Autism (Autism Spectrum Disorder)

Autism is a developmental disorder of the brain. People with autism have problems communicating and interacting socially. They also may have unusual patterns of behavior, interests and activities.

Doctors use the term autism spectrum disorder (ASD). In the past, there were different kinds of autism disorders, but in 2013 the criteria for autism were updated to include all of them under a single diagnosis. The criteria for a diagnosis of autism include:

• Persistent deficits (problems) in social communication and interaction (such as interacting socially, nonverbal communication, or developing, maintaining and understanding relationships)
• Restrictive, repetitive patterns of behavior, interests or activities.

These are the basic symptoms that all children with autism have in common. In addition to these, children with autism may have:

• Intellectual impairment (such as trouble with thinking, reasoning, or abstract concepts)
• Language delays, or lack of language entirely
• Motor problems, such as difficulty walking, clumsiness, or low tone
• Large heads (approximately 25 percent of children with ASD have large heads)

Signs of autism spectrum disorder are typically first seen before a child's third birthday. However, only half of children with autism are diagnosed before kindergarten.

Some syndromes that cause autistic behaviors, such as Rett Syndrome, have a known genetic cause. 

The causes of the other types of autism remain unknown. Various studies suggest that autism may:

• Be inherited
• Be caused by infection or the effects of an environmental toxin
• Result from a brain injury or abnormality that occurs in the womb or in early infancy
• Result from abnormal levels of chemicals messengers in the brain

Studies have found no link between vaccines and autism.

All types of autism except Rett syndrome are more common in boys than in girls.

Symptoms

At birth, a child with ASD often appears normal.

Symptoms may appear as early as the first year of life. But it may not be until the child is 2 or 3 years old that the parents realize something is not quite right.

Infants with autism spectrum disorder:

• May respond abnormally to being touched.
  • Instead of cuddling when they are picked up, they may stiffen or go limp.
• May not show normal developmental behaviors during the first year of life. For example:
  • Smiling at the sound of their mother's voice
  • Pointing out objects to catch someone's attention
  • Reaching out to others with their hands
  • Attempting one-syllable conversations
  • May not maintain eye contact
  • May appear unable to distinguish parents from strangers
  • Typically show little interest in others.

Symptoms vary from mild to severe.

Some behaviors associated with autism include:

• Disordered play — A toddler with ASD:
  • Usually ignores other children and prefers to play alone.
  • Usually does not engage in make-believe play.
  • May spend hours:
    • Repeatedly laying out objects in lines
    • Sitting silently in an apparent trance-like state
    • Concentrating on only one object or topic

Any attempt to divert the child can provoke an emotional outburst.

• Disordered speech — A child with ASD:
  • May not speak much or may remain silent.
  • When the child does speak, the words may be an echo of what another person said.
  • Speech patterns may be different.
    • Instead of saying, "I want a sandwich," the child may ask, "Do you want a sandwich?"
• Repetitive behaviors — A child with ASD may perform repetitive behaviors:
  • Repeating the same phrase or a particular motion
    • Clapping, finger snapping, rocking, swaying and hand flapping are common.
• Abnormal behaviors — Children with ASD may:
  • Develop obsessive routines.
    • Wanting to take the same route to school every day
    • Turning around before entering a room.
  • Become intensely preoccupied with something
  • Become hyperactive, aggressive, destructive or impulsive
  • Intentionally injure themselves

Diagnosis

The diagnosis usually is made by specialists, and is based on:

• Your child's developmental history over time
• Observations of your child's behavior (alone and with others)
• Results of tests that evaluate your child's:
  • language skills
  • motor coordination
  • hearing
  • vision

In some cases, tests will be ordered to check for other medical conditions that can look like autism.

Expected Duration

ASD is a lifelong condition.

Prevention

The causes of most types of ASD remain unknown. There is no way to prevent them.

Treatment

There is no cure for autism spectrum disorder. However, a child's symptoms may improve with intense treatment.

Treatment generally includes education, behavioral management and medications.

Education

Educators develop an individualized education program to address the child's specific problems. This typically includes speech and language therapy, social skills and life-skills training.

Behavioral management

The goal of behavioral management is to enhance appropriate behavior and reduce inappropriate behaviors.

Behavior modification strategies include positive reinforcement, "time out" and comprehensive behavioral interventions. Applied behavioral analysis (ABA) is a teaching approach that reinforces the practice of specific skills.

Medications

There is not one drug that treats all symptoms of autism effectively. Medications that may be considered include:

• Antipsychotic medications to reduce aggression, irritability and repetitive behavior. These medications also have unwanted side effects.
• Antidepressants to treat depression and repetitive behaviors.
• Anti-anxiety medications for anxiety-related behavior.
• Central nervous system stimulants to treat hyperactive or impulsive behavior.

Complementary medicine

Some people believe that changes in diet, herbal medicines, and other forms of complementary medicine can help autistic children. As of now there isn't enough information to recommend them.

Some of these treatments can be dangerous or have side effects. Talk to your doctor about any treatment you may be considering.

When To Call a Professional

Call your doctor if your toddler:

• Does not try to communicate with others
• Repeats words or certain actions over and over again
• Does not seem to want to play with other children

Call your doctor right away if your child tries to injure himself or herself.

Prognosis

Some children with autism are able to live independently. Others may struggle to maintain normal social interactions, communication and behaviors.

Experts believe earlier ASD diagnosis and treatment leads to a better outcome.

Life expectancy depends on whether the person has other conditions and the person's overall health.