Autism generally becomes noticeable in early childhood. There are plenty of cases in which autistic people don't get diagnosed until much later in life, but the symptoms invariably turn out to go back a long way. Older children, teenagers and adults don't just go autistic overnight. Except in this case, if you believe it.The patient, "A", was born to healthy parents and developed perfectly normally, though she was described as somewhat shy. Just before her 14th birthday, she became ill with what at first seemed to be nothing more than a fever and mild headache.
However, a week later, she developed a severe headache and had a seizure. After being rushed to hospital, she was unconscious for a few hours and then awoke, tired but fairly lucid. However, her recovery was only temporary:
On day 6 there was a severe aggravation of symptoms and she became confused, part of the time verbally and physically aggressive, at other times tired and apathetic. She kept complaining of the headache.These complaints would be perhaps the last time she would use language appropriately for the purposes of communication.
From day 10 she became autistic, reacting not to people but to pain. She would avert her gaze when approached. She was still febrile.... From day 12 to day 19 she was sometimes comatose and sometimes awake, "looking through people with her empty staring gaze," in the words of her mother (day 18) according to the medical records. She reacted with a pained facial expression even to rather slight noises (day 19).She then began to recover some of her faculties, but only some:
On day 33: "lying in bed, accepting food orally for the first time, avoiding gaze contact but looking around her when she is not observed. Obviously sensitive to smells and taste. Empty, autistic like gaze."Autism is defined by a 'triad' of symptoms: difficulties with social interaction; difficulties with communication; and insistence on sameness, or repetitive interests and behaviours.
Day 40: "still quite 'fenced-off' but manipulated small objects with great skill. She echoed what nurses and mother said to her. Wrote simple words. Laughed in odd situations and raged with anger without obvious cause."
Day 45: "autistic, not responding to social interactions, but echoing long phrases and sometimes chatting away in a cocktail party fashion."
Of these, it's perhaps not surprising that brain damage could cause the first two. We socialize and communicate with our brains, so of course damage could cause difficulties. What makes this case remarkable is that the patient also developed the third element of triad, repetitive behaviours.
From day 70 bilateral flapping stereotypies of the hands were observed. She had also had bouts when she would laugh intensively and jump up and down, surreptitiously... She would carry with her small plastic objects and protest if these were removed. She would scream for hours if daily routines were changed in any way.10 years later, when the case report was written, her condition had changed only slightly.
At the age of 22 years she moved to a small group home for mentally retarded persons... The most severe problem nowadays is her insistence on sameness. She absolutely refuses to go to the bathroom and screams for a quarter of an hour every morning before she finally accepts... Then she refuses to leave the bathroom and screams for another quarter of an hour. This pattern is followed every day without fail and intrudes on almost all activities of daily life.What happened to her? She suffered from herpes simplex encephalitis, a viral infection of the brain. X-rays at the age of 22 showed serious damage to the temporal lobes of the brain, extending to parts of the parietal lobes. (No pictures were provided, however.)
Can her case really be described as a "typical autistic syndrome"? Certainly, there are striking similarities, from the obsessive routines, to the echolalia (repeating what other people say), to the avoidance of eye contact, all classic symptoms of severe autism.
Of course it's always possible that the case report was written to accentuate these similarities, in order to make a nice publication. There have been a handful of other similar cases, though the same caveats apply. Still, if we do accept that these patients are indeed autistic, the implications for understanding the neurobiology of "normal" autism are obvious.
Link: "The Man With Half A Brain" who developed a rather different pattern of symptoms after herpes encephalitis.
Gillberg, C. (1986). Brief report: Onset at age 14 of a typical autistic syndrome. A case report of a girl with herpes simplex encephalitis Journal of Autism and Developmental Disorders, 16 (3), 369-375 DOI: 10.1007/BF01531665
18 comments:
Truly fascinating.
At the end of the day, Autism is a brain disorder. Regardless of cause, if your loved one has symptoms, why not start with interventions involving the brain? Take a look at what Brain Balance - http://brainbalancecenters.com has to say about changing the brain and correcting miscommunication between the two sides of the brain.
I don't agree with Jennifer. If you have autism then embrace. Make the world a better place with it. And if you can't understand autistics then try harder, catch up.
The insistence on sameness might be a copying mechanism which isn’t unique to autism. I mean look at OCD. The bathroom situation I can understand. She has a problem with running water. She's sensitive to the sounds of water running along the pipes. It probably makes her physically sick.
They might want to put industrial ear muffs on her or heavy duty headphones before entering the bathroom. Why not get her a bucket of water to bathe and a potty. Maybe she was born with mild autism but back in 1986 it wasn't commonly accepted and the trauma from the virus heightened it, not necessarily caused it.
I don't agree either. We can't just go around labeling all sets of behaviors that are odd as "brain disorders" without scientifically verifiable lab tests and evidence. I'm open to the idea that autism MAY be a brain disorder, but if it truly were established as such, it'd be handled by neurologists.
My daughter's autism was induced by Lyme Disease contracted in utero. Brain damage is brain damage. Parents need to get over their fear or disgust? of the idea that their children have sick brains. My daughter is basically non-autistic at this point although not completely well thanks to her ongoing aggressive Lyme treatment. She has had services and stunned therapists with her improvement.
I'm surprised to see this story only because no one really knows about this Lyme-Autism connection yet (there is an organization however). But I'm truly surprised that it happened at an older age like this.
Many people with neuroLyme have described some Autistic traits when it was at its worst (prior to treatment) but not to the point of this diagnosis. The damage must have been at just the right spot.
Was she vaccinated before this illness or is that unknown?
I"m a little confused by the statement that while it's normal for brain damage to cause social impairments, it would be weird for brain damage to cause repetitive behaviors. Why? Presumably all behavior arises from activity in the brain, right?
Anonymous: all behavioral disorders are brain disorders, so far as we know. The only part one can quibble about is "disorder," which not everyone (e.g., @veri) likes because of its negative connotation.
I would urge you and your readers to take a look at this website, put together by the mother of a child who contracted PANDAS. She is a mom at my school and it's fascinating. Strep throat puts children into a state of both autism and psychosis. Her website is very well-researched and substantiated. For one thing, she has data from 200 parents. It's fascinating that something like this could cause autistic symptoms. She also details what protocols brought her son out of his two years with PANDAS.
http://budurl.com/xux7
This website is one of the very few in which consumers/parents have collected and presented their data in a way that allows them to actually communicate with doctors and the medical community. We need to do more of this. For example, everyone should be doing a better job of tracking data about autistic children (parents and doctors alike). Why isn't this being done?
cat
www.neurodevelopmentalbathtub.com
Sorry. Here's the site in NON bud-url format:
http://pandasnetwork.org/
@catmikk
Heckyeah: It's not mentioned. I assume she was vaccinated as normal for someone born in Sweden in 1962. Unfortunately, there's no vaccine against herpes simplex virus.
What if these repetitive behaviors are just the normal response we all have whenever the neurological system is pushed too far... either because of a huge increase in demands from the outside world or because the system is capable of coping with everyday demands.
Plenty of kids with autism don't demonstrate repetitive behaviors when they are in situations that they understand and can actively engage with. These behaviors only appear when things are too hard, confusing, etc. Plenty of non autistic people demonstrate these same behaviors when they are overwhelmed -- after a death in the family, when they are watching and exciting sporting game, or when someone is berating them.
Just my two cents.. having know a lot of kids with autism.
GamesWithWords: I suppose what's surprising about damage being able to cause repetitive behaviours and insistence on sameness is that these are "positive" symptoms in the sense of being additional things that healthy people don't have, rather than "deficits".
If you knock out part of the brain, you knock out certain functions, that's unsurprising, but for damage to create an obsessive interest in carrying around small plastic objects, is a bit odd.
Of course you could just say that repetitive/obsessive behaviour is a "deficit" - a deficit of "variety-liking" or "flexibility" or whatever - which is fine, but it's still interesting, because we generally don't think of those as being functions of the brain.
this is a reminder that they are.
@Neuroskeptic: If "variety-liking" and "flexibility" aren't functions of the brain, what are they functions of? I guess I'm asking: do you think that people often forget that "variety-liking" is a behavior, or that people often don't think about whether this type of behavior arises in the brain?
As far as brain deficits only causing positive behaviors ... whether repetitive behavior is a positive behavior is a matter of definition, right? I mean, take someone who, due to brain damage, is no longer able to move. You can either say they have lost an ability (movement) or gained one (stillness). Similarly, repetitive behavior is the opposite of novelty-seeking; which one is the "deficit" seems definitional, not empirical.
Hello friends -
An adult friend of mine got meningitis a few years ago from a mosquite; he spent a few days in a coma. He told me later that when he woke, there was about a week when he could not figure out how to communicate; he could not speak, write, nod his head, or point to a correct answer to a question. He said is was maddening; the right action was just somewhere he couldn't quite access.
He then told me that I might consider that when trying to deal with my son; who was going through a really dark time in journey autism.
- pD
Heckyeah, I don't entirely agree with you, sorry. Maybe your daughter was meant to be the way she was with or without Lyme disease. If therapy enhances her ability to be herself then so be it. Even people without brain damage.. which from my understanding is a noticeable trauma in a specific region of the brain and not a behavioural oddity, seek therapy. Although I am sorry the Lyme disease may’ve made it more difficult for your daughter to be herself.
@GWW.. have you seen the musical Catz? It's about cats on roller skates. Phantom of the Opera? A man who wears stage costumes, thinks he’s a ghost, can't get laid. Disney.. heresy. I don’t care what the neurologists say, it’s sadistic and kinda sad, they have got to be projections from a brain disorder.
How about a bee flapping its wings for nectar? A monkey toying with his banana.. the one attached down there, an angry elephant remembering its aggressor, a deadly buffalo hammering a tree, an eagle clawing its feathers off.. are these behaviours brain disorders?
Let's say the bee swapped its brain with a human. The bee suddenly goes berserk and chases after the queen bee.. survival of the fittest it must procreate with the mother lode. The human on the other hand FLAPS its hands for honey who cares about the chic.. sound familiar? I'm just joking.
There was a time when humans used to sacrifice and cannibalize each other, lobotomize psychiatric patients.. are these not brain disorders too?
What exactly is a brain disorder?
It’s debatable, but for procedural purposes maybe it becomes a disorder when one is not able to function in society because of a specific condition regarded as non-productive by a particular society.
So I don’t think all odd behaviours stem from brain disorders. Like Clare says they could be sensory reactions from over-stimulation. They were possessed, low on serotonin, too much nitrogen in the air, copying mechanisms to what what.
It need not have to have disordered from the abstract or conscious level of perception. In other words, you might not even be aware you have a brain disorder unless you make it so, or it substantially fx your life.
Anyway..
I reckon some autistics like collecting pens because they just do. Heck some people collect stamps, Star Wars memorabilia ewww, fudderduddys pack jams.. what’s with that? Most people I presume collect money.
Words don't seem to express why they have an obsession with pens. But if you think about it why not? Fascinating in a way.. you could figure out the geopolitical condition of market economies by focusing on the make and model of pens. Maybe it tinkers in their mind without them realizing.
PD, take your son to church if you haven't already done so. I bet he'll love it. Treat him like an angel. A curious cherub in need of guidance is what my mother used to call it.
Perhaps you should have researched Christopher Gillberg before writing this blog post. This is not a trustworthy scientist. His research on austism is inadequately referenced and he has deliberately destroyed research data.
http://www.informath.org/apprise/a6400.htm
I'm pretty unconvinced by the negative/positive behaviour distinction. Limbic encephalitis, Sydenham's chorea, temporal lobe epilepsy, Huntington's, Lewy body dementia, frontotemporal dementia, SLE - these all lead to some pretty odd 'positive' symptoms that can mimic the sort of things we see in psychiatric illness.
To follow on from the PANDAS reference above, Sydenham's chorea (a potential consequence of rheumatic fever following Group A strep and likely auto-immune) is well known for being associated with obsessive-compulsive symptoms so I'm not particularly surprised that encephalitis could be.
BrC: Oh dear oh dear. That doesn't look good at all. although, I'm not sure it directly relates to his work on autism, it seems like it concerns ADHD?
Either way it's serious, thanks for posting, I will probably write a post about this as I'd not heard of the "affair" at all...
pj & GamesWithWords: I'm not saying that the "positive/negative" symptom distinction is a valid one. But it does seem to be how we intuitively think about the brain. At least it's my intuition anyway. Cases like this one, and others in which people develop "positive" symptoms, are therefore especially interesting because they show that actually, the brain doesn't work in the way we thought it does.
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