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Autism is a brain disorder that
often makes it hard to communicate with and relate to others. With autism, the
different areas of the brain fail to work together.
with autism will always have some trouble relating to others. But early
diagnosis and treatment have helped more and more people who have autism to reach
their full potential.
Autism tends to run in
families, so experts think it may be something that you inherit. Scientists are
trying to find out exactly which genes may be responsible for passing down
autism in families.
Other studies are looking at whether autism
can be caused by other medical problems or by something in your child's
False claims in the news have made some parents concerned about a link between autism and vaccines. But studies have found no link between vaccines and autism. It's important to make sure
that your child gets all childhood vaccines. They help keep your child from
getting serious diseases that can cause harm or even death.
Symptoms almost always
start before a child is 3 years old. Usually, parents first notice that their
toddler has not started talking yet and is not acting like other children the
same age. But it is not unusual for a child with autism to start to talk at the same time
as other children the same age, then lose his or her language skills.
Symptoms of autism include:
There is no "typical" person with autism. People can have
many different kinds of behaviors, from mild to severe. Parents often say that
their child with autism prefers to play alone and does not make eye contact
with other people.
Autism may also include other problems:
There are guidelines your
doctor will use to see if your child has symptoms of autism. The guidelines put
symptoms into three categories:
Your child may also have a hearing test and some other
tests to make sure that problems are not caused by some other condition.
Treatment for autism involves
special behavioral training. Behavioral training rewards good behavior
(positive reinforcement) to teach children social skills and to teach them how
to communicate and how to help themselves as they grow older.
With early treatment, most children with autism learn to relate better to
others. They learn to communicate and to help themselves as they grow
Depending on the child, treatment may also include such
things as speech therapy or physical therapy. Medicine is sometimes used to
treat problems such as depression or obsessive-compulsive behaviors.
Exactly what type of treatment your child needs depends on the symptoms,
which are different for each child and may change over time. Because people
with autism are so different, something that helps one person may not help
another. So be sure to work with everyone involved in your child's
education and care to find the best way to manage symptoms.
An important part of your child's treatment plan is
making sure that other family members get training about autism and how to
manage symptoms. Training can reduce family stress and help your child function
better. Some families need more help than others.
of every kind of help you can find. Talk to your doctor about what help is
available where you live. Family, friends, public agencies, and autism
organizations are all possible resources.
Raising a child with autism is hard work. But with
support and training, your family can learn how to cope.
Learning about autism:
Living with autism:
The severity of symptoms varies
greatly, but all people with
autism have some core symptoms in the areas of:
Symptoms of autism are
usually noticed first by parents and other caregivers sometime during the
child's first 3 years. Although autism is present at birth (congenital), signs
of the disorder can be difficult to identify or diagnose during infancy.
Parents often become concerned when their toddler does not like to be held;
does not seem interested in playing certain games, such as peekaboo; and does
not begin to talk. Sometimes, a child with autism will start to talk at the same time as
other children the same age, then lose his or her language skills. Parents also
may be confused about their child's hearing abilities. It often seems that a
child with autism does not hear, yet at other times, he or she may appear to
hear a distant background noise, such as the whistle of a train.
With early and intensive treatment, most children improve their ability
to relate to others, communicate, and help themselves as they grow older.
Contrary to popular myths about children with autism, very few are completely
socially isolated or "live in a world of their own."
During the teen years,
the patterns of behavior often change. Many teens gain skills but still lag
behind in their ability to relate to and understand others. Puberty and
emerging sexuality may be more difficult for teens who have autism than for
others this age. Teens are at an increased risk for developing problems related
Some adults with autism are
able to work and live on their own. The degree to which an
adult with autism can lead an independent life is related to intelligence and
ability to communicate. At least 33% are able to achieve at least partial
Some adults with autism
need a lot of assistance, especially those with low intelligence who are unable
to speak. Part- or full-time supervision can be provided by residential
treatment programs. At the other end of the spectrum, adults with
high-functioning autism are often successful in their professions and able to
live independently, although they typically continue to have some difficulties
relating to other people. These individuals usually have average to
Many people with autism have
symptoms similar to
attention deficit hyperactivity disorder (ADHD). But
these symptoms, especially problems with social relationships, are more severe
for people with autism.
About 10% of people with autism have some form of savant skills—special
limited gifts such as memorizing lists, calculating calendar dates, drawing, or
Many people with autism
have unusual sensory perceptions. For example, they may
describe a light touch as painful and deep pressure as providing a calming
feeling. Others may not feel pain at all. Some people with autism have strong
food likes and dislikes and unusual preoccupations.
problems occur in about 40% to 70% of people with autism.3
Almost half of the children who have autism spectrum disorders tend to "wander off" from a caregiver, or "elope." For many caregivers of these children, elopement is one of the most stressful behaviors they must learn to cope with. Studies show that behavioral assessment interventions, such as applied behavioral analysis, may reduce the number of times a child wanders off.4
Autism is one of several types of
pervasive developmental disorders (PDDs), also called
autism spectrum disorders (ASD). It is not unusual for autism to be confused
with other PDDs, such as
Asperger's syndrome, or to have
overlapping symptoms. A similar condition is called pervasive developmental
disorder—not otherwise specified (PDD-NOS). PDD-NOS occurs when children display
similar behaviors but do not meet the criteria for autism. Also,
other conditions with similar symptoms may also have similarities to or occur
The American Academy of Pediatrics
(AAP) recommends screening children for
autism during regularly scheduled
well-child visits.5 This policy helps doctors identify
signs of autism early in its course. Early diagnosis and treatment can help the
child reach his or her full potential.
When a developmental delay
is recognized in a child, further testing can help a doctor find out whether
the problem is related to autism, another
pervasive developmental disorder (PDD), or a
condition with similar symptoms, such as
language delays or
avoidant personality disorder. If your primary care
provider does not have specific training or experience in developmental
problems, he or she may refer your child to a specialist—such as a
developmental pediatrician, a psychiatrist, a speech therapist, a psychologist, or a child
psychiatrist—for the additional testing.
Other lab tests may be done under specific
circumstances. These tests include:
All doctors who see infants and
children for well-child visits should watch for early signs of developmental
Developmental screening tools, such as the Ages and
Stages Questionnaire or the Modified Checklist for Autism in Toddlers (M-CHAT),
can help assess behavior.
If a doctor discovers the following
obvious signs of developmental delays, the child should immediately be
If there are no obvious signs of developmental delays or
any unusual indications from the screening tests, most infants and children do
not need further evaluation until the next well-child visit.
children who have a sibling with autism should continue to be closely
monitored, because they are at increased risk for autism and other
When socialization, learning, or behavior problems develop in a person at
any time or at any age, he or she should also be evaluated.
Early diagnosis and treatment
helps young children with
autism develop to their full potential. The primary
goal of treatment is to improve the overall ability of the child to
Symptoms and behaviors of autism can combine in many
ways and vary in severity. Also, individual symptoms and behaviors often
change over time. For these reasons, treatment strategies are tailored to
individual needs and available family resources. But in general children with
autism respond best to highly structured and specialized treatment. A program
that addresses helping parents and improving communication, social, behavioral,
adaptive, and learning aspects of a child's life will be most
The American Academy of Pediatrics (AAP) recommends
the following strategies for helping a child to improve overall function and
reach his or her potential:6
Many people with autism have sleep problems. These
are usually treated by staying on a routine, including a set bedtime and time
to get up. Your doctor may try medicines as a last resort.
alternative therapies, such as secretin and auditory
integration training, have circulated in the media and other information
sources. When you are thinking about any type of treatment, find out about the source of the information and about whether the studies are scientifically
sound. Accounts of individual success are not sufficient evidence to support
using a treatment. Look for large, controlled studies to validate
Experts have not yet identified a way to prevent autism.
Public concern over stories linking
autism and childhood vaccines has persisted. But
numerous studies have failed to show any evidence of a link between autism and
the measles-mumps-rubella (MMR) vaccine.7 If you avoid having your children immunized, you put them and
others in your community at risk for developing serious diseases, which can
cause serious harm or even death.
Having a child with
autism requires taking a proactive approach to
learning about the condition and its treatment while working closely with
others involved in your child's care. You also need to take care of yourself so
that you are able to face the many challenges of having a child with
Ask your doctor or
contact autism groups to find training about autism and how to manage
symptoms. Parent and family education can reduce family stress
and improve a child's functioning. Understanding the
condition and knowing what to expect is an important part of helping your child
Become informed about your
child's educational rights. Federal laws require
services for handicapped children, including those with autism. Also,
there may be state and local laws or policies to aid children who have autism. Find
out what services are available in your area.
Learning about autism will also help prepare you for when your child
reaches adulthood. Some
adults with autism can live by themselves, work, and
be as independent as other people their age. Others need continued support.
Close communication with others involved in your child's education and care
will help all concerned. The best treatment for children with autism is a team
approach and a consistent, structured program. Everyone involved needs to work
together to set goals for:
Work closely with the health professionals involved in
your child's care. It is important that they take time to listen to your
concerns and are willing to work with you.
Learn ways to handle the
normal range of emotions, fears, and concerns that go along with raising a
child who has autism. The daily and long-term challenges put you and your other
children at an increased risk for depression or stress-related illnesses. The
way you handle these issues influences other family members.
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
The Autism Science Foundation's mission is to support autism research. The organization also provides information about autism to the public and serves to increase awareness of autism spectrum disorders and the needs of individuals and families affected by autism.
NCBDDD aims to find the cause of and prevent birth
defects and developmental disabilities. This agency works to help people of all
ages with disabilities live to the fullest. The website has information on
many topics, including genetics, autism, ADHD, fetal alcohol spectrum
disorders, diabetes and pregnancy, blood disorders, and hearing loss.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The National Dissemination Center for Children with
Disabilities (NICHCY) is the national information and referral center that
provides information on disabilities and disability-related issues for
families and professionals. The focus is on children and
youth, birth to age 22.
The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.
CitationsVolkmar FR, et al. (2009). Pervasive developmental disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3540–3559. Philadelphia: Lippincott Williams and Williams.American Psychiatric Association (2000). Autistic disorder. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 70–75. Washington, DC: American Psychiatric Association.Zachor DA (2006). Autism. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1219–1226. Philadelphia: Saunders Elsevier.Anderson C, et al. (2012). Occurrence and family impact of elopement in children with autism spectrum disorders. Pediatrics, 130(5): 870–877.Johnson CP, et al. (2007, reaffirmed 2010). American Academy of Pediatrics clinical report: Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5): 1183–1215.Myers SM, et al. (2007, reaffirmed 2010). American Academy of Pediatrics clinical report: Management of children with autism spectrum disorders. Pediatrics, 120(5): 1162–1182.Peacock G, Yeargin-Allsopp M (2009). Autism spectrum disorders: Prevalence and vaccines. Pediatric Annals, 38(1): 22–25.Other Works ConsultedAnderson C, et al. (2012). Occurrence and family impact of elopement in children with autism spectrum disorders. Pediatrics, 130(5): 870–877.Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee and Medical Home Initiatives for Children With Special Needs Project Advisory Committee (2006). Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics, 118(1): 405–4Dumont-Mathieu T, Fein D (2005). Screening for autism in young children: The Modified Checklist for Autism in Toddlers (M-CHAT) and other measures. Mental Retardation and Developmental Disabilities Research Reviews, 11(3): 253–262.Johnson CP, et al. (2007, reaffirmed 2010). American Academy of Pediatrics clinical report: Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5): 1183–1215.Parr J (2010). Autism, search date May 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Volkmar FR, et al. (2009). Autism and autism spectrum disorders: Diagnostic issues for the coming decade. Journal of Child Psychology and Psychiatry, 50: 108–115.Williams K, et al. (2010). Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD) (Review). Cochrane Database of Systematic Reviews (9).Wong V, et al. (2004). A modified screening tool for autism (Checklist for Autism in Toddlers [CHAT-23]) for Chinese children. Pediatrics, 114(2): 166–176.
April 3, 2012
John Pope, MD - Pediatrics & Fred Volkmar, MD - Child and Adolescent Psychiatry
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