The Truth About Autism

And welcome back to the Ask Dr. V show brought to you by Channel of Health, where you can be informed and empowered about healthcare issues that are important to you. I am your weekly host, Dr. Valda Crowder, but you can call me Dr. V. I've been a board certified emergency medicine physician now for 30 years, and I have treated patients through four pandemics, one mass shooting, and a category four hurricane. So rest assured you are in good hands today, and we are going to talk about the truth of autism. We meet here every Monday at 10 a.m. uh to discuss whatever uh health matters uh are important to you. So, first let's get started because there's been a lot of conversation about autism and the Tylenol and everything as a result of um a press conference last week. And I thought it would be really important that we have a conversation about it so those of you who are listening here can help share what is the actual information on autism and and what is autism and how do you prevent it, how do you treat it, um, what does it look like, all of that. So let's start first with um autism uh disorder. Um, and it is usually referred to as ASD, which is autism spectrum disorder, and it's it's really a lifelong condition that really affects uh social communication, interaction. Um you may find that people have uh with autism have problems processing certain sensory inputs, or they may actually have uh very repetitive behaviors. Um, one of the things that actually makes it difficult to diagnose is that it is a spectrum. So you will find that there are some folks that are um mildly affected, and there are some folks that are severely affected. So let me just kind of share with you kind of what this actually looks like. It's almost similar to you have asthma. Some folks with that have asthma are mildly affected and can go on and play professional sports. You have other people with asthma that wind up getting intubated and are in the ICU repeatedly. Um we have we see the same thing with sickle cell anemia. Some folks are mildly affected and some folks are severely affected. So this is what I mean by a spectrum. So let me share a little bit about what this kind of looks like and what I've seen in my clinical practice, right? So you have some folks that have autism, and if you met them and interface with them, you wouldn't necessarily know that they have autism. Um, then you have others that are completely nonverbal. They cannot speak. Um, they may do things like bang their hand repetitively or bang their legs repeatedly, um, and they are completely uh nonverbal. So to kind of give you an idea of what that spectrum looks like, that's kind of it can go from completely nonverbal and repetitive behaviors all the way up to completely normally functioning, and you may or may not know it if you actually had an interaction with them. Um as an example, a couple of famous people that have stated that they have autism. Elon Musk is one, Greta Thornberg, who actually is the climate activist, is uh another. Um, Anthony Hopkins, uh, the famous um actor is another one. Uh Dan Aykroyd, the famous comedian that used to be on Saturday Night Live. That kind of gives you a full breath what how we see it sometimes in the public when there are more higher functioning patients that are with autism. So, how do you know about autism and how do you know that your child actually might have it and when do you actually see it? So the signs of autism often appear in the first two years of life. It can be detected by early screening by the pediatrician, and usually what happens is treatment is in is involved with improving their skills and improving their independence. So, for instance, if someone is nonverbal, it would be very important to actually give them verbal skills, even minor verbal skills where they can actually communicate and express what is working for them and what is not working for them. There are also skills to kind of make sure that eventually uh they can be employed or they can live in an independent uh living set setting. So, what are some of the things that we commonly see in infancy and toddlers? So you may see where a child has either limited uh eye contact or atypical eye contact, they may not respond to their name. A parent may actually wonder, like, hmm, is my child deaf? And bring the child in for hearing, for testing of their hearing. There may be sort of like not really back and forth social play with other children. Um, you can also see um delayed speech where you know they don't speak at the time, you know, that around one or two years old, they're not beginning to actually form speech. Um you also may have unusual speech, would be which would be sort of babbling or maybe a very odd tone. Um you may see repetitive motions like hand flapping or rocking or a strong need for intense routines. Like they really, really love routines. The other thing that we actually see uh early on is the child being very, very sensitive to sounds, um, touch or noises. Um so they may, um, if there's noises, you may see them, you know, hold their hold their ears or scream or cry in relationship to things that are kind of like normal sounds and normal normal lights that are part of normal life. So one of the things that is important is that um if you actually have a child or a grandchild or a niece or nephew that um you see these sorts of signs for, it would be very important to get screened. There is a pediatric screening tool, it's called MChat month for all children, um, and this is actually recommended by the American Academy of Pediatrics. And basically, it is a parental questionnaire, and they ask questions related to, you know, is the child responding to their name? Do they bring objects over to you? Do they repeat behaviors that that you do? They they there's a whole bunch of questions. There's probably about 20 or 30 questions that they ask, and this is scored. And then if there's a particular score, then they actually recommend that you get fully evaluated. And one of the main things is that if a toddler is not responding to their name or they are they avoid eye contact or they have delayed language, these are really, really the high uh high risk things that you should actually really make sure that the child gets in and actually gets screened by the pediatrician. The diagnosis diagnosis of autism is a clinical diagnosis. So there is no test, there's no blood test, there's no CAT scan, there's nothing like that that'll actually tell you. It is actually based upon the structured tools that we use, um, and they're based upon observation of the child and also a parental history. And so, and there are a specific clinical criteria that they use in this thing called the DSM5, which is the diagnostic statistical manual, and there are certain things that you have to actually display, and if you display those things, then they actually will give the child uh the diagnosis of autism. Now, I'm gonna open up the lines here and uh want people to actually join into this conversation. You may have some questions or concerns about um maybe some of your family members or what you have witnessed or seen amongst uh younger people in your family. The call-in number is 1-800-450-7876, 1-800-450-7876. All right, so I want to go into a little bit about what is the um treatments, therapies, and support, and how do you actually um prevent autism? So there is no cure for autism. I just want to, I know there was a lot of talk at the uh at the presidential press conference, but there really is no there is no cure for autism. What we actually try to do with autism is we focus on actually increasing or building skills so and reducing barriers so that child can be a more fully functioning adult. So, for instance, if there are language skills, how do you actually improve the language skills? If there's sensitivity to light or sound, if there's uh things related to uh interaction with others, how do you actually teach that child to uh to socially interact with others? So let's talk about a couple of things. Um there are uh several types of behavioral and developmental uh interventions. Um, there is a early start Denver model, which um also helps to improve communication and social skills. There's a lot of speech and language therapy, which really helps to improve uh communication. There's occupational therapy, which really makes a difference for daily living and sensory challenges, and then there's physical therapy for dealing with specific um motor issues. Um we don't the medications don't in general treat autism itself. Sometimes there may be things that um the physician repres recommends um because sometimes, in addition to autism, uh children also have attention deficit, uh hyperactivity disorder. So there are sometimes medications that will help with some of the actual symptoms. So the other thing they do is a lot of um educational support. Um a lot of these uh kids are in IEPs, which are sort of individualized education plans. Um there are specialized accommodations in the classroom, um, there's a lot of vocational support. Um and the and the real key is to actually have the child actually become in adulthood a normal functioning uh adult that can live as independently and possibl as possible and actually really be um employed. Um a lot of times because of their repetitive uh nature and and and their it's it's almost like uh very, very detailed. Some of them have very artistic, very, very good artistic skills. And so uh some of them are very, very good at drawing. Disney has a whole department that actually uses uh children uh that are now adults um with autism to help with some of the cartoons and some of the designs because it really speaks to their skill set around detail if they're if they're if they are visually inclined. So let's talk about prevention. Um so one of the things that is really important with um with uh autism is uh maternal and paternal age. Um you'll hear some talk about the fact that autism seems to be increasing, there seems to be more people uh with autism. And if you really think about it, what what what's happening a lot in in our society is that um people, men and women both are delaying getting married, they're delaying having children. Um an advanced maternal age is considered uh over 35, uh, advanced paternal age is considered over 40. And I know a lot of times men don't think about their age and when they've actually had a kid, but both the egg and sperm do degrade over time with age. So it is really important that it is it is both maternal and also uh paternal age that is really one of the um one of the bigger risk factors with um autism. All right, what the health is happening, that is the real question. It is also the name of my new podcast where you can literally get life-changing advice. What the health is happening is where I give you an inside scoop on health matters and empower you with information from ever all breaking news to medical and health updates. What the health is happening is your dose of medical reality with me and my friends and other people that are on the front lines of healthcare. We are now on all podcast platforms, so you can get us. It doesn't matter if it's uh Audible, uh Apple Music, uh uh Podbean, um, you can get us on all uh all streaming and podcast uh platforms. The Ask Dr. V show is produced by the nonprofit Channel of Health. The mission of Channel of Health is to inform, educate, and empower communities about pressing health care and healthcare issues. We also provide scholarships and MCAT prep for students that are actually aspiring physicians. I have been asked to actually speak a little bit more about this and from one of our view uh one of our listeners, and I'm gonna do that today. Um so we do a 10-week MCAT course. Um we are our latest course just started on Saturday. Uh we have two uh promising uh young physicians that are actually uh in the process of studying for their MCAT exam, which is the entrance exam for medical school. Um, and um they will finish the course in December. Um I will uh try to bring them on this show once they actually complete the course so they can actually interface with you. If you'd like to donate and help our students, uh you can just go to channelofhealth.org and you can donate there. So that is what uh that is what your donations are doing. We have two students in the course now. Our goal is to actually start another course in the spring. All right, let's go to news you can use. One of the things that I have to talk about today, a lot of the things that are in the big beautiful bill, uh, which is not really big, it's big, but it's not beautiful, um, is actually taking away healthcare subsidies. So if you actually have gone on to a state platform and you got this a discount on your uh health insurance through the state platform, it is going to take that subsidy away. Um, in addition, um they're also going to put a work requirement on Medicaid and you have to you have to recertify every six months, not every year. So we know that what happens with that is about 30% of the people actually can't keep up with the actual paperwork and therefore are um taken off the Medicaid roles. Um the other thing that we know is that it is more expensive to actually administer a program that checks for a work readiness, that is more expensive than actually giving people the health care. So the bureaucracy that is involved in that uh has a cost. Um and so uh we're we're looking at seeing um almost 10 to 11 million people who currently have insurance um possibly not have insurance if all of these cuts uh were to go through. And that is why you'll see um, I guess today there's some big meeting in the White House, but that is why you see the uh Democrats actually saying that they're not going to vote to continue unless there's some negotiation on this. You know, one is that uh there are certain programs that will be mandatory, and there's certain programs that we'll deem to be discretionary. Discretionary programs during government shutdown are either not funded at all or funded at a lower level. So the most important thing is your local emergency departments, we are open, we are mandatory. 911 is open, we are mandatory. Uh so you will always and still be able to use that. Um, what you will find will happen is that there will be some cuts or lack of payments uh through the Medicaid disproportionate share to hospitals, and these are payments that basically compensate hospitals for serving vulnerable and low-income populations. Um sometimes a WIC funding is also considered to be uh discretionary. Um also telehealth services or at hospital home waivers would expire. Umsually a lot of the folks at NIH and nearly about 60% of the CDC staff could be furloughed. Um as far as the FDA, um, routine food safety inspections would be reduced to sort of a bare bone minimum. So these are some of the things that we'll see sort of in a um in a government shutdown. Um Medicaid and Medicare services, um, as well as veteran hospital services and Indian health services will also usually and all crisis hotlines will continue to uh still be up and running. All right, the other news you can use actually relates to what we have going on today. I wanted to actually read this statement. This is uh from the American College of Obstetrics and Gynecology and is related to autism and Tylenol. Um and this is from Stephen Fleischman, and he is the president of the American College of Obstetrics and Gynecology, and that's all of our OBGYN doctors across the country. Um and I'm gonna read a statement. Suggestions that acetaminophen use in pregnancy causes autism are not only highly concerning to clinicians, but also irresponsible when considering the harmful and confusing message they send to pregnant patients, including those who may need to rely on this beneficial medicine during pregnancy. So, this you know is why I actually decided to have this topic today, because I wanted to sort of clear up some of the misconceptions around um autism in general and specifically acetaminophen and autism. And that is the statement from Dr. Fleshman, who is the president of the American College of OBGYNs. So we often get uh emailed with questions. I have people that have emailed me questions. If you want to reach me by email, it's info at askdrv.us. Info at askdrv.us. That's info at asdrv.us. All righty. I have uh several questions here and I'll So Dr. V, thanks for doing this topic. Please clarify the causes of autism. I had a cousin who had a son in her mid to late 40s. He's autistic, and the ex-husband blames her because she kept delaying having kids because of her career. He believes that her older age is what caused the son to be autistic. Is this possible? So older age definitely causes, uh, increases the risk of uh autism. But again, I I'm gonna I'm gonna say this again. It's not just the mother's age. It's the father's age. I know men think the sperm, nothing happens to the sperm with aging, but that is not true. So it is the mother's age and the father's age. It is combined. So um, if you have a mother that is over 35, or if you are uh a man and you are having children and you are over 40, it absolutely is associated with an increased risk of autism. And what happens is, and this is really important, each year after 35 for women, and each year after 40 for men, that risk continues to go up, right? So a man has a man who is 50 has a higher risk than a man who's 42, a woman who is 40 has a higher risk than a woman that's 36. So all of these things actually uh do make a difference. All right. Um, so great question. All right, uh next question here is from Blake. Blake said, I'm curious to know how how does it all work? Are psychiatrists the only physicians who can diagnose autism? So this is a great question. So usually what happens is the pediatricians are usually the first to screen for autism. Then you will actually be sent either to a psychiatrist or sometimes a neurologist, or there's also neuropsychologists who are board certified in both neurology and psychiatry. Um and so, and usually they will actually do a hearing test to make sure that the child actually can hear, because obviously that makes a huge difference, the child's ability to actually hear. So, um, so you know, you psychiatrists are not the only ones that will actually diagnose autism. Um, it can also be diagnosed by neurologists, or it can also be diagnosed by um uh neuropsychologist. All right, great question. All right, Cynthia, can you discuss whether or not autism is hereditary? Because honestly, I feel like all the men on my father's side are a little special. Okay. Um, all right, so let's talk about the general risk of autism. So the general risk of autism in the population is about 1 to 2 percent. Um, there is a genetic uh component to autism. There have been over a hundred genes that have been linked to autism. If you are an identical twin and you have autism, then your identical twin is about 60 to 90 percent twin, a non-identical twin, uh, then the twin is likely to 10 to 30 percent uh to have autism. Uh if you have a parent uh that has autism, um then you are uh 10 to 20 percent more likely to actually have um autism. So there actually is a hereditary, uh hereditary link um there, and there is also a genetic link. All right, we've got a question here from Serena. She said, I heard folate B vitamin B9 has something to do with autism. Is this true and are there certain vitamins that we should take to prevent this? So, yes, so this is actually uh this is actually uh very true. So folate uh and folic acid is a synthetic uh component of it, which is vitamin B9, is important in general for the development of the brain and the spinal cord. Um and um you will find that uh deficiency in folate is associated with um autism and is also associated with other uh neurodevelopment diseases like ancephaly, spina bifida, etc. Now, what's important is that too much folate is also associated with autism. So too little and too much. So this is why I really recommend with um it is so, so important that even if you are trying to get pregnant, that you actually speak with your OBGYN doctor and you actually get on a prenatal vitamin and whatever that prenatal vitamin that OBGYN doctor recommends. Because what you don't want to do is go to your local drugstore and start taking folate or or folic acid on your own and you don't know exactly what dose you're taking and all of that. Um, one of the things that is important about the prenatal vitamins is it is a balanced vitamin. Um, and um usually the OBGYNs have made sure that the amount in their prenatal vitamin is the correct amount that you need. Um, it is important that you actually start that before you get pregnant because a lot of women don't realize that they're pregnant until they're maybe sometimes two months in, and there's a lot of neurodevelopment that actually occurs in the first one to two months when you don't know that you're pregnant. So if you're trying to get pregnant, it is really important um that you actually um start on a prenatal vitamin um during that period before you are actually um uh pregnant. And that brings up actually another issue because at the press conference that uh the president and RFK had, they talked about a drug called, I think it was Lucovorian, Luke Lucovorin uh or leucovorin. It's a it's a it's basically a folinic acid. So let me, it's a folinic acid, which is a derivative of folate. So there have been studies on that, and that is actually there is a form of autism where there is problems in uh getting the folate acid into the brain, crossing the blood-brain barrier. So the mother may have enough uh B9, vitamin B9 circulating in their system, but does that vitamin B9 actually enter into the brain and the nervous system? So, for people that have autism and specifically have problems with this receptor, that drug has made a difference in people's verbal skills and their ability to function. But it is not for everybody, and it is not a cure for autism. It was presented almost like a cure for autism, it is not a cure. It is actually specifically helpful for that slice of autism where that is the specific problem. All right, Mimi has a question. She says, I'm not trying to be funny, but is autism a new name brand condition? I was born in the 1970s, and I think the first time I heard about autism was in the 2000s. So, um so great question. So one is, you know, I think um autism is definitely a disease that we have gotten better at diagnosing. So because we have gotten better at understanding the early signs of autism, recognizing the children that maybe need to be screened, and actually screening those children, it does seem like we're seeing m more more kids actually be diagnosed with with autism, um, which is actually good because the earlier you can get the services in, the better. The earlier you can get the services is better. Um, I had so much fun talking to you. We are here to answer your most pressing healthcare questions. So email me or send me an audio message at info at askdrv.us. You can follow me on Twitter and Instagram at askdr underscore v. That's askdr underscore v. And we will be back right here next week. All right, I look forward to talking to you all next week and hang in there and make sure to take care of yourself. It is important. She blinded me with size.