AUTISM

• What is Autism?

Autism is a neuro-developmental disorder characterized by social impairments, cognitive impairments, communication difficulties, and repetitive behaviors. It can range from very mild to very severe and occur in all ethnic, socioeconomic and age groups. Males are four times more likely to have autism than females.

• Types of Autism

The most recent version of the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5) has just a single category for the diagnosis of an autistic disorder--  autism spectrum disorders, which includes the following disorders that were previously diagnosed as individual disorders:

• Autistic disorder. This is what most people think of when they hear the word "autism." It refers to problems with social interactions, communication, and imaginative play in children younger than 3 years.
• Asperger's syndrome. These children don't have a problem with language -- in fact, they tend to score in the average or above-average range on intelligence tests. But they have the same social problems and limited scope of interests as children with autistic disorder.
• Pervasive developmental disorder or PDD -- also known as atypical autism. This is a kind of catch-all category for children who have some autistic behaviors but who don't fit into other categories.
• Rett syndrome. Children with Rett syndrome, primarily girls, start developing normally but then begin losing their communication and social skills. Beginning at the age of 1 to 4 years, repetitive hand movements replace purposeful use of the hands. Children with Rett syndrome are usually severely cognitively impaired.
• Childhood disintegrative disorder. These children develop normally for at least two years and then lose some or most of their communication and social skills. This is an extremely rare disorder and its existence as a separate condition is a matter of debate among many mental health professionals.

These disorders may now be diagnosed as either a social communication disorder or autism spectrum disorder based on the primary impairments.

• Causes of Autism

Because autism runs in families, most researchers think that certain combinations of genes may predispose a child to autism. But there are risk factors that increase the chance of having a child with autism.

Advanced age of the mother or the father increases the chance of an autistic child. 

When a pregnant woman is exposed to certain drugs or chemicals, her child is more likely to be autistic. These risk factors include the use of alcohol, maternal metabolic conditions such as diabetes and obesity, and the use of anti-seizure drugs during pregnancy. In some cases, autism has been linked to untreated phenylketonuria (called PKU, an inborn metabolic disorder caused by the absence of an enzyme) and rubella (German measles).

Although sometimes cited as a cause of autism, there is NO evidence that vaccinations cause autism.  

Exactly why autism happens isn't clear. Research suggests that it may arise from abnormalities in parts of the brain that interpret sensory input and process language. 

Researchers have no evidence that a child's psychological environment -- such as how caregivers treat the child -- causes autism.

• Signs of Autism

Early signs of Autism:

• Doesn’t make eye contact (e.g. look at you when being fed).
• Doesn’t smile when smiled at.
• Doesn’t respond to his or her name or to the sound of a familiar voice.
• Doesn’t follow objects visually.
• Doesn’t point or wave goodbye or use other gestures to communicate.
• Doesn’t follow the gesture when you point things out.
• Doesn’t make noises to get your attention.
• Doesn’t initiate or respond to cuddling.
• Doesn’t imitate your movements and facial expressions.
• Doesn’t reach out to be picked up.
• Doesn’t play with other people or share interest and enjoyment.
• Doesn’t ask for help or make other basic requests.

Other signs of Autism:

• No big smiles or other warm, joyful expressions by six months or thereafter
• No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
• No babbling by 12 months
• No Gesturing (pointing, waving bye-bye) by 12 months
• No words by 16 months
• No two-word meaningful phrases (without imitating or repeating) by 24 months
• Any loss of speech or babbling or social skills at any age

• Treatment of Autism

Early Intervention

Research shows that early intervention treatment services can greatly improve a child’s development. Early intervention services help children from birth to 3 years old (36 months) learn important skills. Services include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has an ASD or any other developmental problem.

Behavior and Communication Approaches

According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD are those that provide structure, direction, and organization for the child in addition to family participation.

Applied Behavior Analysis (ABA)

A notable treatment approach for people with an ASD is called applied behavior analysis (ABA). ABA has become widely accepted among health care professionals and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills. The child’s progress is tracked and measured.

There are different types of ABA. Following are some examples:

• Discrete Trial Training (DTT)
  DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts and positive reinforcement is used to reward correct answers and behaviors. Incorrect answers are ignored.
• Early Intensive Behavioral Intervention (EIBI)
  This is a type of ABA for very young children with an ASD, usually younger than five, and often younger than three.
• Pivotal Response Training (PRT)
  PRT aims to increase a child’s motivation to learn, monitor his own behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.
• Verbal Behavior Intervention (VBI)
  VBI is a type of ABA that focuses on teaching verbal skills.

Other therapies that can be part of a complete treatment program for a child with an ASD include:

Developmental, Individual Differences, Relationship-Based Approach (DIR; also called "Floortime")
Floortime focuses on emotional and relational development (feelings, relationships with caregivers). It also focuses on how the child deals with sights, sounds, and smells.

Treatment and Education of Autistic and related Communication-handicapped CHildren (TEACCH)
TEAACH uses visual cues to teach skills. For example, picture cards can help teach a child how to get dressed by breaking information down into small steps.

Occupational Therapy
Occupational therapy teaches skills that help the person live as independently as possible. Skills might include dressing, eating, bathing, and relating to people.

Sensory Integration Therapy
Sensory integration therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched.

Speech Therapy
Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.

The Picture Exchange Communication System (PECS)
PECS uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation.

Dietary Approaches

Some dietary treatments have been developed by reliable therapists. But many of these treatments do not have the scientific support needed for widespread recommendation. An unproven treatment might help one child, but may not help another.

Many biomedical interventions call for changes in diet. Such changes include removing certain types of foods from a child’s diet and using vitamin or mineral supplements. Dietary treatments are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of ASD. Some parents feel that dietary changes make a difference in how their child acts or feels.

If you are thinking about changing your child’s diet, talk to the doctor first. Or talk with a nutritionist to be sure your child is getting important vitamins and minerals.

Medication

There are no medications that can cure ASD or even treat the main symptoms. But there are medications that can help some people with related symptoms. For example, medication might help manage high energy levels, inability to focus, depression, or seizures.

Complementary and Alternative Treatments

To relieve the symptoms of ASD, some parents and health care professionals use treatments that are outside of what is typically recommended by the pediatrician. These types of treatments are known as complementary and alternative treatments (CAM). They might include special diets, chelation (a treatment to remove heavy metals like lead from the body), biologicals (e.g., secretin), or body-based systems (like deep pressure).

These types of treatments are very controversial. Current research shows that as many as one third of parents of children with an ASD may have tried complementary or alternative medicine treatments, and up to 10% may be using a potentially dangerous treatment. Before starting such a treatment, check it out carefully, and talk to your child’s doctor.

The purpose of this blog entry was to help parents who think they may have a child with ASD, to provide information to parents that have a child with ASD, and to better help parents with children who do not have a child with ASD better understand a child that does have ASD. 

Sources: CDC, Web MD, National Autism Association

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