As with most subjects, before we can fully comprehend the connection between Autism Spectrum Disorder and regressive encephalopathy, we must break the latter down to understand its standalone definition and what it entails.
What is Encephalopathy?
Definition
Encephalopathy is a medical term that is observed as being used in two different meanings: one as referring to a finding, and the other as indicative of a disease or disorder. The former is associated with brain injury, either reversible or irreversible, either direct or indirect (from an illness, for example).
The latter is used to define a disorder or disease of the brain. In modern usage, it does not specify a singular disease or disorder, but a syndrome of brain dysfunction; especially including chronic degenerative conditions which result in the slowing down of brain function. This means that encephalopathy is a collective term for signs and symptoms that can indicate a particular disorder or disease. As such, tracking the symptoms presented by encephalopathy can help shape an adequate prognosis, enabling the discovery of the underlying cause thereof. Treatment of said cause may help reverse effects, but encephalopathy may also have a lasting impact on an individual, depending on the condition.
The two major categories encephalopathy can be classified into are the following:
- Acute encephalopathy
Characterized by an acute or subacute global functional alteration of mental status, it may result from systemic factors. Its effects can be reversed through the correction of these abnormalities, even reverting to baseline mental status. Acute encephalopathy can be further subcategorized into the divisions of: toxic, metabolic, or toxic-metabolic. - Chronic encephalopathy
This type is characterized by chronic mental status alteration which is slowly progressive in most cases. It is the cause of permanent, typically irreversible structural changes within the brain- though it may be reversible through early detection and treatment.
Examples
There are a number of types of encephalopathy which range from those acquired at birth and unchanging, and those acquired after birth and worsening by age. Some examples of encephalopathy include the following:
- Hypertensive encephalopathy: encephalopathy resulting from severely high blood pressure that has been left untreated for an elongated period of time, thus causing a swelling of the brain
- Encephalomyopathy: a combination of myopathy and encephalopathy, which can be caused by mitochondrial diseases or chronic hypophosphatemia
- Wernicke encephalopathy: caused by vitamin B-1 deficiency, it affects the peripheral and central nervous systems (vitamin B-1 deficiency can be the result of long-term alcoholism, poor nutritional intake, and/or poor food absorption)
- Toxic encephalopathy: acute alteration in mental status through the use of medication, illicit drugs, and/or toxic chemicals
- Metabolic encephalopathy: encephalopathy caused by any from a range of metabolic disruptions
- Toxic-metabolic encephalopathy: a combination of both toxic and metabolic encephalopathies, it can result from organ failure, infections or an exposure to toxins
- Mitochondrial encephalopathy: affected by damage to the mitochondrial DNA; hence impacting many functions of the body, especially those of the brain and central nervous system
- Hypoxic ischemic encephalopathy: encephalopathy caused by lack of oxygen being supplied to the brain, consequently reducing functionality of the brain (may be permanent)
- Static encephalopathy: this is a type of encephalopathy characterized by a permanent and unchanging damage to the brain
What is Regressive Encephalopathy?
Now that we have established what encephalopathy is, it will be easier to absorb the concept of regressive encephalopathy. To break it down, encephalopathy is the disease or disorder of the brain; and regression is when there is a loss of skills previously acquired (antonymous to progression).
Therefore, regressive encephalopathy can mean to describe a brain disease or disorder that makes an individual lose the skills they once had.
This can be observed in children with diagnoses of Autism Spectrum Disorder, for example. Some autistic children may develop akin to an average child in the initial years of life, but may gradually lose those developmental milestones as the condition progresses.
Children with mitochondrial diseases can also be observed as undergoing regressive encephalopathy, regressing around toddler or preschool age, with something triggering the decline (for instance, an illness, dehydration, malnutrition, etc.)
The Link Between Autism Spectrum Disorder and Regressive Encephalopathy
As mentioned above, some autistic children face developmental regression as their age progresses. Autism Spectrum Disorder is defined by lacking in certain dimension of neurodevelopment, but since it is a range the symptoms would vary from person to person. This relates it to regressive encephalopathy, in it that autistic children can be seen losing skills they may have acquired in the past.
Such is definitive of what was described as Childhood Disintegrative Disorder (removed from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders). It used to be considered the severest end of the spectrum, some may alternatively term this condition as Level 3 Autism or Classic Autism. A child would reach developmental milestones by the age of 3 or 4, but then move towards regression and lose their acquired skills. This included language and communicative abilities; motor skills, as well as bladder and bowel control; and social abilities, like self-care and play skills.
It must be acknowledged, as with any reference to Autism Spectrum Disorder, that the condition manifests in each individual differently. Same is the case with regressive encephalopathy in ASD. In view of this, the Centers for Disease Control and Prevention (CDC) explain that most children with the disorder do not and have not had an encephalopathy. That is not to say that there have not been any cases of regression or even of having a regressive encephalopathy.
Autism Spectrum Disorder and Regressive Encephalopathy
At the risk of being redundant, we iterate that the CDC mentions that some autistic children do in fact face suffer from regressive encephalopathy, but at the same time, one cannot classify all individuals with Autism Spectrum Disorder as having regressive encephalopathy. This research helps in better understanding the various aspects of the condition, and as such are encouraged and followed by organizations like Small Steps Big Dreams in Dubai, UAE, so as to remain up to date. Such new findings can prove significant in upgrading treatment plans and aiding inclusion.