Introduction:

Autism is a complex developmental disorder that appears in the first 3 years of life, although it is sometimes diagnosed much later. It affects the brain’s normal development of social and communication skills. Autism encompasses a wide range of behavior. The common features include impaired social interactions, impaired verbal and nonverbal communication, and restricted and repetitive patterns of behavior.

Signs and Symptoms:

The symptoms may vary from moderate to severe. A combination of the following areas may be affected.

Communication:

• Is unable to start or sustain a social conversation
• Develops language slowly or not at all
• Repeats words or memorized passages, like commercials
• Doesn’t refer to self correctly (for example, says "you want water" when the child means "I want water")
• Uses nonsense rhyming
• Communicates with gestures instead of words

Social interaction:

• Shows a lack of empathy
• Does not make friends
• Is withdrawn
• Prefers to spend time alone, rather than with others
• May not respond to eye contact or smiles
• May actually avoid eye contact
• May treat others as if they are objects
• Does not play interactive games

Response to sensory information:

• Has heightened or low senses of sight, hearing, touch, smell, or taste
• Seems to have a heightened or low response to pain
• May withdraw from physical contact because it is over-stimulating or overwhelming
• Does not startle at loud noises
• May find normal noises painful and hold hands over ears
• Rubs surfaces, mouths or licks objects

Play:

• Shows little pretend or imaginative play
• Doesn’t imitate the actions of others
• Prefers solitary or ritualistic play

Behaviors:

• Has a short attention span
• Uses repetitive body movements
• Shows a strong need for sameness
• "Acts up" with intense tantrums
• Has very narrow interests
• Demonstrates perseveration (gets stuck on a single topic or task)
• Shows aggression to others or self
• Is overactive or very passive

Causes:

Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism. Genetic factors seem to be important.

A number of other possible causes have been suspected, but not proven. They involve digestive tract changes, diet, mercury poisoning, vaccine sensitivity, and the body’s inefficient use of vitamins and minerals. Research suggests that heredity and early fetal development may play a causal role in autism, however studies show no association between risk of autism and parental factors such as age and socioeconomic status.

Some parents have heard that the Measles, Mumps, and Rubella (MMR) vaccine that children receive may cause autism. Although many clinicians still believe there is a link, several major studies have found no connection between the vaccine and autism. The American Academy of Pediatrics and the Centers for Disease Control and Prevention report that there is no proven link between autism and the MMR vaccine.

Some doctors attribute the increased incidence in autism to newer definitions of autism. The term “autism” now includes a wider spectrum of children.

Risk Factors:

Autism affects males four times more often than females, and it may be inherited. In fact, about 50% of all boys with autism have a parent with the disease.

Autism occurs more frequently in children with rare genetic disorders and other medical conditions, such as tuberous sclerosis, phenylketonuria, neurofibromatosis, and epilepsy.

Diagnosis:

All children should have routine developmental exams by their pediatrician. Further testing may be needed if there is concern on the part of the clinician or the parents. This is particularly true when a child fails to meet any of the following language milestones:

• Babbling by 12 months
• Gesturing (pointing, waving bye-bye) by 12 months
• Single words by 16 months
• Two-word spontaneous phrases by 24 months (not just echoing)
• Loss of any language or social skills at any age

An evaluation of autism will often include a complete physical and neurologic examination. It may also include a specific diagnostic screening tool, such as:

• Autism Diagnostic Interview - Revised (ADI-R)
• Autism Diagnostic Observation Schedule (ADOS)
• Childhood Autism Rating Scale (CARS)
• Gilliam Autism Rating Scale
• Pervasive Developmental Disorders Screening Test-Stage 3

Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.

Treatment Approach:

An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. An experienced specialist or team should design the individualized program. A variety of effective therapies are available. The best treatment plan may use a combination of techniques.

Teaching Programs

There are many types of teaching programs for children with autism. Some use a one-on-one teaching approach that relies on reinforced practice of various skills to get the child close to typical developmental functioning. Others use picture schedules and other visual cues to help the child work independently and to organize and structure their environments.

Medicine

Medicines are often used to treat behavior or emotional problems that people with autism may have. These include hyperactivity, impulsiveness, attention problems, irritability, mood swings, outbursts, tantrums, aggression, extreme compulsions that the child finds it impossible to suppress, sleep difficulty, and anxiety.

Treatment Options:

Diet

Some children with autism appear to respond to a gluten-free or a casein-free diet. Gluten is found in foods containing wheat, rye, and barley. Casein is found in milk, cheese, and other dairy products. Not all experts agree that dietary changes will make a difference, and not all reports studying this method have shown positive results.

Some clinical studies show that children who have autism benefit from antioxidants like vitamin C. Parents and physicians have reported improvement in symptoms in children with autism who have been given certain supplements, including vitamin B, magnesium, cod liver oil and vitamin C.

If you are considering these or other dietary changes, seek guidance from both a gastroenterologist (doctor who specializes in the digestive system) and a registered dietitian. You want to be sure that the child is still receiving adequate calories, nutrients, and a balanced diet.

Touch Therapy and Massage

Research shows that some children with autism exhibit a reduction in symptoms after several weeks of touch therapy. In one clinical study, after 16 weeks of massage intervention parents reported feeling physically and emotionally closer to their children and children expressed a range of cues to initiate massage at home.

Several clinical studies have found that children who had Qigong massage (a type of massage that focuses on energy) showed a decrease in autistic behaviors and an increase in language development, as well as improvement in motor skills, sensory function, and general health.

Art, Music, and Pet Therapy

Art therapy, music therapy, animal therapy, and sensory integration therapy provide opportunities for children who have autism to develop social and communication skills.

• Art therapy offers a child a nonverbal way to express his or her feelings.
• Music therapy involving singing helps develop the child’s speech and language skills. In fact, research shows that any music intervention effectively reduces symptoms for children and adolescents with autism.
• Animal therapy may include therapeutic riding programs on horses and swimming with dolphins. These types of therapies can help improve the child’s motor skills, while also building self-confidence. In fact, some studies show that children who interact with dolphins learn faster and retain more information than children who learned in a classroom setting.
• Sensory integration focuses on normalizing extreme reactions to sensory input. It tries to help children reorganize and integrate their sensory information so they can better understand the outside world.

While there is little scientific evidence supporting these therapies, many parents and therapists report noticeable improvement in a child’s behavior and communication skills as well as a sense of enjoyment.

Prognosis/Possible Complications:

Autism remains a challenging condition for individuals and their families, but the outlook is much better than it was a generation ago. Today, with appropriate therapy, clinicians can help reduce many of the symptoms of autism, though most people will be affected on some level throughout their lives.

Autism can be associated with other disorders that affect the brain, such as mental retardation or fragile X syndrome. Some people with autism will develop seizures.

Other Considerations:

Viral infection during the first three months of pregnancy -- particularly with rubella -- is a suspected cause of autism.

Alternative Names:

Pervasive developmental disorder