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Lack of Attention to Physical Problems in Autism

Written by Stephen M. Edelson, Ph.D.
Center for the Study of Autism, Salem, Oregon

I am often surprised and upset when I hear that a rather serious physical problem of an autistic child is dismissed as ‘just another symptom of the disorder,’ when the problem should be addressed directly. A commonly reported problem is insensitivity to pain. Many, not all, autistic children lack perception to pain. They may fall and then bruise or cut themselves quite seriously, but they exhibit little or no reaction to the injury. I sometimes hear of an autistic child who will place his/her hand on a hot stove, suffer a severe burn, and show no reaction.

When this type of problem is discussed with a pediatrician or another health care provider, in many cases, very little is done to determine what may be happening. The remark commonly given is: “Autistic individuals tend to have a high threshold for pain.” HOWEVER, if this child did not have autism and exhibited insensitivity to normal levels of pain, then this problem would likely be treated as serious; and there would be much concern about treating the problem.

[Insensitivity to pain may be due to elevated levels of endorphins, endogenous opiate-like substances, in the body. One possible source of these endorphins may be from eating food items containing gluten or casein. If the person has a ‘leaky gut’ (i.e., small holes in the intestinal tract), these proteins may slip through the holes and cause a chemical reaction. The chemical configuration of gluten and casein is similar to endorphins.]

Another problem often seen in autistic individuals is chronic diarrhea. Again, many autistic children suffer from this problem. Chronic diarrhea is very uncomfortable, and the child may not be absorbing all of the nutrients from his/her foods. This can affect brain development and, consequently, cognitive processing and behavior. Again, many health care providers simply state that chronic diarrhea is common in autism; and this problem should not be of any concern. [This problem may be due to some type of intestinal tract problem, such as ‘leaky gut,’ yeast overgrowth, low levels of secretin, some type of infection, presence of a virus and/or toxins, such as metals.]

It is quite obvious from the research literature that many autistic individuals have physical health problems. Some physicians are aware of these problems, but many are not. In fact, it is usually the parents who, through their perseverance, learn the best ways to treat their children’s physical problems. Defeat Autism Now! (DAN!), a coalition of clinicians and researchers sponsored by the Autism Research Institute in San Diego, developed a report on understanding and treating many physical symptoms associated with autism. The report is entitled: ‘Biomedical Assessment Options for Children with Autism and Related Problems.’ A copy of the protocol can be purchased from the Autism Research Institute for $25 (address: 4182 Adams Ave., San Diego, CA 92116).

"Where so ever you go, go with all your Heart."

An article discussing the puzzle surrounding Asperger's Syndrome children's unequal reaction to painful stimuli.
Enlarge ImageAs Parents, Teachers and Professionals of children with Asperger’s Syndrome we are all familiar with the enigma of their unequal reaction to pain and injury. A stubbed toe or paper cut may set off a pain response (crying, screaming, and sobbing) such as is equaled by the loss of a limb; yet a burst ear drum or broken limb may go seemingly unnoticed. As carers of children with Asperger’s Syndrome we are often bewildered by this ‘unequal’ response to pain stimuli. Anecdotal evidence from clients worldwide is full of reports on this topic. So, what’s the answer to this confusing puzzle? The questions surrounding Asperger’s children’s unequal response to pain can be explained scientifically.

The assumption that, physiologically, humans are equipped to limit the amount of stimuli entering our brains thereby preventing the brain from becoming overloaded, has led to the establishment of a ‘normal’ range of feeling. However, those with Autistic Spectrum Disorder are recognized as having a hyper/hypo sensitivity to stimuli i.e. above average range of feeling or super-sensitivity, first written about in 1949 by Bergman and Escolona.

Accounts written by people with Asperger’s Syndrome state that their disability is directly linked to their senses and their sensory processing. So let’s look at the biochemical processes that occur when our senses are stimulated.

Stimulation from the environment enters our brain through our eyes, ears, skin, nose and mouths. Our nervous system passes this information around our brain and body by the use of biochemical neurotransmitters. The amount of stimulation felt is determined by the amount of neurotransmitter processed in each neuron. The enzyme dopamine beta hydroxylase is released from nerve endings during stimulation. Dopamine beta hydroxylase (DBH) is essential for cell communication and regulating neurons in the central and peripheral nervous systems. An increase in stimulation results in an increase in the level of this enzyme. Scientific studies have shown that individuals with Asperger’s Syndrome have much higher levels of dopamine beta hydroxylase in their systems than in ordinary individuals. The presence of this enzyme is also linked to behaviors such as repetition, agitation and aggression.

Repetitious activity, such as rocking, flapping or pacing, results in the release of Endorphins through the system. Endorphins reduce the sensation of pain and have the ability to block pain. In other words, when endorphins are present, the amount of sensory reaction is reduced or stopped completely. Children with Asperger’s Syndrome have the ability to purposely, but unknowingly, overload their sensory system in order to shut it down completely i.e. by rocking, flapping or pacing etc.

Blocking out all sensation by the production of endorphins might seem like a simple and easy way of coping with sensory overstimulation; however, in caring for Asperger children we must realize that reaction to ALL sensation becomes limited. They won’t recognize hunger, tiredness, body temperature (risk of overheating), full bladder/bowel or pain.

Children with Asperger’s Syndrome display agitation through use of repetitious behaviors such as rocking, flapping, pacing, head-banging, staring, screaming, spinning, chanting or humming. Our job as Carers, Teachers and Professionals of children with Asperger’s Syndrome is to recognize these signals of agitation. These behaviors are used to block out
• direct over stimulation from their environment;
• their emotions (happy, fearful, or excited) and
• their response to pain.
These repetitive behaviors also serve to calm an Asperger child, if their use is monitored rather than unlimited.

For Asperger children, the build-up or cumulative affect of these endorphins throughout the day also needs to be taken into consideration. This is why Asperger children who suffer accidents in the afternoon or evening may not show pain or seem to feel it.

All physical exercise causes the release of natural endorphins into the system that can help to ‘protect’ the child with Asperger’s Syndrome without switching off the sensory response. So exercise such as walking, running, and swimming is extremely beneficial in your child’s daily routine as a preventative measure. It may be used during periods of agitation to help calm the child with Asperger’s Syndrome. In this way exercise is used to develop appropriate social responses e.g. it is more acceptable to jump on a trampoline rather than on the furniture.

With this information revealed it becomes obvious that we must monitor our Asperger child’s production of endorphins, because the presence of excess endorphins causes them to lose the ability to respond to any stimulation. This means that children with Asperger’s Syndrome miss much of what they are meant to be learning.

Also, we must realize that these stereotyped/repetitive behaviors have social consequences for children with Asperger’s Syndrome – they are a visual reminder that these children are different from their peers. We must take into account the Asperger child’s socializing skills and ability when monitoring and setting limits on the use of repetitive behaviors. That is, we should tell them times and places when flapping/rocking/head-banging are acceptable, for controlled periods of time.

We should not attempt to eliminate sensory stimulation in order to protect children with Asperger’s Syndrome. Without stimulation, our world becomes meaningless to them. Rather we should attempt to provide them with a safe sensory environment –dim lights, softer noises/voices, reduced odors - giving them the opportunity to learn and respond appropriately.
By Nelle Frances
Published: 3/14/2006

Repetitious activity, such as rocking, flapping or pacing, results in the release of Endorphins through the system. Endorphins reduce the sensation of pain and have the ability to block pain. In other words, when endorphins are present, the amount of sensory reaction is reduced or stopped completely. Children with Asperger’s Syndrome have the ability to purposely, but unknowingly, overload their sensory system in order to shut it down completely i.e. by rocking, flapping or pacing etc.

and that doesnt go away, just because a child eventually becomes an adult, and i can relate to what this person wrote about aspergers, but mein is more random, i did actually scream when ni snapped my ligament, but after the intial schock wore off so did the pain, my oma took me to see the doc, who recomend i still have it e-rayed even though he could examin my foot without causeing pain. but i rember being far more upset by my mum brushing my hair then skating into a wall and spraining my wrist.

Nursing education teaches us that;
Pain is what the patient says it is, without question.
Pain is to be viewed as the 5th vital sign, to be managed around the clock or as needed,
because unmanaged pain directly affects the other vital signs; Blood pressure, heart rate, etc.

But, in actual practice among physicians and nurses alike,
patient's reported pain is very often brushed off "drug seeking", psychosomatic, whining, etc.

"Some kids piss their name in the snow. Chuck Norris can piss his name into concrete."

in the modern world time for compasion is not shedualed in,
and other peoples pain just something that slow down productivity

the pace of life on an island is a lot slower, and doctors have more time, and still make home visits here even brought painkillers and antiinflamotorys when i could litterly not get up cos my back was hurting and body aching.

Pain was quasi classified in the healthcare professions as the Fifth Vital Sign, because it negatively affects so many workers in this nation.
That especially goes for nurses.

and it is in doubt, because too many people fake it and abuse the system.