Sunday, 3 April 2011

Autism and PUBERTY!

It is the one thing that everyone goes through and don't we all know it. Nature probably had a smirk on its face when it thought up puberty. That transitionary period where girl becomes woman and boy becomes man. Acne, mood swings, and lots of physical changes - hair everywhere.

Puberty always reminds me of Harry Enfield's Kevin the teenager and his over-used catchphrases to his parents 'I hate you', 'it's so unfair'. An illustration whereby the physical body is shouting 'grow up!' but more often than not, the mind is a little way behind (or is it the other way around?).

There is no doubt about it, puberty can be a really rough time for lots of children and their parents. For a child diagnosed with an autism spectrum condition, puberty has been described as bringing its own set of new challenges.

I remember the discussions with our collaborating partners whilst working on the ScanBrit trial of a gluten- and casein-free diet for autism. When it came to deciding the age range of our participant group, there was lots of chatter but only one message - avoid puberty.

The reason why so many studies and research avoid puberty when evaluating things like interventions is partly to do with a leaning towards assessing early interventions for young children with autism and partly because there is quite a lot of evidence to suggest that puberty for children with autism can be a bit of a torrid time and will potentially play havoc with any study results obtained (tip: best way to show that something does not work, study it during puberty!).

One of the first people to investigate autism and puberty was Christopher Gillberg. In one of the first papers on the subject, Gillberg discussed how autistic symptoms were negatively affected by puberty in a case series investigation. His follow-up work down the years has presented a similar message; a message that has been echoed by others. The message is that puberty, more often than not, tends to increase (worsen?) the presentation of various autistic symptoms.

At this point, most people would probably say 'what did you expect?' bearing in mind what puberty does to children who do not have autism e.g. questioning authority, wanting to spend more time alone, wanting to be more independent. Mmm - sounds like the border regions of 'challenging behaviours' to me - I jest of course.
But question more closely the details of puberty in relation to autism.

Puberty is all about hormones driving maturational changes. Hormones such as oestrogen and testosterone (testosterone.. I've heard that somewhere before related to autism). Within this period (pardon the term) of hormonal soup, are we saying that 'puberty affects autism' or does puberty merely affect a child with autism the same way is does a child without autism but is further complicated by the presence of autism (and any other comorbidities)?

There is some interesting research being done, directly and peripherally, in is this area.

It appears that there is a potential link between some cases of autism and onset of various comorbidity following puberty. Likewise, various mechanisms linked to autism have been suggested to 'intensify' as a result of puberty including those related to epilepsy.

Peripherally also, it seems that there is some evidence that important compounds such as serotonin (5-HT) don't seem to show the same maturational patterns in autism as in non-autism - is this an effect of puberty?
I don't think there is anything that can be done to 'get' around puberty - nothing that ethically we would want to use anyway - and so like not-autism, it is mainly a case of 'grin and bear it'. The light at the end of the tunnel is that, whilst disruptive, puberty does not last forever; and as many authors have noted, culturally-speaking, puberty is an important rite of passage into adulthood.