Autism

Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior. Autistic disorder, sometimes called autism or classical ASD, is the most severe form of ASD, while other conditions along the spectrum include a milder form known as Asperger syndrome, and childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Although ASD varies significantly in character and severity, it occurs in all ethnic and socioeconomic groups and affects every age group. Experts estimate that six children out of every 1,000 will have an ASD. Males are four times more likely to have an ASD than females.

Causes, incidence, and risk factors

Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism.

Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism. Similarly, language abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other nervous system (neurological) problems are also more common in families with autism.

A number of other possible causes have been suspected, but not proven. They involve:

Diet

Digestive tract changes

Mercury poisoning

The body's inability to properly use vitamins and minerals

Vaccine sensitivity

Core symptoms
The severity of symptoms varies greatly, but all people with autism have some core symptoms in the areas of:

Social interactions and relationships.
Symptoms may include:
Significant problems developing nonverbal communication skills, such as eye-to-eye gazing, facial expressions, and body posture.
Failure to establish friendships with children the same age.
Lack of interest in sharing enjoyment, interests, or achievements with other people.
Lack of empathy. People with autism may have difficulty understanding another person's feelings, such as pain or sorrow.

Verbal and nonverbal communication.
Symptoms may include:
Delay in, or lack of, learning to talk. As many as 40% of people with autism never speak.
Problems taking steps to start a conversation. Also, people with autism have difficulties continuing a conversation after it has begun.

Stereotyped and repetitive use of language.
People with autism often repeat over and over a phrase they have heard previously (echolalia).
Difficulty understanding their listener's perspective. For example, a person with autism may not understand that someone is using humor. They may interpret the communication word for word and fail to catch the implied meaning.
Limited interests in activities or play. Symptoms may include:
An unusual focus on pieces. Younger children with autism often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy.
Preoccupation with certain topics. For example, older children and adults may be fascinated by video games, trading cards, or license plates.
A need for sameness and routines. For example, a child with autism may always need to eat bread before salad and insist on driving the same route every day to school.

Signs and tests

All children should have routine developmental exams done by their pediatrician. Further testing may be needed if the doctor or parents are concerned. This is particularly true if a child fails to meet any of the following language milestones:

Babbling by 12 months

Gesturing (pointing, waving bye-bye) by 12 months

Saying single words by 16 months

Saying two-word spontaneous phrases by 24 months (not just echoing)

Losing any language or social skills at any age

These children might receive a hearing evaluation, blood lead test, and screening test for autism (such as the Checklist for Autism in Toddlers [CHAT] or the Autism Screening Questionnaire).

A health care provider experienced in diagnosing and treating autism is usually needed to make the actual diagnosis. Because there is no biological test for autism, the diagnosis will often be based on very specific criteria from a book called the Diagnostic and Statistical Manual IV.

An evaluation of autism will often include a complete physical and nervous system (neurologic) examination. It may also include a specific screening tool, such as:

Autism Diagnostic Interview - Revised (ADI-R)

Autism Diagnostic Observation Schedule (ADOS)

Childhood Autism rating Scale (CARS)

Gilliam Autism Rating Scale

Pervasive Developmental Disorders Screening Test - Stage 3

Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and may have metabolic testing.

Autism includes a broad spectrum of symptoms. Therefore, a single, brief evaluation cannot predict a child's true abilities. Ideally, a team of different specialists will evaluate the child. They might evaluate:

Communication

Language

Motor skills

Speech

Success at school

Thinking abilities

Sometimes people are reluctant to have a child diagnosed because of concerns about labeling the child. However, without a diagnosis the child may not get the necessary treatment and services.

How is autism treated?

There is no cure for ASDs. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children. Most health care professionals agree that the earlier the intervention, the better.

Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as Applied Behavioral Analysis. Family counseling for the parents and siblings of children with an ASD often helps families cope with the particular challenges of living with a child with an ASD.

Medications: Doctors may prescribe medications for treatment of specific autism-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.

Other therapies: There are a number of controversial therapies or interventions available, but few, if any, are supported by scientific studies. Parents should use caution before adopting any unproven treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child’s nutritional status is carefully followed.

Homeopathic Treatment

Medicines are often used to treat behavior or emotional problems that people with autism may have, including:

Aggression

Anxiety

Attention problems

Extreme compulsions that the child cannot stop

Hyperactivity

Impulsiveness

Irritability

Mood swings

Outbursts

Sleep difficulty

Tantrums


DIET

Some children with autism appear to respond to a gluten-free or casein-free diet. Gluten is found in foods containing wheat, rye, and barley. Casein is found in milk, cheese, and other dairy products. Not all experts agree that dietary changes will make a difference, and not all studies of this method have shown positive results.

If you are considering these or other dietary changes, talk to both a doctor who specializes in the digestive system (gastroenterologist) and a registered dietitian. You want to be sure that the child is still receiving enough calories, nutrients, and Ta balanced diet.


References

www.ncbi.nlm.nih.gov
http://www.webmd.com/brain/autism/autism-symptoms
http://www.autism.org.uk/about-autism/autism-and-asperger-syndrome-an-introduction/what-is-autism.aspx