Autism

Signs and Symptoms

Symptoms may vary from moderate to severe. Each child's behavior is different, but here are some common signs in the 3 areas most likely to be affected, language, social interaction, and behavior:

Communication:

• Cannot start or keep a social conversation going
• Develops language slowly or not at all
• Repeats words or memorized passages, like commercials, but does not understand them
• Does not refer to self correctly, for example, says "you want water" when the child means "I want water"
• Uses nonsense rhyming
• Uses gestures instead of words

Social interaction:

• Does not seem aware of others' feelings
• Is withdrawn
• Prefers to spend time alone, rather than with others
• May not respond to eye contact or smiles
• May avoid eye contact
• Does not like to be held
• Does not respond to their name

Behavior:

• Repeats body movements
• May find normal noises painful and hold hands over ears
• May be sensitive to light
• May find even slight touch to be overstimulating
• Rubs surfaces, mouths or licks objects
• Does not like even the smallest changes in routine; needs everything to be the same
• "Acts up" with intense tantrums

Causes

Researchers do not know what causes autism, and there may be several causes. It may run in families, and research shows that a number of genes may be involved.

Other possible causes have been suspected, but not proven. Some researchers believe that damage to a specific part of the brain, called the amygdala, may be involved. Other researchers are looking at whether a virus may trigger symptoms. More recent studies suggest that advanced parental age increases the risk of autism. In one study, children of men over age 50 were more than twice as likely to have autism as those born to men under age 29.

Some parents have heard that the measles, mumps, and rubella (MMR) vaccine that children receive may cause autism. 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 there is no link between autism and the MMR vaccine.

Some doctors think the increase in the number of children with autism is due to better diagnosis and newer definitions of autism. The term "autism spectrum disorders" now includes a wider range of developmental problems.

Risk Factors

Autism is four times more likely to develop in boys than in girls, and it may be inherited. In fact, about 50% of all boys with autism have a parent with the disease.

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

Some research suggests that children born to older mothers and fathers (over age 40) may be more likely to develop autism. Other studies suggest that in-utero exposure to toxins, such as heavy metals, and medications, such as antidepressants, may increase the risk of developing autism.

Diagnosis

There is no specific test to diagnose autism. Children develop at different rates, and your child's pediatrician will look at your child's development during regular check ups. Your child may need further evaluation if the child:

• Is not babbling by 12 months
• Does not gesture (pointing, waving bye-bye) by 12 months
• Is not saying single words by 16 months
• Does not say two-word spontaneous phrases by 24 months (not just echoing)
• Loses any language or social skills at any age

Children with known or suspected autism will often be tested for chromosome abnormalities and perhaps metabolic testing.

Treatment Approach

Children with autism do best with an early, intensive, appropriate treatment program. An experienced specialist or team should create a program specifically for your child. Many effective therapies are available. The best treatment plan may use a combination of these.

Teaching Programs

There are many types of educational programs for children with autism. Many children do well with structured programs that reinforce the learning and practice of certain skills. When started early (pre-school) these programs may help a child advance in development and learn to function well.

Medications

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, sleep problems, and anxiety.

Treatment Options

Diet

Some children with autism seem 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 changing a child's diet will make a difference, and a review of studies in 2008 found no evidence that the diets helped. However, some parents say they see a difference in their children's behavior. If you want to try a special diet, talk to a registered dietitian who has experience working with children with autism.

Some studies have suggested that vitamin B6 and vitamin C may help some children with autism. The studies examining whether vitamin B6 may help used doses that are higher than the recommended amount, enough to be potentially toxic. DO NOT give these doses except under a doctor's supervision.

Some doctors suggest adding magnesium to vitamin B6 because they think the combination may work better, although two studies did not find any benefit.

One small study found that vitamin C supplements may help improve behavior in children with autism. The amounts used were high enough to possibly cause diarrhea. More research is needed on vitamin C and autism.

One small study found that taking a multivitamin improved sleep and digestive problems in children with autism.

If you are considering these supplements, it is important to talk with your doctor, a gastroenterologist (doctor who specializes in the digestive system), and a registered dietitian. You want to be sure that your child is still receiving enough calories, nutrients, and a balanced diet, and is not taking too much of a supplement.

Touch Therapy and Massage

Research shows that some children with autism have fewer symptoms after several weeks of touch therapy. In one clinical study, after 16 weeks of massage therapy for their children, parents said they felt physically and emotionally closer to their children and the children gave a range of cues to start massage at home.

Several clinical studies have found that children who had Qigong massage, a type of massage that focuses on energy, showed an improvement in behavior and an increase in language development. They also had improvement in motor skills, sensory function, and general health.

Art, Music, and Animal 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 way to express his or her feelings without using words.

Music therapy including singing helps develop speech and language skills. In fact, research shows that any music therapy may reduce symptoms for children and adolescents with autism.

Animal therapy may include therapeutic horse riding programs and swimming with dolphins. These types of therapies can help improve motor skills while also building self confidence. Some studies suggest that children who interact with dolphins learn faster and retain more information than children who learned in a classroom setting.

Sensory integration focuses on helping children reorganize and integrate what they perceive with their senses so they can better understand the outside world.

While there is little scientific evidence to say these therapies work, many parents and therapists say their child's behavior and communication skills improve, and that the children seem to enjoy these therapies.

Prognosis/Possible Complications

Autism is a challenging condition for children and their families, but the outlook is much better than it was a generation ago. Today, doctors and therapists can help manage many of the symptoms of autism, though most people still have symptoms throughout their lives.

Autism can be associated with other disorders that affect the brain, such as mental disability or fragile X syndrome. Some people with autism may have seizures. People with autism often have psychiatric conditions, such as attention deficit hyperactivity disorder (ADHD), anxiety, and bipolar disorder.

Many families find a support group helps them cope with the challenges of autism.

Following Up

You will need a team of educational and medical professionals to help treat a child with autism. It is important to find teachers, doctors, and behavioral specialists who can help you navigate the medical and educational landscape. They can help you find out what legal and financial options exist for schooling and treating children with disabilities.

Other Considerations

Viral infection during the first three months of pregnancy, particularly with rubella, is a suspected cause of autism. Low birth weight and babies who are small for their gestational age are also increased risk.

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