How to Assemble the puzzle of autism - Tampa Bay Times

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Times Correspondent

Dr. Heather Agazzi is an associate professor in the Psychiatry and Behavioral Neurosciences department at the University of South Florida Morsani College of Medicine. She teaches and trains medical students, medical interns and future psychologists how to evaluate children with autism spectrum disorder, or ASD, and provide therapy to improve their communication and social skills.

An estimated 1 in 59 children have the disorder, according to a report cited by the National Autism Center at May Institute. Agazzi recommends that parents of these children read the center’s National Standards Project, Phase 2.

“It describes the evidence for all the interventions that are out there,” she said. Agazzi, 45, talked about the disorder with the Tampa Bay Times.

What are the characteristics of autism spectrum disorder?

Impaired social skills, difficulty understanding and using nonverbal social cues, such as making eye contact, using facial expressions to communicate feelings, thoughts… making gestures with (their) hands and other body language, like shrugging the shoulders, moving your head, body posturing. Individuals with autism have a very difficult time engaging with other people and using those skills. And individuals with autism are more comfortable dealing with objects, to be quite frank. They have an inability to recognize and use those cues and it makes it hard for people with autism to understand the feelings of other human beings. ... So if I have a hard time using nonverbal social cues myself, I also have a hard time reading those cues from other people who may be trying to communicate with me.

And then behavioral signs of those deficits might include reduced eye contact during social interactions, not knowing to look at the person during a conversation, maybe not even understanding to stay present and physically near someone during an interaction – walking away, avoiding interactions. We also see repetitive types of behaviors… such as rocking, repetition of words or noises, sometimes making finger movements or handclapping. … In higher functioning people they may be more repetitive statements about interests that they have.

Yahir Manuel Charneco Roldan, 6, looks through the glass doors after a visit with Santa at International Plaza in 2019 where the family attended an early event for families with sensory-sensitive children. There were no flashing lights or loud music for a more calming experience for children who prefer it like Yahir who is diagnosed with autism. [ MARTHA ASENCIO RHINE | Times ]

What behaviors in babies should cause parents concern?

In really young children and babies they should look for a social smile. They should look for eye contact. Babies should be looking for their parents when they go in and out of rooms and respond to their parents when they return to the room. If you have a baby that really is just content to be alone and not be bothered for extended periods of time, that should not be confused as an easy baby; that should be a concern. …

I would say most people miss those symptoms in infancy, so as you get closer to the toddler years, not pointing – when you look in the sky at a cool big airplane when your kid is little… and you point it out to them, most babies look at that and then they look at you and say, oh, wow, with gestures or eye contact. They don’t say the words, but they make a reaction.

Toddlers with autism do not do that. ... You go to the zoo, you look at the monkeys, the monkeys are incredible. I point to the monkey; I look at my toddler. My toddler should look at me and look back at the monkey and share that experience with me. And that’s something that most toddlers with ASD don’t do, or they don’t do it fully as we would expect. They also may have delays in their language, so that’s also a warning sign, that their language is delayed. And spending excessive time with one toy, doing the same kind of repetitive play. … Spending an hour with (one) toy is not really appropriate for a one-year-old.

Is there some part of the brain that may be the center of this disorder?

Unfortunately, no one has really pinpointed a definite answer. It’s very complicated. Many labs are pursuing this question. ... There are changes in over 1,000 genes that have been reported to be associated with autism, but a large number of these associations have not been confirmed.

There are many common gene variations thought to affect risk of developing autism, but again, not all people with the gene variation will be affected. And most of these variations have only a small effect, and many of them can combine with environmental risk factors like parental age when the child is conceived, birth complications, as well as other environmental factors that we haven’t really identified, to determine an individual’s risk of developing autism. So there is a genetic component for sure and we know that if you have a child with autism, their siblings are more at risk for having autism.

Is there an advantage to identifying this condition early?

Yes, there really is an advantage for early intervention. Children with autism usually can benefit from really intensive early intervention, like behavioral interventions, speech and language therapy, sometimes occupational therapy to help them learn to use their fingers to engage in daily life tasks like self-feeding, dressing, zipping and unzipping, buttoning clothes.

A number of parents enroll their children in what’s called equine therapy – horseback riding – in an effort to improve behavior. That and other “therapies’' you named, such as a gluten-free diet, do not work, you say.

They do not change the core social deficits, communication deficits or repetitive behavioral deficits of children with ASD. Children with ASD as well as all kinds of other children may enjoy doing those things for a number of reasons, like it’s pleasurable, its fun, animals are interesting. … And they may be happy while they’re doing them. But we cannot equate that to learning how to use language in a functional way, improving eye contact, etc. There have been studies and those things are not proven to work.

What therapy works?

Behavioral interventions are the gold standard interventions and those are well-documented in the National Standards Project, Phase 2.

What would be an example of that?

An early intervention provider who goes into the family’s home during the breakfast routine and teaches the parents behavioral strategies to teach the child how to come to the table, sit at the table, pick up their spoon, dip their spoon in their oatmeal, put the oatmeal in their mouth… breaking these skills that we may take for granted down… into their component parts, using behavioral techniques like direct instruction, modeling the skill, repeating the skill over and over and over again.

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