnant women in 183 children with autism compared to 209 without autism. Found the incidence of urinary tract infections, high fever and depression in mothers look in number significantly in group of mothers with children with autism.
PERIOD OF LABOR
Childbirth is the most decisive period in the life of the next baby. Some of the complications that arise during this period will determine the condition of the baby to be born. If an interruption occurs during the birth then the most dangerous is the resistance of blood flow and oxygen to all organs of the baby's body including the brain. The organs of the brain is the organ most sensitive and sensitive to these disturbances, if the brain is disrupted greatly affect the quality of life of children in both child development and behavior later.
Labor disturbances which could increase the risk of autism are: cutting the cord too soon, asphyxia in infants (low value of SCORE Apgar <6), complications during labor, duration of labor, where the presentation of infants at birth and low birth closely (<2500 grams).
BABY AGE PERIOD
In early life at the age of the baby, some initial conditions or disturbances that occur can lead to disturbances in optak which could ultimately be at risk for the occurrence of autism disorders. Conditions or disorders that are at risk for the occurrence of autism is prematurity, food allergies, failure to gain weight, congenital abnormalities: congenital heart defects, genetic disorders, metabolic disorders, digestive disorders: frequent vomiting, colicky, difficult bowel movements, frequent bowel movements and neurological disorders / neurological: head trauma, seizures, atypical muscle, muscular weakness.
Preventive action is the most important in avoiding the risk of disruption or interference with the organs of our body. Many disorders can be done with good prevention strategies, because of the etiology and risk factors can be clearly known. In contrast to autistic disorder, because the theory of the causes and risk factors have remained unclear so prevention strategies may not be done optimally. In this condition, prevention efforts seem only intended to make behavioral disorders that occur are not getting worse not to prevent the occurrence of autism. Prevention efforts are based on the theory of the causes or risk factors for autism research.
Prevention can be done as early as possible since planning pregnancy, during pregnancy, childbirth and the period of the child's age.
SINCE PREGNANCY PREVENTION
To prevent the developmental disorder since the pregnancy, we should see and observe the causes and risk factors for the occurrence of developmental disorders in pregnancy since. To reduce or avoid risks that can arise in pregnancy may be through several ways.
As for how to prevent the occurrence of developmental disorders in pregnancy since these include check and consultation to a specialist in obstetrics and gynecology earlier, kalu since planning a pregnancy should consult. Perform a complete examination skrening especially viral infections TORCH (Toxoplasma, Rubella, Citomegalovirus, herpes or hepatitis). Check and consult a physician specialist in obstetrics and gynecology routinely and regularly, and always follow your doctor's advice and instructions very well.
If there peradarahan during pregnancy immediately see a gynecologist. Bleeding during pregnancy is most often caused by placental abnormalities. These conditions resulted in impaired transport of oxygen and nutrients to the baby that resulted in disturbances in fetal brain. Bleeding in early pregnancy is also associated with premature birth and low birth weight. Premature and low birth weight is also a high risk for autism and other language disorders.
Be careful to take medication during pregnancy, if necessary, should consult a doctor first. Medications taken during pregnancy especially the first trimester. Researchers in Sweden reported Thaliodomide drug administration in early pregnancy may interfere with the formation of the central nervous system that cause autism and other developmental disorders including speech disturbances. When babies are at risk of allergic mothers should begin to avoid exposure to allergy in the form of cigarette smoke, dust or food allergens since the age of 3 months. Avoid exposure to foods or chemicals or other toxic during pregnancy. Take care of hygiene, sanitation and hygiene and the environment. Eat good and nutritious food in sufficient quantities. Well as consumption of certain vitamins and minerals as recommended by your doctor regularly.
The presence or Maternal Fetal Atopy Atopy, which is an allergic condition in the fetus caused by entry of allergens through the mother. According to the writer's observation that, in view of the baby's movement reflux movement oesefagial (hiccupps / hiccups) is excessive in the womb is especially true at night. Kedaaan suspected in the baby's digestion and its activity is affected by certain causes, including allergies or other toxic substances during pregnancy. When the baby's movement and the movement of hiccups / hiccup in fetuses excessive, especially at night and there were symptoms of allergies or sensitive digestive one or both parents. Mothers should avoid or reduce the causes of food allergies since the age of pregnancy over 3 months. Avoid cigarette smoke, either directly or stay away from cigarette smoke-filled room. Adequate rest, avoid stress and depression as well as the circumstances are always closer to God.
PRECAUTIONS WHEN LABOUR
Childbirth is the most decisive period in the life of the next baby. Some of the complications that arise during this period will determine the condition of the baby to be born. If an interruption occurs during the birth then the most dangerous is the resistance of blood flow and oxygen to all organs of the baby's body including the brain. The organs of the brain is the organ most sensitive and sensitive to these disturbances, if the brain is disrupted greatly affect the quality of life of children in both child development and behavior later
Some things that happen during birth that can increase the risk of development and behavior in children, so be aware of some important things. Conduct consultations with the gynecologist and obstetrics about birth plan. Get a clear and complete information about the risks that can occur during labor. If there is a risk in the delivery should be anticipated if something happens. Both in terms of assistance during delivery pediatrician or NICU care facilities (Neonatology Intensive Care Unit) when needed.
If there is a risk factor for labor such as cutting the umbilical cord too soon, asphyxia in newborns (babies do not cry or low values SCORE Apgar <6), complications during labor, prolonged labor, where the presentation is not normal at birth, low birth weight ( <2500 grams) then you should be monitoring developments closely from an early age.
PREVENTION SINCE BABY'S AGE
After entering the age of the baby there are some risk factors to watch out for and made efforts to prevent it. If you need therapy and early intervention when it started to suspect there are symptoms or signs of developmental disorders. As for some of the precautions that can dilakukanl
Observe gastrointestinal disorders in infants from birth. Teresebut disorder include: frequent vomiting, do not dispose of every day, frequent bowel movements (over the age of 2 weeks 3 times per day), difficult defecation (straining), often bloated, cranky night (colic), Hiccup (Hiccups ) Excessive, frequent passing of wind. When there were complaints that the most common cause is food allergy and food intolerance. The best way to overcome these ganggguan not by drugs but by finding food and avoiding the cause of the complaint. Prolonged gastrointestinal disorders will be able to disrupt the function of the brain that ultimately affect child development and behavior.
If there is difficulty increases in body weight, should be wary of. Giving vitamin appetite is not the best way in treating the physically, but to look for the cause. If there are congenital abnormalities: congenital heart defects, genetic disorders, metabolic disorders, it must be treated by a specialist. Should be observed for signs and symptoms of autism are carefully early on.
Similarly in case of neurological disorders such as neurological or head trauma, seizure (not a simple febrile seizures) or muscle weakness disorders, we must more carefully to detect early developmental disorders.
In premature infants, infants with a history of high yellow (hiperbilirubinemi), serious infections during infancy (sepsis, etc.) or certain antibiotics when the baby's growth monitoring should be done regularly and carefully, especially developmental and behavioral disorders in children.
If found irregularities that led to developmental disorders especially in developmental disorders and behavior then you should be consulting the experts for early diagnosis and early intervention.
In infants with gastrointestinal disorders that are accompanied by symptoms of allergies or a history of allergies in the elderly, should delay the provision of food allergies are at risk until the age above 2 or 3 years. Foods that should be delayed is eggs, fish, peanuts, certain fruits, cheese and so forth.
Infants who experience digestive disorders should also have to avoid monosodium glutamate (MSG), amines, tartarzine (food dyes), When the indigestion is suspected as the Celiac Disease or Gluten Intolerance Casein and then the diet should be free casein and gluten, Create a loving family environment unfortunately both in quality and quantity, avoid hostility, conflict, emotion and violence.
If there is a risk factor for the period of pregnancy or childbirth, we should be more vigilant. According to some studies the risk the greater the possibility of autism. Next we must carefully observe the signs and symptoms of autism since the age of 0 months. When you get symptoms of autism at an early age, if necessary early intervention in terms of prevention and treatment. Earlier we intervene the incidence of autism can be prevented or at least we will minimize complaints that arise. If the risk is already apparent at the age of the baby then we have to minimize these conditions even if we need to eliminate. For example the failure of the increase in weight should really be looking for the cause, provision of vitamins is not the best way to find the cause of these disorders.
Similarly Demikan food allergy disorders and digestive disorders in infants, the cause must be sought immediately. The most common is due to food allergy or food intolerance, the cause of certain types of foods including baby milk. Administration of drugs is not the best way to find the cause of allergic disorders or digestive disorders. The ideal is that we must avoid foods cause the disorder without the help of medication. Medications can be given while when complaints occur quite heavy, not forever.
Autism is a disorder that is influenced by the multifactorial. But so far there is still not clear exactly on the causes and risk factors. So that prevention strategies that do not yet optimal. Currently the purpose of prevention may be limited only to prevent the disruption that occurred not more serious, not to avoid the incidence of autism. Further research is needed to clearly reveal the mystery of why autism disorders so that preventive strategies will be done so that a child can be prevented autistic disorder.