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What Is Autism?
Autism (also termed autism spectrum disorders or ASDs) is a wide range or spectrum of brain disorders that is usually noticed in young children that decreases the individual's ability to communicate and relate emotionally to others. This disability may range from mild to severe. Autism occurs about four to five times more often in boys than girls.
Signs of Autism
Autism, or autism spectrum disorders (ASDs), can develop at various ages. Some infants may show early signs of ASD while others may develop normally until ages 15 to 30 months when they start to regress (loose communication skills). Although the symptoms listed below may occur with ASDs, each one may also occur in children without ASDs at some point in time:
- Avoiding eye contact
- Avoiding physical contact
- Rocking, spinning, or other repeated movements
- Delayed speech development
- Repetitive speaking of words or short phrases
- Inability to cope with small changes in a daily routine
- Limited or no interactions with peers
Early Warning Signs: First Year
Early warning signs and symptoms of ASDs are recognizable. Infants (under the age of 1 year) with ASD may exhibit some or most of these behaviors:
- Will not make eye contact
- Will not respond to parent’s voice
- Will not babble (baby talk) or point by 1 year of age
- Will not respond to their name
- Will not smile or laugh in response to others behavior
Early Warning Signs: Second Year
As some ASD children reach age 2, they may regress or lose language skills; others may simply have no single words by about 16 months or no two-word phrases by 2 years. Other signs of ASD are lack of interest in any pretend games and ignoring or acting detached from whatever is of interest to others.
Additional Symptoms and Signs
Other ASD symptoms are physical problems such as poor coordination while running or climbing, poor hand control, constipation, and poor sleeping. Some children develop seizures.
How Is the Brain Affected By Autism?
ASD apparently affects the brain. Some children with ASD have larger than normal brains but findings are inconsistent. MRI scans of some ASD children show abnormal cortical responses and some show other abnormalities. Inconsistent findings have made diagnosis of ASD by MRI or CT scans currently not possible but future advances in brain studies may change our understanding of the brain’s role in ASD.
Early Screening for Autism
Because ASDs range from mild to severe disorders, many children are not diagnosed early so that treatments that may help the child may be delayed for years. Because ASDs usually begin early in children’s lives, many pediatric doctors screen children, especially those with any developmental delays at 9, 18 and 24 months of age. Older children are often screened if they seem to fall behind age-related developmental levels.
Diagnosis: Speech Problems
At the intervals mentioned in the previous slide, your baby's doctor will observe how the baby reacts to the parent's voice, smile, and other stimuli and may ask a few questions about the child's reactions. Other tests that determine hearing, speech development, and behaviors may be done to help distinguish ASD from other problems.
Diagnosis: Poor Social Skills
A major part of the diagnosis of ASD is determining social skills. Some features of many ASD children are their inability to look another person in the eye, even the eyes of their parents. ASD children often focus on objects and do so intently, virtually ignoring other people or other stimuli for long time periods. If children with ASDs do communicate, it is often robot-like without facial expressions or gestures.
Although there is no medical test for autism (ASDs), there are a number of questions that serve as screening tools that help to determine if the individual fits the criteria for ASD. In general, most clinicians now accept the three criteria listed below for diagnosis:
- Impairments in social interactions
- Impairments in communication
- A restricted and repetitive range of interests, behaviors, and activities
Some treatments, presented in following slides may improve the outcome of ASD.
Asperger's syndrome is very similar to ASD; however, there are no language or cognitive developmental delays and they are usually diagnosed in older children (age 3 years and older). The children may be normal or have superior intelligence but have difficulty in relating to people and making friends. They also tend to focus on specialized tasks.
Treatment: Behavior Programs
Treatment of ASD (and similar problems like Asperger's syndrome) is available. Behavioral therapy programs are available from several sources and they are designed to aid people in talking, communicating effectively, interacting with others, and avoiding negative or antisocial behaviors. The Autism Society maintains a Web site and offers a toll-free hotline (1-800-3-AUTISM/1-800-328-8476). This resource provides information and referral services to anyone who requests them.
Treatment involves the education of the child with ASD. The Individuals with Disabilities Education Act authorized states to determine how to provide educational services to children younger than 3 years of age. The Education for All Handicapped Children Act of 1975 requires free and appropriate public education for all children, regardless of the extent and severity of their handicaps while amendments to the Education of the Handicapped Act of 1986 extended the requirement for free and appropriate education to children aged 3 to 5 years. Parents are advised to check with their individual school administrators to determine what programs best fit their child.
Although there is no medical treatment for ASDs, there are treatments for some ASD symptoms. You and your child's pediatrician need to discuss medical therapy before it is administered to be sure the benefits outweigh any risks. The medical agents commonly used are antipsychotic agents like risperidone or aripiprazole. Drugs such as methylphenidate, fluoxetine, antiseizure medications, and others may help specific symptoms. Close observation is required to monitor the child's response to any medication.
Treatment: Sensory Integration
As previously mentioned, children with ASD may be extremely sensitive to various sensory stimuli such as sounds, lights, textures, taste, and odors. Some children may become agitated by touching, hearing, or seeing specific things such as a bell, blinking lights, touching something cold, tasting certain foods, or smelling a specific odor like a disinfectant. Some children can be trained to adapt and thus improve behavior.
Autism and Assistive Technology
Technology has recently given some children with severe ASD symptoms (for example, ASD patients who are nonverbal) ways to communicate. The assistive technology may be a computer tablet, a computer, or even a phone app with programs especially designed to engage children with ASD (see attached reference).
Autism and Diet
A balanced diet, along with some vitamin supplementation, is advised by clinicians for children with ASDs. It is important to have a good diet as some patients show good improvement in symptoms when eating such a diet. Some ASD patients suffer from constipation and others may develop a habit of eating items like dirt or paper. A good diet may help reduce these ASD symptoms.
Beware of ASD "treatments" that are not proven or claim to "cure" ASDs. Do not start any therapy until it is discussed with the child's doctor or medical team because some treatments could be dangerous for your child. In addition to checking with medical personnel, there are national agencies such as the Autism Society of America that can help answer your treatment questions.
What Causes Autism?
Researchers still do not know exactly what causes ASDs. However, genetics may play a significant role because ASDs occurs more frequently in certain families and in patients with other genetic problems (fragile X syndrome or tuberous sclerosis). Researchers also suggest that some toxins or drugs may play a role. For example, valproic acid, thalidomide, and infection exposure during pregnancy increases ASD risk in the infant.
Vaccines Don't Cause Autism
There has never been any definitive link between childhood vaccines (or ANY vaccines) and ASD. None has been linked to thimerosol, a form of mercury previously but no longer used as a preservative in childhood vaccines. Children with ASDs should be vaccinated; it seems inappropriate to most medical caregivers to leave children open to potentially very harmful infections for no good reason.
Autism Among Siblings
ASDs have increased as a diagnosis over the years. Researchers are not sure if the increase is due to actual increases in patients or is due to better diagnostic methods. Also, the incidence of ASDs is higher in siblings of diagnosed ASD patients. Identical twins have the highest percentage of ASD occurrence, about a 75% chance that both will develop ASD if one twin has ASD. As previously mentioned, boys are about four to five times more likely to develop ASDs.
Accommodation in School
Remember, you can get help for your child with ASD. There are federal laws that spell out some of the help available in public schools. In addition, you can contact organizations that can help you approach and plan for both public and private sources that may help your child with the complex symptoms that can accompany ASDs.
Living With Autism
ASDs and similar problems like Asperger's syndrome do not necessarily mean your child cannot lead an independent and useful life. People with early treatment and mild-to-moderate symptoms can even graduate from college or graduate schools. Others with below-average abilities may still be able to do specialized jobs and live independently or in group homes. The key to ASD treatment is early recognition of the signs and symptoms of ASDs in infants and young children.