About 500,000 Americans currently have some form of autism, making it the third most common developmental disability. Autism knows no racial, ethnic or social boundaries, and it is 2.6 to 4.0 times more prevalent in boys than in girls. If a family already has one autistic child, the risk of a second child developing the same disorder is 2.5% to 3.0%. Since this is 50 to 100 times the rate seen in the general population, it lends some support to a genetic (inherited) basis for the disorder.

Symptoms

The first signs of autism may appear in infants who display abnormal responses to being touched. Instead of cuddling when they are picked up, they may stiffen or go limp. They also do not display typical developmental behaviors common during the first year of life, such as: smiling at the sound of their mother's voice; pointing out objects to catch someone's attention; reaching out to others with their hands; or attempting one-syllable conversations. The child may not maintain eye contact, and he may appear unable to distinguish his parents from strangers. It is usually not until the child is 2 or 3 years old that the parents realize something is wrong. By that age, the toddler shows little interest in others.

Some behavioral clues to the presence of autism include:

• Disordered Play
-An autistic toddler usually prefers to play alone. He may spend hours repeatedly laying out objects in lines or sitting silently in an apparent trance-like state. He may concentrate on only one object or topic, and any attempt to have him switch to another can provoke an emotional crisis. Also, young children with autism are typically unable to engage in make-believe play.
• Disordered Speech
- An autistic child may speak infrequently or remain totally silent. When the child does speak, he may echo the words of another person, or his speech pattern may be significantly disordered. For example, the child may say, "Do you want a sandwich?" when he means, "I want a sandwich."
• Repetitive Behaviors
- The autistic child may engage in repetitive behavior such as saying the same phrase, or making the same motion, over and over again. Repetitive movements such as clapping, finger snapping, rocking, swaying and hand-flapping are also common.

Some autistic children may also become hyperactive, aggressive, destructive or impulsive. Others may intentionally injure themselves.

What your doctor looks for

Your doctor will ask you about your child's behavior, including signs of: aloofness; discomfort at being touched; or delays in typical developmental behaviors (smiling, pointing to objects, attempting one-syllable "communication" with others). Your doctor will also ask specific questions about the speech abnormalities and repetitive behaviors outlined above (see Symptoms).

Diagnosis

There are no physical tests for autistic disorders. Your doctor will make the diagnosis based on your child's developmental history, observations of your child's behavior (alone and with others), and the results of tests that evaluate your child's language skills, motor coordination, hearing, and vision. To rule out the possibility that your child's behavior is due to a physical or physiological disorder, such as epilepsy (a brain disorder that produces seizures ), the doctor may order an electroencephalogram (EEG). The EEG is a painless recording of the brain's electrical activity or "brain waves."

Depending on your child's presentation, other medical tests, such as a brain scan, may be considered. Blood and urine tests to rule out metabolic disorders ("chemical imbalance") may also be used.

Diagnosing autism is difficult. The final diagnosis is usually made only after a child has been examined by a team of psychiatrists, psychologists, speech pathologists, educational specialists and medical doctors.

Expected duration

Autism is a life-long condition.

Prevention

Since the cause or causes of this disorder remain unknown, there is currently no way to prevent it.

Treatment

Currently, there is no curative treatment for autistic disorders. However, a child's symptoms may improve after a multi-treatment approach involving:

• Education
- Educators will develop an individualized education program (IEP) to address the child's specific educational problems. This typically includes speech and language therapy.
• Behavioral management
- Behavior modification strategies include positive reinforcement (rewarding "good" behavior) and "time-outs." The goal is to enhance appropriate behavior and reduce inappropriate behaviors (such as inflicting injury to one's self).
• Medications
- No single drug has been able to treat all symptoms of autism effectively. In some children, antipsychotic medications (thioridazine, chlorpromazine, mesoridazine, haloperidol) have reduced some of the symptoms associated with autism, such as aggression, irritability and repetitive behavior. However, these medications have also been associated with unpleasant side effects, such as involuntary muscle movements and mild sedation. To limit side effects, the doctor may order a treatment-free "drug holiday" every six months. Medications such as fluoxetine and clomipramine may be affective in reducing repetitive and other anxiety-related behavior. Other medications used to treat specific symptoms of autism include naltrexone, methylphenidate and clonidine.

When to call your doctor

You should contact your doctor if your toddler shows a consistent pattern of aloofness, short attention span, repetitive speech or actions, or a lack of desire to play with other children. Also, call your doctor promptly if your child repeatedly tries to injure himself.

Prognosis

The disturbed behavior seen in autistic toddlers tends to improve between ages 6 to 10. However, it may re-surface during the teen and young adult years, eventually calming down again in middle and later life. Ultimately, 90% of autistic children fail to become independent as adults. The remaining 10% typically face a lifelong struggle to maintain normal social interactions, communication and behaviors. In a few cases, autistic individuals have earned college degrees, married and found fulfilling employment.

Life expectancy depends on the presence of other conditions (such as epilepsy), as well as the general health of the autistic individual.

Additional info

For more information about autism, you can contact:

National Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814
1-800-3AUTISM
301 657-0881x150
Fax: 301 657-0859
www.autism-society.org

Last updated April 14, 1999
Used with the permission of the copyright owner. All rights reserved.