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Autism

Topic Overview

What is autism?

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.

Most people 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.

What causes autism?

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 surroundings.

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.

What are the symptoms?

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:

  • A delay in learning to talk, or not talking at all. A child may seem to be deaf, even though hearing tests are normal.
  • Repeated and overused types of behavior, interests, and play. Examples include repeated body rocking, unusual attachments to objects, and getting very upset when routines change.

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:

  • Many children with autism have below-normal intelligence.
  • Teenagers with autism often become depressed and have a lot of anxiety, especially if they have average or above-average intelligence.
  • Some children get a seizure disorder such as epilepsy by their teen years.

How is autism diagnosed?

There are guidelines your doctor will use to see if your child has symptoms of autism. The guidelines put symptoms into three categories:

  • Social interactions and relationships. For example, a child may have trouble making eye contact. People with autism may have a hard time understanding someone else's feelings, such as pain or sadness.
  • Verbal and nonverbal communication. For example, a child may never speak. Or he or she may often repeat a certain phrase over and over.
  • Limited interests in activities or play. For example, younger children often focus on parts of toys rather than playing with the whole toy. Older children and adults may be fascinated by certain topics, like trading cards or license plates.

Your child may also have a hearing test and some other tests to make sure that problems are not caused by some other condition.

How is it treated?

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 older.

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.

How can your family deal with having a child with autism?

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.

Take advantage 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.

Remember these tips:

  • Plan breaks. The daily demands of caring for a child with autism can take their toll. Planned breaks will help the whole family.
  • Get extra help when your child gets older. The teen years can be a very hard time for children with autism.
  • Get in touch with other families who have children with autism. You can talk about your problems and share advice with people who will understand.

Raising a child with autism is hard work. But with support and training, your family can learn how to cope.

Frequently Asked Questions

Learning about autism:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with autism:

Symptoms

Core symptoms

The severity of symptoms varies greatly, but all people with autism have some core symptoms in the areas of:

  • Social interactions and relationships. Symptoms may include:
    • Significant problems developing nonverbal communication skills, such as eye-to-eye gazing, facial expressions, and body posture.
    • Failure to establish friendships with children the same age.
    • Lack of interest in sharing enjoyment, interests, or achievements with other people.
    • Lack of empathy. People with autism may have difficulty understanding another person's feelings, such as pain or sorrow.
  • Verbal and nonverbal communication. Symptoms may include:
    • Delay in, or lack of, learning to talk. As many as 40% of people with autism never speak.1
    • Problems taking steps to start a conversation. Also, people with autism have difficulties continuing a conversation after it has begun.
    • Stereotyped and repetitive use of language. People with autism often repeat over and over a phrase they have heard previously (echolalia).
    • Difficulty understanding their listener's perspective. For example, a person with autism may not understand that someone is using humor. They may interpret the communication word for word and fail to catch the implied meaning.
  • Limited interests in activities or play. Symptoms may include:
    • An unusual focus on pieces. Younger children with autism often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy.
    • Preoccupation with certain topics. For example, older children and adults may be fascinated by video games, trading cards, or license plates.
    • A need for sameness and routines. For example, a child with autism may always need to eat bread before salad and insist on driving the same route every day to school.
    • Stereotyped behaviors. These may include body rocking and hand flapping.

Symptoms during childhood

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."

Symptoms during teen years

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 to depression, anxiety, and epilepsy.

Symptoms in adulthood

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 independence.2

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 above-average intelligence.

Other symptoms

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 musical ability.1

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.

Sleep 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

Other conditions

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 with autism.

Exams and Tests

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.

  • Behavioral assessments. Various guidelines and questionnaires are used to help a doctor determine the specific type of developmental delay a child has. These include:2
    • Medical history. During the medical history interview, a doctor asks general questions about a child's development, such as whether a child shows parents things by pointing to objects. Young children with autism often point to items they want, but do not point to show parents an item and then check to see if parents are looking at the item being pointed out.
    • Diagnostic guidelines for autism. The American Association of Childhood and Adolescent Psychiatry (AACAP) has established guidelines for diagnosing autism.2 The criteria are designed so a doctor can assess a child's behavior relating to core symptoms of autism.
    • Clinical observations. A doctor may want to observe the developmentally delayed child in different situations. The parents may be asked to interpret whether certain behaviors are usual for the child in those circumstances.
    • Developmental and intelligence tests. The AACAP also recommends that tests be given to evaluate whether a child's developmental delays affect his or her ability to think and make decisions.
  • Physical assessments and laboratory tests. Other tests may be used to determine whether a physical problem may be causing symptoms. These tests include:
    • Physical exam, including head circumference, weight, and height measurements, to determine whether the child has a normal growth pattern.
    • Hearing tests, to determine whether hearing problems may be causing developmental delays, especially those related to social skills and language use.
    • Testing for lead poisoning, especially if a condition called pica (in which a person craves substances that are not food, such as dirt or flecks of old paint) is present. Children with developmental delays usually continue putting items in their mouth after this stage has passed in normally developing children. This practice can result in lead poisoning, which should be identified and treated as soon as possible.

Other lab tests may be done under specific circumstances. These tests include:

  • Chromosomal analysis, which may be done if intellectual disability is present or there is a family history of intellectual disability. For example, fragile X syndrome, which causes a range of below-normal intelligence problems as well as autistic-like behaviors, can be identified with a chromosomal analysis.
  • An electroencephalograph (EEG), which is done if there are symptoms of seizures, such as a history of staring spells or if a person reverts to less mature behavior (developmental regression).
  • MRI, which may be done if there are signs of differences in the structure of the brain.

Early detection

All doctors who see infants and children for well-child visits should watch for early signs of developmental disorders. 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 evaluated:5

  • No babbling, pointing, or other gestures by 12 months
  • No single words by 16 months
  • No 2-word spontaneous phrases by 24 months, with the exception of repeated phrases (echolalia)
  • Any loss of any language or social skills at any age

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.

But children who have a sibling with autism should continue to be closely monitored, because they are at increased risk for autism and other developmental problems.

When socialization, learning, or behavior problems develop in a person at any time or at any age, he or she should also be evaluated.

Treatment Overview

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 function.

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 successful.

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

  • Behavioral training and management. Behavioral training and management uses positive reinforcement, self-help, and social skills training to improve behavior and communication. Many types of treatments have been developed, including Applied Behavioral Analysis (ABA), Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), and sensory integration.
  • Specialized therapies. These include speech, occupational, and physical therapy. These therapies are important components of managing autism and should all be included in various aspects of the child's treatment program. Speech therapy can help a child with autism improve language and social skills to communicate more effectively. Occupational and physical therapy can help improve any deficiencies in coordination and motor skills. Occupational therapy may also help a child with autism to learn to process information from the senses (sight, sound, hearing, touch, and smell) in more manageable ways.
  • Medicines. Medicines are most commonly used to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.
  • Community support and parent training. Talk to your doctor or contact an advocacy group for support and training.

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.

Stories about 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 claims.

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.

Home Treatment

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 autism.

Educate yourself about autism

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 develop independence.6

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.

Work closely with others who care for your child

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:

  • Education.
  • Identifying and managing symptoms of autism and any related conditions.
  • Behavior and interactions with family and peers, adjustment to different environments, and social and communication skills.

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.

Take care of yourself

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.

  • Get involved in a hobby, visit with friends, and learn ways to relax.
  • Seek and accept support from others. Consider using respite care, which is a family support service that provides a break for parents and siblings. Also, support groups for parents and siblings are often available. People who participate in support groups can benefit from others' experiences. For more information on support groups in your area, contact the Autism Society of America at www.autism-society.org.
  • Talk with a doctor about whether counseling would help if you or one of your children is having trouble handling the strains related to having a family member with autism.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD  20824
Phone: 1-800-352-9424
Phone: (301) 496-5751
TDD: (301) 468-5981
Web Address: www.ninds.nih.gov
 

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.


Autism Science Foundation
419 Lafayette Street
2nd Floor
New York, NY 10003
Phone: (646) 723-3977
Fax: (212) 228-3557
Email: contactus@autismsciencefoundation.org
Web Address: www.autismsciencefoundation.org
 

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.


Centers for Disease Control and Prevention (CDC): National Center on Birth Defects and Developmental Disabilities (NCBDDD)
1600 Clifton Road, MS E-87
Atlanta, GA  30333
Phone: 1-800-CDC-INFO (1-800-232-4636)
TDD: 1-888-232-6348
Email: cdcinfo@cdc.gov
Web Address: www.cdc.gov/ncbddd
 

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.


KidsHealth for Parents, Children, and Teens
Nemours Home Office
10140 Centurion Parkway
Jacksonville, FL 32256
Phone: (904) 697-4100
Web Address: www.kidshealth.org
 

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.


National Dissemination Center for Children with Disabilities
1825 Connecticut Avenue NW
Suite 700
Washington, DC  20009
Phone: 1-800-695-0285 (voice/TTY)
(202) 884-8200 (voice/TTY)
Fax: (202) 884-8441
Email: nichcy@fhi360.org
Web Address: http://nichcy.org
 

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.


National Institute of Mental Health (NIMH)
6001 Executive Boulevard
Bethesda, MD 20892-9663
Phone: 1-866-615-6464 toll-free
Phone: (301) 443-4513
Fax: (301) 443-4279
Web Address: www.nimh.nih.gov
 

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.


References

Citations

  1. Volkmar 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.
  2. 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.
  3. Zachor DA (2006). Autism. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1219–1226. Philadelphia: Saunders Elsevier.
  4. Anderson C, et al. (2012). Occurrence and family impact of elopement in children with autism spectrum disorders. Pediatrics, 130(5): 870–877.
  5. 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.
  6. 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.
  7. Peacock G, Yeargin-Allsopp M (2009). Autism spectrum disorders: Prevalence and vaccines. Pediatric Annals, 38(1): 22–25.

Other Works Consulted

  • Anderson 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): 405–4
  • Dumont-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.

Credits

By Healthwise Staff
Primary Medical Reviewer John Pope, MD - Pediatrics
Specialist Medical Reviewer Fred Volkmar, MD - Child and Adolescent Psychiatry
Last Revised April 3, 2012

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