Autism

Autism, disorder that affects the social, emotional, and behavioral development of children. Autism is marked by serious difficulties in interacting and communicating with other people. Other symptoms may include constantly repeating certain actions or behaviors, or having intense interests restricted to only particular things or topics. Symptoms of autism usually appear before the age of three and can last the rest of a person’s lifetime. Autism is at least four times more common in boys than in girls.


The term autism comes from Greek auto, meaning “self,” and refers to an abnormal withdrawal from the world outside oneself. The American psychiatrist Leo Kanner first described the disorder in 1943. Autism was originally thought to be a form of schizophrenia, but it has been recognized since the 1960s as a distinct developmental disorder that is not a psychosis. Modern researchers now identify a wide “spectrum” of autism symptoms that may occur in different combinations or with different severities in children

The causes of autism remain a major area of research and of controversy. Studies indicate that autism is often associated with abnormalities in the functioning of the brain and that the disorder may have a genetic basis in most cases.

Raising a child with autism can present special challenges for a family. There is no cure for autism but some treatments and therapies can lessen the symptoms. Some persons with autism may need special care throughout their lives while others may learn to function independently in society.

Prevalance


The number of children diagnosed with autism has increased since the 1990s. Until the mid-1990s, autism was estimated to occur in 1 in 3,000 children. More recent estimates suggest that autism occurs in approximately 1 in 500 children, and that 1 in 150 children may be on the “autism spectrum” with one or more symptoms. An estimated 560,000 children in the United States may have autism spectrum disorders.


Possible reasons why more cases of autism are being reported include dramatically improved and standardized methods for diagnosing autism, along with increased awareness of autism, first among the medical community and then in the media. Children and adults with less severe symptoms are more likely to be diagnosed with autism today than they were 15 years ago.






On the other hand, some researchers believe that the greater number of autism diagnoses represents a true increase in the incidence of the disorder and points to some environmental factor that may have changed over the same period of time. Although no scientific data currently support a connection with autism, possible environmental factors proposed include toxic chemicals, vaccines, pollutants, food products, and prenatal exposure to certain drugs or infectious agents.





A still unexplained feature of autism is the much higher incidence of the disorder in boys, about four times as frequent as in girls. Girls with autism, however, tend to show more severe symptoms and mental impairment




Symptom

1. Social difficulties

     Symptoms of social difficulty are usually the first signs of autism. Normally an infant should respond to others with a social smile within the second or third month of life. Lack of such a smile during this period is often the earliest indication of autism. Infants who are later diagnosed with autism also make poor eye contact and do not imitate caregiver sounds or gestures.

Children with autism typically do not share their enjoyment with others. For example, toddlers with autism may smile or laugh in response to a noisy toy, but they will not bring this toy to the caregiver. Another early sign of problems in social communication is a lack of gestures, including pointing. As they get older, children with autism often fail to develop typical friendships or even typical relationships with siblings or parents. They may also seem unaware of the feelings of other people or fail to comfort a person who is upset.

2. Communication difficulties


 Children with autism have difficulties with communication, including both gestures and speech. Often children with autism have a delay in speech and in severe cases sometimes do not speak at all. They also fail to use gestures to replace words. How well children with autism will be able to function as they grow older can often be predicted based on their early language skills


When children with autism are able to speak, they may repeat back exactly what is said to them, a behavior that is called echolalia. Sometimes they will quote whole conversations or a dialog from a movie. Frequently, children with autism misuse pronouns. For example, they may say, “You want a cookie?” to indicate that they want a cookie. As they get older, children with autism will be unable to have conversations with others. They will also not play make-believe but instead will often simply line up objects or replay a TV show or movie using their toys.


3.  Unusual behavior


The restricted interests or repetitive behaviors that often occur in autism are sometimes the least obvious symptoms when children are toddlers. These symptoms usually become a larger problem around the age of four or five

Many children with autism will have a limited number of intense interests, such as dinosaurs, trains, or characters from a cartoon. They may also be preoccupied with parts of objects. For example, they may spin the wheel of a toy car instead of pretending to drive it.

Frequently, children with autism will insist on doing things in exactly the same way or on following the same routine from day to day. As a result, they may become very upset in response to a minor change, such as not having their usual breakfast cereal or taking a different route when driving home from school. Children with autism may also repeat body movements, such as spinning, rocking, or flapping hands.


When upset or excited, they may also harm themselves by skin-biting or head-banging. They may also show significant aggression toward other people or inanimate objects, or may have episodes of extreme anger or frustration.




Treatment


1. Therapy and training approach


 Ivar Lovaas, an American psychologist, pioneered a behavioral modification system that includes immediate rewards and punishments to shape a child’s behavior. A controversial aspect of this approach is the use of electric shock to deter self-destructive behavior in extreme cases.


The Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) system uses a picture schedule of time-limited tasks to gradually build on skills while also including well-liked tasks as a reward.


The Floortime system uses frequent play sessions with a parent to connect therapy goals with activities that a child finds exciting or fun, ideally gaining skills and developing a deeper relationship with a parent at the same time. Other systems have also been applied, but it is not yet clear whether any one approach is better than another


2. Medication


Medication is not a primary treatment for autism itself but can be helpful for related symptoms.


Risperidone (Risperdal) received Food and Drug Administration (FDA) approval in 2006 for “irritability” in autism and is the first medication to receive FDA approval in treatment of the disorder. Most of the children in the studies of risperidone treatment had significant aggression toward themselves or others or episodes of extreme anger or frustration. Risperidone may have significant side effects including weight gain, risk of diabetes, and movement disorders.


A group of medications called the serotonin reuptake inhibitors have been used successfully to treat compulsive behaviors in autism. These medications include fluoxetine (Prozac), fluvoxamine (Luvox), and escitalopram (Lexapro). Some children experience decreased sleep and agitation on these medications, and the dose needs to be carefully monitored by an experienced clinician.
 A number of other medications may also be used in children with autism, particularly when they also have extreme hyperactivity, poor sleep, or aggression. No medication has been shown to have significant effects on the social or communication difficulties seen in autism.


3. Alternative Treatment


Many clinicians and parents have looked to alternative treatments for autism. These treatments often have no scientific basis or offer no evidence that they are effective. Approaches such as providing special vitamin supplements or making dietary changes should cause no serious harm to children in most cases, although some proposed diets can lead to vitamin deficiencies. Most concerning, however, are invasive treatments such as heavy metal chelation. Chelation therapy uses chemicals to remove heavy metals such as mercury and cadmium from the body. The treatment has caused the death of at least one child with autism without having any known benefit.