Autism is a disorder that can affect the way a child thinks, behaves, communicates and interacts with others. Children with autism are affected in different ways. Some have only mild symptoms and grow up to live independently, while others have more severe symptoms and need supported living and working environments throughout their lives.
Autism affects up to one in every 150 school-age children, which translates to about 560,000 children, according to the US Centers for Disease Control and Prevention. It's more common in boys than girls, and is usually diagnosed when a child is between 15 and 36 months old, although signs of the disorder can show up earlier.
While there is no cure for autism, and researchers are unsure of its cause, a variety of therapies and resources are available to help children with autism and their families.
WHAT IS AUTISM?
Autism is a spectrum disorder, meaning it affects children in different ways, at different levels of severity, regarding their ability to communicate, process thoughts and interact socially. Because there's nothing abnormal about the physical appearance of a child with autism, and because children develop at different rates, the disorder can be difficult to recognise.
Autism is characterised by
communication problems, which may include delays in developing speech, repeating words and speaking in a monotone that lacks pitch, inflection or rhythm;
poor social interaction;
repetitive behaviour and interests;
unusual behaviours, such as spinning or flapping hands.
About one-third of children who are diagnosed with autism develop fairly typically in the first year or two of life, and then begin to regress in the way that they speak and socialise. They may
prefer to play by themselves;
not acknowledge other children who play alongside them;
like to line up objects and sort them into colours;
have difficulty making eye contact with other people.
If a child shows any one of these behaviours on an isolated basis, it's probably not autism. Usually, it's the collection of these behaviour patterns that leads to a diagnosis of autism.
Though children with autism are affected in different ways, in all cases their capacity to communicate and interact with others is impaired. Other behaviours of children with autism may include
speech that's often limited to a few repeated or 'echoed' words or phrases;
stopping speaking altogether;
problems with communicating needs;
withdrawing from physical contact with other people;
seldom playing fantasy or imagination games;
throwing tantrums that are prolonged and begin with little warning;
laughing or crying for no reason;
difficulty showing or receiving affection;
resistance to change in daily routines;
no fear of danger;
very physically active or very underactive;
lack of response to verbal cues, such as calling the child's name or questions;
unusual responses to many sensory experiences, especially to sudden, loud noises or high-pitched sounds;
obsession with predictable rituals and sometimes playing with only one part of a toy.
Not every child with autism will have all of these types of behaviour. Because some children with autism have just a few of these symptoms, they may appear to be developing within typical expectations, although somewhat slowly.
WHAT CAUSES AUTISM?
There isn't one specific cause of autism. Research has focused on whether chemical imbalances, differences in the brain, genetics or problems with the immune system play a role in causing the disorder.
Food allergies, excessive amounts of yeast in the digestive tract and exposure to environmental toxins have all been mentioned as causes of autism. But there is no scientific evidence to support these theories.
Some people believe that thimerisol (a vaccine ingredient) and vaccines - particularly the shot for measles-mumps-rubella (MMR) - may be linked to autism because the same age range in which children are vaccinated with MMR is the same age range in which autism is diagnosed. But there isn't any scientific evidence to support that link and, in fact, the main 1998 study that reported it was widely discredited in 2004.
DIAGNOSING AUTISM
Autism can't be detected at birth or through any prenatal screening. But researchers do know that if you have one child with autism, you have about a 10 percent chance of having another child with autism or a similar disorder.
Because autism is difficult to recognise and diagnose, it's important that families seek an evaluation by a medical professional who is experienced in diagnosing and treating the disorder as soon as possible. If, for example, you're concerned because your child is nearing 12-15 months old and isn't gesturing, it's important not to wait to express concerns until the 18-month well-child visit. If there is something wrong, early intervention can help parents find ways to manage a child's symptoms.
If parents have concerns throughout infancy and the early toddler months - particularly about the way a child is learning to communicate - they should be sure to closely document their observations and talk with their child's doctor promptly.
There is no single diagnostic test for autism, so the doctor will probably order different tests to rule out other medical problems before making a diagnosis, and also may refer parents to a developmental pediatrician, a pediatric psychiatrist or a pediatric neurologist.
EARLY INTERVENTION PROGRAMMES
If a child has been diagnosed with autism, the health team assessing the child's development and providing treatment might include
a developmental pediatrician (a doctor who specialises in child development);
a pediatric psychologist;
a speech/language pathologist (who specialises in human communication, its development and its disorders);
an occupational therapist (who addresses psychological, social and environmental factors that may hinder an individual's functioning);
special education teacher or early childhood educator.
Finding a good early intervention programme is very important. These programmes provide educational and therapeutic services for young children who have been diagnosed with a physical or cognitive disability. Often, these programmes are geared toward 'breaking through' whatever barriers a child has to social interaction and can help the child learn to communicate with others through speech and other tools, like pointing, pictures and sign language. These programmes also try to pull a child through the repetitive behaviour and guide them toward other activities.
Some children with autism are given medication to help control their symptoms - such as antidepressants for minimising repetitive behaviour, stimulants for controlling hyperactivity and anticonvulsants for treating aggression. Some children are also given antipsychotic medications to control repetitive and aggressive behaviour.
A child's pediatrician, the Autism Society of America (www.autism-society.org) or the organisation The Arc (www.thearc.org) can refer parents to an early intervention programme in their area. Other agencies such as Easter Seals (www.easterseals.com) and United Cerebral Palsy (www.ucp.org) also provide programmes. And the local school district may offer intermediate units or have "child study teams".
HELPING anAUTISTIC CHILD
Learning that a child has autism can be wrenching for parents. Feeling like they've lost the child they once knew, parents often move through the emotional stages of grief: denial, anger, bargaining, depression and acceptance. Ongoing professional counseling can help families accept the diagnosis, move forward and learn how to help an autistic child develop to his or her greatest potential.
And parents play an extremely important role in helping their child develop. Like other children, those with autism learn primarily through play. So, it's important for parents to join their child in play that they both enjoy.
Here are some of the positive ways that parents can interact with their child at home:
Be consistent, have routines at home and when out.
Have a place where the child feels comfortable and secure.
In addition to verbal praise, find other ways to reinforce good behaviour and promote self-esteem. After the child has successfully completed a task, for example, give him or her extra time to play with a favourite toy.
Present information visually as well as verbally. Combine the spoken word with the presentation of photographs and pictures, sign language, symbols or gestures to help the child make his or her needs, feelings or ideas known.
Try to show the child affection in as many ways as possible. Though some children with autism have trouble receiving and expressing affection, they can still benefit from nurturing from a parent.
Talk with the child's doctor or members of the child's educational team about support groups and other local resources.
For more health information for parents, children and teens, visit kidshealth.org. KidsHealth is from the health experts of Nemours, a nonprofit devoted to children's health. © 2007, The Nemours Foundation/KidsHealth
Illustration by Jennifer Pritchard & Kurt Strazdins/mct