Autism is a brain disorder that affects a person's ability to communicate, form relationships with others, and respond appropriately to the external world. People with the condition often exhibit repetitive behavior or narrow, obsessive interests. Other characteristics of autism include problems with verbal and nonverbal communication and social interaction. Scientists aren't certain what causes the disorder, but it's likely that both genetics and environment play a role.
Experts estimate that three to six children out of every 1,000 will have autism. Males are four times more likely to have it than females. Girls with autism tend to have more severe symptoms and greater cognitive impairment.
Autism is a behaviorally defined developmental disorder that begins in early childhood. Although the diagnosis of autism may not be made until a child reaches preschool or school age, the signs and symptoms of autism may be apparent by the time the child is aged 12-18 months, and the behavioral characteristics of autism are almost always evident by the time the child is aged 3 years. Language delay in the preschool years (younger than 5 years) is typically the presenting problem for more severely affected children with autism. Higher functioning children with autism are generally identified with behavioral problems when they are aged approximately 4-5 years or with social problems later in childhood. Autism disorder persists throughout the person's lifetime, although many people are able to learn to control and modify their behavior to some extent.
Autism is classified by the American Psychiatric Association as one of a group of disorders known as the pervasive development disorders (PDD). In addition to autistic disorder, the other types of pervasive developmental disorders include Asperger's syndrome, childhood disintegrative disorder, Rett disorder, and pervasive developmental disorder not otherwise specified (PDD NOS).
All of these disorders are characterized by varying degrees of problems with communication, social interaction, and atypical, repetitive behaviors. This group of disorders is sometimes called the autism spectrum disorders (ASDs).
There is a wide range of symptoms, severity, and other manifestations of these disorders. The expression of autism spectrum disorders varies widely among affected individuals. A child with significant impairment in all three of the core functioning areas (socialization, communication, and atypical, repetitive behaviors) may have autism, while a child with similar problems but without delays in language development may have Asperger's syndrome.
Some people are affected with fairly mild symptoms and signs of autism. Many of these individuals learn to live independent lives. Others are more severely affected and require lifelong care and supervision.
As the following statistics indicate, autism is a common developmental disorder.
The number of children diagnosed with autism spectrum disorders appears to be increasing. The most recent studies show that of children born in 1998, 9 out of every 1000 have an autism spectrum disorder, corresponding to an average of 1 out of every 110 children. Although there is a concern that the actual number of children with autism spectrum disorders is increasing, several factors, such as improvements in diagnostic methods and the view of autism spectrum disorders as being on a continuum, also may account for the increase.
As many as 1.5 million people in the U.S. may have some form of autism.
Autism affects all races, ethnic groups, and socioeconomic levels.
Boys are 3-4 times more likely than girls to have autism.
There is no cure for autism; however, there is good news.
A generation ago, most children with autism were institutionalized. This is no longer the case and most children with this disorder live with their families.
Our improving understanding of autism has shown that, regardless of the severity of the condition, appropriate treatment and education can eventually help many children with autism to be integrated into their community.
Early diagnosis is essential for implementing appropriate treatment and education at an early age, when they can do the most good.
Autism has no single, known cause. Given the complexity of the disease, the range of autistic disorders and the fact that no two children with autism are alike, there are likely many causes. These may include:
Genetic problems. A number of genes appear to be involved in autism. Some may make a child more susceptible to the disorder; others affect brain development or the way brain cells communicate. Still others may determine the severity of symptoms. Each problem in genes may account for a small number of cases, but taken together, the influence of genes may be substantial. Some genetic problems seem to be inherited, whereas others happen spontaneously.
Environmental factors. Many health problems are due to both genetic and environmental factors, and this is likely the case with autism as well. Researchers are currently exploring whether viral infections and air pollutants, for example, play a role in triggering autism.
Even though it is not fully proven yet, causes of autism have been linked to pesticides, infections, and diet.
No link between vaccines and autism
One of the greatest controversies in autism is centered on whether a link exists between autism and certain childhood vaccines, particularly the measles-mumps-rubella (MMR) vaccine. No reliable study has shown a link between autism and the MMR vaccination. A study published in 1998 that theorized there could be a link has been retracted because there's little evidence to support that theory.
Avoiding childhood vaccinations can place your child in danger of catching serious diseases, including whooping cough (pertussis), measles or mumps.
Autism affects children of all races and nationalities, but certain factors increase a child's risk. They include:
Your child's sex. Boys are three to four times more likely to develop autism than girls are.
Family history. Families who have one child with autism have an increased risk of having another child with the disorder. It's also not uncommon for the parents or relatives of an autistic child to have minor problems with social or communication skills themselves or to engage in certain autistic behaviors.
Other disorders. Children with certain medical conditions have a higher than normal risk of having autism. These conditions include fragile X syndrome, an inherited disorder that causes intellectual problems; tuberous sclerosis, a condition in which benign tumors develop in the brain; the neurological disorder Tourette syndrome; and epilepsy, which causes seizures.
Parents' ages. Having an older father (being 40 or older) may increase a child's risk of autism. There may also be a connection between children being born to older mothers and autism, but more research is necessary.
Autism is a condition surrounded by myth and generalizations about people with autism that are rarely appropriate. The common beliefs that people with autism never express emotion, never smile or laugh, never make eye contact, never talk, and never display affection are simply that - myths. Just as every person is unique, with his or her own personality and characteristics, every person with autism manifests the disorder in his or her unique way.
The list of symptoms and behaviors associated with autism is long, and each affected person expresses his or her own combination of these behaviors. None of these clinical features is common to all people with autism, and many are occasionally exhibited by people who are not autistic.
That said, however, all people with autism have abnormal functioning in three core areas of development: social interaction, verbal and nonverbal communication, and the presence of repetitive and restricted patterns of behavior, interests, and activities. The diagnosis of autism is typically made when impairment is significant in all three areas.
Examples include the following:
poor use of body language and nonverbal communication, such as eye contact, facial expressions, and gestures;
lack of awareness of feelings of others and the expression of emotions, such as pleasure (laughing) or distress (crying), for reasons not apparent to others;
remaining aloof, preferring to be alone;
difficulty interacting with other people and failure to make peer friendships;
may not want to cuddle or be cuddled;
appears unaware of others' feelings;
lack of or abnormal social play;
not responding to verbal cues (acting as if deaf).
Examples include the following:
delay in, or the total lack of, the development of spoken language or speech;
if speech is developed, it is abnormal in content and quality;
difficulty expressing needs and wants, verbally and/or nonverbally;
repeating words or phrases back when spoken to (known as echolalia);
inability to initiate or sustain conversation;
absent or poorly developed imaginary play.
Examples include the following:
insisting on following routines and sameness, resisting change;
ritualistic or compulsive behaviors;
sustained odd play;
repetitive body movements (hand flapping, rocking) and/or abnormal posture (toe walking);
preoccupation with parts of objects or a fascination with repetitive movement (spinning wheels, turning on and off lights);
narrow, restricted interests (dates/calendars, numbers, weather, movie credits).
There are a number of associated features and behaviors that are seen in some people with autism, including the following:
Cognitive function: Autism occurs at all intelligence levels. Although about 75% of autistic individuals have an intelligence quotient (IQ) below average, the other 25% have an average or above average intelligence. The performance IQ is generally higher than the verbal IQ. A small percentage have high intelligence in a specific area such as mathematics.
Seizures may develop in 25% to 35% of children with autism and can be resistant to treatment. The onset of seizures peaks in early childhood and again in adolescence. There is an increased risk of seizures in children with autism who have mental retardation or a family history of autism.
Uneven gross and/or fine motor skills (well developed in some areas, poorly developed in others)
Behavioral symptoms include:
aggressive or self-injurious behavior;
noticeable extreme underactivity or overactivity;
throwing tantrums;
short attention span;
abnormal responses to sensory stimuli (for example, expressing over sensitivity or undersensitivity to pain);
abnormalities in eating or sleeping;
not responding to normal teaching methods;
playing in odd or unusual ways;
having inappropriate attachment to objects;
may be unusually sensitive to light, sound and touch and yet oblivious to pain;
having no apparent fear of dangerous situations.
Mood and affect vary considerably, and may include being unaware of the feelings of others, withdrawn, or emotionally labile. Some people with autism become outwardly anxious or they may become depressed in response to the realization of their problems.
In some children with autism who express affection, the affection may be indiscriminate.
When to see a doctor
Babies develop at their own pace, and many don't follow exact timelines found in some parenting books. But children with autism usually show some signs of delayed development by 18 months. If you suspect that your child may have autism, discuss your concerns with your doctor. The earlier treatment begins, the more effective it will be.
Your doctor may recommend further developmental tests if your child:
Doesn't babble or coo by 12 months
Doesn't gesture — such as point or wave — by 12 months
Doesn't say single words by 16 months
Doesn't say two-word phrases by 24 months
Loses previously acquired language or social skills at any age
Autism is one of five types of autism spectrum disorder. Autism spectrum disorders are developmental brain disorders. These disorders are characterized by impaired social interaction and communication skills, and a limited range of activities and interests.
Other types of autism spectrum disorder include:
Asperger syndrome
Childhood disintegrative disorder
Rett syndrome
Pervasive developmental disorder -- not otherwise specified (PDD-NOS, including atypical autism).
Data from several studies that used the current criteria for diagnosing autism and autism spectrum disorders (ASD), such as Asperger syndrome and pervasive developmental disabilities (PDD-NOS), found occurrence rates for autism spectrum disorders between 2 and 6 per 1,000 individuals. Therefore, it can be summarized that between 1 in 500 (2/1,000) to 1 in 166 children (6/1,000) have an ASD.
Your child's doctor will look for signs of developmental delays at regular checkups. If your child shows some signs of autism, you may be referred to a specialist in treating children with autism. This specialist, working with a team of professionals, can perform a formal evaluation for the disorder.
Because autism varies widely in severity, making a diagnosis may be difficult. There isn't a specific medical test to pinpoint the disorder. Instead, an autism specialist will observe your child and talk to you about how your child's social skills, language skills and behavior have developed and changed over time. To help reach a diagnosis, your child may undergo a number of developmental tests covering speech, language and psychological issues.
Although the signs of autism often appear by 18 months, the diagnosis sometimes isn't made until age 2 or 3, when there may be more obvious delays in language development and social interactions. Early diagnosis is important because early intervention — preferably before age 3 — appears to be the most helpful.
For your child to be diagnosed with autism, he or she must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
To be diagnosed with autism, your child must have six or more of the following symptoms and two or more of those symptoms must fall under the social skills category.
Social skills
Has difficulty with nonverbal behaviors, such as making eye contact, making facial expressions or using gestures
Has difficulty forming friendships with peers and seems to prefer playing alone
Doesn't share experiences or emotions with other people, such as sharing achievements or pointing out objects or other interests
Appears unaware of others' feelings
Communication skills
Starts talking later than age 2 and has other developmental delays by 30 months, and doesn't make an attempt to communicate with gestures or miming
Can't start a conversation or keep one going
May repeat words or phrases verbatim, but doesn't understand how to use them
Doesn't play make-believe or doesn't imitate the behavior of adults when playing
Behavior
Develops interests in objects or topics that are abnormal in intensity or focus
Performs repetitive movements, such as rocking, spinning or hand-flapping
Becomes disturbed at the slightest change in routines or rituals
May be fascinated by parts of an object, such as the spinning wheels of a toy car
No cure exists for autism, and there is no "one-size-fits-all" treatment. The range of home-based and school-based treatments and interventions for autism can be overwhelming.
Your doctor can help identify resources in your area that may work for your child. Treatment options may include:
Behavior and communication therapies. Many programs have been developed to address the range of social, language and behavioral difficulties associated with autism. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or how to communicate better with other people. Though children don't always outgrow autism, they may learn to function well with the disorder.
Educational therapies. Children with autism often respond well to highly structured education programs. Successful programs often include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions show good progress.
Medications. No medication can improve the core signs of autism, but certain medications can help control symptoms. Antidepressants may be prescribed for anxiety, for example, and antipsychotic drugs are sometimes used to treat severe behavioral problems.
Autistic children may also have other medical conditions, such as epilepsy or gastrointestinal problems. Talk to your child's doctor about how to best manage your child's conditions together, and always tell each of your child's health care providers all the medications and supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.
Because autism is an incurable disease, many parents seek out alternative therapies. Though some families have reported good results with special diets and other complementary approaches, researchers aren't sure how useful the treatments are. Some of the most common alternative therapies include:
Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy, music therapy or sensory integration, which focuses on reducing a child's sensitivity to touch or sound.
Special diets. Several diet strategies have been suggested as possible treatments for autism, including restriction of food allergens; probiotics; a yeast-free diet; a gluten-free, casein-free diet; and dietary supplements such as vitamin A, vitamin C, vitamin B-6 and magnesium, folic acid, vitamin B-12, and omega-3 fatty acids. One popular diet eliminates gluten — a protein found in most grains, including wheat — and casein (a milk protein), but more research is necessary to see if the diet has any effect on autism signs and symptoms. To find out more, talk to a registered dietitian with special expertise in autism.
Chelation therapy. This treatment is said to remove mercury and other heavy metals from the body. However, there's no known link between mercury and autism, and chelation therapy can be very dangerous. Chelation therapy can cause kidney failure. Some people who have participated in chelation therapy studies have died.