Autism
(Autism Spectrum Disorders; Pervasive Developmental Disorders)
Definition
Autism represents a spectrum of complex brain disorders resulting in social, behavioral, and communication problems. Other conditions that are part of this spectrum include Asperger syndrome and pervasive developmental disorder. In the US, autism spectrum disorders affect about 1 in 100 children aged 3-17 years old.
Causes
Autism is a neurodevelopmental disorder. This means that problems in brain development cause autism. Scientists are searching for answers about what causes these development problems. Studies suggest:
- Autism seems to run in some families. Several genes may be involved.
- Problems during pregnancy or delivery may interfere with normal brain development.
- Something in the environment that a child is exposed to may be a factor.
Risk Factors
These factors increase your chance of developing autism:
- Sex: male (Boys are four times more likely to have autism than girls.)
- Family history: siblings of a child with autism have a 3%-7% chance of being autistic.
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A number of other conditions are associated with autism, although the relationship between them is not clear:
- Neurofibromatosis
- Tuberous sclerosis
- Fragile X syndrome
- Phenylketonuria (PKU)
- Möbius syndrome
- Epilepsy
- Herpes encephalitis
- Cytomegalovirus
- Problems during pregnancy or delivery
- Contracting rubella during pregnancy (a risk for the child)
- Having parents who are older
The Conditions Above Primarily Affect the Central Nervous System
Symptoms
Autism usually first appears during early childhood (2-6 years old). The severity of symptoms varies over a wide spectrum. Behaviors and abilities may differ from day to day; symptoms may decrease as the child grows older. Children with autism may exhibit a combination of abnormal behaviors.
Symptoms include:
- Avoiding social contact
- Having problems with language (loss of language)
- Using words incorrectly, changing the meaning of a common word
- Gesturing frequently
- Avoiding eye contact
- Having trouble with nonverbal communication
- Lacking interest in normal activities for that age
- Spending a lot of time alone
- Not playing imaginatively
- Not starting pretend games
- Not imitating others
- Having sensitivity to sound, smell, taste, sights, and touch
- Responding to stimulation in an abnormal way
- Not reacting to smiles in the manner expected
- Being hyperactive
- Being passive
- Having tantrums
- Being single-minded
- Being aggressive
- Hurting self (self-mutilation)
- Engaging in repetitive movement, such as rocking or flapping a hand
- Resisting change
- Forming odd attachments to objects
- Sniffing or licking of toys
- Not understanding other peoples' feelings and needs
- Having constipation and being a picky eater
Some people with autism suffer from other disorders as well, including:
- Seizures
- Intellectual disability
- Genetic disorders, such as fragile X syndrome
Diagnosis
Doctors who specialize in autism will observe the child's behavior, social contacts, and communication abilities. They will assess mental and social development and ask parents about the child's behavior. Some doctors ask parents to bring in videos of the child at home.
Tests may include:
- Neuropsychological tests
- Questionnaires and observation schedules
- Intelligence tests
Medical tests to rule out other conditions that cause similar symptoms may include:
- Blood tests
- Urine tests
- DNA testing
- Electroencephalogram (EEG) —a test that records the brain's activity by measuring electrical currents through the brain
Treatment
There is no cure for autism. The severity of symptoms may decrease over the years. But the condition lasts for life. Children with autism and their families may benefit from early intervention. For instance, children aged 18-30 months who participate in high-intensity intervention targeting developmental behavior, showed improvements in their IQ, language, and adaptive behavior.
Children with autism respond well to a structured, predictable schedule. With help, many children with autism learn to cope with their disabilities. Most need assistance and support throughout their lives. Others are able to work and live independently when they grow up.
Interventions to help children with autism include:
Special Education
Programs designed to meet the child's special needs improve the odds of learning. Children with autism may have trouble with assignments, concentration, and anxiety. Teachers who understand the condition can build on the child's unique abilities. Programs should incorporate the child's interests. Some children do better in a small-group setting. Others do well in regular classrooms with special support. Vocational training can help prepare young adults for a job.
Therapy Services
Speech, physical, and occupational therapies may improve speech and activities. Children with autism need help developing social skills. Mental health professionals also help a family cope with caring for a child with autism. Counselors help parents learn how to manage behaviors.
Medication
Although there are no drugs to treat autism, several drugs are used to help manage symptoms. Aripiprazole and risperidone are the only drugs currently approved by the United States Food and Drug Administration (FDA) for treating behaviors associated with autism. Medicines for anxiety and depression can also help treat obsessive and aggressive behaviors. Your child's doctor may use other medicines to help control other disruptive behaviors.
Prevention
There are no guidelines for preventing autism because the cause is unknown. Scientists are searching for its underlying causes.
Autism Information Center
Centers for Disease Control and Prevention
Autism Society of America
Autism Canada Foundation
Autism Society Canada
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Centers for Disease Control and Prevention. Autism information center. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncbddd/autism/index.htm.
Dawson G, Rogers S, Munson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the early start Denver model. Pediatrics. 2009 Nov 30.
Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institute of Mental Health, 1999.
National Institute of Mental Health. Autism spectrum disorders (pervasive developmental disorders). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental-disorders/index.shtml. Accessed July 1, 2009.
National Institute of Mental Health. Autism spectrum disorders (pervasive developmental disorders): treatment options. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/autism/treatment-options.shtml. Accessed Sept 10, 2010.
National Institute of Neurological Disorders and Stroke. Autism fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/autism/detail_autism.htm. Updated April 24, 2009. Accessed July 1, 2009.
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10/30/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Ibrahim S, Voigt R, Katusic S, Weaver A, Barbaresi W. Incidence of gastrointestinal symptoms in children with autism: a population-based study. Pediatrics. 2009;124(2):680.
12/31/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Rice C. Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, United States, 2006. MMWR Surveill Summ. 2009;58(SS10):1.
Last reviewed September 2011 by Konda Mohan Reddy, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
