 Joining us for our Your Health segment tonight is Dr. Peter Crino, Professor of Neurology at the University of Maryland School of Medicine and Chair of the Department of Neurology at the University of Maryland Medical Center. Dr, nice to see you again. You have been focusing new attention there on the needs of adults with autism and related disorders. Why the new focus on that area? Well, first of all, good evening and thanks so much for having me on the show. You know, it's a big challenge for many families who have adult children who have autism with epilepsy and or intellectual disability. There's many resources available. There's lots of physicians who specialize in autism and epilepsy for pediatric age groups. Unfortunately, when folks get to be age 18 to 21 and they kind of graduate out of a pediatric practice, there really is kind of no place to go. There are very few designated centers for adults who have autism. Autism is caused by a variety of different genetic disorders. And there is really not a whole lot of choice out there in terms of where to take you are adult family member. So the center that we've developed at the University of Maryland allows us to provide really comprehensive care evaluation and in many cases treatment for adults who have autism. So something that I think offers hope to a lot of families. A couple of basic questions. What is meant by the autism spectrum? And is it right to understand that as merely being about degrees and the extent to which somebody is affected? Yeah, that's a great question. Autism or as it's referred to autism spectrum disorder, abbreviated ASD, it really is a broad range of conditions characterized by a variety of challenges with social skills, repetitive behaviors, speech disorders and nonverbal communication. You know, we know that there's no such thing as one autism, but many subtypes and these are influenced by a combination of genetic and environmental factors. You know, to your point, because autism is a spectrum disorder, each person with autism has a distinct set of strengths and challenges, the ways in which people with autism learn and think and problem solve can range from highly skilled to severely challenged. So we see a broad range and it truly is a spectrum disorder. How often is there that area of excellence, whether it's in music or math or something else that goes along with the limited abilities in some other areas? Yeah, you know, so it's really astounding how often that you find that both children and adults with autism will have a range of sort of islands of ability. So even though they may have profound challenges with language generation, with complex abstract reasoning or with social skills and socialization, they may have other talents that relate to artistic abilities or to playing musical instruments or to puzzle or problem solving. So in each patient that I meet, I always try to look and see kind of what their special talent is. And remember, special talents don't always have to be genius level talents, but just something that they can do that brings them happiness and joy and quality of life. I have patients in my practice now that are concert level pianists, that are fabulous artists and sculptors, some that can do jigsaw puzzles faster than you and I could ever do them. So it's kind of interesting to find those abilities in someone who has major challenges with language and social skills. You mentioned the genetic connection. What else has been learned about possible causes and maybe what's been ruled out? Sure. So we know that the majority of people who have autism have it from probably a combination of some genetic factor that's frankly yet to be identified in most. As well as potentially some environmental contributors. Now, for those listening, there has been obviously lots of talk about the relationship between vaccines and autism and let me just allay everyone's fears and put this to rest. There has just been simply no evidence to support a link or an association between vaccines and the development of autism. In fact, the incidence of autism is rising worldwide even in countries that don't use vaccines for public health prevention of diseases. So there's clearly something happening in terms of why autism is presenting and we're seeing it more widely. Now, some of it frankly is physicians ability to ascertain autism. Years ago, we thought patients with autism sometimes could be defined as intellectual disability. This isn't actually true. Autism really is a sort of a complicated multisphere disorder that affects language and socialization and behavior, not really necessarily intellectual function. We know that autism is associated with a number of genetic diseases, for example, fragile X syndrome and tuberous sclerosis complex, two of the more common genetic syndromes. But there are a variety of other genes that have been identified that cause or at least are linked to awesome autism. These are important because they provide us insights into cellular pathways or mechanisms by which autism may arise. And again, one size doesn't fit all. It's possible that autism in one particular genetic disease has a somewhat different cause or network abnormality in the brain than another genetic disease or someone who has no identifiable genetic factor. Now, what happens as a young person with ASD ages and becomes an adult? Do their abilities change? Do they adapt? Is their life defined by this diagnosis from when they were a kid? It really depends on the degree to which they are affected. As I mentioned, some people with ASD require significant support in their daily lives while others need less support and in some cases may live entirely independently, have a job and be productive contributors to society. It really depends from patient to patient. The challenges that we see in adults with autism as they sort of come into themselves are, first of all, things like going to college and higher education, employment, getting and maintaining a job, social and interpersonal relationships, partnerships, marriages, etc. These are challenges for the individuals who have autism spectrum disorder. We often use the term neuroatypical for people with autism. It is, I think, more appropriate label for them than the word abnormal. I don't use the word abnormal in my practice. Neuroatypical is a nice description because it just means that their set of behavioral skills, their repertoire of ways that they interact with the world are just different from the rest of the world that we refer to as neurotypical individuals. The challenges that we may see in terms of relationships and jobs and higher education and also with aging parents who may not be able to take care of them anymore. These become much more realistic challenges than in the pediatric age group where there's often a nice safe home environment and there's lots of facilities and support and infrastructure available from local communities, from school districts, even from the state here in Maryland. So as individuals get to be 1821, they sort of age out of all of this and they find themselves very much in a world that is kind of set up not to fit with many of their abilities and so it really does become a challenge. Some behaviors that we see in autistic individuals as children, such as anxiety, acting out behaviors where they are really uncomfortable or awkward in social situations, may get better in adulthood. Sometimes they stay about the same and we try to figure this out and try to help as best we can. But suffice it to say that the challenges of becoming an adult as a neurotypical individual are not that different from being a typical individual. Life is challenging and you really need to be able to adapt and adjust. And to bring it back to the New Center's University of Maryland medical system, how can people get more information and why should they? What can you do to help individuals? For sure. Remember that our center really focuses on adults who have autism and epilepsy. Epilepsy occurs in about basically 20 to 40% of adults who have autism and so this is what we call a comorbidity. It adds to the disease burden in autism. In addition, the medicines that we use to treat seizures have side effects and some of them can actually affect cognitive function and behavior and mood. So it becomes a very complicated engagement to have someone with both autism as well as seizures requiring medications. So what we do is we see patients oftentimes an individual who is told they just have autism. We do genetic screening and we can find a gene mutation that is the cause of their underlying syndrome. We look at their epilepsy and we can use medications and other therapies to try to control seizures so that they can live a seizure free life. We provide support. We have social work services in our center that help with advanced directives, family planning, connecting with social services. So we really try to have a comprehensive and sort of holistic view to care so that people can really achieve the best that they can achieve and enjoy a life that is happy, well and fulfilled. Thanks to Dr. Peter Crino of the University of Maryland Medical Center and that is direct connection for this week. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.