الفهرس 
HISTORY OF AUTISMOnly 14 pages are availabe for public view
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Abstract
The aim of the study is to find the neurochemical changes that cause the
alterations in the clinical picture and behavioural changes between the childhood
autism and the atypical autism, to examine the evidence that childhood autism may
be a disorder of the immune system, as well as its correlation to other brain
neurochemicals and to investigate more effective neurochemical markers to help in
diagnosing both childhood autism and atypical autism.
The current study is a case control study carried out on 90 children divided
into two main groups; one group diagnosed as childhood autism and the other
group diagnosed as atypical autism. The number in the childhood autism group
was 60 which was divided according to Childhood Autism Rating Scale (CARS)
scores into two subgroups of 30, the mild-moderate autism group which includes
23 males and 7 females and the severe autism group which include 22 males and 8
females, the number of the atypical group was 30 which includes 21 males and 9
females. The age ranges of the two main groups are 2-7 years. In atypical autism
the mean age was (5.11±1.5) and in childhood autism it was (6.1±2.1). All of them
are collected from the psychiatric clinic of the Institute of Postgraduate Childhood
Studies, Ain Shams University. The study also included 30 healthy children aged
2-7 years (6.6±0.7); 15 males and 15 females. They were age and gender matched
and they are relatives of children going to pediatrics Surgery clinics, Ain Shams
Faculty of Medicine as a control group.
All children included in the study (subjects and control) were subjected to the
following:
1- Full Psychiatric History and Complete Psychiatric Examination:
2- Full Medical History and Clinical Examination:
3- Childhood Autism Rating Scale Second Edition (CARS-2)
4- Vineland Adaptive Behaviour Scale (VABS) Second Edition
5- Assessment of Socioeconomic Status:
6- Biochemical measurements:
- Determination of ArgininVassopressin (AVP) plasma level.
- Determination of Tumour Necrosis Factor-α plasma level.
- Determination of Gamma-aminobutyric acid (GABA) plasma level.
- Determination of Glutamate (Glu) serum level.
- Determination of Brain drived neurotrophic factor (BDNF) serum level.
- Determination of Serotonin (5HT) plasma level.
- Determination of Dopamine (DA) plasma level.
- Determination of reduced Glutathione (GSH) plasma level.
- Determination of Lipid peroxide, Malondialdehyde (MDA) serum level.
- Determination of Zinc (Zn) plasma level.
- Determination of Mecury in Human Hair Samples:
Our results showed:
- 33.3% of the autistic children were diagnosed with atypical autism and 66.7%
were diagnosed with childhood autism. The preponderance of autistic patients in
both the atypical autism and the childhood autism groups were boys (70%) and
(75%) respectively.
- CARS scores demonstrated that in the atypical autism group, 100% had autistic
features (25-29), while in the childhood autism group, 50% had mild-moderate
autism (30-36) and the rest 50% had severe autism (37-60). CARS total score
changes significantly by the diagnostic group, with patients diagnosed with
childhood autism having significantly higher (P<0.0001) total CARS scores than
individuals with atypical autism.
- The level of social IQ measured by Vineland Adaptive Behaviour Scale
demonstrated that in the atypical autism group , 53.3% had mild deficient IQ,
13.3% had moderate deficient IQ, 23.3% had borderline IQ, 6.7% had low average
IQ and 3.3% had average IQ, while the mild-moderate autism group showed 30%
had mild deficient IQ, 40% had moderate deficient IQ, 13.3% had Severe deficient
IQ, 10% had borderline IQ, 3.3% had low average and average IQ respectively,
while in the severe autism group 6.6% had mild deficient IQ, 46.7% had moderate
deficient IQ, 46.7% had severe deficient IQ.
- All the patients from all our autistic groups, atypical autism (46.7%), mildmoderate
autism (56.7%), and the severe autism groups (40%) were of high middle
social status (49-58).
- A highly significant (P<0.0001) concentrations of mercury excreted in hair
among both atypical autism group and childhood autism group compared with the
healthy control group and compared with each others (P<0.0001). the level of
mercury excreted in hair was significantly decreased with the increases in the
severity of the disease as it was greatly significant low (P<0.0001) in childhood
autism group in comparison to atypical autism group and it was also significantly
low (P=0.02) in the mild-moderate autism group compared with atypical group
while highly significant low (P <0.0001) in severe autism group in comparison to
the atypical autism group, but significantly lower (P=0.03) in severe autism group
compared with the mild-moderate autism group.
- There was insignificant (P=0.1) change of plasma level of glutathione in the
atypical autism group in comparison to the healthy control group, while
glutathione level in the childhood autism group showed a significantly (P=0.02)
low level versus the healthy control group and highly significant low level
(P<0.0001) compared it with the atypical autism group.
- A remarkably significant elevation (P<0.0001) of the plasma level of TNF-α in
both atypical autism group and childhood autism group versus the healthy control
group and its level was also significantly highly elevated (P<0.0001) in atypical
autism group versus the childhood autism group. The remarkably elevated level of
TNF-α in both autistic groups decrease with the increase in the severity of the
disease measured by CARS..
- A marked significant increase (P<0.0001) in the serum level of glutamate in
atypical autism group versus the healthy control group and a significant increase
(P=0.01) in its serum level in childhood autism group versus the control group,
while reported a highly significant decrease (P<0.0001) in its level comparing
childhood autism group to the atypical autism group.
- A significantly elevated (P=0.005) plasma levels of GABA comparing atypical
autism group to the healthy control group and highly significantly elevation
(P<0.0001) in GABA levels comparing childhood autism group to both control
and the atypical autism group and increase of its level with the increase in the
severity of the disease..
- The level of Glutamate/GABA ratio was insignificantly changed (P=0.7)
comparing atypical autism group to the healthy control group, while the
Glutamate/GABA ratio was highly significantly (P<0.0001) decreased comparing
childhood autism group with both healthy control and the atypical autism groups.
The reduction of the Glutamate/GABA ratio was linked with the increase in the
severity of the disease.
- A significantly high (P=0.02) serum level of BDNF among atypical autism group
and a remarkably significantly high (P<0.0001) level among childhood autism
group compared both to healthy control and the atypical autism group. The
heightened of BDNF level with an increase in the severity of the disease.
- A highly significantly elevation of serotonin plasma level (P<0.0001) comparing
both atypical and childhood autism groups to the healthy control group and also
has insignificant change of its level comparing all autistic groups with each others
and a significant negative correlation between serotonin level and both dopamine
(P=0.02) and glutathione (P=0.006) levels in the atypical autism group.
- Plasma concentration of dopamine showed insignificant (P=0.2) change in
atypical autism group relative to the healthy control group, while it showed a
remarkably significant (P<0.0001) increase in childhood autism group relative to
both healthy control and the atypical autism group. Its level was significantly
increased with the severity of the disease.
- The plasma level of AVP was highly significantly decreased (P<0.0001) in both
atypical and childhood autism groups compared to the healthy control group, and
there were no significant change of its level comparing all our autistic groups with
each others and a significantly negative (P=0.04) correlation between AVP and
GABA and a significantly positive correlation (P=0.01) of AVP compared it with
dopamine in atypical autism group.
- A significantly (P=0.04) lower plasma level of zinc in childhood autism group
compared to the healthy control group, insignificantly low level comparing
atypical autism group to childhood autism, healthy control and also to mildmoderate
and the severe autism groups.