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Revealing Autism

Chapter 3

Etiopathogenesis of Autism

 

In the light of real rates of increase of recorded incidence of diagnosis of autism and other learning delay disorders world-wide, the current debate for the reasons of the increases in numbers is ongoing. The purpose of this document is to review the data that has accumulated in the Delacato Organization worldwide over the past forty years to add to the pool of knowledge.

In 1965, in a paper entitled "Neurological Organization: The Basis of Learning", Delacato, Doman, Doman, LeWinn, Spitz and Thomas, proposed causes of Neurological Disorganization, which in turn would lead to diagnosis of Autism or any other Autism related condition. The following major groupings are founded as nearly as possible on etiological relationships.

The paper presented its findings of work by the group after two decades of clinical research with several thousand brain injured children.

Causes of Neurological Disorganisation

(A) Defective or arrested development due to;

  1. Genetic Factors
    • Chromosomal Aberrations - In Structure and in number.
    • Metabolic Factors Genetically Linked - Protein, Lipid, Carbohydrate
  2. Maternal Metabolic Disorders
    • Diabetes Mellitus
    • Dysthyroidism
  3. Nutritional Factors
    • Gestational
    • Postnatal
  4. Exposure of Fetes or Child to Noxious Influences
    • Maternal Infection
    • Irradiation
    • Drugs
    • Hypoxia
  5. Infection
    • Encephalitis
    • Meningitis
    • Cytomegalic Inclusion Disease
    • Toxoplasmosis
  6. Mechanical Intercranial Injury
    • Gestational
    • Perinatal
    • Postnatal

B Circulatory Disturbance

  • Cerebral vascular Thrombosis
  • Cerebral Embolism
  • Cerebral arterial compression in association cerebral edema
  • Dural sinus thrombosis
  • Cerebral hemorrhage

During the years 1972 to 1997 Carl Delacato aided by numerous associates established clinics around the world for the sole purpose of administering Rehabilitation Therapy to Neurological dysfunctional children. Israel in 1972, Germany in 1976, Italy in 1976, Japan in 1982, and England in 1997. In every clinic, the children attending came with a clinical diagnosis, and every child came with a questionnaire, which detailed gestational, perinatal and postnatal history of the child. From this information a very clear understanding of the level of neurological dysfunction could be established as well as possible causes of the dysfunction.

In 1999, Antonio Parisi MD neurologist, attached to the Sorrento Clinic in Italy and medical advisor to Delacato Organizations in Europe, wrote the book "Children who do not look you in the eye - The secrets of autistic behaviour". His book is based on information gathered by the organization team at the Sorrento clinic with the advantage of 23 years of accumulation of medical histories of patients attending clinics with diagnoses.

The chapter entitled Etiopathogenesis of autism, outlines the causes gleaned from study of medical records, and considers the causes of autism to be all the causes of brain injury during pregnancy, child- birth and the first years of early life, conventionally defined as the first thirty months.

(i) PRE - NATAL (exogenous or environmental factors)

a) Infectious Diseases

Toxplasmosis
Cytomegalovirus
Influenza
Measles during the first 3 months of pregnancy
Viral Hepatitis
Herpes Infection
Syphilis

b) Intoxication

Alcohol, tobacco, substance abuse
Thalidomide
benzodiazepine

c) Malnutrition

d) X-ray examinations

(ii) PRE-NATAL (endogenous factors)

Genetic Causes

PERI-NATAL

Environmental changes to which the foetus is subjected
Delivery
Mechanical trauma
Perinatal hypoxia

POST NATAL

Encephalitis
Brain contact with poisonous substances
Brain contact with substances which become poisonous due to the lack of an enzyme (genetic)
Trauma
All causes of hydrocephalus

In the case of pre-natal causes, infections which may cause the death of the foetus should be considered, followed by those which may cause brain injury but leading to neurological disturbances such as autism. It is important to note here our clinic's record that a very high percentage of mothers of autistic children risked miscarriage during the first four months of pregnancy compared to average population.

It is also noteworthy that in Italy all potential mothers are tested to measure immune cells fighting measles, and vaccination is recommended whenever the immune level is insufficient. This has greatly reduced secondary autism caused by congenital encephalopathy due to measles. The screening for phenylalanine and phenylketonuria is also important for the prevention of congenital brain injury and the consequent avoidance of secondary phenlyketonuria autism.

Peri-natal causes of encephalitic disturbance are environmental changes to which the new- born baby is subjected at the moment of birth, delivery through the birth canal, mechanical trauma and hypoxy (lack of oxygen).
Hypoxy following over rapid or lengthy labour can lead to death or neurological effects such as autism.

Of the four possible causes, hypoxy is undoubtedly the most risky, despite the fact that brains of new-born babies are less vulnerable to lack of oxygen than those of adults. Hypoxy causes selective injury of the central nervous system affecting above all the cortex, base nuclei, and white matter of the hemisphere.

Between the years 2002 to 2004 a number of researchers using computerized imaging in a number of Medical Establishments in the United States observed changes in white matter in the brains of Autistic children.

The lack of oxygen in a premature foetus leads to selective injury of the periventricular blood islets of the germinal tissue.

Hypoxy is also the cause of brain injury during delivery, associated with the use of forceps or suction devices, strangulation with the umbilical cord.

Tonic reflux of the neck of the birth canal eases childbirth, but the lack is itself caused by a disorder of the foetus, so dystocia is not the sole cause of the brain injury. This is a common occurrence in the case of autistic children. Our research team often encounter's one cause of brain injury which seems to provoke further vulnerability to a second pathogenic cause of brain injury.
We find a high percentage of brain injury occurring at the perinatal stage.

Postnataly, the brains of newborn babies are extremely vulnerable to direct attack by viruses or bacteria (encephalitis) and to agents originating in the rest of the body, through metabolic injury.

The study of Hydrocephalus as a cause of autism deserves special attention. The hydrocephalus is caused by an accumulation of cerebral spinal fluid in the ventricles and/or sub-arachnid space whose volume increases. Hydrocephalus may be caused by obstructions of various types, and this prevents the flow of fluid, alternatively by hypersecretion of fluid (secreting tumour of the plexis), or by the reduced re-absorption of fluid. In 99% of cases, the cause is obstruction.

Hydrocephalus in new -born babies has no symptoms except an increase in the volume of the skull with consequent tension of the fontanels and sutural diastases. All widespread or focal symptoms of disorder the central nervous system may be due to the disorder causing onset of hydrocephalus, and for which hydrocephalus is a symptom, or by endocranial hypertension which sooner or later accompanies the hydrocephalus.

At this point it is worth commenting on the influence of cerebral spinal fluid. Cerebral spinal fluid is a clear colourless liquid with a variety of functions, including the balanced regulation of the pressure and volume of the brain; if the volume of blood or of the brain increases, the volume of the liquid decreases and vice versa. This is why children with brain injuries should be monitored closely for the intake of liquids, which - if excessive - could cause an epileptic fit and/or hyperactivity and/or bruxism. The presence of a larger than normal ventricular space (the location of cerebral fluid) in brain-injured children leads to the creation of larger quantities of cerebral spinal fluid and hence the reduction of blood volume and lack of oxygen, causing epileptic fits and hyperactivity.

In their published paper "Neurophysiological view of Autism: Review of Recent Research as it Applies to the Delacato Theory of Autism" by Delacato, Szegda and Parisi, the authors noted that 81% of children with autism exhibited enlarged ventricles on CT or MRI scans.

Reducing the amounts of cerebral spinal fluid in the ventricles has the effect of increased blood flow and consequently an increased flow of oxygen to the brain.

At the end of April 2004, the National Institute for Clinical Excellence, (NICE), reported at a press conference, that they were concerned about the rise in occurrence of Caesarian Section births. The Delacato Centre immediately responded to NICE to the effect that, observation of birth records of children currently attending Delacato Clinics or having had therapy for Neurological Dysfunction, showed that over 20% of those children had been delivered by emergency or elective Caesarian Section.

In early June, a team led by Dr Emma Glasson at the University of Western Australia announced, that as part of their findings into a study of Autistic children, whose mothers had problems during pregnancy and birth procedures, compared with problem free children, that, delivery by emergency and elective Caesarian Section increased the risk of those births leading to incidence of Autism. She goes on to state that children who developed autism were more likely to have had a birth procedure of less than 1 hour. Caesarian section delivery is most likely to be considered as a rapid procedure.

Survey of Patient Records

Records of past and current records were initially reviewed to establish which fell into the three main groups of;

Prenatal

Perinatal

Post Natal.

A more comprehensive review of each group was carried out to identify a reasonable cause of the dysfunction.

Patient records giving excellent data on the pregnancy, birth and early childhood were reviewed.

Prenatal Observations; 1% - without indicated birth problems.

Prenatal leading to perinatal problems; 35%

Perinatal (without pre natal indication); 30%

Post natal Observations; 22%

1% of children suffered severe reaction within hours after immunisation.

1% of children attending the clinic was known to have a chromosomal abnormality.

Caesarean section procedures were carried out in 25% of cases

Children subjected to delayed neurological organisation due to interrupted development as a result of not having crept on hands and knees before walking accounted for 12% of patients.

In the prenatal group, mothers notified illnesses, including infections as well as accidents during pregnancy, which led to birth procedure problems, which necessitated a high number of caesarean section procedures.

In the perinatal group hypoxia, lack of oxygen, including those suffering umbilical cord strangulation was a contributory effect. The vast majority of birth procedures were overlengthy (more than 10-12 hours), and conversely over rapid (less than 2 hours).

The children attending clinics came with a wide range of diagnoses at the extreme end of which we noted Agnesis of Corpus Collosum to the milder affected children with sensory difficulties diagnosed as hyperactive, reading, and development delay, and those diagnoses of Asperger Syndrome, Autism, and Cerebral Palsy lying between.

As a consequence of the review we noted that 78% of clinic attending patients acquired mild diffuse brain injury during pregnancy and birth procedures which led to their current diagnoses.

Just as significant, half of patients with post natal development delay was due to the interruption of the natural development sequence in very early childhood (up to 18 months) resulting of a missed development opportunity, that is creeping on hands and knees.

Chapter Four - Sensory Integration Therapy>>

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© theautismcentre.co.uk 2004

 
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