Deutsche Welle (English edition)
The brain of an autistic person simply works differently
Autistic people can find communicating and engaging with others hard. But a typical autistic person does not exist, and autistic traits may be in all of us.
A whole range of different conditions belong to the autism spectrum disorder (ASD) or autism, a life-long neurodevelopmental disorder that affects how people communicate and interact with the world.
One in 160 children has autism but several recent studies have reported rates that are substantially higher, according to the World Health Organization (WHO).
ASD is considered a developmental disorder because — although it can be diagnosed later in life — it begins in early childhood and tends to persist into adolescence and adulthood.
The level of intellectual functioning in autistic people varies hugely, ranging from profound impairment to superior non
verbal cognitive skills. It is estimated that around 50% of people with autism also suffer from an intellectual disability, ac
cording to the WHO.
There is a wide range of symptoms in autistic people. Some of the main symptoms include communication problems like delayed speech development, and difficulty in social interactions, such as making friends, maintaining eye contact, reading people's body language or facial expressions, and expressing how they feel. Repetitive behaviors and strict routines may also be noticed, like repetitive body movements or finding it difficult to adjust even to small changes.
"There are autism spectrum disorders in which all autistic symptoms appear in a very strong form. These include the so-called syndrome autistics. In them, there are often severe underlying developmental disorders that then lead, among other things, to the symptoms typical of autism," says Hannelore Ehrenreich, the head of the Department of Clinical Neuroscience at the Max Planck Institute for Experimental Medicine in Göttingen, Germany.
"Autism is an extremely complex disorder. Research on it has to come from different disciplines," Ehrenreich told DW. Important pillars include psychiatry and neurology, but also genetics and neurobiology. Only in this way is it possible to develop effective therapies for certain forms of autism, she said. This may be necessary, for example, if other serious issues are also present.
These can be neurodevelopmental disorders, difficulties in fine motor skills or pronounced repetitive movements. "This is the case, for example, when a child always sits in the corner and continuously wiggles his head or wrings his hands, making so-called manege movements [movements sidewards with the head]," said Ehrenreich.
Some people with ASD also have savant syndrome, a rare condition where someone has exceptional skills often related to memory, but also art, mathematics and music.
The 1988 film "Rain Man" starring Dustin Hoffmann and Tom Cruise was one of the first films to include a main character with autism.
While the film introduced autism to people on a large-scale and brought attention to the disorder, it is sometimes criticized for having created a stereotype of people with autism.
Dustin Hoffmann's character, Raymond, is an autistic man who can memorize vast amounts of numbers but is incapable of managing his daily life and who lives in a home for people with disabilities. The film was inspired by the life of Kim Peek, an American with exceptional memory abilities who said he could memorize the contents of about 12,000 books.
But highly gifted autistic people are quite rare. Studies determining the number of autistic people who are savants vary, but at least one in 10 people with autism has savant abilities. One study found that 37% of people in the sample exhibited either savant skills or unusual cognitive skills or both.
Ehrenreich cares for one such gifted patient. "If you ask him what's in the phone book on page 923 in the middle column, he can tell you with no problem," said Ehrenreich, "but he can't manage to get dressed in the morning. He puts his shoes on first and then his pants. That means he needs help."
Expert diagnosis essential
Ehrenreich said the diagnosis of "autistic" absolutely must be made by people who are well versed in that specialty. "There are various instruments and tests that help with the diagnosis and back it up. In appropriate centers, specialists can perform these tests," Ehrenreich said. It's just not enough to be a psychiatrist or neurologist. A great deal of experience and expertise is needed to determine whether autism is present and what form it takes.
"About half of the people who are sent to us with suspected autism don't have autism at all. That's where the diagnoses are simply wrong. In addition, autism has become a kind of fashionable diagnosis," Ehrenreich said.
While other conditions can be treated with medication, specific medications for autistic people with severe disorders do not exist. None of the potential medications have led to a breakthrough, such as the endogenous messenger oxytocin, which acts directly in the brain. "As a hormone, oxytocin enters the body through the bloodstream. It has been found to be able to improve social interaction in autistic people in the short term. It doesn't have a lasting effect, though. But through this new experience they're having, it might encourage autistic people to start behavioral psychotherapy." First, however, a diagnosis must be made that is as sound and clear as possible.
Building on the observation that autistic people largely avoid eye contact, scientists have done eye-tracking experiments. This involves a camera recording eye movements. "With this eyetracking, you can see that the autistic person is not looking at the eyes or mouth of their counterpart, as most people do, but at facial regions that play little role in communication. They then look at the neck or cheek, for example," Ehrenreich said.
Another tool is thermography. It can provide information about the surface temperature of a person's face. "In doing so, you see very characteristic behavior of heat and cold in the face. We were able to show that social stimuli cause a change in the thermo response in the face. This allows us to distinguish social stimuli from purely cognitive stimuli, for example, those based on perception and thinking independent of social interaction," Ehrenreich explained.
"Such tests lead to a relatively objective measure of diagnosis, because they can show how much stress an autistic person experiences when interacting with others." Such a test can help medical professionals and researchers better understand the mechanisms and causes of autism.
There is now an extensive database available, which Ehrenreich started it in 2004. It registers not only autistic people but also people with schizophrenia. With the help of this database, scientists can identify and describe phenotypes. These describe the set of all characteristics that an organism has, including behavioral traits. Those in particular are essential to understanding autism.
"When I started this database, people didn't always take me very seriously. Many thought you could find just about anything with the help of genetic testing or blood analysis," said
Ehrenreich, "today, however, it's known that we need to know quite a lot about a person in order to understand where certain disorders and problems originate."
The database is intended to help classify test subjects as correctly as possible. Among other things, this involves determining how severely individual subjects are affected and whether they can be grouped into groups with similar characteristics. "Our goal is to draw more information about autism and its biological causes from this vast heterogeneity."
For severe cases, that can also lead to more targeted therapies. "If I know what the biological cause of a disorder is, I can treat it better," Ehrenreich sums up. Genetic causes are a prime candidate for this. But environmental factors that act very early, for example infections during pregnancy, for example, in utero, can also play a role in the development of autism.
The autist in us
Ehrenreich said that autistic traits are a part of the normal human behavioral repertoire, and only in extreme cases do they result in a disorder.
"If we took the whole population and measured everyone's autistic traits, we would get a very broad spectrum," said Ehrenreich. "We would probably find quite a few people who have distinct autistic traits."
Walking through the hallways of the Max Planck Institute, for example, she repeatedly encounters people who stare fixedly at the floor, completely absorbed in their own data world and in no way eager to communicate. "But that does have its advantages. As a scientist, it's great when they're not partying but working intensively on their research."
cases of thrombosis in 1.6 million vaccinated people?
Karl Lauterbach, a public health expert from Germany's center-left Social Democrats, criticized this comparison in an interview with German public radio Deutschlandfunk. CVST is not comparable in severity to thromboses caused by the contraceptive pill, he argued.
When people talk about thrombosis in connection with the contraceptive pill, they are usually referring to leg vein thrombosis. In this case, blood clots form within the veins in the legs and, if they break loose, can travel to the lungs and cause an embolism.
But that is not the entire truth. Taking the pill also increases the risk of the more dangerous CVST. "Women are affected more often than men, and hormones probably play a role. In late pregnancy, in the puerperium and in women taking the contraceptive pill, we see CVST most frequently," Peter Berlit, secretary-general of the German Society for Neurology, told DW. Regardless of gender, younger people are generally affected more often than older people, he added.
AstraZeneca: Concerns jus
The decision to refrain from giving the vaccine to people under the age of 60 as a rule, of course, does not come out of the blue. The Stiko had recommended the step on Tuesday, the day before the announcement. The thromboses are rare but serious, it said in a press release. Because they occur predominantly in people younger than 60, the Stiko recommends limiting vaccines administration to people outside that age group.
There's still no conclusive information on how the sinus vein thromboses actually develop and whether there is a connection to the vaccine. Researchers at the University of Greifswald, Germany,had published study results at the end of March in which they described a possible mechanism.
For example, antibodies that activate blood platelets were detected in the blood samples of four individuals who had developed thromboses after being vaccinated with AstraZeneca. This causes the blood to clot and can lead to thrombosis.
These results were published in Research Square, a preprint publication, which means the data has not yet been reviewed by independent experts. But for safety reviews and recommendations by committees such as Stiko, quick results like this may be important.
"The picture is not yet complete, but the question is what preliminary conclusions can be drawn from it," Robert Klamroth, chief physician for internal medicine at Vivantes Hospital in Berlin, said.
He sees the data as strengthening the link between AstraZeneca and thromboses.
"If you consider the large number of vaccinations, it becomes vividly clear how rarely sinus thrombosis occurs and how low the risk is," said Alice Assinger of the Medical University of Vienna in Austria. "Never before have so many people been vaccinated in such a short time, which is what makes the recognition of these rare side effects possible in the first place."
Researchers have long observed that COVID-19 infections, for example, also lead to more frequent thrombosis. This is presumably due to the fact that in the case of COVID-19, our immune system upregulates a certain defense mechanism that influences blood clotting and can thus lead to more thromboses.
Vaccination strategy: Which decision is the right one?
It remains striking that, looking to the United Kingdom, only four explicit cases of sinus vein thrombosis have been reported in the current 13.7 million doses of AstraZeneca vaccine administered. There, the vaccination drive continues without restriction.
"One possible explanation could be that the older groups of people were vaccinated first, and this complication is virtually not observed there. One consequence of this could be to use a different vaccination for women up to 55 years of age in order to keep the number of atypical thromboses as low as possible," said Johannes Oldenburg, chairman of the board of the Society for Thrombosis and Hematosis Research (GTH).
The European Medicines Agency ( EMA) announced renewed consultations on the safety of AstraZeneca's vaccine for next week. Across the EU, 59 cases of sinus vein thrombosis have been recorded in the EudraVigilance database as suspected adverse events. Most recently, the EMA had emphasized in a press release that the benefits of the vaccine outweigh their risks.
There's no word on a possible connection between the other COVID vaccines and any thromboses. "So far, there is no evidence that this complication is clustered with any of the other approved vaccines," Oldenburg said, adding that this question was of course in focus now. "Any newly approved vaccine will certainly be closely monitored in this regard."
What should vaccinated individuals be aware of?
Those who have already received the AstraZeneca's vaccine should watch out for the following symptoms, according to Berlit: "People who have persistent and very severe headaches within the first 2-3 weeks after vaccination need to get further evaluation." Similarly, pinpointshaped hemorrhages in the skin along with headache may indicate CVST.
For the 2.7 million people who have so far received their first dose of AstraZeneca, the second shot would be due in early May. But what about young women, who under the new circumstances would be considered to be a risk group? The Stiko said in its press release it is working on having a recommendation ready by the end of April.
This article was last updated on March 31, 2021. It was translated from German.