Autism

What is autism?

Autism is a brain disorder that can severely limit a child's ability to communicate or interact with others. National statistics for how many children are affected by autism don't yet exist. However, the National Institute for Mental Health estimates that three to six children out of every 1,000 suffer from autism. The condition strikes boys more often than girls. About half of all autistic children show developmental problems shortly after birth; the rest seem perfectly normal at first but lose their language and social skills usually between the ages of 18 months and 3 years.

In many cases, the first sign of trouble comes when an infant or toddler seems to tune out everyone around him. Often, autistic children cry if they're cuddled or even touched, a heartbreaking development for any parent. Although autism can take many forms, certain features stand out as hallmarks of the disorder.

• Language. Children with autism are slow to pick up words, and some never learn to talk at all. Those who do speak may have excellent pronunciation, but they often struggle with the rhythm, intonation, and meaning of speech. Many children with autism simply echo whatever they hear. (If you ask, "Would you like some milk?" the child might respond with, "You would like some milk.") Others have rich vocabularies, but they may spend most of their time talking obsessively about favorite subjects; they may also have trouble understanding humor or irony.
• Social interactions. Children with autism tend to live in a shell. As infants, they may ignore sounds, faces, and other things that usually captivate babies. As they grow older, autistic children rarely make eye contact and prefer to play by themselves. Far from being simply shy, children with autism often act totally indifferent to others. They may, however, be fascinated with moving objects, such as cars or fans, and become greatly attached to an inanimate thing, such as a stick or rubberband.
• Intelligence. About three out of four children with autism suffer from serious mental retardation. But the brain abnormalities that make children autistic can also endow a select few with extraordinary, although highly specific, talents -- an exceptional memory, say, or unusual ability in art, math, or music. Some can draw complex three-dimensional images while their peers are still scribbling; others can recall the weather from every day in their childhood. Even these gifted children, however, can struggle with basic tasks such as reading and writing. A child who has mastered Tchaikovsky may be baffled by Dr. Seuss.
• Dangerous behaviors. Self-inflicted injuries are by far the most frightening aspect of having a child with autism. Autistic children sometimes bite themselves repeatedly or violently bang their heads against a wall whenever they feel stress or anxiety.
• Daily living. Children with autism often become fixated on certain activities or objects. They may spend hours every day pacing the same piece of floor or rocking back and forth in the same chair. Others constantly flap their arms or flip their ears. Autistic children also demand precise order and structure to their lives. They may perform exacting, highly complicated rituals for daily tasks such as eating or going to bed. A misplaced piece of silverware, an unfolded blanket, or any other change in their routine can send them into a rage.

What causes autism?

Nobody knows for sure what causes the condition. According to the Mental Health America, several studies indicate that it may stem from a combination of factors, including exposure to a virus in the womb, an immune system disorder, and genetics. One thing is certain: It's not the result of bad parenting.

How is autism treated?

Some children with autism will go on to have a normal adulthood, but the great majority have lifelong symptoms. While autism has no cure, many children with the condition learn to speak, read, write, and interact with others through behavioral and educational therapy. Such programs can also help them to master basic skills, such as using a toilet and getting dressed.

Doctors recommend sometimes as much as 40 hours a week of highly structured training sessions. Using this approach, a therapist may spend hours repeatedly asking your child to make eye contact, rewarding each success with a smile or applause. This technique is also used less intensively in natural, everyday settings and can be especially effective when started early in a child's life. With proper training, you can turn a trip to the park into a quick lesson in social skills by praising your child for talking to and playing with other children.

The success of any treatment program will depend on a variety of factors, but your child's intellectual level and amount of brain dysfunction will tend to dictate the best approach. For example, highly structured behavioral programs, which include methods for nonverbal communication, are most successful with children functioning at a lower-than-normal level.

Whether the therapy is in-depth or more casual, experts agree that every child has his own talents and limitations. You'll need to keep informed about current research in the field and to work closely with your child's doctors to make sure he gets the help he needs.

Is my autistic child entitled to any benefits?

Yes. There are various laws in place to offer health and education services to families with a child who has autism or other developmental disabilities. These benefits include the following:

• Family training, counseling, and home visits
• Health services
• Nursing
• Diagnostic testing
• Psychological therapy
• Physical therapy
• Social work services
• Speech-language instruction
• Transportation
• Vision services

To see which agency takes the lead in coordinating these services, contact your local board of education and ask for a copy of the state's administrative code. If your child is diagnosed as autistic, you're eligible for early intervention services: education, counseling, and health services that are made available early in your child's life. To find the contact person for your state's early intervention program, get in touch with the National Dissemination Center for Children with Disabilities. You may also want to contact a local chapter of the Autism Society of America for further assistance.

Don't assume, though, that your local school board will provide the best program for your child. These programs are often expensive and your school may not have sufficient trained staff. For these reasons, be prepared to act as your child's advocate by knowing the law, what resources are available in your area, and the latest research in the field.

Can medications help?

Although there's no medication specifically designed to treat autism, certain drugs may ease a few of your child's symptoms. Antidepressants such as fluoxetine and fluvoxamine can make some children less aggressive, help them break out of repetitive behaviors, and cope with changes in their surroundings. However, these particular drugs are also part of a class of antidepressants that have been shown to increase suicidal tendencies in young people. As a result, the FDA requires these drugs to have a black box warning, the most serious type of warning for a prescription drug. The drug risperidone may help children who have explosive outbursts control their rage. In extreme cases, tranquilizers may be needed to prevent self-inflicted injuries. Be sure to work with a doctor who has experience working with autistic children and will closely monitor your child's reaction to these medications. Be alert to side effects of some of the more potent medications.

Are there any alternative therapies that work?

Unfortunately, autism has spawned many false claims and just as many false hopes. Some experts offer facilitated communication, a process thought to let a nonverbal child express his thoughts by guiding another person's fingers on a keyboard. Many families have embraced the technique, but studies show that the words really come from the typist, not the child. Secretin, a hormone that controls digestion, is another alternative therapy that is not an effective treatment for autism. To protect yourself and your child, stick to treatments recommended by a qualified psychiatrist, psychologist, neurologist, or other specialist.

You'll want to become an expert of sorts by keeping abreast of developments in research on autism and its treatment. This isn't as hard as it may sound: You'll learn an enormous amount by joining and becoming active in a local advocacy group and, if possible, by reading scientific journals that deal with autism.

What can I do to help?

Your child may act distant and aloof, but he definitely needs your love and attention. Help him by keeping his life as structured as possible, but also do what you can to slowly pull him out of his shell. If your child is pacing around a room, for instance, experts recommend joining him for a while and then leading him to a different room. Such small steps can result in a breakthrough. As one psychologist (and parent of an autistic child) put it, "You need to enter their world to help guide them into yours."

Further Resources

National Mental Health Association
(800) 969-6642
http://www.nmha.org

Autism Society of America
(800) 3-AUTISM
http://www.autism-society.org

References

National Institute of Mental Health. Autism Spectrum Disorders (Pervasive Developmental Disorders). http://www.nimh.nih.gov/publicat/autism.cfm

Centers for Disease Control and Prevention. Autism Spectrum Disorders (ASDs).

http://www.cdc.gov/ncbddd/autism/index.html

Food and Drug Administration. Antidepressant Use in Children, Adolescents, and Adults.

http://www.fda.gov/cder/drug/antidepressants/defau...

National Institute of Mental Health. Autism Spectrum Disorders Overview. http://www.nimh.nih.gov/health/topics/autism-spect...

American Academy of Pediatrics. Meyers SM et al. Management of Children with Autism Spectrum Disorders. Pediatrics. Volume 120, Number 5. http://pediatrics.aappublications.org/cgi/reprint/...

Centers for Disease Control. Autism Information Center Congressional Activities.

National Institute of Child Health and Human Development. The Use of Secretin to Treat Autism. http://www.nichd.nih.gov/news/releases/secretin.cfm

Food and Drug Administration. FDA Approves First Generic Risperidone to Treat Psychiatric Conditions. http://www.fda.gov/NewsEvents/Newsroom/PressAnnoun...

National Institute of Neurological Disorders and Stroke. Autism fact sheet. http://www.ninds.nih.gov/disorders/autism/detail_a...