Autism

Also you can see other web sites:

1. www.behavior.org/autism

2. www.aspergers.com

3. www.asperger.net

4. www.autisminfo.com

5. www.autismlessons.org

6. www.autismspeaks.org

7. www.autismtoday.com

8. www.cdc.gov/ncbddd/autism

9. www.cureautismnow.org

10. www.do2learn.com

11. www.easterseals.com/site/PageServer?pagename=reus_autism_service

12. www.ianproject.org

13. www.kylestreehouse.org

14. www.maapservices.org

15. http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

16. www.udel.edu/bkirby/asperger

17. http://www.talkaboutcuringautism.org/index.htm

http://www.firstsigns.org

It is not caused by thymersol nor the MMR.. see: MMR

They suggest a questionnaire if you think your child 18mo to 3 yr old might have it:  M-Chat

Autism is a subset of a group of developmental disorders known as Pervasive Developmental Disorders (PDD).

PDD is a broad term used to describe a broad spectrum of abnormal behaviors, while the narrower terms like Autistic Disorder, Asperger’s Syndrome, Rett’s Disorder, and Disintegrative Disorder refer to more specific signs and symptoms. The behavioral criteria for each disorder are stipulated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Autism is frequently diagnosed during the preschool years. The presenting symptoms are frequently noticed by parents or preschool teachers. Between the ages of eighteen and thirty-six months, speech delay, absence of speech or loss of words is usually noted. Parents may also be concerned about a lack of reciprocal and imaginative play. That is: Reciprocal play implies an interchange or relationship between persons while engaged in an activity. Young autistic children may run around during a game of tag, but do not seem to understand the idea that the game involves an interaction between the person who is "it" and the other players. Young children with autism do not generally engage in make-believe or "pretend" games. They may play with the toy kitchen by sorting food rather than pretending to cook or eat the food. If another child is playing too, they will not seek to include that child in their activity.

Occasionally, parents of infants with impaired attachment may seek medical attention. Older children may present to their pediatrician with odd speech or unusual behaviors. These include stereotypic behaviors, preservation, detachment(A child who appears detached may isolate herself. Or a child may be described as "being in his own world.") or echolalia(Repeating what someone has just said. For example, "Jason, you are a big boy!" "Big boy," repeats Jason.). Autism persists into adulthood, but the outcome varies. Some adults continue to have severe speech deficits, while others develop adequate communication skills and appear close to normal. Often these adults are described as eccentric, introverted or compulsive.

Symptoms of Autism.  The main symptoms of autism are:

1. severe impairments in social skills
2. deficits in communication
3. a limited repertoire of interests, activities and play

These symptoms may be manifested as follows:

1. Social Skills

Young children diagnosed with autism are frequently described as being independent. They do not ask for assistance with difficult situations. For example a young child may not point to a desired food or toy, but will cry or try to get the object himself. The child may prefer to play alone rather than interact with others.

Contrary to popular belief, children with autism may display affectionate signs such as hugging or kissing. However, these displays usually lack a reciprocal quality. New places or unfamiliar people may create anxiety in autistic children, resulting in crying, tantrums or aggression. Also, large group activities, like circle time or play groups, may be overwhelming.

Older children with autism may have difficulty making friends, because of a lack of social skills. They may be described as shy or aloof. An autistic child may prefer to spend time alone rather than participate in cooperative games. Sports and other physically demanding activities may be difficult, because motor skills are mildly impaired. This usually manifests itself as clumsiness in a child who later becomes known as the "bench warmer" at school.

2. Communication

Expressive language skills are always impaired in children with autism. Some young children with autism may lack speech altogether, while others may have a large vocabulary but lack the communicative intent of language. These children may speak long sentences but their speech is perseverative, filled with jargon, or characterized by echolalia. The autistic child tends not to use language to communicate socially, but merely to get the things he or she needs. Parents may report that their child’s language milestones were on target for the first twelve to eighteen months, and then the child stopped talking. This history of language regression may also mark the time when parents notice abnormal socialization.

Receptive language skills, or comprehension, are always impaired as well. The deficit varies from mild to severe. A child with a mild receptive impairment may have difficulty understanding open-ended questions or jokes. A child with a severe receptive language impairment may be unable to understand language at all.

Non-verbal communication is also abnormal in children with autism. This includes the use of gestures, body posture, eye gaze, and facial expression. Prosody is usually abnormal in children with autism. The child’s speech may sound flat, high-pitched, or machine-like. The communication skills of an autistic child change over time, due to developmental processes and interventions.

3. Play, Interests and Activities

Young children with autism usually do not engage in imaginative play. They may line up toys without awareness as to what the toys represent. Their play is usually restricted to repetition and perseveration. They may line up their toys for hours, or watch the same video over and over again. Stereotypies like hand flapping may also dominate their play, further restricting their range of activities.

Transitioning between activities is often difficult for children with autism, resulting in tantrums or ritualistic behaviors. It is not uncommon for some autistic children to become obsessed with certain objects, television programs or videos. The child may sing or repeat commercials or songs endlessly. For example, they may insist upon holding a small car everywhere they go. Eating may be affected by a limited list of food preferences. For example, the child may refuse all green foods or want only "fast-food." Decreased need for sleep or other sleep irregularities may be particularly difficult for families.

Comorbid Impairments in People with Autism

Patients with autism may show comorbid impairments affecting their cognition, sensory functioning, or attention/activity level. They may also have symptoms of epileptic syndromes.

1. Cognition

About 75% of persons diagnosed with autism are mentally retarded. The severity of their autistic symptoms is directly correlated to their level of cognitive impairment. For example, the more stereotypies, perseveration, and restriction of activities, the lower the IQ. However, one must be cautious in diagnosing mental retardation in young autistic children, since preschool IQ tests are not always predictive of later outcome. Some children improve significantly after exposure to effective language, educational, and behavioral treatments. A few children with autism may have exceptional artistic, mathematical, or memory skills despite significant deficits in other areas. The term savants has been used to describe people with these gifted abilities.

2. Sensory

Many children with autism are hypersensitive to particular sensory stimuli such as light, sound, touch, and smell. Examples of this include hiding or covering the ears when loud noises like the vacuum cleaner are on. Florescent lighting may cause some children to shield their eyes, while some children are fascinated by sparkling visual displays. Tactile hypersensitivity causes some children to rip the tags off their shirts or refuse to wear certain fabrics. Other children must sniff their food before eating.

3. Attention/Activity Level

Attentional skills may be very variable. An autistic child may be able to sustain long periods of fixed attention when playing alone with toys, ie, spend hours lining up matchbox cars. However the same child may be unable to concentrate when involved in an activity that requires interaction with another person. Some children with autism are very hyperactive, further complicating their ability to focus on certain activities.

4. Epilepsy

Approximately one-third of adults with autism will have had a seizure. A few children are diagnosed with autism following infantile spasms or seizures due to Lennox-Gastaut syndrome. However, the risk of seizures increases with age and peaks during adolescence. Children with mental retardation and autism have a higher risk of developing epilepsy.

Treatment of Autism

There is no cure for autism. Treatment should be directed at improving functional language and social skills, while reducing maladaptive behaviors. Pharmacologic interventions may be helpful in reducing targeted symptoms such as hyperactivity.

The standard treatment approach to autism includes a multidisciplinary approach, involving education, speech and language therapy, behavior modification, and sometimes pharmacologic treatment. This approach has been very effective for many children.

There are also many nonstandard treatments that have not been scientifically proven to be effective. One should keep an open mind regarding new treatments and carefully weigh the pros and cons of therapeutic options. Parents are eager to learn more about new treatments, and frequently ask their physician for advice. Many physicians are uncomfortable about discussing alternative approaches. However, physicians must recognize that about 25% of their pediatric patients with chronic diseases are taking nontraditional treatments. The physician can guide the parent without endorsing the treatment in determining whether or not a new treatment is appropriate for their child.

Guidelines and Questions to Ask When Evaluating Treatments of Autism

The following treatments include both standard and nonstandard therapies.

Note: it is important to understand that many nonstandard treatments are targeted at nonspecific symptoms, and their effectiveness is unknown. Despite this, many parents are eager to try anything in the hope of helping their child. Nonstandard treatments are not generally provided by the public education system, nor reimbursed by health insurance companies.

Standard Treatments.   The standard treatments for autism include:

1. Educational Programs
2. Behavioral Modification
3. Language and Communication Therapy
4. Social Skills Training
5. Medication
   

1. Educational Programs

A structured, individualized educational program emphasizing language and behavioral interventions offers the best approach to helping a young autistic child. The program should be geared to the developmental level of the child. For example, if the child has normal intelligence, he may do well while "included" in a classroom with his peers. Special educational services to address the language and social skills deficits can be delivered in the classroom or as pull-out services.

On the other hand, a child with mental retardation and autism should be placed in a class with similarly functioning students. Class size is ideally kept small, with a teacher and an aide trained in the educational and behavioral needs of autistic children. The Individuals with Disabilities Education Act, (IDEA) ensures children with autism, and other disabilities, a free and appropriate public education. The education must be provided in the least restrictive setting and tailored to the unique, individual needs of the child. Ideally, the educational program should be a collaborative effort between the school and parents. Autistic children are eligible for services through their educational system beginning at diagnosis. Parents can contact their local Infant and Toddler or Child Find program.

2. Behavior Modification

The use of behavioral interventions in the treatment of children with autism has been shown to be effective in improving social behaviors, and reducing or eliminating maladaptive behaviors. Since persons with autism vary widely in skills and behavior, it is important that a program be tailored to the individual. A program should be implemented only after a detailed behavioral analysis has been obtained.

A good behavioral program will include methods to increase positive behaviors as well as behavior reduction techniques. Aversive techniques, like water sprays, should be used sparingly and with informed consent. Most schools for children with autism employ persons trained in behavior modification. Parents may wish to consult privately with a psychologist specializing in child behavior.

There has been recent interest in a type of intensive behavior therapy called Lovaas. This program, which is not yet a standard treatment, is described later in this review.

3. Language and Communication Therapy

All autistic children should receive speech and language therapy, since communication deficits are core symptoms of autism. Therapy should begin as early as possible, to improve outcome. Current methods of therapy emphasize improving spontaneous language and maximizing the child’s communication skills. Generalization of acquired communication skills to other settings should be emphasized. Speech and language services at school are provided free through IDEA. Parents may consult privately with a speech and language pathologist. Some insurance companies will pay for these services.

4. Social Skills Training

Programs to increase the development of social competence and social skills for children with a variety of developmental disorders have emerged recently. The goals of a social skills program for autistic children include learning how to act and react in social situations. Basic skills such as maintaining eye contact improve dramatically with treatment. Social skills training should be provided at school, as part of the child’s individualized educational plan. Private services can be obtained by licensed social workers or psychologists.

5. Medication

Psychotropic drugs that target specific symptoms may be very helpful. For example, methylphenidate (Ritalin), may significantly reduce hyperactivity. Serotonin reuptake inhibitors, like fluoxetine (Prozac), may reduce such symptoms as stereotypies, perseveration, and mood swings. Dopamine receptor blockers like haloperidol (Haldol) are prescribed to reduce severe aggression, self-injury and destructive behavior. Well-controlled studies on the long-term effectiveness and adverse sequelae of psychotropic medications in autism are needed.

Nonstandard Treatments.  Some nonstandard treatments for autism are:

1. Lovaas
2. Auditory Integrative Training (AIT)
3. Megavitamins
4. Immune Therapy
5. Secretin
   
   

1. Lovaas

There has been recent interest in a type of intensive behavior therapy called Lovaas, which requires treatment during most of the child’s waking hours. A person trained in the Lovaas program spends forty hours a week working with the child. Although significant improvement has been reported, scientific evidence to establish the effectiveness of this method is lacking. The treatment is costly and intrusive, but many families report remarkable positive results. More information regarding the Lovaas program can be obtained through the University of California Los Angeles (UCLA), Department of Psychology.

2. Auditory Integrative Training (AIT)

This method treats children with a wide range of communication, behavior, learning and emotional disorders. There are a variety of AIT programs around the country, each using a different protocol. Auditory stimuli (music, mother’s voice) are presented via headphones. Treatment hours vary from 10 to 200 depending upon the specific method. There are anecdotal reports of autistic children having less sound sensitivity, better eye contact, increased verbalizations, and improved articulation following AIT treatment. Most AIT practitioners in the U.S. are speech-language pathologists.

3. Megavitamins

Supplemental vitamin B6 and magnesium has been reported to improve autistic symptoms. These are mostly anecdotal reports; controlled, scientific studies are needed to support these claims. The Autism Research Institute in San Diego, CA endorses this treatment and sells a megavitamin product.

Ascorbic Acid (vitamin C) supplementation has been noted to be effective in reducing a number of autistic symptoms. Large, controlled studies are needed to validate these observations.

4. Immune Therapy

A dysregulated immune system has been reported in some children with autism. Researchers have also reported that children with Landau-Kleffner Syndrome an epileptic disorder in which children stop talking and appear autistic improved after a trial of intravenous immunoglobulin (IVIG). The use of immune therapy in autism is the focus of ongoing clinical trials.

5. Secretin

Secretin is a newcomer to the group of nonstandard therapies. An autistic child was reported to improve after undergoing an evaluation for gastrointestinal problems. Researchers determined that the secretin given intravenously as part of the workup was responsible for the positive effect. Various research centers are now conducting clinical trials to investigate the possible role of secretin in the treatment of autism.

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