الفهرس 
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Abstract
There is an agreement amongst all professionals that
autism is one of the most puzzling diseases. The increase of
ASDs prevalence cannot be fully explained by advances in
diagnostics or sudden genetic shifts. There is a growing
consensus among scientists and clinicians that ASDs ensue
from an interaction between biological vulnerability factors
and environmental or iatrogenic insults.
The aim of the present study was to measure the levels
of toxic heavy metals in hair of an Egyptian sample of
autistic children comparing them with age and sex matched
controls, and correlating their levels with the clinical
severity of the disease.
This study comprised 140 children. They were
classified into two groups. Group I (Autistic patients): It
included 70 children diagnosed as having one of the autistic
disorders according to the DSM-IV TR (2000) criteria. They
were 57 males (81.4%) and 13 females (18.6%). Their ages
ranged from 2.5 to 12 years with mean age 6.30, SD ± 2.2
years, and group II (Control group) which included 70
clinically healthy children of comparable age and sex. They
were 58 males (82.9%) and 12 males (17.1%). Their ages
ranged from 3 to 12 years with mean age 6.0., SD± 2.2 years. To all studied cases, full history, clinical examination,
psychiatric evaluation and measurement of hair mercury,
lead and aluminium levels were done.
In the current study several risk factors for autism were
evaluated. The results showed that 55.7% of the studied
autistic patients were first order of birth, 58.6% of them were
born by Cesarean section while 41.4% were vaginally
delivered, and their mean birth weight was 3.2 + 0.6 kg.
However On comparing between the studied autistic patients
& the control group there was no statistically significant
differences as regards the previously mentioned factors; p >
0.05 for all.
The maternal age at conception was significantly
higher in the autistic group than that of the controls (p <
0.01). The present study revealed that consanguinity rate was
significantly higher in the autistic cases (n= 15) compared to
controls (n= 5) (p < 0.05). On comparing between the autistic
patients and controls as regards their maternal occupation,
there was no statistically significant difference; p > 0.05.
A delay in motor development among autistic patients
was documented compared to their matched controls
however it was not statistically significant; p = 0.091. Also
failure of development of sphincteric control was significantly more encountered among the autistic patients
(34.3%) compared to 8.6% in the controls (p = 0.001).
The mean IQ of the studied cases (47.6 + 16.9) was
significantly lower than that of the control group (95.7 +
4.3), meanwhile the anxiety & depression scores were
significantly higher in the studied cases when compared to
the control group (p < 0.001) The current study also revealed
negative correlation between the IQ level and the severity of
autism (measured by CARS & ATEC) which means that the
higher the IQ level, the lower the severity of autism, whereas
anxiety score and depression score showed a positive
significant correlation with the severity of autism (measured
by CARS & ATEC) meaning that the higher the autism
severity, the higher the anxiety and depression scores. Also
the IQ level showed a negative correlation with anxiety and
depression scores.
On comparing between the levels of heavy metals in
hair of the autistic patients and the control group, levels were
significantly higher among the studied cases than the control
group (p < 0.001) however these levels were not correlated
with autism severity. In the current study, the mean mercury
level of the autistic patients (0.36 + 0.29) was significantly
higher than that of the controls (0.27 + 0.22) with p = 0.015 The mean lead level of the autistic patients (3.13 +
1.78) was significantly higher than that of the controls (1.55
+ 1.06) with p = 0.005.
The mean aluminum level of the autistic patients
(64.47 + 58.23) was significantly higher than that of the
controls (16.11 + 10.62) with p = 0.0001.
There was no significant difference in hair heavy metals
concentrations among different autistic groups classified
according to age.
Several different sources of heavy metals exposure were
evaluated. On comparing between the studied autistic
patients & the control group as regards their maternal fish
consumption during pregnancy, it was significantly higher
than that of the controls (p < 0.01). Also there was
statistically significant increase in mercury levels as fish
consumption increased (p < 0.05).
There was no statistically significant difference between
the autistic cases and the controls as regards the maternal use
of dental amulgum & the use of Anti-d; also there was no
statistically significant difference between mercury level in
autistic children in relation to maternal use of dental
amalgam or the use of Anti-d (p > 0.05 for both). On comparing between the autistic patients & the
control group as regards their house age, it was significantly
higher in the autistic patients than that of the controls (p <
0.01).
There was no statistically significant difference between
the autistic patients & the control group as regards the
presence of gasoline stations (p > 0.05) while there was
statistically significant increase in lead levels with presence
of nearby gasoline stations (p < 0.05).
On comparing between the studied autistic patients &
the control group in the current study as regards the passive
smoking & the use of aluminum pans, the studied cases were
significantly higher than that of the controls (p < 0.01).
On studying the different clinical characteristics of the
studied cases in the present study, they showed that
hyperactivity was significantly higher in studied cases with
higher mercury level (p < 0.05), meanwhile there was no
statistically significant relationship between mercury level
and other clinical characteristics among the studied cases (p
> 0.05 for all). Also the reported results of the current study
demonstrated that that there was no statistically significant
relationship between either lead and aluminum level and the
clinical characteristics of the studied cases (p > 0.05).