Autism spectrum disorders (ASD) are complex, severe, heterogeneous and pervasive neuro-developmental disorders. These syndromes are characterized by various problems in social interaction and communication skills; restricted interests; repetitive, stereotyped, verbal and non-verbal behaviors. A wide range of neurobehavioral, cognitive and emotional changes are associated with autism. Typically, the symptoms are evident before 3 years. The exact etiology of these disorders is still unclear. Probably, the interaction of several genes and environmental risk factors is the basis of their origin. Autism could be defined as a multifactorial and polygenic disease, because it is a complex combination of genetic, epigenetic and environmental (i.e. infections, toxins, air pollution, organophosphates, heavy metals, …) and immunological factors. Perinatal and neonatal adverse conditions could also play a role in the pathogenesis of autism.

From a molecular and cellular point of view, ASD are associated with different cellular and biochemical processes, such as oxidative stress; endoplasmic reticulum stress; decreased methylation capacity, limited production of glutathione, mitochondrial dysfunction, intestinal dysbiosis, increased metal charge-toxicity, immune dysregulation, immune activation of neuroglia cells.

The social impact of ASD is very problematic, because these diseases adversely affect the family life. The estimated prevalence of these disorders continues to increase, such as to consider them as a public health problem. Their frequency is increasing dramatically: up to now one of 88 children of 8 years in the United States has autism, according to the Center for Disease Control.

Currently, there is no effective drug therapy for the treatment of the main symptoms. The available drugs are directed only toward specific symptoms, without addressing the basic etiologies. An international standardized and defined approach does not exist, however, current available treatments for autism can be divided into: behavioral, sensory, nutritional, pharmacological and psychotherapeutic. The behaviors, such as irritability, depression, anxiety, inattention and obsessive-compulsive processes are neuropsychiatric co-associated disorders with autism. These symptoms are secondary target of drug therapy. Several drugs are prescribed and used: psycho-stimulants, alpha-2 agonists, beta blockers, lithium, anticonvulsants, mood stabilizers, atypical antipsychotics, conventional antipsychotics, selective serotonin reuptake inhibitors, antidepressants. The effectiveness of these drugs in the treatment of autism spectrum disorders is not definitively proven, and side effects are very important, such as to raise concerns about their usefulness.

Several treatments have been proposed as new options: acetylcholinesterase inhibitors, carnitine, glutamate antagonists, treatment with hyperbaric oxygen, immunomodulation and anti-inflammatory drugs, melatonin, naltrexone, oxytocin, special food supplements, tetrahydrobiopterin, vitamin C.

More effective intervention strategies currently in use are behavioral therapy and music therapy. The use of computer assisted interventions can improve the social and emotional skills of people with autism.

Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASD, however, it can be difficult to recognize and characterize a gastrointestinal dysfunction because of communication difficulties faced by many autistic children.

Several investigations are intended to develop recommendations for diagnostic evaluation and management of gastrointestinal problems for ASD individuals. A study of Valicenti-McDermott evaluated children with ASD and two control groups matched for age, gender and ethnicity (one with non-autistic developmental disorders, and the other with normal development). The results were that 70% of children with ASD had gastrointestinal problems compared with 42% of children with developmental disorder other than ASD, and 28% of children with normal development.

Just like everyone else, people with autism may suffer from gastritis, colitis, irritable bowel syndrome, constipation, motility disorders, allergy or food sensitivity, overgrowth syndromes.

Food allergy is common in this population. Research indicates the following prevalence rates of food allergies in children: 5-8% of neurotypical children without autism suffer from food allergies, 36% of autistic children suffer from food allergies. May autistic children are intolerant to gluten and cow milk.

If your child complains of a stomach ache, or take unusual positions to put pressure on his/her lower abdomen, try to identify the causes when possible. Basic tests could help identify factors such as infections, allergies or food sensitivities, and the causes of constipation.

Autism is a neurodevelopmental disorder characterized by social, cognitive and communication difficulties and repetitive behaviors. It can vary from very mild to very severe degree, and occurs in all ethnic and socio-economic groups.

The males have a chance of having autism four times higher than females. Some children with autism appear normal before one or two years and then suddenly "regress" and lose the faculty of language or social skills they had previously acquired. This is called the regressive type of autism.

Signs of Autism:

• No big smiles or other joyful expressions for six months or thereafter.
• No sharing of sounds, smiles, or other facial expressions by nine months or thereafter.
• No babbling at 12 months.
• No expression in gestures (pointing, waving).
• There are no words at the age of 16 months.
• No significant phrase of two words (without imitating or repeating) by 24 months.
• Any loss of speech or babbling or social skills at any age.

Early signs of autism:

• No eye contact.
• Do not smile when smiled before.
• Do not respond to his name or the sound of a familiar voice.
• Do not follow objects visually.
• Do not use other gestures to communicate.
• Do not follow gesture when choosing things.
• Do not make noise to get attention.
• Do not start or respond to cuddles.
• Do not imitate the movements and facial expressions.
• Do not play with other people.
• Do not ask for help or do other basic requirements.

Communication

Communication is usually severely impaired in people with autism. What the individual understands (receptive language), as well as what is actually spoken by the person (expressive language) are significantly delayed or nonexistent. The deficits in language comprehension include the inability to understand simple questions or commands. People with an high functioning autism spectrum disorder may include a simple speech,  but still they find difficult to interpret the meaning of the conversation thinner. There may be a lack of dramatic play or fake, and these children may not be able to engage in simple and appropriate games of childhood. Adolescents and adults with autism may continue to engage in play with games that are for young children and can try to establish friendships with people much younger than themselves.

Individuals with autism who can speak may be able to start or participate in a two-way conversation (mutual). Often the way a person with this disorder speaks is perceived as unusual. Their speech may seem normal that lacks emotion and it is a sound flat or monotonous. The sentences are often very immature, "I want water" instead of "I want a bit 'of water, please." People with autism often repeat  words or phrases that are spoken to them. For example, you might say: "Look at the plane!" and the child or adult can answer "airplane", without any knowledge of what was said. This repetition is known as echolalia. Memorization and recitation of songs, stories, commercials, or even entire script is not uncommon. While many feel that this is a sign of intelligence, the autistic person usually does not appear to include any content in his speech.

Behavior

People with autism often have a number of unusual and repetitive behaviors. There may also be a hypersensitivity to sensory stimuli through sight, sound, or touch (tactile). As a result, there may be an extreme intolerance to loud noise or visual stimulation, or things that have been heard. Birthday parties and other celebrations can be disastrous for some of these individuals. Wear socks or clothing labels may be perceived as painful. On the other hand, there may be a hyposensitivity to the same type of stimulation. Autistic people may resort to means abnormal visual, auditory, tactile or touch experience. This person may scream instead of speaking in a normal tone, and bring all things to your doorstep in a narrow field of view. They can also touch an object, graphic, or other people just to experience sensory input.

Children and adults with autism are often related to daily routine activities and for many can be ritual. Something simple, such as taking a bath, can be realized only after that the precise amount of water is in the tub, the temperature is correct, the same soap is in its assigned position, and also the same cloth is in the same position. Any break in routine can cause a severe reaction in the individual and put a strain on the adult who tries to work with him or her.

There may also be repeated action or behavior without a definite object. Persistent rocking, teeth grinding, twisting the hair or finger, banging his hand, walking on tiptoe are not uncommon. Often, there is a concern with a very limited interest. A child or adult can play continuously with only one type of toy. The child can line up all the dolls or toy cars and adults line up their clothes, for example, and repeatedly and systematically perform the same action on each of them. Any attempt to disturb the person can cause extreme reactions by the individual with autism, including tantrums or direct physical attack. The objects that turn, open and close, or perform other actions can contain extreme charm. If left alone, a person with this disorder can sit for hours turning on and off a light switch, twirling a toy, or stack objects. Some individuals may also have a special bond with specific objects and become hysterical without that piece of rope, paper clip, or paper roll.

Interest and abnormal behavior

Many people with ASD have interests or unusual behavior. Examples of special interests and behaviors related to autism:

• playing with toys in the same way every time,
• particularly love parts of objects (for example, wheels),
• be very organized,
• angry for small changes,
• have obsessive interests,
• having to run to force certain routines,
• rotate the hands, stiffening the body, or turn on itself.

Repetitive movements are repeated actions over and over again. They can involve a body part or the entire body or an object or toy. For example, autistic children may spend a lot of time repeatedly flapping their arms or rocking from side to side. They can turn on a light or repeatedly spinning the wheels of a toy car. These types of activities are known as "self-stimulation".

People with ASD often thrive on routine. A change in the normal daily pattern, as a stopover on the way back from school, can be very upsetting for people with autism. Could "lose control" and start to make tantrums, especially if in an unusual place.

Some autistic children may also develop a routine that might seem unusual or useless. For example, a person might try to look at every window that is or could ever be willing to watch a video from start to finish, including previews and the credits. Not being allowed to do these types of routines could cause severe frustration.

Other symptoms

Some people with ASD have other symptoms. These might include:

• Hyperactivity (very active)
• Impulsivity (acting without thinking)
• Short attention span
• Aggression
• Self-injury
• Anger
• Unusual eating habits and sleep
• Unusual mood or emotional reactions
• Lack of fear or more fear than expected
• Unusual reactions to sound, smell, taste, appearance.

People with autism may have unusual reactions to the touch, the smell, the sounds, the visions, the taste and feel of, for example, could over-or under-react to pain or a loud noise. They may also have abnormal eating habits. For example, some people with ASD limit their diet to a few foods. Others may eat non-food objects like rocks and sand. They might also have problems such as constipation or have chronic diarrhea.

Even sleep is abnormal. The children with autism may have abnormal moods or emotional reactions. For example, they might laugh or cry at unusual times or show no emotional reaction where one would expect to have one. In addition, they may not be afraid of dangerous things, and may be fearful of objects or events harmless.

Development

Children with autism develop at different rates in different areas. They may have delays in language, social interaction and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but may have problems with social activities like talking or making friends. Children with ASD may also learn a difficult job before one easy to learn. For example, a child might be able to read long words, but not be able to tell which sound makes a "b".

Children develop at their own pace, so it can be hard to tell exactly when a child will learn a particular skill. There are, however, specific development indicators used to measure social progress and emotional child in the early years of life.

Normally, the immune system has to:

• Recognize all foreign organisms (bacteria, viruses, parasites, fungi, worms);
• Destroy efficiently and quickly the invaders;
• Prevent a second infection with the same micro-organism (have a good memory);
• Not cause damage to the person (ability to discriminate self from non-self).
• Immune system dysfunctions:
• Immunodeficiency: immune answer defective or ineffective.
• Hypersensitivity: hyper-reaction to the foreign material harmless, out of proportion to the potential harm (allergy).
• Autoimmunity: inappropriate reaction towards your body, loss of self-recognition (self).
• Inflammation: hyper-vigorous attack against invaders by damage to normal tissue.

The dysregulation of the immune system in persons with autism can lead to any of these four problems.

Sometimes the autistic child has a family history of autoimmunity (i.e. rheumatoid arthritis, thyroiditis). In children with ASD show several types of autoantibodies, although the significance of this is not yet clear. Several studies have found that some autistic children have low immunoglobulin (IgG, IgM, IgA), and / or low numbers of T cells, cytokine profiles altered and / or low-functioning, low levels of NK cells; a subgroup of children presents a true immunodeficiency.

Some children have low serum IgA, which predisposes them to respiratory and gastrointestinal infections.

Antibodies are divided into several classes:

• IgA mucosal surfaces - if the level of these antibodies is low, the child may be predisposed to respiratory and gastrointestinal infections, and autoimmunity.
• IgM: rapid antibody response in blood flow made at the beginning of an infection; it can be high or low in ASD.
• IgG antibody levels in the blood slower but longer lasting; it can be high or low in ASD.
• IgE: allergy; it can be high or normal in ASD.

Conclusion # 1

An autistic child with recurrent infections deserves an evaluation of the immune system to immune deficiency.

Conclusion # 2

An autistic child with eczema, chronic nasal symptoms, asthma, gastrointestinal symptoms or significant recurrent respiratory infections deserves an evaluation for IgE levels and food allergies.

According to reports from the American Academy of Pediatrics and the US National Research Council, behavioral approaches and communication that help autistic children are the ones that provide the structure, management and organization for the child, in addition to the participation of the family .

Applied Behavior Analysis - Applied Behavior Analysis (ABA)

One approach to treatment very important for people with ASD is the Applied Behavior Analysis (ABA). The ABA has been widely accepted among health care workers and used in many schools and clinics. The ABA encourages positive behaviors and discourages those negative behaviors, in order to improve a variety of skills. The child's progress is monitored and measured.

There are different kinds of ABA. Following are some examples:

Discrete Trial Training (DTT)

DTT is a type of teaching which uses a series of tests to teach each step of a desired behavior or response.

The lessons are broken down into their simplest parts and positive reinforcement is used to reward good behavior and responses. Incorrect answers are ignored.

Early Intensive Behavioral Intervention (EIBI)

The EIBI is a type of ABA for autistic children very young, usually under the age of five years and often younger than three years.

Pivotal Response Training (PRT)

The PRT aims to increase a child's motivation to learn, monitor their behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.

Verbal Behavior Intervention (VBI)

The VBI is a type of ABA that focuses on the teaching of verbal skills.

Biomedical is a way of thinking based on problem-solving, not a fixed set of tests and treatment. The subject of Biomedical Thought is the individual, the details of whose personal history provide the basis for personalized treatment. There is no default protocol of biomedical treatment for autism. But there is a biomedical approach to treating every autistic child. The patient, and not the protocol, is the expert and expresses its experience through the answers to tests and treatments which become the guide for a better understanding of the options. [...].

There are several approaches to the biomedical treatment of autism. Some are: vitamin therapy, anti-yeast therapy, facilitated communication, music therapy, occupational therapy, physical therapy and sensory integration.

The different types of treatments can be broadly categorized as follows:

• Approaches to Behaviour and Communication.
• Dietary Approaches.
• Dressing.
• Complementary and Alternative Medicine.

Stem cells

Based on data from clinical studies, stem cell therapy is the great promise for the future of molecular medicine and regenerative. Some characteristics  that define stem cells make them potentially useful as therapeutic agents for autism.

These properties are: 1) their ability to self-renewal, or the ability to generate other identical stem cells, 2) their ability to give rise to differentiated cells, 3) the paracrine activity.

Because of the particular neural and immune dysregulation observed in autism, the stem cell therapy could offer extraordinary potential as a treatment modality.

Other approaches

ITogether with the early educational guidance, other therapeutic approaches can play an important role in improving communication skills and reduce the associated behavioral symptoms. These complementary therapies may include music, art or therapy animals and can be taken on an individual basis or integrated into an educational program.

All these therapies can help the child, increasing the communication skills, the development of social interaction and providing a sense of accomplishment.

Art and music are particularly useful in the sensory stimulation providing a tactile, visual and auditory integration. Music therapy is good for the development and understanding of language. Songs can be used to teach the language and increase the ability to put words together. Art therapy helps the child to express himself.

Therapy with animals may include horseback riding or swimming with dolphins. Therapeutic riding programs provide benefits both physical and emotional, improve coordination and motor development, by creating a sense of well-being and increasing self-confidence.