Definition
Autism s a complex developmental disorder that appears in the first 3 years of life, although it is sometimes diagnosed much later. It affects the brain's normal development of social and communication skills.

Common features of autism include impaired social interactions, impaired verbal and nonverbal communication, problems processing information from the senses, and restricted and repetitive patterns of behavior.

Alternative Names
Pervasive developmental disorder - autism

Causes, incidence, and risk factors
Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism.

Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism. Similarly, language abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other neurological problems are also more common in families with autism.

A number of other possible causes have been suspected, but not proven. They involve digestive tract changes, diet, mercury poisoning, vaccine sensitivity, and the body's inefficient use of vitamins and minerals.

The exact number of children with autism is not known. A report released by the U.S. Centers for Disease Control and Prevention (CDC) suggests that autism and related disorders are more common than previously thought, although it is unclear if this is due to an increasing rate of the illness or an increased ability to diagnose the illness.

Autism affects boys 3 to 4 times more often than girls. Family income, education, and lifestyle do not seem to affect the risk of autism.

Some parents have heard that the MMR Vaccine that children receive may cause autism. This theory was based, in part, on two facts. First, the incidence of autism has increased steadily since around the same time the MMR vaccine was introduced. Second, children with the regressive form of autism (a type of autism that develops after a period of normal development) tend to start to show symptoms around the time the MMR vaccine is given. This is likely a coincidence due to the age of children at the time they receive this vaccine.

Several major studies have found NO connection between the vaccine and autism, however. The American Academy of Pediatrics and the Center for Disease Control and Prevention report that there is no proven link between autism and the MMR vaccine.

Some doctors attribute the increased incidence in autism to newer definitions of autism. The term "autism" now includes a wider spectrum of children. For example, a child who is diagnosed with high-functioning autism today may have been thought to simply be odd or strange 30 years ago.

Symptoms
Most parents of autistic children suspect that something is wrong by the time the child is 18 months old and seek help by the time the child is 2. Children with autism typically have difficulties in verbal and nonverbal communication, social interactions, and pretend play. In some, aggression -- toward others or self -- may be present.

Some children with autism appear normal before age 1 or 2 and then suddenly "regress" and lose language or social skills they had previously gained. This is called the regressive type of autism.

People with autism may perform repeated body movements, show unusual attachments to objects or have unusual distress when routines are changed. Individuals may also experience sensitivities in the senses of sight, hearing, touch, smell, or taste. Such children, for example, will refuse to wear "itchy" clothes and become unduly distressed if forced because of the sensitivity of their skin. Some combination of the following areas may be affected in varying degrees.

Communication

* Lack of pointing to direct others' attention to objects (occurs in the first 14 months of life) Does not adjust gaze to look at objects that others are looking at

Cannot start or sustain a social conversation

Develops language slowly or not at all

Repeats words or memorized passages, such as commercials

Does not refer to self correctly (for example, says "you want water" when the child means "I want water")

Uses nonsense rhyming Communicates with gestures instead of words

Social interaction

Shows a lack of empathy

Does not make friends

Is withdrawn

Prefers to spend time alone, rather than with others

May not respond to eye contact or smiles

May actually avoid eye contact

May treat others as if they are objects

Does not play interactive games

Response to sensory information

Has heightened or low senses of sight, hearing, touch, smell, or taste

Seems to have a heightened or low response to pain

May withdraw from physical contact because it is over stimulating or overwhelming

Does not startle at loud noises

May find normal noises painful and hold hands over ears

Rubs surfaces, mouths or licks objects

Play

Shows little pretend or imaginative play

Doesn't imitate the actions of others

Prefers solitary or ritualistic play

Behaviors

Has a short attention span

Uses repetitive body movements

Shows a strong need for sameness

"Acts up" with intense tantrums

Has very narrow interests

Demonstrates preservation (gets stuck on a single topic or task)

Shows aggression to others or self

Is overactive or very passive

Signs and tests
All children should have routine developmental exams by their pediatrician. Further testing may be needed if there is concern on the part of the clinician or the parents. This is particularly true whenever a child fails to meet any of the following language milestones:

Babbling by 12 months

Gesturing (pointing, waving bye-bye) by 12 months

Single words by 16 months

Two-word spontaneous phrases by 24 months (not just echoing)

Loss of any language or social skills at any age.

The other pervasive developmental disorders include: An evaluation of autism will often include a complete physical and Neurological examination. It may also include a specific diagnostic screening tool, such as:

Autism Diagnostic Interview - Revised (ADI-R)

Autism Diagnostic Observation Schedule (ADOS)

Childhood Autism rating Scale (CARS)

Gilliam Autism Rating Scale

Pervasive Developmental Disorders Screening Test-Stage 3

Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.

Autism encompasses a broad spectrum of symptoms. Therefore, a single, brief evaluation cannot predict a child's true abilities. Ideally, a team of different specialists will evaluate the child. They might evaluate speech, language, communication, thinking abilities, motor skills, success at school, and other factors.

Sometimes people are reluctant to have a child diagnosed because of concerns about labeling the child. However, failure to make a diagnosis can lead to failure to get the treatment and services the child needs.

Treatment
An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. Most programs will build on the interests of the child in a highly structured schedule of constructive activities. Visual aids are often helpful.

Treatment is most successful when geared toward the child's particular needs. An experienced specialist or team should design the individualized program. A variety of effective therapies are available, including applied behavior analysis (ABA), speech-language therapy, medications, occupational therapy, and physical therapy. Sensory integration and vision therapy are also common, but there is little research supporting their effectiveness. The best treatment plan may use a combination of techniques.

DIET
Some children with autism appear 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 dietary changes will make a difference, and not all reports studying this method have shown positive results.

OTHER APPROACHES
Beware that there are widely publicized treatments for autism that do not have scientific support, and reports of "miracle cures" that do not live up to expectations. If your child has autism, it may be helpful to talk with other parents of children with autism, talk with autism specialists, and follow the progress of research in this area, which is rapidly developing.

At one time, there was enormous excitement about using secretin infusions. Now, after many studies have been conducted in many laboratories, it's possible that secretin is not effective after all, but research is.

Complications
Autism can be associated with other disorders that affect the brain, such as Tuberous Sclerosis, Mental retardation or Fragile X syndrome.

Some people with autism will develop Seizures.

The stresses of dealing with autism can lead to social and emotional complications for family and caregivers, as well as the person with autism.

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