Some children seem to live in a world all their own. They appear distant and closed-in, avoiding eye contact and shying away from their parents' hugs. They may exhibit strange behaviors, like flapping their arms or obsessively lining up their toys. They are among the approximately 1.5 million children in
Autism has up to now been very difficult to decipher. Scientists still don't fully understand the mystery that lies deep in the brains of children with autism. Although researchers have uncovered clues to what causes the condition, they have not yet discovered a way to prevent or cure autism.
What is concerning to many scientists is that autism appears to be on the rise. Today, one out of every 150 American children has the condition, according to the Centers for Disease Control and Prevention (CDC). Since the 1980s and early 1990s, the rate of autism has increased by approximately 10 to 17 percent annually. Doctors don't know whether this apparent increase is the result of some environmental factor -- such as greater exposure to toxic chemicals -- or simply that children are being diagnosed more effectively than they were two decades ago.
Autism is part of a cluster of conditions called autism spectrum disorders (ASDs), or known by the broader term, pervasive developmental disorders (PDDs). All of these conditions share similar symptoms. Although autism can affect children of any race and ethnicity, it is four times more common in boys than in girls.
Autism can range from mild to severe, but most children with the condition have difficulty in these three areas:
Communication - Children with autism have trouble with both verbal and nonverbal communication. They may avoid making eye contact or smiling, and may not understand the meaning of a smile, wink or wave. About 40 percent of children with autism don't speak at all. Another 25 percent start talking at between 12 and 18 months, but then rapidly lose their language ability. Some children with autism have difficulty forming words into sentences, or repeat exactly what they hear -- a condition called echolalia. Because they can't communicate what they want, sometimes autistic children scream or cry out of frustration.
Social interaction - Children with autism have difficulty relating to other people, in part because they can't understand other people's feelings and social cues. As a result, they can appear distant or aloof. They may shy away from physical or emotional contact, avoiding hugs and eye contact. Because autism affects the senses, some everyday sounds or smells may be unbearable to autistic children. They may cover their ears and scream when the phone rings, or gag from the smell of a peach. Or they may be less sensitive to pain than other children, and not feel a thing when they get a cut or bruise.
Repetitive behaviors - Autistic children often repeat the same behaviors (called stereotyped behaviors, or stereotypy) over and over, including waving their arms, banging their head against a wall, repeating the same words, or obsessively lining up toys, books or other objects. Repetition is a theme throughout an autistic child's life. Any change to their daily routine -- even something as simple as cutting a sandwich straight across rather than on a diagonal -- can lead to a meltdown.
The symptoms of autism can vary dramatically from child to child. While one child may be entirely unable to communicate, another may be able to recite entire Shakespearian plays. One child may be unable to add 3 + 4, another may be able to perform advanced calculus functions.
In addition to autism, four other conditions fall under the header of ASDs
· Asperger syndrome - Children with this condition have some symptoms of autism, including poor social skills and a lack of empathy, but they have age-appropriate language skills and a normal or high IQ.
· Rett syndrome - This condition affects only 1 out of every 10,000 to 15,000 children, the vast majority of them girls. Those with Rett syndrome shy away from social contact. They may wring their hands and be unable to control the movement of their feet.
· Childhood Disintegrative Disorder (CDD) - This rare disorder affects only about two out of every 100,000 children with ASDs, most of them male. Children with CDD will develop normally until about age 3 or 4, then will suddenly and dramatically lose their motor, language and social skills.
· Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) - This condition shares some of the same symptoms with autism (communication and social delays), but does not meet the full criteria for diagnosis.
Autism is much more common in people with certain genetic, chromosomal, and metabolic disorders, such as fragile X syndrome (an inherited form of mental retardation whose name refers to a damaged and fragile-looking X chromosome), phenylketonuria (an inherited condition in which the body lacks the enzyme needed to process the amino acid phenylalanine, leading to mental retardation) and tuberous sclerosis (a rare genetic disorder that causes benign tumors to grow throughout the body and brain). Epileptic seizures, mental retardation and vision and/or hearing loss are also common in children who have autism.
Next, we'll look at some of the potential causes of autism.
Theory of Mind
In 1995, Dr. Simon Baron-Cohen of
proposed a new theory about autism. He suggested that many individuals with autism suffer from "mindblindness" -- that is, they are unable to understand that other people have their own unique thoughts and emotions. It is this inability to empathize and relate to differences in others' way of thinking that results in the communication and social difficulties that people with autism exp erience, according to Dr. Baron-Cohen. Cambridge University
Within the first few months of their baby's life, the parents of an autistic child may begin to feel that something is not quite right. They may notice that their child, who once seemed normal in every way, is acting strangely, refusing to make eye contact, point to toys, or speak.
Even though the signs may appear before age two, most children aren't diagnosed with autism until age four or five, according to the CDC. Part of the reason for this delay is that the symptoms of autism can look much like those of other conditions, which is why autism screening is a multi-step process involving several different health and mental health Professionals.
The first step to diagnosing autism begins with a developmental test administered by the child's pediatrician. If this test suggests an ASD, the next step is to bring in a team of experts, which may include a psychologist, neurologist, child psychiatrist, speech therapist, occupational therapist, physical therapist, and possibly other professionals. These doctors will evaluate the child for neurologic or genetic problems, as well as for cognitive and language skills. Evaluation may include observations, parent interviews, patient histories, speech and language assessments and psychological tests.
Screening tests for autism include:
· The Autism Diagnostic Observation Schedule (ADOS-G): An observational test used to identify delayed social and communication behaviors.
· The Autism Diagnosis Interview-Revised (ADI-R): An interview that assesses the child's communication and social skills.
· Childhood Autism Rating Scale (CARS): An observational test to determine autism severity that uses a 15-point scale to evaluate a child's verbal communication abilities, listening skills, body use, and social relationships.
· The Autism Screening Questionnaire: A 40-question scale used in children four and older to evaluate social and communication abilities
According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), children with autism meet at least six of the following criteria:
· Social impairments:
o Does not properly use nonverbal behaviors such as gestures and facial expressions
o Fails to develop age-appropriate peer relationships
o Does not spontaneously share objects or interests with other
o Lacks social or emotional reciprocity
· Communication impairments:
o Is slow to speak
o Has difficulty sustaining a conversation
o Repeatedly uses the same language
o Does not engage in age-appropriate make-believe or socially imitative play
· Repetitive behaviors:
o Is intensely preoccupied with one or more interests
o Is inflexible and unwilling to change set routines
o Repeats motions or mannerisms (such as waving arms, flapping, or twisting)
o Is preoccupied with parts of objects
Next, we'll look at conventional treatments for autism.
Discovering AutismAlthough it may seem as though autism emerged only recently, scientists believe that children exhibited its behaviors as early as the 18th century. Autism wasn't formally recognized as a unique condition until 1943, when Dr. Leo Kanner of the
Helping Children with Autism
Because there are no real cures for autism, parents often turn to complementary and alternative therapies for their children. Although some parents have had success with these methods, none is scientifically proven to treat autism.
Vitamin and mineral supplements - Dietary interventions stem from the belief that food allergies or vitamin and mineral deficiencies can trigger autism. Some parents give their children B Vitamin supplements (B vitamins create enzymes needed by the brain) or magnesium, although research has not proven their effectiveness.
Special diets - Some research suggests that children with autism may have trouble digesting proteins such as gluten-- found in the seeds of wheat, oat, rye, and barley plants, and casein -- found in dairy products. Many children with autism are on gluten- or casein-free diets.
Secretin - Some research found that this hormone, which aids in digestion, improved communication and social skills in autistic children. However, research by the National Institute of Child Health and Human Development found no real improvements with this treatment compared to placebo.
Chelation therapy - Following the school of thought that autism may be caused by exposure to environmental toxins, such as mercury and other heavy metals, chelation uses a chemical agent to bind to and remove these metals from the body. Although a number of parents have claimed that this treatment has improved their children's symptoms, chelation hasn't been scientifically proven, and the substances used in the treatment can themselves be toxic and cause allergic reactions in some children.
Facilitated communication - In this type of therapy, a facilitator holds the hand, arm or shoulder of a autistic child and helps him type on a computer keyboard to assist in communication. This technique is not considered a valid treatment for autism, and it is very controversial, because some people claim that the facilitator is doing the communicating rather than the child.
In the next section, we'll examine some common myths about autism.
From the 1950s until the 1980s, a prevailing theory about the cause of autism was that it stemmed from bad parenting -- the so-called "refrigerator mother theory" (meaning the mother is emotionally cold) put forth by child psychologist Bruno Bettelheim. Today, we know this is untrue. Autistic children aren't poorly raised -- they are born with an inherited susceptibility to the condition.
Autistic children also are not badly behaved -- their temper tantrums and other unusual behaviors stem from their frustration in being unable to effectively communicate and interact socially. They are not dumb, either; in fact, some autistic children are extremely gifted in one or more areas
A common misconception is that people with autism are slow or mentally retarded. In fact, a small percentage of people with ASDs are remarkably gifted. Consider Kim Peek, the inspiration for Dustin Hoffman's character, Raymond Babbitt, in the 1988 film, "
There are also people who were diagnosed with autism as a child but may actually have Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS). Dr. Temple Grandin, a professor of Animal Science at