CLINICAL MANIFESTATIONS OF AUTISM CHANGE AS THE CHILD DEVELOPS
Throughout life, the clinical course of ASD is variable and includes a wide range of clinical manifestations. Despite the prevailing opinion that the signs of autism become noticeable in toddler age, there are symptoms of future autism in infants. Clinically, the initial signs of potential autism can be detected early in development with appropriate alertness on the part of neonatologists and pediatricians. For example, with significant caution on the part of doctors, some signs of developing autism, including withdrawnness, little or no social interest, decreased engagement of attention, marked passivity, decline in eye fixation, irritability, frequent episodes of illness, can be identified at this stage of the child's development[1] [2] [3] [4].
Then, prior to the onset of neuropsychiatric symptoms and signs, clinical observations have identified a wide range of sensory problems represented by abnormalities in the auditory, visual, olfactory, gustatory, tactile, vestibular, proprioceptive, and interoceptive organ systems[5] [6] [7] [8] [9]. These sensory distortions can hinder the ability to perceive and integrate information, thereby affecting a child’s ability to acquire necessary skills and knowledge resulting in inability of understanding typical behavior and adaptation, compromised cognitive functioning, underdeveloped problem-solving abilities, and impaired decision-making skills[10] [11].
In addition to sensory problems, many autistic children develop fine and gross motor impairments, including clumsy and uncoordinated gait, difficulty manipulating objects, and trouble writing[12] [13], which in many cases, continue to present into adolescence[14].
As an autistic child grows older, the mental and neurological disorders usually become more pronounced. These disorders reveal themselves by conduct disorder, mood dysregulation disorder, anxiety disorder, pathologic insomnia, elimination disorder, seizure disorders, depression, ADHD, OCD, bipolar disorder, and others[15] [16] [17] [18] [19] [20] [21].
Many non-neurological pathologies were found in autistic individuals. They include a variety of infectious, endocrine, metabolic, and other diseases and deficiencies many of which continue into adulthood [22] [23] [24] [25] [26] [27]. Clinical manifestations of digestive tract diseases in children with ASD may reveal themselves by diarrhea, cramping, constipation, bloating, abdominal pain, nausea, and vomiting[28] [29]. Several studies have demonstrated increased association of allergic pathologies and autoimmune diseases including eczema, asthma, rheumatoid arthritis, psoriasis, and systemic lupus erythematosus in individuals with ASD[30] [31] [32] [33] [34]. In the neuroendocrine system, many studies observe endocrinological abnormalities[35] [36] including thyroid and adrenal gland dysfunctions[37] [38]. Autism is often associated with increased prevalence of androgen-related conditions, such as polycystic ovary syndrome (PCOS) in women[39] and hyperandrogenism in men[40]. Autistic individuals have a high risk of metabolic dysregulations, including type 1 and 2 diabetes [41] [42], diabetes insipidus[43], hypocholesterinemia[44], potassium disorders and sodium deficiencies [45] [46], etc.
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