4 - Autism versus cerebral palsy
Myers (1972) found that a prolonged period of partial
hypoxia late in gestation produced the pattern of brain
damage associated with cerebral palsy [1]. Children
with cerebral palsy are not also often autistic.
Matsuishi (1999) found different perinatal risk factors
for cerebral palsy versus autism [2]. Autism was more
often associated with meconium aspiration, a sign
perhaps of catastrophic oxygen deficiency great
enough to lead to gasping for air in the moments
before birth.
Delay in motor development is often reported in
children with autism, as was the case in monkeys
subjected to sudden total asphyxia at birth. Perinatal
complications are associated with autism, though most
reports dismiss these as "mild" and without any
unifying feature; but oxygen insufficiency is the great
worry whenever birth is difficult.
In addition to the hypoxia that may occur during a long
and difficult labor, the final moments of delivery may
include a brief period of asphyxia, especially in an
infant with a large head, malpresentation (such as
brow or face) of the head, or breech birth.
Resuscitation may be possible after a total cutoff of
oxygen for five to ten minutes, but this is long enough
for permanent impairment of function in the inferior
colliculus to take place.
Figure 7 is from the article by William F. Windle that
appeared in the October 1969 issue of the Scientific
American, and shows the damage that can be caused
by a brief period of asphyxia at birth. The moment I
looked at these pictures I gasped; this certainly
seemed to me the reason Conrad, my five-year-old
son who had been resuscitated at birth, was not
learning to speak.
Pregnancies yielding larger healthier infants are on
the increase. Difficult labor and birth are more likely
to occur during delivery of larger infants, and perhaps
this might be partly responsible for the recent
increase in cases of autism. My children were all just
under or just over 9 pounds at birth. I long attributed
Conrad's difficult birth to his large head, and my small
pelvic outlet.
However, up until about five years ago, it never
occurred to me to ask about delivery room
procedures.
- Myers RE (1972) Two
patterns of perinatal brain
damage and their conditions
of occurrence.
- Matsuishi T et al. (1999) Brief
report: incidence of and risk
factors for autistic disorder in
neonatal intensive care unit
survivors.
- Windle WF (1969a) Brain
damage by asphyxia at birth.
Damage (top) found in
the inferior colliculi in monkeys
subjected to sudden, catastrophic
asphyxia - inflicted by delivering
the head of infant monkeys into a
saline-filled sac, and clamping the
umbilical cord. Compare with the
appearance of the inferior colliculi
in a monkey born normally
(bottom).
These pictures were published in
the Scientific American in October
1969 as part of an article by
William Windle on asphyxia at
birth. They were also published in
the article by Faro & Windle (1969).
Figure 7:
- Myers RE (1972) Two patterns of perinatal brain damage and their conditions of
occurrence. American Journal of Obstetrics and Gynecology 112:246-276
- Matsuishi T, Yamashita Y, Ohtani Y, Ornitz E, Kuriya N, Murakami Y, Fukuda S,
Hashimoto T, Yamashita F.(1999) Brief report: incidence of and risk factors for
autistic disorder in neonatal intensive care unit survivors. J Autism Dev Disord. 1999
Apr;29(2):161-6.
- Windle WF (1969a) Brain damage by asphyxia at birth. Scientific American 221 (#4):
76-84.
