The autism spectrum disorders (ASD) affect an estimated 3.4 children of every 1,000 children 3-10 years old had autism.
All children with ASD demonstrate deficits in
- social interaction
- verbal and nonverbal communication
- repetitive behaviors
They will often have unusual responses to sensory experiences, such as certain sounds or the way objects look.
Each of these symptoms can range from mild to severe, so that two individuals with an autism spectrum disorder diagnosis can seem very very different from each other.Each child will display communication, social, and behavioral patterns that are individual but fit into the overall diagnosis of ASD.
Children with ASD do not follow the typical patterns of child development. Some may show early signs of being different from birth. Some other children will appear to have very few signs, and then start to appear to react to people more differently than other children their age. Sometimes, parents are the first to notic that their children’s communication and social skills seem to be delay compared to their peers, and it may be difficult to get others to appreciate the differences. Eventually, as the child with an ASD lags farther and farther behind their peers in social and communication skills, their differences become more apparent.
It is important to remain proactive if you have concerns about your child’s development, ask questions, gather data. The earlier the diagnosis is made, the sooner treatment interventions can be started.
- These disorders are congenital, which means that something happened to the child before birth to cause the problem.
- The concordance rate for Autistic Disorder is 91% for identical twins but 0% for fraternal twins.
- Evidence indicates that the brain structure and chemicals in these children are abnormal, and therefore they do not process information in the usual way, especially in terms of sounds and language.
- Scientists are also exploring the possible interaction between those and environmental factors as a contributor to onset.
- Autism is NOT caused by parenting behaviors
- Other explanations for autism, such as purported links between childhood vaccination and onset, are unproven and go against the consensus view.
Children with autism have an increased risk for several other medical problems:
- Epilepsy afflicts almost a third of children diagnosed with autism once they reach adulthood.
- Sleep disorders, allergies, and digestive problems are commonly seen,
- Tic disorders like Tourette’s are often seen.
- Kids with autism are also more likely than others to be cognitively impaired.
Sensory problems. Many children with ASD children are extremely sensitive to certain sounds, textures, tastes, or smells. They may not like the feel of certain types of fabric against their skin. They may not transition well from clothes that are for one season to another (such as changing from long to short sleeved shirts) Sounds such as a vacuum cleaner, a ringing telephone, or the echoes of voices in the school lunchroom or gymnasium—will cause these children to cover their ears and scream. They may be choosy about food textures, and have a very limited repertoire of foods that they will eat.
In ASD, the brain seems unable to balance the senses appropriately. Some ASD children are oblivious to extreme cold or pain. An ASD child may fall and break an arm, yet never cry. Some children with ASD may over react to the slightest touch or injury.
Seizures. One in four children with ASD develops seizures, often starting either in early childhood or adolescence. Seizures, caused by abnormal electrical activity in the brain, can produce a temporary loss of consciousness (a “blackout”), a body convulsion, unusual movements, or staring spells. An EEG (electroencephalogram—recording of the electric currents developed in the brain by means of electrodes applied to the scalp) can help confirm the diagonsis.
Seizures can usually be controlled by anticonvulsant medications.
Mental retardation. Many children with ASD have some degree of mental impairment. When tested, some areas of ability may be normal, while others may be especially weak. For example, a child with ASD may do well on the parts of the test that measure visual skills but earn low scores on the language subtests.
Fragile X syndrome. This is the most common inherited form of mental retardation. It occurs when one part of the X chromosome has a defective piece that appears pinched and fragile when under a microscope. Fragile X syndrome affects about two to five percent of people with ASD. It is important to have a child with ASD checked for Fragile X, especially if the parents are considering having another child. For an unknown reason, if a child with ASD also has Fragile X, there is a one-in-two chance that boys born to the same parents will have the syndrome. Other members of the family who may be contemplating having a child may also wish to be checked for the syndrome.
5% of people with autism are affected by fragile X and 10% to 15% of those with fragile X show autistic traits.
Tuberous Sclerosis. Tuberous sclerosis is a rare genetic disorder that causes benign tumors to grow in the brain as well as in other vital organs. It has a consistently strong association with ASD. One to 4 percent of people with ASD also have tuberous sclerosis.
Dietary and Integrative Interventions
In an effort to do everything possible to help their children, many parents continually seek new treatments.
Although an unproven treatment may help one child, it may not prove beneficial to another. To be accepted as a proven treatment, the treatment should undergo clinical trials, preferably randomized, double-blind trials, that would allow for a comparison between treatment and no treatment.
In the past, for example, Secretin was believed to be an effective intervention for children with autism. However, after careful, randomized,double-blind trials this intervention was found to have no effect, and was costly and carried health risks.
Following are some of the interventions that have been reported to have been helpful to some children but whose efficacy or safety has not been proven.
Dietary interventions are based on the idea that
- Food allergies cause symptoms of autism, and
- An insufficiency of a specific vitamin or mineral may cause some autistic symptoms.
A diet that some parents have found was helpful to their autistic child is a gluten-free, casein-free diet. Gluten is a casein-like substance that is found in the seeds of various cereal plants—wheat, oat, rye, and barley. Casein is the principal protein in milk. Since gluten and milk are found in many of the foods we eat, following a gluten-free, casein-free diet is difficult.
A supplement that some parents feel is beneficial for an autistic child is Vitamin B6, taken with magnesium (which makes the vitamin effective). The result of research studies is mixed; some children respond positively, some negatively, some not at all or very little. It is possible to supplement a child with too much Vitamin B, and this can be neurotoxic.
If parents decide to try for a given period of time a special diet, they should be sure that the child’s nutritional status is measured carefully. Many children with ASD have significant sensory issues related to food, and these diets can be costly and frustrating for parents.
Medications are often used to treat behavioral problems, such as aggression, self-injurious behavior, and severe tantrums, that keep the person with ASD from functioning more effectively at home or school. The medications used are those that have been developed to treat similar symptoms in other disorders. Many of these medications are prescribed“off-label” This means they have not been officially approved by the FDA for use in children, but the doctor prescribes the medications if he or she feels they are appropriate for your child. Further research needs to be done to ensure not only the efficacy but the safety of psychotropic agents used in the treatment of children and adolescents
A child with ASD may not respond in the same way to medications as typically developing children. It is important that parents work with a doctor who has experience with children with autism. A child should be monitored closely while taking a medication. The doctor will prescribe the lowest dose possible to be effective. Ask the doctor about any side effects the medication may have and keep a record of how your child responds to the medication. It will be helpful to read the “patient insert” that comes with your child’s medication. Some people keep the patient inserts in a small notebook to be used as a reference. This is most useful when several medications are prescribed.
Anxiety and Depression
The selective serotonin reuptake inhibitors (SSRI’s) are the medications most often prescribed for symptoms of anxiety, depression, and/or obsessive-compulsive disorder (OCD). Recent studies have shown that the treatment of obsessive-compulsive behaviors associated with ASDs with these agents is not efficacious, the way that it is in persons with OCD who do not have an ASD.
Antipsychotic medications have been used to treat severe behavioral problems. These medications work by reducing the activity in the brain of the neurotransmitter dopamine. Among the older, typical antipsychotics, such as haloperidol (Haldol®), thioridazine, fluphenazine, and chlorpromazine, haloperidol was found in more than one study to be more effective than a placebo in treating serious behavioral problems.However, haloperidol, while helpful for reducing symptoms of aggression, can also have adverse side effects, such as sedation, muscle stiffness, and abnormal movements.
Placebo-controlled studies of the newer“atypical” antipsychotics are being conducted on children with autism. The first such study, conducted by the NIMH-supported Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, was on risperidone (Risperdal®). Results of the 8-week study were reported in 2002 and showed that risperidone was effective and well tolerated for the treatment of severe behavioral problems in children with autism. The most common side effects were increased appetite, weight gain and sedation. Aripiprazole (generic name) or Abilify (brand name) has also been approved by the FDA for the symptomatic treatment of irritability (aggression, deliberate self-injury, temper tantrums) in autistic children and adolescents ages 5 to 16. There are other medications in this class of agents that are used “off label” for similar symptoms. (Off label occurs when a doctor prescribes a medication to treat a disorder or in an age group that is not included among those approved by the FDA)Other atypical antipsychotics that have been studied recently with encouraging results are olanzapine (Zyprexa®) and ziprasidone (Geodon®). Ziprasidone has not been associated with significant weight gain.
Seizures are found in one in four persons with ASD, most often in those who have low IQ or are mute. They are treated with one or more of the anticonvulsants. These include such medications as carbamazepine (Tegretol®), lamotrigine (Lamictal®), topiramate (Topamax®), and valproic acid (Depakote®). The level of the medication in the blood should be monitored carefully and adjusted so that the least amount possible is used to be effective. Although medication usually reduces the number of seizures, it cannot always eliminate them.
Inattention and Hyperactivity
Stimulant medications (amphetamine and methylphenidate products) as well as non stimulant medications that have been used safely and effectively in persons with attention deficit hyperactivity disorder have also been prescribed for children with autism. These medications may decrease impulsivity and hyperactivity in some children, especially those higher functioning children.
Several other medications have been used to treat ASD symptoms, though the safety and efficacy of these medications in children with autism has not been proven. Since people may respond differently to different medications, your child’s unique history and behavior will help your doctor decide which medication might be most beneficial.
There is no single “best treatment” package for all children with ASD, but most experts agree:
- early intervention is important
- most individuals with ASD respond well to highly structured, specialized programs.
Before you make decisions on your child’s treatment, you will want to gather information about the various options available. Learn as much as you can, look at all the options, and make your decision on your child’s treatment based on your child’s needs. You may want to visit public schools in your area to see the type of program they offer to special needs children.
Guidelines used by the Autism Society of America include the following questions parents can ask about potential treatments:
- 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? (Do not become so infatuated with a given treatment that functional curriculum, vocational life, and social skills are ignored)
The National Institute of Mental Health suggests a list of questions parents can ask when planning for their child:
- 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 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?
An effective treatment program will:
- build on the child’s interests
- offer a predictable schedule
- teach tasks as a series of simple steps
- actively engage the child’s attention in highly structured activities
- provide regular reinforcement of behavior.
- should be involved, as their participation is a major factor in treatment success.
- can work with teachers and therapists to identify the behaviors to be changed and the skills to be taught.
- are the child’s earliest teachers–more programs are beginning to train parents to continue the therapy at home.
As soon as a child’s disability has been identified, instruction should begin.Effective programs will teach early communication and social interaction skills.
In children younger than 3 years, appropriate interventions usually take place in the home or a child care center:
- Interventions target specific deficits in learning, language, imitation, attention, motivation, compliance, and initiative of interaction.
- Included are behavioral methods, communication, occupational and physical therapy along with social play interventions.
- Often the day will begin with a physical activity to help develop coordination and body awareness; children string beads, piece puzzles together, paint, and participate in other motor skills activities.
- At snack time the teacher encourages social interaction and models how to use language to ask for more juice.
- The children learn by doing.
- Students, behavioral therapists, and parents who have received extensive training work with the children
- Positive reinforcement is used to teach the children.
In Children older than 3 years , interventions usually include school-based, individualized, special education.
- The child may be in a segregated class with other autistic children or in an integrated class with children without disabilities for at least part of the day.
- Different methods may be utilized, but all interventions should provide a structure that will help the children learn social skills and functional communication.
- In these programs, teachers often involve the parents, giving useful advice in how to help their child use the skills or behaviors learned at school when they are at home.
In elementary school, the child should receive help in any skill area that is delayed and, at the same time, be encouraged to grow in his or her areas of strength. Ideally, the curriculum should be adapted to the individual child’s needs. Many schools today have an inclusion program in which the child is in a regular classroom for most of the day, with special instruction for a part of the day. This instruction should include such skills as learning how to act in social situations and in making friends. Although higher-functioning children may be able to handle academic work, they too need help to organize tasks and avoid distractions.
During middle and high school years, instruction will begin to address such practical matters as work, community living, and recreational activities. This should include work experience, using public transportation, and learning skills that will be important in community living.
All through your child’s school years, you will want to be an active participant in his or her education program. Collaboration between parents and educators is essential in evaluating your child’s progress.
- Like all children, children with ASD need help in dealing with their sexual development.
- Some behaviors may improve during the teenage years and some may worsen
- Increased aggressive behavior may be one way some teens express their newfound tension and confusion.
- The teenage years are also a time when children become more socially sensitive.
- Teens with autism may become painfully aware that they are different from their peers.
- They may notice that they lack friends, or aren’d dating or do not have the same plans for a career.
- For some youth with ASD, these realizations motivate them to learn new behaviors and acquire better social skills.
Possible Indicators of Autism Spectrum Disorders
The following are possible indicators of autism spectrum disorders, according to the Public Health Training Network Webcast, Autism Among Us
- Does not babble, point, or make meaningful gestures by 1 year of age
- Does not speak one word by 16 months
- Does not combine two words by 2 years
- Does not respond to name
- Loses language or social skills
Some Other Indicators
- Poor eye contact
- Doesn’t seem to know how to play with toys
- Excessively lines up toys or other objects
- Is attached to one particular toy or object
- Doesn’t smile
- At times seems to be hearing impaired
From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile.
Children with ASD seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction:
- Many do not interact and they avoid eye contact
- They seem indifferent to other people, and often seem to prefer being alone.
- They may resist attention or passively accept hugs and cuddling.
- As they become toddlers, they may not seek comfort or respond to parents’ displays of anger or affection the way other children do.
Children with ASD are attached to their parents, but they may not respond interactively the way a normally developing child does, and may not enjoy cuddling, or playing, with their parents. Some parents may doubt their child’s attachment.
Children with ASD also are slower in learning to interpret what others are thinking and feeling, and unable to predict or understand the actions of others:
- Facial expressions, gestures, body language, subtle social cues, are missed.
- The can be egocentric, and have difficulty seeing things from another person’s viewpoint.
- Most 5-year-olds understand that other people have different information, feelings, and goals than they have.
Children with ASD may have trouble regulating their emotions.
- They may cry, or have verbal outbursts that seem immature or inappropriate
- They may be disruptive and even may be physically aggressive at times
- They may lose control when they are confused or overwhelmed by the environment around them, and this can result in self-harming behaviors as well as aggrssion toward people around them.
By age 3, most children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is “no.”
Children with ASD may never speak, or may start out cooing and babbling, but then stop. Still others may have language delay, so that they don’t start speaking until well into their elementary years.
Children with ASD who do speak may use “idiosyncratic” (unusual) language, such as:
- speaking in single word
- having trouble combining words into sentences that make sense
- repeating sentences over and over again
- repeating what they hear others saying, which is called echolalia
- some may have trouble with tone of their voice, so that they are monotone, or speak with a high-pitched voice, or in a sing-song way that makes what they are saying difficult to follow.
Some ASD children may have only slight language delays, or may even have expansive vocabularies, yet cannot sustain a conversation:
- they may speak without give-and-take, and without an awareness that the person they are talking to has lost interest.
- often they may talk on and on about a topic of interest to themselves, without any interest in having others comment, and without providing others with the opportunity to do so.
- they may take figurative phrases literally, such as believing someone’s heart is really “broken” when they hear the term “broken-hearted.” They may have trouble understanding humor.
- some of these kids may speak in an “overly mature” way so that they do not fit in with their peers well, and they may relate better to adults.
- they do not understand body language, facial expression, or tone of voice
Children with ASD will often have facial expressions, movements and gestures that do not match what they are saying, and often their tone of voice is different from the way that they feel.
These communication difficulties make it difficult for persons with ASD to ask for what they need. They may simply scream or grab what they want, until they are taught ways to express themselves. As people with ASD grow up, they may become aware of their differences, and that it is difficult to make themselves be understood. This can lead to feelings of anxiety and or depression.
Children with ASD often have odd or repetitive behaviors that make them appear different than other children.
- They may walk on their toes, or flap their arms, or sniff things more than other children their age.
- They may play with their toys differently than others, so that they prefer to sort and organize their toys instead of engaging in imaginative play. They may become upset if their toys are moved out of the organized way that they’ve intended. They may prefer to take objects apart rather than play with them.
- Ritual and routine may be very important, such as driving to and from school the same way each time, and having to have a fixed schedule. A slight change in routine can lead to confusion and overwhelm, which can lead to frustration, and emotional outbursts. For example, children with ASD may have significant difficulties on a day that a substitute teacher is in their classroom.
- As older children and adults, they may have a limited range of interest, with an intense focus on a topic, and may know many, many details about their interest, which they enjoy sharing with those around them, in a sort monologue. Often their interests are related to things mechanical or scientific, such as trains, dinosaurs, or plants.
Frequently Asked Questions
Is autism brain damage?
Autistic brains are structured and function differently than normal ones, but autism has not been definitively linked to any environmental factors or trauma. Most experts agree that autistic kids are born that way.
Is my child retarded?
Autism and cognitive impairment are separate conditions, though some studies have suggested that a majority of children with autism have IQ scores that fall below the cutoff of around 70 for mental retardation. Hence it may be far more likely than the norm for a child with autism to have cognitive impairment, but it’s not a given or part of the ASD diagnosis.
Will my child grow out of it?
No. Autism is a lifelong condition—at this time, the differences in brain structure and chemistry thought to contribute to the disorder can’t be fixed. But behavioral therapy can help teach your child how to function in the world and interact with others at a higher level than he could on his own.
Will drugs help?
No drug can cure autism or treat all of the core symptoms of the disorder. But kids with autism often have other mental and behavioral problems that are treatable with medication, and that treatment can positively impact your child’s quality of life and ability to participate in therapies aimed at his autistic behavior. For instance, antidepressants could help a child suffering from depression, which affects some with autism. In other cases, medication can be used to curb aggressive behavior.
What’s the prognosis?
Children with autism can improve over time—the question isn’t really whether they will improve but to what degree the disorder will impair development. Experts agree that a young child’s language development is a good gauge of the severity of the disorder—that is, the easier language comes to the autistic child, the less severe the symptoms of the disorder will be later on. Of course, the earlier a child with autism receives treatment, the better the prognosis for his maximizing his potential.