Autism Spectrum Disorder
Children from all backgrounds experience autism. Awareness and improved screening methods have contributed to the increase in diagnoses in recent years.
Autism spectrum disorder is a developmental condition that affects a person’s ability to socialize and communicate with others. Considered a lifelong disorder, the degree of impairment in functioning varies greatly from person to person. The term “spectrum” refers to the degree to which the symptoms, behaviors, and severity vary within and between individuals. Some people are mildly impaired by their symptoms, while others are severely disabled.
According to the Centers for Disease Control and Prevention, 1 in 59 8-year-olds in the U.S. has autism. Boys are four times more likely than girls to develop symptoms of autism.
Risk Factors
While scientists have not discovered a single cause of autism, they believe several factors contribute to this developmental disorder.
Genetics. If one child in a family has autism, another sibling is more likely to develop it too. Scans reveal that people on the autism spectrum have certain abnormalities of the brain's structure and chemical function.
Environment. Many prenatal factors may contribute to a child’s development, such as a mother’s health. Other postnatal factors may affect development as well. Despite many claims that have been highlighted by the media, strong evidence has shown that vaccines do not cause autism.
Diagnosis
Currently, there is no medical test that can determine the possibility of developing autism. Specialists make the diagnosis after screening for social and communication difficulties, and repetitive or restricted behaviors.
Diagnosing autism is often a 2-stage process. The first stage involves general developmental screening during well-child checkups with a pediatrician. Children who show some developmental problems are referred for further evaluation. The second stage involves a thorough evaluation by a team of doctors and other health professionals with a wide range of specialties. At this stage, a child may be diagnosed as having autism or another developmental disorder. Typically, children with autism can be reliably diagnosed by age two, though some may not be diagnosed until they are older.
Symptoms
For most, symptoms of autism start to appear during the first three years of life.
Typically, developing infants are social by nature. They gaze at faces, turn toward voices, grasp a finger, and even smile by 2-3 months of age. Parents are often the first to notice that their child is showing unusual behaviors. These behaviors can include failing to make eye contact, not responding to his or her name, or playing with toys in unusual, repetitive ways.
Most children who develop autism have difficulty engaging in everyday human interactions. Autism can also cause difficulties with verbal and nonverbal communication and preoccupation with certain activities.
More specific symptoms are outlined below:
Delay in language development, such as not responding to their own name or speaking only in single words, if at all.
Repetitive and routine behaviors, such as walking in a specific pattern or insisting on eating the same meal every day.
Difficulty making eye contact, such as focusing on a person’s mouth when that person is speaking instead of their eyes, as is usual in most young children.
Sensory dysregulation forms a strong component of autism. This often presents as hyper (overly-sensitive) or hyposensitivity (less sensitive) to certain sensory stimuli. Examples include experiencing pain or pleasure from certain sounds, like a ringing telephone, or not reacting to intense cold or pain, certain sights, sounds, smells, textures, and tastes. The physical and emotional response in these cases can be very overwhelming and result in sensory overload, often leading to meltdowns.
Difficulty interpreting subtle gestures & facial expressions, such as misreading or not noticing subtle facial cues, like a smile, wink, or grimace, that could help understand the nuances of social communication.
Problems expressing emotions, such as facial expressions, movements, tone of voice, and gestures that are often vague or do not match what is said or felt.
Fixation on parts of objects, often to the detriment of understanding the “whole,” such as focusing on a rotating wheel instead of playing with peers.
Absence of pretend play, such as taking a long time to line up toys in a certain way, rather than playing with them.
A lack of social understanding that makes interaction with peers challenging.
Self-injurious behavior. Individuals with autism will often appear to hurt themselves in response to certain activities or environments.
Sleep problems, such as falling asleep or staying asleep.
The learning, thinking, and problem-solving abilities of people with autism ranges from gifted to severely challenged. Some people with autism need a lot of help in their daily lives. With a thorough evaluation, doctors can make a diagnosis to help find the best treatment plan.
Early signs of this disorder can be noticed by parents/caregivers or pediatricians before a child reaches one year of age. However, symptoms typically become more consistently visible by the time a child is 2 or 3 years old. In some cases, the functional impairment related to autism may be mild and not apparent until the child starts school, after which their deficits may be pronounced when amongst their peers.
Social communication deficits
Decreased sharing of interests with others
Difficulty appreciating their own or others' emotions
Lack of eye contact
Lack of proficiency with the use of non-verbal gestures
Stilted or scripted speech
Interpreting abstract ideas literally
Difficulty making or keeping friends
Restricted interests and repetitive behaviors may include:
Inflexibility, extreme difficulty coping with change
Being overly focused on niche subjects to the exclusion of others
Expecting others to be equally interested in those subjects
Difficulty tolerating changes in routine and new experiences
Sensory hypersensitivity, e.g., aversion to loud noises
Stereotypical movements such as hand flapping, rocking, spinning
Arranging things, often toys, in a very particular manner
Treatment
Most health care professionals will implement an early intensive behavioral intervention, involving the child's entire family in education and training. In some early intervention programs, therapists come into the home to deliver services. Other programs deliver therapy in a specialized center, classroom or preschool. Types of therapy may include:
Applied behavioral analysis: This involves a systematic study of the child's functional challenges, which is used to create a structured behavioral plan for improving their adaptive skills and decreasing inappropriate behavior
Social skills training: This intervention helps children with autism improve their ability to navigate group or individual social situations
Speech & language therapy: It can improve the child's speech patterns and understanding of language
Occupational therapy: This addresses adaptive skills deficits with activities of daily living, as well as problems with handwriting
Parent management training: Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism
Special education services: Children with autism can achieve their full academic potential under an Individual Education Plan provided by their school, which accommodates their social communication deficits, restricted interests, and repetitive behaviors. This includes special classes for very young children to address language, social, and life skills.
Several complementary and alternative interventions involving special diets and supplements have been tried over the years by parents/caregivers seeking ways to help their child with autism function better. To date, no compelling evidence has been found to clearly recommend any such specific interventions. Research continues, and parents/caregivers interested in them should discuss them with their child's treating clinician.
Medication
There are no FDA-approved medications for the core symptoms of autism. Two antipsychotic medicines, Aripiprazole and Risperidone, have been approved for irritability associated with autism. Other off-label medications are best used in combination with psychotherapy and other interventions. They should target specific symptoms with an outcome to measure their effectiveness. Please consult a psychiatrist on the best medication plan for the individual.
Children with autism are at higher risk of developing mental health conditions such as Anxiety Disorders, Attention Deficit Hyperactivity Disorder (ADHD), or Depression. A child psychiatrist can evaluate for co-morbid depression, anxiety, and impulsivity. If appropriate, medications can be helpful when prescribed judiciously by a knowledgeable clinician in collaboration with the child's parents.
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