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This spectrum includes Autistic disorder, Asperger syndrome, and Pervasive Developmental disorder not otherwise specified. DSM-5 states diagnostic criteria within two domains: 1.
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The severity of the diagnosis is further detailed into three levels: 1. Requiring support, 2. Requiring substantial support, 3. Requiring very substantial support. Additional diagnoses are made if a patient presents with or without intellectual impairment, language impairment, or any other known medical, neurodevelopmental or behavioral disorder .
In , the Centers for Disease Control and Prevention reported the prevalence of autism to be 1 in every 68 births in the United States, with 4 times as many males affected as females . Figure 1 Visual Aid example for tooth brushing.
Epidemiological studies have reported below-average intelligence scores IQ in approximately three-quarters of individuals with autism. Two-thirds of these individuals demonstrate an IQ of less than 70, placing them in the range defined as having intellectual disability . Children with ASD demonstrated poorer performance relative to typically-developing individuals in response inhibition, vigilance, working memory, flexibility, and shifting of tasks . Nation et al. Dawson et al. Of the individuals assessed by Hayashi et al. This level of reasoning may not persist, as multiple studies report that children with ASD experience decreased executive functioning with aging .
Dyspraxia, a brain-based condition that negatively affects planning and coordination of physical movement has been reported consistently in children with autism. Difficulty performing skilled motor gestures is one commonly reported trait in children with autism . Impaired performance of skilled gestures has been suggested as contributory to abnormal social development and communication . Motor deficits associated with autism can be identified in infancy, and may be associated with abnormalities in perception of biological motion as well as the favoring of proprioception over visual feedback when learning motor skills .
Serdaravic et al. Neuromotor functioning during infancy is a valuable gauge of central nervous system development.
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Therefore, motor problems, especially hypotonia, detected in early infancy are a valuable part of screening for ASD . Language abilities are highly variable in individuals with autism . Joseph et al. When comparing subjects with similar IQ, individuals with autism often demonstrated more impaired language skills than typically-developing individuals . Communication impairments can affect both expressive and receptive language abilities.
As early as the first year of life, before the emergence of spoken language, signs of social and communication disruption may be detected in children with autism. By the second and third years of life, communication is impaired by reduced frequency and diversity of babbling, gestures, and use of consonants in syllables, in addition to the use of unusual words or word combinations . Wetherby et al. Recent craniofacial studies of individuals with autism noted the common finding of increased head circumferences.
Studies of head circumference in autism established a group mean head circumference at the 60th through 70th percentile in relation to typical norms, which was disproportionate in consideration of height and weight . An increase in total brain volume has been confirmed using magnetic resonance imaging and was recognized in children starting between the ages of years .
ASD has established associations with increased seizure frequency, epilepsy, and sensory hyper-reactivity.
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Shifts in cortical excitability affect sensory function due to the dependence on the dynamic accuracy of the excitatory and inhibitory balance to distinguish neural signals [25,26]. Evidence proposes that the pathway involved in cortical excitability is associated with impairments of specific aspects of inhibitory Gamma-Aminobutyric Acid GABA neurotransmission. GABA is the primary inhibitory neurotransmitter synthesized from the excitatory neurotransmitter glutamate .
Somatic sensory perception and emotional reaction affect pain sensitivity or tolerance. Abnormal touch sensitivity, proprioception, and painful stimuli are characteristics that have been described in individuals with ASD . Using well-controlled stimulations, it has been suggested that individuals with ASD are hyposensitive to pain.
Riquelme et al. Furthermore, children with ASD had a decreased capability in object manipulation and expressed poorer upper limb proprioception. The high pain sensitivity may be attributed to an abnormality in processing of the affective component of pain mediated by C-fibers. This study demonstrated the impairment of tactile and pain thresholds in children with ASD, supporting the notion that abnormal processing of the affective-motivational dimension of touch may be contributory .
Numerous familial studies over several decades demonstrate the heritability of autism spectrum disorder. ASD shows great etiological and clinical heterogeneity, complicating the determination of a genetic basis of the disorder . Symptoms present as behavioral manifestations of numerous interacting genomic imbalances, mutations and environmental factors .
Structural variations in chromosomes are implicated in ASD, with linkage on chromosomes 5, X, and 19, and minor evidence for linkage on chromosomes 2, 3, 4, 8, 10, 11, 12, 15, 16, 18, and 20 [33,34]. ASD is times more common in males than females, emphasizing the significance of X-linked inheritance . Polymorphisms in the X chromosome are observed to result in intellectual disability due to the location of various genes that express neuronal function on the X chromosome .
Impairments in language and social cognition are observed with several of these mutations . Table 1 Summary of strategies for improving the dental environment for patients with autism [49,50,52]. Gastrointestinal symptoms and disorders are among the most commonly reported medical conditions associated with autism spectrum disorder. However, gastrointestinal disorders can be challenging to recognize due to communication barriers that exist for many patients diagnosed with ASD.
Kang et al. Forty nine percent of the children with ASD exhibited chronic gastrointestinal complaints, including diarrhea, constipation, bloating, gassiness, vomiting, and GERD .
These commonly experienced gastrointestinal symptoms often cause pain and discomfort, and may be linked to unusual eating and sleeping habits, anxiety, and regression of ASD symptoms . The gut and brain have signaling pathways, which affect exchange of metabolites, influence the immune system, and control gene function in an individual . Children with ASD often have an altered gut microbiota [38,39].
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Strati et al. However, some microorganisms including Collinsella, Corynebacterium, Dorea, and Lactobacillus were significantly increased compared to individuals without ASD. This study identified an association between constipation and different bacterial patterns of the gut, and concluded that the constipation experienced by many individuals with ASD could be attributed to these microbial differences. Microbiota transplant has been proposed to be a promising therapy for individuals with ASD.
Current data suggests that shifting the gut microbiota to a healthy state can reduce the gastrointestinal symptoms associated with ASD. Because these symptoms not only cause pain and discomfort, but include behavioral symptoms as well, altering the microbiota in individuals with ASD may potentially affect eating and sleeping habits, anxiety, and symptom regression [36, 40]. Shigwedha et al. Using fecal microbiota transplant FMT , Kang et al. After FMT, the microbial profile shifted towards that of agematched healthy control subjects. The shift in microbial populations, as well as improvements in behavioral and gastrointestinal symptoms, lasted for an 8-week period post-treatment.
Recent meta-analysis assessed the oral health status of children with ASD compared to typically-developing individuals. The systematic review concluded that considerably higher prevalence of dental caries and periodontal diseases occurs in patients with ASD . However, other studies have reported no differences in caries prevalence between children exhibiting autistic or typical behavioral tendencies .
Regardless, children with autism are noted to have poorer oral hygiene, modified dietary behaviors, and lower compliance in oral health maintenance [42,43].