Autism

Autism spectrum disorders (ASDs) are used to describe three of the five pervasive developmental disorders, including autistic disorder, Asperger disorder, and a third category that includes pervasive developmental disorders that do not fit into the classic descriptions of developmental disorders.

Signs & SymptomsSigns of these disorders usually become apparent in children by the time they are 3 years old. Autistic symptoms include a significant delay in language and cognitive development, while there is no significant language or cognitive development delay in Asperger syndrome. Because there are not significant language impairments in Asperger when compared to autism, Asperger syndrome may be referred to as “high functioning autism.”

Symptoms can range from mild to severe. Some people may be considered autistic but function in society without issues, while for others, the condition can have a substantial impact on their lives and on the lives of those close to them.

DiagnosisAutism spectrum disorders are found across the world, seemingly regardless of race or cultural and economic background. ASD occurs more often in boys than in girls, with a 4:1 male:female ratio.

The U.S. Centers for Disease Control and Prevention (CDC) state that the numbers affected by autism are estimated to be around one out of every 110 children in the United States. However, various epidemiological studies have found varying rates of the condition, ranging from between one out of 80 children to one out of 240 children.

There are indications that instances of ASD are on the rise, but experts debate whether it is an actual increase or rather a case of more frequent diagnosis.

Types of Autism Spectrum DisordersAs its name infers, ASD refers to a range of symptoms.

ASDs were first defined as disorders in the 1940s by two different researchers working independently of each other. Dr. Leo Kanner studied what would come to be defined as severe or classic autism. At the same time, Dr. Hans Asperger defined the condition that now bears his name.

Classic autism usually entails substantial problems in all of the areas affected by ASDS, while someone with Asperger usually has issues with behavior and social interaction but often does not have problems with developing language. The symptoms experienced by people with Asperger are often also less severe.

There is debate as to whether Asperger Syndrome is a variation of classic autism (high-functioning autism) rather than a separate disorder.

PDD-NOS is a classification given when someone is exhibiting signs of autism but does not otherwise fit into the categories of classic autism or Asperger Syndrome.


Causes, Treatments & OutlookThe exact cause of autism and other autistic spectrum disorders is unknown. The most current science demonstrates that there is not a single cause for autism but that the disease is multi-factorial with a strong genetic component.

There is no cure for ASDs. The most effective treatments involve the use of early intensive behavioral interventions to improve the function of the child. It is generally agreed that the earlier a child is enrolled in these programs, the better their outlook.

Since conventional treatment has not found a cure for ASDs, patients and their advocates have sought unproven therapies including:

• high dose vitamins
• chelation therapy
• hyberbaric oxygen

There is currently no evidence that these treatments are effective, and parents should weigh the evidence and costs before investing in any therapies for their child.

Risk FactorsBack to top While the cause, or causes, of autism spectrum disorders (ASDs) remain elusive, experts believe they have pinpointed factors that may place people more at risk of developing autism.

Genetic FactorsAmong other factors, genetics can place an individual at risk for developing some form of autism. If a person has a brother, sister (especially an identical twin), or parent with an ASD, that person is more likely to also have an ASD.

Some medical conditions have been connected to a higher risk of having autism. These include genetic disorders such as Fragile X syndrome and tuberous sclerosis. Though the link between tuberous sclerosis and ASD is unclear, studies have shown that ASD rates are much higher among children with tuberous sclerosis than those who do not have the disease.

Some key risk-related statistics provided by the U.S. Centers for Disease Control and Prevention (CDC) include:

• If one identical twin has an ASD then there is a 60 to 96 percent chance the other twin will have some sort of ASD.
• Fraternal twins have a lower chance, but if one has an ASD then the other has up to a 24 percent chance.
• If a family already has one biological child with autism, there is a two to eight percent chance of the family having another biological child with an ASD.
• About 10 percent of children who have an ASD also have another genetic, neurological, or metabolic disorder.

Exposure to Certain DrugsThe CDC states that some drugs, like thalidomide and valproic acid, have also been implicated in causing higher risks of ASDs if they are taken while a woman is pregnant.

Environmental FactorsExposure to heavy metals and other toxins in the environment is also suspected of increasing the risk of ASDs.

SymptomsBack to top The signature of Autism Spectrum Disorders (ASDs) in a child is atypical development of behavior, social skills, and ability to communicate. These signs might be apparent from birth, or may not become noticeable until the child is a few years old, usually by the age of three.

Children with an ASD might not have any friends or other interactions with children their own age. They may not show what is considered “normal” play behavior, including usual use of toys, imitation, or pretend play. Instead, they will likely show a preoccupation with a particular object or interest and show a significant need to stick to specific routines through the day.

Children may repeat the same gestures or other motions, which can include:

• flapping hands
• rocking their bodies
• turning in circles

They might also show sensitivity­­—in some cases extreme—to sights, sounds, smells, and things they touch or that touch them.

Both verbal and other forms of communication may be limited, lost, or even lacking entirely. The child may have problems conversing and could also parrot what they hear from other people or from the radio, television, and other sources instead of developing original speech patterns.

A child with an ASD may avoid eye contact, not show affection to parents or others, or fail to acknowledge affectionate behavior exhibited towards him or her.

The severity of these symptoms can vary, and a child might show many or very few of them. If you are seeing any of these signs, it does not necessarily mean that your child has a disorder on the autism spectrum, but it can be a good indicator that it is time to visit the doctor.

It is also important to see a doctor regularly so the child can be observed by a clinician who is constantly around children. It may be difficult for a parent to notice any uniqueness to their child’s behavior because they are not familiar with typical patterns of development.

DiagnosisBack to top There is no “one-stop” evaluation, like a blood test, that can verify the presence of an autism spectrum disorder (ASD). Diagnoses of ASDs must be made based on evaluations of a child’s behavior, social skills, and ability to communicate. A confirmed diagnosis requires two steps.

Routine TestingFirst, the family doctor or pediatrician should perform routine tests during regular visits that measure the pace of a child’s development. These checks are called developmental screening tests, during which the doctor measures how well a child is developing in the areas that can be affected by ASDs. This can bring potential signs of an ASD or other issue to light.

Developmental TestsDevelopmental tests, meant to specifically find ASDs, should be performed by the doctor at the 18- and 24-month checkups. More tests than these may be done if the child is at higher risk of having ASDs, or for other reasons such as premature birth or a low birth weight.

Comprehensive TestingIf these initial rounds of screening spot problems, then the second step, involving comprehensive testing by specialists, is carried out. These examinations are designed to pinpoint what is going on—whether it is an ASD or something else. Some conditions have similar symptoms to autism and there can also be other disorders or conditions present in addition to autism.

The enhanced testing can include genetic and neurological testing as well as more measures of the child’s behavior, and communication and social skills.

Child BehaviorAt both levels of testing, the parents will be questioned by the investigators and their observations of their child’s behavior in daily life can be very helpful in determining whether an ASD is present. The National Institute of Mental Health suggests reviewing picture albums and video recordings of the child to try to spot signature behaviors or when the child should have reached certain developmental benchmarks.

Early diagnosis can be the key to successfully dealing with the issues a child faces because of ASDs. Spotting an ASD early on can mean quicker enrollment in programs that help the child learn the skills he or she needs to cope with ASD. Consensus is that the earlier an autistic person is enrolled in a program, the better the outcome.

Educational DiagnosisQualified school officials can also make what is called an educational diagnosis. This is not the same as the medical diagnosis. Instead, it is done to determine what needs and services can be provided to a child in the school environment. This diagnosis is not necessarily dependent on a medical diagnosis.

Often, the first ones to notice potential problems are a child’s parents. If you think something might be wrong with your child, tell your doctor.

TreatmentBack to top Autism spectrum disorders (ASDs) affect the ability of a person to communicate and interact with the people and the world around him or her. The severity of these effects can vary widely with each autistic individual. Though there is no cure for ASDs, there are a number of programs that are designed to help someone with an autism spectrum disorder strengthen their particular areas of difficulty.


Intervention ProgramsThese programs, called interventions, should begin at the earliest opportunity after diagnosis. It is generally agreed that if an intervention is put into play early, its chance of having a positive effect is improved.

TechniquesThese programs can use a variety of techniques, including:

• positive reinforcement to encourage appropriate behavior or use of skills
• breaking basic tasks into a number of simple steps to aid in understanding the task
• providing visual cues to indicate where the student is supposed to be and what they are supposed to do in a particular situation

Some of the better known interventions are Applied Behavior Analysis (or ABA); Developmental, Individual Differences, Relationship-Based Approach (also called DIR or “Floortime”); and Treatment and Education of Autistic and related Communication-handicapped Children (also known as TEACCH).

What program your child uses is up to you and whichever one you choose will have to be customized for your child’s particular situation.

GuidelinesThe National Institute of Mental Health has provided guidelines for factors you should keep in mind when selecting a treatment program:

RecoveryBack to top Unfortunately, there is no way to prevent autism spectrum disorders (ASDs).

Experts are still seeking the definite cause or causes of ASD. There is also no known cure for ASDs. In both cases, there is a great deal of research going on in the hopes a breakthrough can be found.

But that does not mean nothing can be done. There are numerous treatments available that—while they cannot stop autism—can help people with ASDs work around the shortcomings of their condition and build on their strengths. Many people who have ASDs live well-rounded, fulfilling, and independent lives.