Autism: Causes, Symptoms and Treatment
Autism is a disorder of the brain characterized by difficulty communicating and socializing with others. Some patients may also have difficulty thinking and feeling. Approximately 1.5% of children in the US have some form of autism. The first signs of autism may occur by the time a child is 1.5 years old, although the disorder is usually not formally diagnosed until 2 or 3 years of age. Some children may progress normally for the first year or two of their life before regressing and displaying the symptoms.
Autism belongs to the group of conditions called pervasive developmental disorders, also including Asperger’s syndrome, childhood disintegrative disorder, Rett syndrome and pervasive developmental disorder not otherwise specified. All these conditions involve problems with social skills, but each of them has different symptoms.
Many patients with autism (up to 70%) also have mental retardation. However, some autistic patients have normal or even above average intelligence despite their difficulties communicating and applying knowledge to everyday life situations. In addition, a small number of patients are classified as “autistic savants” (i.e., having exceptional skills in one area of life).
Although autism is 3-4 times more common in boys than girls, girls with this disorder tend to have more intense symptoms and greater cognitive impairment than boys. The incidence of autism appears to be increasing in the developed world, which is more likely a result of improved diagnostic techniques rather than increasing prevalence.
Children with autism usually need to attend specially structured classes that meet their specific needs. Some patients may experience improvement in their condition as they grow older, allowing them to live normal lives. However, other patients with autism may actually experience a worsening of their condition during adolescence.
Causes of Autism
Autism does not have just one single cause, but instead, it is likely to be the result of abnormalities in several different areas of the brain. The causes of these abnormalities are not well understood. However, genetic factors appear to be at least partially responsible for autism as 5% of siblings of autistic children also have this disorder. Children who have fragile X syndrome, untreated phenylketonuria, tuberous sclerosis and congenital rubella syndrome seem to be at increased risk for also having autism. One controversial theory has it that autism is caused by autoimmune reactions that damage the brain cells in young children. Another unlikely theory links autism with abnormal timing of the brain growth in young children. Also, speculations of a possible link between autism and some vaccines or their ingredients appear to be unfounded.
Symptoms of Autism
The first symptoms of autism usually become apparent by the time a child is 1.5 years old. Most children with autism may appear to develop normally before symptoms emerge. Autistic symptoms may vary dramatically between patients, ranging from mild to severe. Patients with below-average intelligence levels are said to have low-functioning autism, while those with average to above-average intelligence are said to have high-functioning autism.
Patients with autism tend to communicate poorly and may have difficulty making friends. Therefore, they spend a lot of time alone, typically focusing on a narrow range of interests. Some patients have serious impairment in cognition (and therefore learning difficulties) and may experience delays in language development. Some may never speak at all. The eating disorder pica, in which kids (ages 1-6) consume various objects with no nutritional value, is more common among autistic children than those without the disorder.
Patients with autism often ignore the presence of others or some may lash out at others in unprovoked physical attacks. They may also experience increased sensory sensitivity (i.e., lights are brighter, sounds are louder and smells are stronger). As a result, they may be easily startled or may pull back when others try to hug them. Some patients may harm themselves or display repetitive behavior (e.g., rocking back and forth or spinning in circles) and can be overly concerned with order. In addition, about one-third of autistic children experience seizures.
The following signs in the child’s behavior may indicate autism.
- Appears not to hear at times
- Begins speaking later than other kids
- Failure to respond when name is called
- Impairment in nonverbal behaviors, e.g., poor eye contact, odd facial expressions, body postures and other gestures
- Lack of awareness of others’ feelings
- Physically and verbally rejects cuddling and holding
- Prefers to play alone
- Engages in repetitive movements
- Fascination with parts of an object such as spinning wheels on a car
- Performs non-functional routines and rituals, while reacting negatively to slightest change in these routines and rituals
- Sensitive to sound, light, touch and other sensory stimuli
- Absence or delay in spoken-language development
- Masters words and sentences, then later forgets how to say them
- Repeats words, but does not appear to understand them
- Struggles to start or maintain conversations
- Uses abnormal tone or rhythm in speech
Autism is often associated with other mental health disorders, including attention deficit hyperactivity disorder (ADHD), anxiety disorders, depression, psychosis and obsessive compulsive disorder (OCD).
While patients with autism may appear cold and unapproachable, they also experience emotions and feel affection for others. They just express these feelings differently than people who do not have the disorder.
Since each case of autism is unique, there are no standard rules about when autism may first be suspected in a child. However, if the child does not appear to be developing normally by the age of 1.5 years, parents may become concerned enough to consult a doctor. The doctor may suspect autism if the child fails to babble, coo or gesture (such as waving or pointing) by the age of 12 months. Children who fail to say single words by 16 months or two-word phrases by 24 months or lose their formerly-held language skills at any age also elicit concern and may need to be screened for autism.
A team of specialists with expertise in treating autism (including psychologists, psychiatrists, neurologists, developmental pediatricians and speech therapists) will have to be involved in making a diagnosis. Speech, language and psychological testing may need to be performed. Autistic children usually perform poorly on tests of joint attention. In this test of social skill, two people simultaneously look at an object or watch an event. The ability to point at an object or to follow another person’s gaze is a major indicator of developing language and social skills. The currently used diagnostic criteria for autism can be found here. Other developmental disorders with similar characteristics (e.g., Asperger’s or Rett syndrome) must be ruled out before autism can be diagnosed.
Treatment of Autism
Autism cannot be cured because it is a disorder rather than a disease. However, treatment can help the patient to better cope with the disorder and associated conditions. Individualized education programs can help autistic children to improve patterns of speech and learning and teach them basic living skills. Behavioral therapies may help patients reduce problem behaviors while learning new social skills. Other possible treatments include speech, physical and occupational therapy. Some patients with autism may also benefit from alternative treatments such as art or music therapy and sensory integration therapy, the aim of which is to reduce hypersensitivity to sound or touch.
Although medications cannot treat the core symptoms of autism, they can help control related behaviors in some patients. For instance, antidepressants can be used to control repetitive behaviors, stimulant drugs can be used to treat hyperactivity and anticonvulsants can be used to treat seizures. Some medications may only be used to treat symptoms of autism in adults (but not in children), including antidepressant and antipsychotic drugs.
Parents can help their children to better cope with autism by providing structure to the child’s day and by providing love and support. Support groups may provide parent training. Some autistic children may experience improvement in their development at later stages. Nonetheless, many patients will still require support from their parents or caregivers and society for the rest of their lives.