Autism

Introduction (Brief Summary)

Autism Spectrum Disorder is a neurodevelopmental disorder that appears in early childhood. Children with Autism Spectrum Disorder may have a serious lifelong disability. However, with appropriate treatment and training, some children with Autism Spectrum Disorder can develop certain aspects of independence in their lives. The treatments now available can achieve a far better quality of life for sufferers than was the case just a few years ago. Parents should support their children with Autism Spectrum Disorder in developing those skills that use their strengths so they will feel good about themselves.

Overview and Facts

Autism was once considered a relatively rare condition. Recent epidemiological data have radically altered this perception. Based on large surveys in the US, the Centers for Disease Control and Prevention (CDC), estimates the prevalence of ASD as 1 in 68 children, occurring in all racial, ethnic and socioeconomic groups, although it is five times more common among boys (1 in 42) that girls (1 in 189).

Symptoms

Some of the signs that infants and toddlers with ASD exhibit are:

Does not cuddle or respond to affection and touching.
Does not make eye contact.
Appears to be unable to communicate.
Displays persistent failure to develop two-way social relationships in any situation.
Does not show a preference for parents over other adults.
Does not develop friendships with other children.
Has poor language skills; or nonexistent ones.
Shows unusual, extreme responses to objects – either avoidance or preoccupation.
Finds moving objects, such as a fan, hold great fascination.
May form an unusual attachment to odd objects such as a paper or rubber band.
Displays repetitive activities of a restrictive range.
Spins and repeats body movements, such as arm flapping.
May repeat television commercials.
May indulge in complex bedtime rituals.

The symptoms of Autism Spectrum Disorder range from mild to severe. Although symptoms of the disorder sometimes can be seen in early infancy, the condition may appear after months of normal development. About 7 in every 10 children and adolescents with Autism Spectrum Disorder also have intellectual disabilities or other problems with their brain function or structure.

Causes and Risk Factors

Researchers are unsure about what causes autism. Several studies suggest that ASD might be caused by a combination of biological factors, including genetics.

Tests and Diagnosis

The American Academy of Pediatrics (AAP) recommends screening children for Autism Spectrum Disorder during regularly scheduled well-child visits. This policy helps doctors identify signs of Autism Spectrum Disorder early in its course. Early diagnosis and treatment can help the child reach his or her full potential. When a developmental delay is recognized in a child, further testing can help a doctor find out whether the problem is related to Autism Spectrum Disorder or a condition with similar symptoms, such as language delays or social anxiety. If your primary care provider does not have specific training or experience in developmental problems, he or she may refer your child to a specialist—such as a child psychiatrist or a psychologist for the additional testing.

Behavioral assessments. Various guidelines and questionnaires are used to help a doctor determine the specific type of developmental delay a child has. These include:
- Medical history: During the medical history interview, a doctor asks general questions about a child's development, such as whether a child shows parents things by pointing to objects. Young children with Autism Spectrum Disorder often point to items they want, but do not point to show parents an item and then check to see if parents are looking at the item being pointed out.
- Diagnostic guidelines for Autism Spectrum Disorder. The American Association of Child and Adolescent Psychiatry (AACAP) has established guidelines for diagnosing Autism Spectrum Disorder. The criteria are designed so a doctor can assess a child's behavior relating to core symptoms of Autism Spectrum Disorder.
- Clinical observations: A doctor may want to observe the developmentally delayed child in different situations. The parents may be asked to interpret whether certain behaviors are usual for the child in those circumstances.
- Developmental and intelligence tests. The AACAP also recommends that tests be given to evaluate whether a child's developmental delays affect his or her ability to think and make decisions.
Physical assessments and laboratory tests. Other tests may be used to determine whether a physical problem may be causing symptoms. These tests include:
- Physical exam, including head circumference, weight, and height measurements, to determine whether the child has a normal growth pattern.
- Hearing tests, to determine whether hearing problems may be causing developmental delays, especially those related to social skills and language use.
- Testing for lead poisoning, especially if a condition called pica (in which a person craves substances that are not food, such as dirt or flecks of old paint) is present. Children with developmental delays usually continue putting items in their mouth after this stage has passed in normally developing children. This practice can result in lead poisoning, which should be identified and treated as soon as possible.

Other lab tests may be done under specific circumstances. These tests include:

Chromosomal analysis, which may be done if intellectual disability is present or there is a family history of intellectual disability. For example, fragile X syndrome, which causes a range of below-normal intelligence problems as well as autistic-like behaviors, can be identified with a chromosomal analysis.
An electroencephalograph (EEG), which is done if there are symptoms of seizures, such as a history of staring spells or if a person reverts to less mature behavior (developmental regression).
MRI, which may be done if there are signs of differences in the structure of the brain.

Treatment

The use of psychotropic medication in this population calls for caution and sound knowledge. In summary, medication is currently justified in the management of challenging behaviors (e.g., aggression, self-harm) that do not respond to other approaches and to treat comorbid conditions e.g. ADHD.
The main treatment for ASD is multidisciplinary, combining behavioral approaches, parent training, special education and other supportive services.