Autism

What is autism?

Autism is a disorder in which children have problems with communicating and getting along with others. They have unusual, repetitive, or severely limited activities or interests.

There is a wide range of symptoms and abilities. A child with autism can be very high-functioning or very severe. Autism is the most common disorder in a group of conditions called autistic spectrum disorders (ASD), also called Pervasive Developmental Disorders (PDD).

What is the cause?

In autism there is a problem in the brain. Brain scans show that the structure or shape of the brain is different in children with autism. The cause is not known. There are many possible causes.

Autism and similar disorders sometimes run in families. There may be certain genes linked to autism. Researchers are also studying if a problem during pregnancy or environmental factors, such as exposure to chemicals, may be a cause. Having a father older than age 40 may increase a child’s risk.

Children with other brain problems and genetic syndromes such as congenital rubella syndrome, neurofibromatosis, and fragile X syndrome, are sometimes also autistic. Boys are more likely to have autism than girls.

What are the symptoms?

Children with autism may look and act normal for the first few months of life. Your child may then become more and more unresponsive to you. Many parents first notice a problem when their child does not develop language skills like other children of the same age. Many parents notice a problem before the child's first birthday, and almost all parents of children with an ASD saw problems by the child's third birthday.

There are many symptoms, but not all autistic children will have all of these symptoms. They may have some symptoms that are not on this list.

• Social skills: Your child may resist being cuddled and may scream to be put down when held. He may withdraw from you, avoid eye-to-eye contact, and prefer to play alone. Your child may not care about the feelings of others.
• Language and imagination: An autistic child usually speaks later than age 2. He often cannot understand or copy speech or gestures. The rate, pitch, tone, or rhythm of speech is abnormal. Your child will probably be unable to start a conversation or keep one going and respond inappropriately to sounds. His speech will be immature and unimaginative. Your child will probably be unable to engage in fantasy or imaginative play such as role playing and storytelling.
• Behavior, activities, and interests: Autistic children develop strong habits and compulsive routines. They may get very upset at the slightest change in routine. Your child may be obsessed with one topic or idea and may become attached to unusual objects. He may walk on tiptoe or flick or twiddle his fingers for long periods. He may even bang his head, rock, stare, or have sudden screaming spells. He may injure himself on purpose. Autistic children often have trouble learning manual tasks and are sometimes hyperactive. Some children develop seizures.
• Sensory problems: Autistic children may also have problems with their senses. Many are very sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin almost unbearable. Some sounds, such as a vacuum cleaner, a ringing telephone, a sudden storm, even the sound of waves lapping the shoreline, will cause these children to cover their ears.

How is it diagnosed?

It is very difficult to diagnose autism when children are young. There may be a wide range in abilities because of the child's age and how severe the symptoms are.

Besides your child’s healthcare provider, your child may see specialists such as:

• a child psychiatrist
• psychologist
• occupational therapist
• physical therapist
• speech and language therapist

Some of the behaviors that the specialists will look for include:

• Does the child respond to his or her name when called? Children diagnosed with autism often fail to respond to their own name. They tend to turn and look at the person only about 20% of the time. They may fail to respond to their parent calling their name, but immediately respond to the television being turned on. It is not unusual for parents to suspect their child has a hearing loss.
• Does the child share? Children with autism rarely follow along with games, do not often shift their gaze back and forth from objects to people, and do not "show" toys to the parent.
• Does the child imitate others? Children with autism less often imitate others. They tend to avoid waving, making faces, or playing pat-a-cake.
• Does the child respond to others? Children with autism may seem unaware of the emotions of others. They may not look or smile in response to other's smiles. They also may ignore others who are upset or in pain.
• How does the child play? Children with autism may not be interested in toys at all, paying more attention to the movement of his hands, or a piece of string. If interested in toys, only certain ones may catch their interest. They may be more interested in turning a toy car upside down and spinning the wheels than pushing the car back and forth.

Your child's doctor will probably do lab tests to rule out other medical problems. Your child will also have a hearing test. Because it can be inherited, your healthcare provider may want to screen your other children for symptoms.

What is the treatment?

There is no one best treatment for all children with autism. The focus is usually on improving social skills, communication, and behavior. Before you decide on your child's treatment, find out what your options are. Learn as much as you can and make your choice for your child's treatment based on your child's needs. A good treatment program will:

• build on the child's interests
• offer a predictable schedule
• teach tasks as a series of simple steps
• actively hold the child's attention in highly structured activities
• provide regular evaluation of educational and behavioral goals

Usually children are placed in public schools and the school district pays for all needed services. These will include working with a speech therapist, occupational therapist, school psychologist, social worker, school nurse, or aide. You may want to visit public schools in your area to see the type of program they offer to special needs children.

By law, public schools must prepare and carry out a teaching plan. This plan is designed to help children in a special education program to learn specific skills. The list of skills is known as the child's Individualized Education Program (IEP). The IEP is an agreement between the school and the family about the child's goals. Parents play an important part in creating the program, as they know their child and his or her needs best. If your child is under 3 years of age and has special needs, check into early intervention programs.

A cognitive behavioral therapist can help your child learn to manage stress, and cut back on obsessive interests and repetitive routines. Other therapies may include art therapy, music therapy or sensory integration, which focuses on reducing a child's sensitivity to touch or sound.

Treatment includes doing activities at home as well as at school. The first step is to choose a skill to work on. You need to make sure the child can succeed. When your child succeeds, reward the behavior. When they are rewarded, they start to understand what you want them to do. A reward follows a behavior and increases the chances that the behavior will be repeated. Be sure that the reward you use is something your child wants, and that it works for the behavior you are trying to change.

It is important to show your child that interacting with people is fun and that communicating with people leads to good things (rewards). Give your child lots of supervised opportunities to practice communication and social skills.

Where can my family get help and support?

When parents hear that their child has autism, they may feel fear, anger, guilt, and other difficult emotions. Many families find that seeing a mental health professional helps them to cope.

Children with autism can cause stress on the entire family. It can affect recreation and family finances. It can also strain your marriage and relationships between siblings.

You will probably want to explore community and government resources as well as local support groups. Support groups can help by sharing common concerns and solutions to problems with other families in the same situation. You can find these services through your healthcare provider, schools, therapy programs, and local and national support organizations.