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.

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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.

Highly gifted

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.

Diagnosing autism

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.

Accumulate­d knowledge

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

tified?

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.

 ??  ?? Rituals are often very important for autistic people
Rituals are often very important for autistic people
 ??  ?? Pi: Some autistic people can memorize numbers very well
Pi: Some autistic people can memorize numbers very well

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