As Todd moved toward his second birthday, his parents became increasingly concerned that something might be wrong. Todd did not seem to be developing the same skills that many of the other children his age were showing. He seemed to have great difficulty getting along with others, communicating effectively and playing imaginatively. After taking Todd to his pediatrician and having him tested by a psychologist, it became apparent that Todd was suffering from autism.
Autism is a very complicated developmental disorder, and children diagnosed with autism usually show symptoms by the age of 3. Its most notable symptom is impairment in the brain's development, which results in difficulty with communication and social skills. These symptoms are evidenced by impaired social interaction, problems processing sensory information, difficulty with both verbal and nonverbal communication, and the presence of repetitive motor movements and stereotyped patterns of behavior.
A child with autism may show difficulty making eye contact or using language to communicate. He may avoid interacting with people and have trouble showing empathy or understanding for others. He may repeat memorized phrases such as commercials and use hand gestures rather than words to communicate. He may have trouble making friends and show aggression if pressured to do something he doesn't want to do. He may have a heightened or lowered sensitivity to sight, sound, touch and taste, such as covering his ears and screaming when normal noises are present. He also may show a short attention span, repetitive motor movements and an unusual preoccupation or obsession with a specific interest.
These symptoms can occur along a continuum of severity and life impairment, which has led to the newer term "autistic spectrum disorders." Once called childhood or infantile autism, the disorder is now recognized as occurring in varying forms. Autistic characteristics can be very mild, as in Asperger syndrome and pervasive developmental disorder, or, at the other end of the continuum, they can express themselves as full-blown autism.
It is estimated that approximately 8.7 per 10,000 children have autism, while some 1 in 300 children have a milder form with some but not all the symptomspresent. Interestingly, the disorder occurs in males at greater than a 3-to-1 ratio over females. Otherwise, autism seems to be an equal opportunity disorder, as it does not appear to be associated with family income, geographic location, race, culture or lifestyle.
Just as the symptoms can vary in severity, so can the degree of life impairment. Autism is considered a lifelong disorder that has no cure at this point. In mild cases, individuals can eventually live independently and even work in some capacity. In severe cases the patient is fully disabled and requires lifelong supervision and support.
It is believed that autism is a physical or biological condition that expresses itself socially and emotionally. While the exact cause of autism is not known, research seems to be closing in on its origins. While there are a number of speculations regarding environmental causes - such as mercury or lead poisoning, exposure to certain vaccines, food allergies and even yeast build up - none of them have been proven.
Current theory holds that no single factor causes autism, but that it results from a combination of biological and chemical problems in brain functioning. Studies of autistic individuals have found neurological differences such as lower amounts of dendrite branching and density. Also, there is evidence that autism has a genetic component, since identical twins are much more likely to both have the disorder than fraternal twins or siblings. In addition, there is some evidence of higher rates of chromosomal abnormalities and other types of neurological problems running in families with autism.
While the condition cannot be cured, an early and aggressive treatment intervention can greatly improve the prognosis and the level of functioning. Psychologists have successfully applied a program known as Applied Behavioral Analysis (ABA) to target specific skills with reinforced practice in order to increase the individual's success in a variety of areas such as toilet training, eating behaviors and self-regulation.
Schools also have developed a program known as the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), which teaches children to organize and structure their environments and learn through alternative mediums such as pictures and visual cues. Unfortunately, the program is highly specialized and expensive, and is not yet widely available.
These approaches can be enhanced with use of physical therapy, occupational therapy, nutritional therapy and medication. Physical therapy attempts to improve muscle coordination and sensory integration, while occupational therapy tries to teach important skills for day-to-day living. Nutritional therapy may find and eliminate certain food allergies, such as gluten, that exacerbate the symptoms, while medications like resperidone can help calm aggressive behavior or tantrums.
Families with an autistic child can be highly stressed. It is a difficult and challenging job to raise an autistic child or to care for a disabled autistic adult. In addition to counseling, there are a number of support groups available to help. To get information on local groups, contact the Bethesda-based Autism Society of America at 301-657-0881 or online at www.autism-society.org.
Dr. Scott E. Smith is a licensed clinical psychologist with Spectrum Behavioral Health in Annapolis and Arnold. For services or ideas regarding this column, call 410-757-2077 or write to 1509 Ritchie Highway, Suite F, Arnold, MD 21012.
