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An Introduction to Autism

What is autism?

An Introduction to Autism According to the National Institute of Mental Health (NIMH), there was no name for autism until 1943, when Dr. Leo Kanner conducted a study of the disorder at Johns Hopkins Hospital and labeled it 'early infantile autism.' A milder form of autism became known as Asperger's syndrome, named for the German scientist Dr. Hans Asperger.

NIMH describes autism and Asperger's syndrome as two of five known developmental disorders, most commonly referred to as 'autism spectrum disorders' (ASD). Each disorder on the spectrum displays a certain amount of impairment in communication skills and social interactions, as well as restricted, repetitive patterns of behavior. Although most cases are diagnosed by the age of 3, some cases are detected as early as 18 months. Doctors are hopeful that eventually most cases will be identifiable as early as the age of 1.

The warning signs

Any signs of autism a child may be exhibiting are reason enough to have him evaluated by a professional that specializes in the disorder. Autism can display several warning signs, with the earliest ones usually noted by the parents. Early diagnosis is essential in helping the child through treatment interventions and can have a huge impact on reducing symptoms, but initial signs are usually dismissed by parents and other caregivers. NIMH estimates that only 50 percent of children with the disorder are diagnosed before kindergarten.

Early warning signs of autism in children may be exhibited from birth, such as unresponsiveness, or a fixation on one item for very long periods of time. Other times, signs appear in children who had been developing normally. In many cases, children between the ages of 12 and 36 months start acting strangely and rejecting people, and appear to lose language and social skills they had already acquired. This can happen suddenly, or children may plateau, so their lack of progress becomes more apparent as their social and communication skills fall behind those of other children their age. For example, when an otherwise friendly and talkative toddler suddenly becomes withdrawn, silent, self-abusive, or indifferent, parents should have him evaluated. The severity of these symptoms ranges on the autism spectrum from mild - known as Asperger's syndrome, to severe - known as autistic disorder.

Children who are diagnosed as being on the autism spectrum show developmental delays in social interactions and verbal and nonverbal communication, and also exhibit repetitive behaviors. How these symptoms present themselves differs in each child, but all of them fit into the overall symptoms of ASD. NIMH has provided a list of specific things to look for if parents suspect their child may be showing signs of ASD:

Diagnosis

According to NIMH, evidence over the last 15 years shows that intensive early intervention for at least two preschool years improves the outcome for most children diagnosed with ASD. To provide a diagnosis, specialists look for certain behavioral characteristics. The child must exhibit problems in at least one of the areas of communication, socialization, or restricted behavior before the age of 3.

Diagnosis of ASD is done in two stages. The first stage occurs during a routine checkup that includes a developmental screening test. If any possible indicators of ASD present themselves during this checkup, the pediatrician will request further testing by a team that includes a psychologist, neurologist, psychiatrist, and speech therapist. The specialists then perform neurological and genetics assessments, as well as cognitive and language testing. According to the Autism Genetic Resource Exchange (AGRE), testing may include the use of the Autism Diagnosis Interview Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS-G). The ADI-R consists of a structured interview, conducted with a caregiver, which contains over 100 items covering four main factors: the child's communication, social interaction, repetitive behaviors, and age of onset symptoms. The ADOS-G is an observational assessment that looks for communication behaviors that are usually absent, abnormal, or delayed in children with ASD.

NIMH describes another test, called the Childhood Autism Rating Scale (CARS), which evaluates the child's body movements, adaptation to change, listening response, verbal communication, and relationship to people. The child is then rated on a scale based on the typical behavior of children the same age. This test is mostly used with children over 2 years old.

Once these tests have been completed by the team of specialists, a diagnosis is usually reached and treatment options can be explored.

Treatment options

How well any one treatment option works varies from child to child, but most professionals agree that early intervention is important, and that most children diagnosed with ASD respond best to structured, specialized programs. The Autism Society of America provides parents with a list of suggested questions to ask when considering a certain treatment option:

One widely accepted form of treatment is known as Applied Behavior Analysis (ABA). According to Mental Health: A Report of the Surgeon General, research has shown that this method of treatment reduces inappropriate behavior and increases communication, learning, and appropriate social behavior. The basis of the treatment relies on intensive, one-on-one child-teacher interaction for 40 hours a week, and focuses on reinforcing desirable behaviors.

An effective treatment program for a child with ASD should focus on the child's interests while offering a predictable schedule and highly structured activities. Behavior reinforcement and parental involvement are both major factors in the success of any given program. The ideal program should focus on helping the child in any specific area he is delayed in, while at the same time encouraging growth in his areas of strength. Each program should be unique to an individual's needs, and no one program will work for all children diagnosed with ASD. For a more in-depth look at treatments, read this article on alternative treatments.