Friday, 28 October 2011

Autism Spectrum Disorders

Autism - 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.1
    • 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.
    • Stereotyped behaviors. These may include body rocking and hand flapping.

Symptoms during childhood

Symptoms of autism are usually noticed first by parents and other caregivers sometime during the child's first 3 years. Although autism is present at birth (congenital), signs of the disorder can be difficult to identify or diagnose during infancy. Parents often become concerned when their toddler does not like to be held; does not seem interested in playing certain games, such as peekaboo; and does not begin to talk. Sometimes, a child will start to talk at the same time as other children the same age, then lose his or her language skills. They also may be confused about their child's hearing abilities. It often seems that a child with autism does not hear, yet at other times, he or she may appear to hear a distant background noise, such as the whistle of a train.
With early and intensive treatment, most children improve their ability to relate to others, communicate, and help themselves as they grow older. Contrary to popular myths about children with autism, very few are completely socially isolated or "live in a world of their own."

Symptoms during teen years

During the teen years, the patterns of behavior often change. Many teens gain skills but still lag behind in their ability to relate to and understand others. Puberty and emerging sexuality may be more difficult for teens who have autism than for others this age. Teens are at an increased risk for developing problems related to depression, anxiety, and epilepsy.

Symptoms in adulthood

Some adults with autism are able to work and live on their own. The degree to which an adult with autism can lead an independent life is related to intelligence and ability to communicate. At least 33% are able to achieve at least partial independence.2
Some adults with autism need a lot of assistance, especially those with low intelligence who are unable to speak. Part- or full-time supervision can be provided by residential treatment programs. At the other end of the spectrum, adults with high-functioning autism are often successful in their professions and able to live independently, although they typically continue to have some difficulties relating to other people. These individuals usually have average to above-average intelligence.

Other symptoms

Many people with autism have symptoms similar to attention deficit hyperactivity disorder (ADHD). But these symptoms, especially problems with social relationships, are more severe for people with autism. For more information, see the topic Attention Deficit Hyperactivity Disorder.
About 10% of people with autism have some form of savant skills-special limited gifts such as memorizing lists, calculating calendar dates, drawing, or musical ability.1
Many people with autism have unusual sensory perceptions. For example, they may describe a light touch as painful and deep pressure as providing a calming feeling. Others may not feel pain at all. Some people with autism have strong food likes and dislikes and unusual preoccupations.
Sleep problems occur in about 40% to 70% of people with autism.3

Other conditions

Autism is one of several types of pervasive developmental disorders (PDDs), also called autism spectrum disorders (ASD). It is not unusual for autism to be confused with other PDDs, such as Asperger's disorder or syndrome, or to have overlapping symptoms. A similar condition is called pervasive developmental disorder-NOS (not otherwise specified). PDD-NOS occurs when children display similar behaviors but do not meet the criteria for autism. Also, other conditions with similar symptoms may also have similarities to or occur with autism.


What is autism?

Autism is a brain disorder that often makes it hard to communicate with and relate to others. With autism, the different areas of the brain fail to work together.
Most people with autism will always have some trouble relating to others. But early diagnosis and treatment have helped more and more people who have autism to reach their full potential.

What causes autism?

Autism tends to run in families, so experts think it may be something that you inherit. Scientists are trying to find out exactly which genes may be responsible for passing down autism in families.
Other studies are looking at whether autism can be caused by other medical problems or by something in your child’s surroundings.
Some people think that childhood vaccines cause autism, especially the measles-mumps-rubella, or MMR, vaccine. But studies have not shown this to be true. It’s important to make sure that your child gets all childhood vaccines. They help keep your child from getting serious diseases that can cause harm or even death.

What are the symptoms?

Symptoms almost always start before a child is 3 years old. Usually, parents first notice that their toddler has not started talking yet and is not acting like other children the same age. But it is not unusual for a child to start to talk at the same time as other children the same age, then lose his or her language skills.
Symptoms of autism include:
  • A delay in learning to talk, or not talking at all. A child may seem to be deaf, even though hearing tests are normal.
  • Repeated and overused types of behavior, interests, and play. Examples include repeated body rocking, unusual attachments to objects, and getting very upset when routines change.
There is no "typical" person with autism. People can have many different kinds of behaviors, from mild to severe. Parents often say that their child with autism prefers to play alone and does not make eye contact with other people.
Autism may also include other problems:
  • Many children have below-normal intelligence.
  • Teenagers often become depressed and have a lot of anxiety, especially if they have average or above-average intelligence.
  • Some children get a seizure disorder such as epilepsy by their teen years.

How is autism diagnosed?

There are guidelines your doctor will use to see if your child has symptoms of autism. The guidelines put symptoms into three categories:
  • Social interactions and relationships. For example, a child may have trouble making eye contact. People with autism may have a hard time understanding someone else’s feelings, such as pain or sadness.
  • Verbal and nonverbal communication. For example, a child may never speak. Or he or she may often repeat a certain phrase over and over.
  • Limited interests in activities or play. For example, younger children often focus on parts of toys rather than playing with the whole toy. Older children and adults may be fascinated by certain topics, like trading cards or license plates.
Your child may also have a hearing test and some other tests to make sure that problems are not caused by some other condition.

How is it treated?

Treatment for autism involves special behavioral training. Behavioral training rewards good behavior (positive reinforcement) to teach children social skills and to teach them how to communicate and how to help themselves as they grow older.
With early treatment, most children with autism learn to relate better to others. They learn to communicate and to help themselves as they grow older.
Depending on the child, treatment may also include such things as speech therapy or physical therapy. Medicine is sometimes used to treat problems such as depression or obsessive-compulsive behaviors.
Exactly what type of treatment your child needs depends on the symptoms, which are different for each child and may change over time. Because people with autism are so different, something that helps one person may not help another. So be sure to work with everyone involved in your child’s education and care to find the best way to manage symptoms.

How can your family deal with having a child with autism?

An important part of your child's treatment plan is making sure that other family members get training about autism and how to manage symptoms. Training can reduce family stress and help your child function better. Some families need more help than others.
Take advantage of every kind of help you can find. Talk to your doctor about what help is available where you live. Family, friends, public agencies, and autism organizations are all possible resources.
Remember these tips:
  • Plan breaks. Daily demands of caring for a child with autism can take their toll. Planned breaks will help the whole family.
  • Get extra help when your child gets older. The teen years can be a very hard time for children with autism.
  • Get in touch with other families who have children with autism. You can talk about your problems and share advice with people who will understand.
Raising a child with autism is hard work. But with support and training, your family can learn how to cope.

High-Functioning Autism and Asperger's Syndrome

Autism is a brain disorder in which communication and interaction with others is difficult. The symptoms of autism may range from total lack of communication with others to difficulty in understanding others' feelings. Because of the range of symptoms, this condition is now called a utism spectrum disorder (ASD).
High-functioning autism is at one end of the ASD spectrum. Signs and symptoms are less severe than with other forms of autism. In fact, a person with high-functioning autism usually has average or above average intelligence. The differences from other forms of autism have led many psychiatrists to consider high-functioning autism as similar to or the same as Asperger's syndrome.
Whether it's labeled high-functioning autism or Asperger's syndrome, coping with this condition presents daily challenges -- for those who have it and for their family and friends.

What Are the Symptoms of High-Functioning Autism, Asperger's Syndrome?

People with high-functioning autism or Asperger's syndrome do not have the delayed language development that's typically found in people with autism. In addition, people with high-functioning autism have average or above average intelligence. However, they may show other behaviors and signs similar to what's seen with other types of autism:
  • delay in motor skills
  • lack of skill in interacting with others
  • little understanding of the abstract uses of language, such as humor or give-and-take in a conversation
  • obsessive interest in specific items or information
  • strong reactions to textures, smells, sounds, sights, or other stimuli that others might not even notice, such as a flickering light
Unlike people with other forms of autism, people with high-functioning autism or Asperger's syndrome want to be involved with others. They simply don't know how to go about it. They may not be able to understand others' emotions. They may not read facial expressions or body language well. As a result, they may be teased and often feel like social outcasts. The unwanted social isolation can lead to anxiety and depression.

Causes of High-Functioning Autism, Asperger's Syndrome

Autism runs in families. The underlying causes, however, are not known. Potential causes under investigation include:
  • inherited genetic conditions
  • other medical problems
  • environmental factors

Diagnosing High-Functioning Autism, Asperger's Syndrome

Children with high-functioning autism or Asperger's syndrome may not be diagnosed as early as children with more severe forms of autism. That's because the symptoms aren't as noticeable. Symptoms may not become a problem until a child is in school. A diagnosis is based on the doctor's assessment of the child's symptoms in three areas:
  • social interactions -- symptoms such as lack of eye contact or an inability to understand another person's feelings
  • verbal and non-verbal communication -- symptoms such as not speaking or repeating a phrase over and over again
  • interests in activities, objects, or specialized information -- symptoms such as playing with only a part of a toy or being obsessed with a particular topic
The doctor may gather information about these areas in several ways:
  • conducting psychological testing
  • establishing the history of the child's development
  • interviewing parents and others who have frequent contact with the child
  • observing the child's behavior
  • requesting physical, neurological, or genetic testing
  • seeking a speech and language assessment
In addition, the doctor may request tests to rule out other causes of the behavior, such as hearing problems.

Treating High-Functioning Autism, Asperger's Syndrome

High-functioning autism and Asperger's syndrome can be treated with a variety of therapies. Behavior training is the primary method used to help people with high-functioning autism overcome problems with social interaction.
Applied behavior analysis (ABA) is a method of rewarding appropriate social behavior and communication skills. This method is based on the theory that rewarding behavior encourages it to continue.
Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is a structured way of teaching communication and coping skills. The system uses the child's strengths in memorization and visual skills.
In addition, other treatments may be recommended. These will be based on the child's needs:
  • medications to treat obsessive behaviors or depression
  • physical or occupational therapy for assistance with motor skills
  • speech and language therapy to help with communication and language development

Living With High-Functioning Autism, Asperger's Syndrome

High-functioning autism and Asperger's syndrome present ongoing challenges from childhood through adulthood.
In children. Young children may have problems at school in areas of behavior and communication. Because the focus in early grades is often on memorization of facts, they may do well academically.
In older children and teens. As children grow older, a lack of social skills and the presence of obsessive interests or behaviors may put the child in the position of being teased. Forming new friendships may become increasingly difficult.
In adults. It may be difficult to live independently as an adult. Work and personal relationships may be hard to establish and maintain.

How Loved Ones Can Help

Family and friends can help if they understand what high-functioning autism is and know the symptoms and treatments associated with the disorder.

How Loved Ones Can Help continued...

Family members can advocate for a child with high-functioning autism or Asperger's by being sure that the child receives medical treatment and any other services available. For example, the federal Individuals with Disabilities Education Improvement Act (IDEIA) requires that students with a disability be provided a free and appropriate education, which may include special services.
Other services that may be helpful include:
  • counseling to assist with behavior therapy and coping skills
  • finding a buddy or mentor who can give informal advice on social and communication challenges as they arise
  • occupational therapy for any motor problems that affect daily activities
  • speech and language therapy to address language and communications challenges
In addition, family and friends may want to seek out help and support from counselors or others who are also dealing with children who have high-functioning autism or Asperger's syndrome. Many online information and support groups are available.
Many individuals with high-functioning autism or Asperger's syndrome have found support in groups like The Global and Regional Autism Spectrum Partnership (GRASP). GRASP's members and leadership are drawn from people with some form of autism or Asperger's syndrome. Organizations such as GRASP give hope that while challenges are many, people with high-functioning autism can lead healthy, fulfilling lives.

Autism Spectrum Disorders

The forms of autism are thought to overlap considerably. But the fact that there is wide variation in symptoms among children with autism led to the concept of autism spectrum disorder.
Autism seems to be on the rise, and autism spectrum disorders affect between two and six children out of every 1,000 in the U.S. It's unclear, though, whether the growing incidence of autism represents a real increase or just improved detection.
Early diagnosis of an autism spectrum disorder is important. That's because detection leads to treatment, and with early treatment, a child with autism can gain improved language and social skills.

Signs of Autism Spectrum Disorder

Autism spectrum disorders affect three different areas of a child's life:
  • social interaction
  • communication (nonverbal and/or verbal)
  • repetitive behaviors or interests
Each child with an autism spectrum disorder will have his or her own individual pattern of autism. Sometimes, a child's development is delayed from birth. Other children with autism develop normally before suddenly losing social or language skills. In some children, a loss of language is the impairment. In others, unusual behaviors (like spending hours lining up toys) predominate.
Parents are usually the first to notice something is wrong. However, the diagnosis of autism is often delayed. The parents or a physician often downplay early signs of autism. They may optimistically suggest "it's just a phase" or a trivial delay in development. Children with a suspected autism spectrum disorder should be evaluated by a professional team with experience in diagnosing autism.
There are three main types of autism spectrum disorder, and two rare, severe autistic-like conditions:
  • Asperger's syndrome
  • pervasive developmental disorder, not otherwise specified (PDD-NOS)
  • autistic disorder
  • Rett's syndrome
  • childhood disintegrative disorder

Asperger's Syndrome

The mildest form of autism, Asperger's syndrome affects boys three times more often than girls. Children with Asperger's syndrome become obsessively interested in a single object or topic. They often learn all about their preferred subject, and discuss it nonstop. Their social skills are markedly impaired, though. They are often awkward and uncoordinated physically.
Because Asperger's syndrome is mild compared to other autism spectrum disorders, some doctors call it "high-functioning autism." As children with Asperger's syndrome enter young adulthood, though, they are at high risk for anxiety and depression.

Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

This mouthful of a diagnosis applies to most children with autistic spectrum disorder. Children whose autism is more severe than Asperger's syndrome but not as severe as autistic disorder are diagnosed with PDD-NOS.
Autism symptoms in kids with PDD-NOS vary widely, making it hard to generalize. Overall, compared to children with other autistic spectrum disorders, children with PDD-NOS have:
  • impaired social interaction -- like all children with autistic spectrum disorder
  • better language skills than kids with autistic disorder, but not as good as those with Asperger's syndrome
  • fewer repetitive behaviors than children with Asperger's syndrome or autistic disorder
  • a later age of onset
However, no two children with PDD-NOS are exactly alike in their symptoms. In fact, there are no agreed-upon criteria for diagnosing PDD-NOS. In effect, if a child seems autistic to professional evaluators but doesn't meet all the criteria for autistic disorder, he or she has PDD-NOS.

Autistic Disorder

Children who meet more rigid criteria for a diagnosis of autism have autistic disorder. They have more severe impairments involving social and language functioning, as well as repetitive behaviors. Often, they have mental retardation and seizures as well.
There are two rare, severe forms of autistic spectrum disorder that are considered separately from the others: Rett's syndrome and childhood disintegrative disorder.

Rett's Syndrome

Almost exclusively affecting girls, Rett's syndrome is rare. About one in 10,000 to 15,000 girls develop this severe form of autism. Between 6 and 18 months of age, a little girl stops responding socially, wrings her hands habitually, and loses language skills. Coordination problems appear and can become severe.
Rett's syndrome is usually caused by a genetic mutation. The mutation usually occurs randomly, rather than being inherited. Treatment focuses on physical therapy and speech therapy to improve function.

Childhood Disintegrative Disorder

The most severe autistic spectrum disorder, childhood disintegrative disorder (CDD), is also the least common.
After a period of normal development, usually between age 2 and 4, a child with CDD rapidly loses multiple areas of function. Social and language skills are lost, as well as intellectual abilities. Often, the child develops a seizure disorder. Children with childhood disintegrative disorder are severely impaired and don't recover their lost function.
Fewer than two children per 100,000 with an autistic spectrum disorder meet criteria for childhood disintegrative disorder. Boys are affected by CDD more often than girls.

Autism - Treatment

Early diagnosis and treatment helps young children with autism develop to their full potential. The primary goal of treatment is to improve the overall ability of the child to function.
Symptoms and behaviors of autism can combine in many ways and vary in severity. Also, individual symptoms and behaviors often change over time. For these reasons, treatment strategies are tailored to individual needs and available family resources. But in general children with autism respond best to highly structured and specialized treatment. A program that addresses helping parents and improving communication, social, behavioral, adaptive, and learning aspects of a child's life will be most successful.
The American Academy of Pediatrics (AAP) recommends the following strategies for helping a child to improve overall function and reach his or her potential:5
  • Behavioral training and management . Behavioral training and management uses positive reinforcement, self-help, and social skills training to improve behavior and communication. Many types of treatments have been developed, including Applied Behavioral Analysis (ABA), Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), and sensory integration.
  • Specialized therapies. These include speech, occupational, and physical therapy. These therapies are important components of managing autism and should all be included in various aspects of the child's treatment program. Speech therapy can help a child with autism improve language and social skills to communicate more effectively. Occupational and physical therapy can help improve any deficiencies in coordination and motor skills. Occupational therapy may also help a child with autism to learn to process information from the senses (sight, sound, hearing, touch, and smell) in more manageable ways.
  • Medicines . Medicines are most commonly used to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.
  • Community support and parent training . Talk to your doctor or contact an advocacy group for support and training.
Many people with autism have sleep problems. These are usually treated by staying on a routine, including a set bedtime and time to get up. Your doctor may try medicines as a last resort.3
Stories about alternative therapies, such as secretin and auditory integration training, have circulated in the media and other information sources. When you are thinking about any type of treatment, find out about the source of the information and about whether the studies are scientifically sound. Accounts of individual success are not sufficient evidence to support using a treatment. Look for large, controlled studies to validate claims.
Experts have not yet identified a way to prevent autism. Public concern over stories linking autism and childhood vaccines has persisted. But numerous studies have failed to show any evidence of a link between autism and the measles-mumps-rubella (MMR) vaccine.6, 7 If you avoid having your children immunized, you put them and others in your community at risk for developing serious diseases, which can cause serious harm or even death.

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