Autism

Autism affects one out of 1,000 people in the United States and is diagnosed more often in boys than girls on average, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), as part of the National Institutes of Health (NIH).

Autism was first diagnosed in the 1940's, but little was known until the 1990's about the disorder.

Dr. Eid Guirguis, a pediatrician in Spring Hill, advised that presently an estimated 3.4 out of 1,000 children aged 3-10 years are diagnosed.

"In the most recent survey the Centers for Disease Control (CDC), found autism to affect male children more so than female," said Guirguis. "The diagnosis of autism has become more prevalent than that of cerebral palsy, hearing loss and vision impairment."

According to the NICHD, although more cases of autism are being identified, it is not clear why. Some of the increase may result from better education about the symptoms of autism or from more accurate diagnoses of autism.

April is an awareness month for autism.

Currently there is no cure or definitive cause for autism. However, with early detection, intervention and treatment, the symptoms related to autism can be improved. Also, autism does not affect a person's life expectancy.

"Parents are usually the first to notice the behavior changes in their child," said Guirguis, "some parents notice their child as being 'different' from birth, sometimes unresponsive to people or having an intent focus on a particular item for an extended period of time."

Autism symptoms involve language, social behavior, and behaviors concerning objects and routines.

During the 1950's and 70's, autism was thought to be caused by neglect, which caused the children to regress into their own world, the common term during that time was "Refrigerator Mothers", according to the National Autism Association (NAA).

Health care providers now diagnose autism on a 'spectrum' of the disorder into three categories of autism spectrum disorders (ASDs). They are: Autistic disorder (also called "classic" autism), Asperger syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (or atypical autism). In addition to these initial categories, a broaden perspective of pervasive developmental disorders (PDD) includes the ASDs and childhood disintegrative disorder, and Rett syndrome.

It is most common now for health care providers to use ASD and PDD interchangeably depending on the symptoms, as autism is in both categories.

"Children with ASD do not follow typical patterns of development," said Guirguis, "communication and social skills are undeveloped and become noticeable when a child is around other his/her own age."

These changes are often seen starting at 12 to 36 months of age, added Guirguis.

"The changes can be mild or quite severe," said Guirguis. "The differences in how they react to people and unusual behaviors, rejecting people, acting strangely, and the loss of language and social skills that had previously been learned can occur."

A leveling in the progression of autism is noticeable, as with autism, children with ASD struggle to engage in everyday human interaction, Guirguis added.

"Children with ASD may have sensory problems, some mental retardation, seizures, and/or a fragile X syndrome (inherited form of mental retardation), where the X chromosome is defective, and tuberous sclerosis," said Guirguis.

Environmental, genetics and vaccinations have all been investigated as to the possible causes of autism, as these continue to be researched.

Researchers have been searching for the 'autism' gene that triggers the disorder, which most experts are of the opinion that this is a genetic pre-disposition. However, there is significant concern regarding the increase of diagnoses within the past 15 years, and cannot all be attributed to genetics alone.

Environmental triggers have become more the focus to determining how autism is triggered, preventable and treatable as a disorder. Currently researchers are exploring the possibility of viral infections and/or air pollutants as a cause to triggering autism.

According to the NAA, there are five specific behaviors that signal the need for a doctor's evaluation of autism in a child.

• Does not babble or coo by 12 months old.

• Does not gesture (point, wave, grasp, etc.) by 12 months old.

• Does not say a single word by 16 months of age.

• Does not say two-word phrases on his/her own (other than the child repeating what someone says to him/her) by 24 months of age.

• Has ANY loss of ANY language or social skills at ANY age.

There are standardized tests used by professionals, such as psychologists, psychiatrists, developmental pediatricians, and school psychologists.

"Evidence from research indicates, intense early intervention results in improved outcomes in most children with ASD," said Guirguis.

According to the NAA, the following tests may be used to diagnose autism can be: CARS (Childhood Autism Rating Scale), Autism Diagnostic Checklist Form E-2, CHAT (Checklist for Autism in Toddlers), M-CHAT (Modified Checklist for Autism in Toddlers), Pervasive Developmental Disorders Screening Test -2, ADOS (Autism Diagnostic Observation Scale), and ADI-R (Autism Diagnostic Interview – Revised). In addition, parental interview and medical history are taken into consideration.

The treatments for autism depend on the severity of the disorder.

"There is no specific treatment or regimen that works for every child," said Guirguis.

These treatments may include behavior modification, sensory integration dysfunction, as well as therapies such as occupational, physical, speech, music, and vision.

There are suggested treatments some consider as controversial. Therefore, before attempting any 'new' treatments, discussing your options with you health care professional is strongly recommended.

There are medication options for autism, however, the medications prescribed do not treat autism, but more so the behavioral problems associated with the condition.

"Behaviors such as aggression, injuring one self, and severe tantrum can prevent a person with ASD from functioning at school or home," said Guirguis. "Medications being prescribed should be those that are proven to help treat those with similar symptoms."

However, further research is needed to ensure the safety of children and psychotropic medications, Guirguis added.

The Food and Drug Administration (FDA) uses "black-box" warning on labels for all antidepressant medications to alert the public about the potential increased risk to suicidal thinking and attempts in children and adolescents taking antidepressants.

This is the most serious warning issued in drug labeling. Since 2007, this warning has been increased to these individuals up to age 25.

Before engaging in any treatments, the Autism Society of America recommends asking yourself the following:

•Will the treatment result in harm to my child?

How will failure of the treatment affect my child and family?

Has the treatment been validated scientifically?

Are there assessment procedures specified?

How will the treatment be integrated into my child's current program?

Other questions for parents, recommended by the National Institute for Mental Health suggest:

How successful has the program been for other children?

How many children have gone on to placement in a regular school and how have they performed?

Do staff members have training and experience in working with children and adolescents with autism?

How are activities planned and organized?

Are there predictable daily schedules and routines?

How much individual attention will my child receive?

How is the progress measured?

Will my child's behavior be closely observed and recorded?

Will my child be given tasks and rewards that are personally motivating?

Is the environment designed to minimize distractions?

Will the program prepare me to continue the therapy at home?

What is the cost, time commitment, and location of the program?

Research indicates effective applied behavior analysis (ABA) has become a widely accepted treatment.

"Effective treatment programs include building on a child's interests, predictable schedules, simple steps when teaching tasks, actively engaging the child to gain his/her attention during highly structured activities, and regular reinforcement of behaviors," said Guirguis, "parental involvement has indicated as a major factor for success in treatment programs."

INFORMATION BOX:

The American Academy of Pediatrics (AAP) recommends that health care providers ask questions about different aspects of development.

These questions include (but are not limited to) those listed here:

Does your child….

Not speak as well as other children his/her age?

Have poor eye contact?

Act as if he/she is in his/her own world?

Seem to "tune out" others?

Not smile when smiled at?

Seem unable to tell you what he/she wants, and so takes your hand and leads you to what he/she wants, or gets it him/herself?

Have trouble following simple directions?

Not play with toys in a usual way?

Not bring things to you to "show" you something?

Not point to interesting things or direct your attention to items of interest?

Have unusually long or severe temper tantrums?

Show an unusual attachment to objects, especially "hard" ones, such as a flashlight or key chain, instead of "soft" ones, such as a blanket or stuffed animal?

Prefer to play alone?

Not pretend or play "make believe" (if the child is older than age two)?

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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.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER).