Autism

A recent report from the CDC indicates that the prevalence of autism has increased by 78% since 2002. It is unclear what has caused this increase in prevalence. According to the CDC, this increase may be due to the way autism is identified, diagnosed and treated. Public awareness of this condition has steadily increased over the past decade partly due to media exposure and concerns about environmental causes of autism. CDC statistics indicate that autism is found in 1 out of 88 children, and it is 3-4 times more common in boys than girls.

Autism or Pervasive Developmental Disorder (PDD) is a developmental disorder that typically starts before 3 years of age. This is a condition that affects social behavior, communication, and intelligence. Research has indicated that genetic factors are important and that identical twins are more likely than fraternal twins or siblings to both have autism. Language problems are also more prevalent in relatives of autistic children. Chromosomal problems and neurological conditions are more common in families with autism. Some hypotheses include exposure to toxic agents, prenatal, perinatal, and post-natal infections. Maternal rubella infections have been associated to higher rates of autism. There are also some environmental factors that are associated with autism such as advanced maternal and paternal age and oxygen deprivation during birth.

The most common perception of autism is related to the movie Rainman; in this movie the actor portrays a character that had limited social behavior, repetitive behaviors, and an extraordinary ability with memorization. In reality autism spans a wide variations of difficulties in social interaction, intelligence, communication, and repetitive behaviors. There are also many types of autism including Asperger Syndrome, Rett Syndrome, Autistic disorder, and Pervasive Developmental Disorder. The symptoms of autism usually start at about 18 months to 2 years of age. They appear to have difficulties in social interactions, verbal and non-verbal communication, and pretend play. Social interaction problems include not making friends, appear withdrawn, avoid eye contact, show a lack of empathy, or do not play interactive games. Communication problems may include not maintaining conversations, communicating with gestures instead of words, repeats words, or slow language development. Some behaviors signs are extreme tantrums, has very narrow interests, or perseverates on a particular idea.

Many parents are worried about vaccines causing autism. There is a belief that a mercury-based preservative in vaccines called thimerosal can cause behavioral problems. Some vaccines contain a minute amount of thimerosal and today most vaccines administered to children under 6 years old have no thimerosal. The Institute of Medicine (IOM) reviewed all the available data and concluded that there is no link between the preservative in vaccines and autism. In 1998, the British Medical Journal (BMJ) Lancet published an article that linked vaccines and autism. This created the panic about vaccines that is still present today. An investigation into the original research indicated that the data was falsified to make it appear that the Measles-Mumps-Rubella (MMR) vaccine was linked to autism. The BMJ retracted the article and the researcher had lost his medical license as a result of the fraud. As a result of the article thousands of children did not receive the MMR vaccine in England and caused an increase in Measles rate and a Mumps epidemic. Parents need to consider the benefits and risks of delaying or avoiding vaccines completely.

The diagnosis of autism starts with routine health and developmental exams with the child’s Pediatrician. Regular developmental tests that monitor language development and social development can help identify early signs of autism. Normally a 1-year-old child can say mama or dada, has some fear of strangers, follows simple instructions, and pulls to stand. Routine lead level testing is usually performed at the 1-year-old physical exam. An 18-month old plays pretend, such as feeding a doll, hands things to others to play, says “no” or shakes head, points to get the attention of others, and follows one-step commands like “sit down”. At 2 years old, children begin to imitate adults or older children, become excited when seeing other children, plays alongside other children and may begin some interactive play such as chasing each other, start speaking in short 2 to 4 word sentences, points to things in books, follows 2 step commands, and play make-believe games. By 3 years old, children should show affection towards friends, shows concern for a crying friend, names a friend, speaks clear enough for strangers to understand, and plays make-believe with toys and people. If there is a sign of speech delay, a formal hearing screen should be performed. There are screening questionnaires such as the Checklist for Autism in Toddlers (CHAT) or the Autism Screening Questionnaire. For children who are suspected to have autism, a referral to a Developmental Specialist or Neurologist may be done for further diagnostic testing.

The treatment of autism includes behavioral therapy, speech-language therapy, occupational and physical therapy, and medications. Applied Behavioral Analysis therapy is a form of positive reinforcement therapy. This form of therapy is recognized as a safe effective form of behavior modification for autism. The goal of ABA is to get the child as close to normal development as possible. Medications can be used to modulate disruptive behaviors, anxiety, attention problems, mood swings and self-injurious behaviors. Autism is sometimes associated with other developmental problems that can be treated with speech therapy and occupational and physical therapy. Studies have shown that early intensive therapy can produce the best results in helping a child develop social skills and learning skills and can become independent adults.

The most powerful tool that a parent of a child with autism is knowledge about the condition.  Knowledge about causes of autism, the signs and symptoms, and treatments can help the parents navigate through the educational and medical system to get the best treatments available.  Excellent resources are the books Ten Things Every Child With Autism Wishes You Knew and 1001 Great Ideas for Teaching and Raising a Child with Autism or Aspergers.

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