Related Information
Autism
Also listed as: Pervasive developmental disorder
Autism is 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. Autism encompasses a wide range of behavior. The common features include impaired social interactions, impaired verbal and nonverbal communication, and restricted and repetitive patterns of behavior.
Signs and Symptoms
The symptoms may vary from moderate to severe. A combination of the following areas may be affected.
Communication:
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Is unable to start or sustain a social conversation
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Develops language slowly or not at all
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Repeats words or memorized passages, like commercials
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Doesn’t refer to self correctly (for example, says "you want water" when the child means "I want water")
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Uses nonsense rhyming
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Communicates with gestures instead of words
Social interaction:
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Shows a lack of empathy
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Does not make friends
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Is withdrawn
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Prefers to spend time alone, rather than with others
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May not respond to eye contact or smiles
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May actually avoid eye contact
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May treat others as if they are objects
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Does not play interactive games
Response to sensory information:
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Has heightened or low senses of sight, hearing, touch, smell, or taste
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Seems to have a heightened or low response to pain
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May withdraw from physical contact because it is over stimulating or overwhelming
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Does not startle at loud noises
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May find normal noises painful and hold hands over ears
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Rubs surfaces, mouths or licks objects
Play:
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Shows little pretend or imaginative play
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Doesn’t imitate the actions of others
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Prefers solitary or ritualistic play
Behaviors:
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Has a short attention span
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Uses repetitive body movements
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Shows a strong need for sameness
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"Acts up" with intense tantrums
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Has very narrow interests
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Demonstrates perseveration (gets stuck on a single topic or task)
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Shows aggression to others or self
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Is overactive or very passive
Causes
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.
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. Research suggests that heredity and early fetal development may play a causal role in autism, however studies show no association between risk of autism and parental factors such as age and socioeconomic status.
Some parents have heard that the MMR vaccine that children receive may cause autism. However, several major studies have found no connection between the vaccine and autism. 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.
Risk Factors
Autism affects males four times more often than females, and it may be inherited. In fact, about 50% of all boys with autism have a parent with the disease.
Autism occurs more frequently in children with rare genetic disorders and other medical conditions such as
tuberculosis
, phenylketonuria, neurofibromatosis, and epilepsy.
Diagnosis
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 when a child fails to meet any of the following language milestones:
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Babbling by 12 months
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Gesturing (pointing, waving bye-bye) by 12 months
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Single words by 16 months
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Two-word spontaneous phrases by 24 months (not just echoing)
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Loss of any language or social skills at any age
An evaluation of autism will often include a complete physical and neurologic examination. It may also include a specific diagnostic screening tool, such as:
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Autism Diagnostic Interview - Revised (ADI-R)
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Autism Diagnostic Observation Schedule (ADOS)
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Childhood Autism Rating Scale (CARS)
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Gilliam Autism Rating Scale
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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.
Treatment Approach
An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. An experienced specialist or team should design the individualized program. A variety of effective therapies are available. The best treatment plan may use a combination of techniques.
Teaching Programs
There are many types of teaching programs for children with autism. Some use a one-on-one teaching approach that relies on reinforced practice of various skills to get the child close to typical developmental functioning. Others use picture schedules and other visual cues to help the child work independently and to organize and structure their environments.
Medicine
Medicines are often used to treat behavior or emotional problems that people with autism may have. These include hyperactivity, impulsiveness, attention problems, irritability, mood swings, outbursts, tantrums, aggression, extreme compulsions that the child finds it impossible to suppress, sleep difficulty, and anxiety.
Treatment Options
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.
Some studies show that children who have autism benefit from antioxidants like
vitamin C
. Parents and physicians have reported improvement in symptoms in children with autism who have been given certain supplements, including vitamin B, magnesium, cod liver oil and vitamin C.
If you are considering these or other dietary changes, seek guidance from both a gastroenterologist (doctor who specializes in the digestive system) and a registered dietitian. You want to be sure that the child is still receiving adequate calories, nutrients, and a balanced diet.
Touch Therapy and Massage
Research shows that some children with autism exhibit a reduction in symptoms after several weeks of touch therapy. In one study, after 16 weeks of
massage
intervention parents reported feeling physically and emotionally closer to their children and children expressed a range of cues to initiate massage at home.
In another study, researchers found that 4 weeks of Qigong massage (a type of massage that focuses on energy) children showed a decrease in autistic behaviors and an increase in language development, as well as improvement in motor skills, sensory function, and general health.
Art, Music, and Pet Therapy
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Art therapy, music therapy, animal therapy, and sensory integration therapy provide opportunities for children who have autism to develop social and communication skills.
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Art therapy offers a child a nonverbal way to express his or her feelings.
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Music therapy involving singing helps develop the child’s speech and language skills. In fact, research shows that any music intervention effectively reduces symptoms for children and adolescents with autism.
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Animal therapy may include therapeutic riding programs on horses and swimming with dolphins. These types of therapies can help improve the child’s motor skills, while also building self-confidence. In fact, some studies show that children who interact with dolphins learn faster and retain more information than children who learned in a classroom setting.
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Sensory integration focuses on normalizing extreme reactions to sensory input. It tries to help children reorganize and integrate their sensory information so they can better understand the outside world.
While there is little scientific evidence supporting these therapies, many parents and therapists report noticeable improvement in a child’s behavior and communication skills as well as a sense of enjoyment.
Prognosis/Possible Complications
Autism remains a challenging condition for individuals and their families, but the outlook is much better than it was a generation ago. Today, with appropriate therapy, clinicians can help reduce many of the symptoms of autism, though most people will be affected on some level throughout their lives.
Autism can be associated with other disorders that affect the brain, such as mental retardation or fragile X syndrome. Some people with autism will develop seizures.
Other Considerations
Viral infection during the first three months of pregnancy -- particularly with
rubella
-- is a suspected cause of autism.
Supporting Research
Cullen L, Barlow J. Kiss, cuddle, squeeze: the experiences and meaning of touch among parents of children with autism attending a Touch Therapy Programme.
J Child Health Care.
2002;6(3):171-181.
Smeeth L, Cook C, Fombonne E, et al. MMR vaccination and pervasive developmental disorders: a case-control study.
Lancet
. 2004; 364: 963–969.
Cullen-Powell LA, Barlow JH, Cushway D. Exploring a massage intervention for parents and their children with autism: the implications for bonding and attachment.
J Child Health Care.
2005;9(4):245-55.
Cullen LA, Barlow JH, Cushway D. Positive touch, the implications for parents and their children with autism: an exploratory study.
Complement Ther Clin Pract.
2005;11(3):182-9.
Gillberg C, Cederlund M. Asperger syndrome: familiar and pre- and perinatal factors.
J Autism Dev Disord.
2005;35(2):159-166.
Larsson HJ, Eaton WW, Madsen, KM, Vestergaard M, Olsen AV, Agerbo E, Schendel D, Thorsen P, Mortensen PB. Risk factors for autism: perinatal factors, parental psychiatric history and socioeconomic status.
Am. J Epidemiol.
2005;161(10):916-925.
McGinnis WR. Oxidative stress in autism.
Altern Ther Health Med.
2004;10(6):22-36.
Nye C, Brice A, Nye C. Combined vitamin B6-magnesium treatment in autism spectrum disorder.
Cochrane Database Syst Rev.
2005;(4):CD003497.
Silva LM, Cignolini A. A medical qigong methodology for early intervention in autism spectrum disorder: a case series.
Am J Chin Med.
2005;33(2):315-27.
Whipple J. Music intervention for children and adolescents with autism: a meta-analysis.
J Music Ther
. 2004;41(2):90-106.
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Review Date:
11/23/2005
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Reviewed By: A.D.A.M. editorial. Previously reviewed by Angela Smyth, M.D., Department of Psychiatry, University of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network (5/14/2004).
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