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Autism:

Definition

Autism is one of a group of serious developmental problems called autism spectrum disorders that appear in early childhood — usually before age 3. Though symptoms and severity vary, all autism spectrum disorders affect a child's ability to communicate and interact with others.

The number of children diagnosed with autism appears to be rising. It's not clear whether this is due to better detection and reporting of autism or a real increase in the number of cases or both.

While there is no cure for autism, intensive, early treatment can make a big difference in the lives of many children with the disorder.

Symptoms

Some children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired.Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because autism symptoms and severity vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, children with severe autism have marked impairments or a complete inability to communicate or interact with other people.

Though each child with autism is likely to have a unique pattern of behavior, these are some common autism symptoms:

Social skills

• Fails to respond to his or her name
• Has poor eye contact
• Appears not to hear you at times
• Resists cuddling and holding
• Appears unaware of others' feelings
• Seems to prefer playing alone — retreats into his or her own world
• Doesn't ask for help or request things

Language

• Doesn't speak or has delayed speech
• Loses previously acquired ability to say words or sentences
• Doesn't make eye contact when making requests
• Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
• 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 appear to understand simple questions or directions

Behavior

• Performs repetitive movements, such as rocking, spinning or hand-flapping
• Develops specific routines or rituals and becomes disturbed at the slightest change
• Moves constantly
• May be fascinated by details of an object, such as the spinning wheels of a toy car, but doesn't understand the "big picture" of the subject
• May be unusually sensitive to light, sound and touch, and yet oblivious to pain
• Does not engage in imitative or make-believe play
• May have odd food preferences, such as eating only a few foods, or craving items that are not food, such as chalk or dirt
• May perform activities that could cause self-harm, such as headbanging

Young children with autism also have a hard time sharing experiences with others. When read to, for example, they're unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.

As they mature, some children with autism become more engaged with others and show fewer disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the teen years can bring worse behavioral problems.

Most children with autism are slow to gain new knowledge or skills, and some have signs of lower than normal intelligence. Other children with autism have normal to high intelligence. These children learn quickly, yet have trouble communicating, applying what they know in everyday life and adjusting in social situations. A small number of children with autism are savants — they have exceptional skills in a specific area, such as art, math or music.

When to see a doctorBabies 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 within the first year. If you suspect that your child may have autism, discuss your concerns with your doctor. The symptoms associated with autism can also be associated with other developmental disorders.The earlier that treatment begins, the more effective it will be.

Your doctor may recommend more developmental tests if your child:

• Doesn't respond with a smile or happy expression by 6 months
• Doesn't mimic sounds or facial expressions by 9 months
• 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.

Causes

Genetic problems. Several genes appear to be involved in autism. Some may make a child more susceptible to the disorder. Others affect brain development or the way that 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 is likely substantial. Some genetic problems seem to be inherited, while others happen spontaneously.Autism has no single, known cause. Given the complexity of the disease, and the fact that symptoms and severity vary, there are probably many causes. Both genetics and environment may play a role.

• Environmental factors. Researchers are currently exploring whether such factors as viral infections, complications during pregnancy and air pollutants play a role in triggering autism.

No link between vaccines and autismOne 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. Despite extensive research, no reliable study has shown a link between autism and the MMR vaccine.

Avoiding childhood vaccinations can place your child in danger of catching and spreading serious diseases, including whooping cough (pertussis), measles or mumps.

Risk factors

Your child's sex. Boys are four to five times more likely to develop autism than girls are.Autism affects children of all races and nationalities, but certain factors increase a child's risk. They include:

• 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. There may also be a connection between children born to older parents and autism, but more research is necessary to establish this link.

Tests and diagnosis

Because autism varies widely in severity, making a diagnosis may be difficult. There isn't a specific medical test to determine the disorder. Instead, an autism specialist may: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 who treats children with autism. This specialist, working with a team of professionals, can perform a formal evaluation.

• Observe your child and ask how your child's social skills, language skills and behavior have developed and changed over time
• Give your child developmental tests covering speech, language, developmental level, and social and behavioral issues
• Present structured social and communication interactions to your child and score the performance

Signs of autism often appear early in development when there are obvious delays in language skills and social interactions. Diagnosis is usually made before age 3. Early diagnosis and intervention is most helpful and can improve skill and language development.

Diagnostic criteria for autismFor your child to be diagnosed with autism, he or she must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. This manual 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

• Doesn't speak or has delayed speech 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, detail 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.

Treatments and drugs

The goal of treatment is to maximize your child's ability to function by reducing autism symptoms and supporting development and learning. Your doctor can help identify resources in your area. Treatment options may include: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.

• Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with autism. Some programs focus on reducing problem behaviors and teaching new skills. Others 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.
• 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 often show good progress.
• Family therapies. Parents and family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.
• Medications. No medication can improve the core signs of autism, but certain medications can help control symptoms. For example, antidepressants may be prescribed for anxiety, and antipsychotic drugs are sometimes used to treat severe behavioral problems. Other medications may be prescribed if your child is hyperactive.

Managing other medical conditionsChildren with autism may also have other medical conditions, such as epilepsy, sleep disorders, limited food preferences or stomach problems. Ask your child's doctor how to best manage these conditions together. Keep all of your child's health care providers updated on any medications and supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.

Teens and young adults with autism may have issues with body changes, increased social awareness and transitions. Your health care provider and community advocacy and service organizations can offer help.