Autism (015)

Autism Spectrum Disorders • ASD

The facts (6)

Imagine living in a world that doesn't completely reach you, and to which you can't always respond. For many people who have autism, this great divide exists between their world and the reality outside of them.

Autism affects about 1 in 66 children. Children with autism usually display signs before the age of 2.

Autism is part of a group of developmental disorders called autism spectrum disorders (ASD), which includes 4 other disorders:

• Asperger's syndrome, which, unlike autism, does not have delayed development of language and cognition
• childhood disintegrative disorder, which is characterized by 2 to 4 years of normal development followed by the onset of autistic symptoms
• Rett syndrome, which is a genetic disease that affects only girls
• pervasive developmental disorder

Autism is 3 to 4 times more likely to be diagnosed in boys than girls. People with autism may  have learning disorders or some degree of intellectual disability.

Causes (6)

Many factors may be connected to autism, but no conclusive causes have been found.

There is some evidence that some people with autism have structural and chemical differences in their brain.

Genetics may also be a factor. In studies of identical twins, if one has autism, there's up to a 95% chance the other twin will have it as well. For siblings of a person with autism, chances of having the condition are higher than for the general population. Research has discovered autism risk genes.

Exposure to pollutants and toxins during fetal development may put the child at higher risk of developing ASD. As well as, other events that may occur before and during birth, such as low birth weight, maternal illness, birthing difficulties, and age of parents at conception.

Although the causes of autism are not fully understood, it is clear that vaccinations do not cause autism.

Symptoms and Complications (7)

The most obvious sign that a child has autism is their inability to interact socially. Babies and infants won't respond to smiles, vocal games, or other stimuli and activities around them. Children won't follow other people with their eyes, or make eye contact. Facial expression and body language are neither understood nor expressed by children with autism. They may also not be able to develop emotional and social relationships.

Many children with autism find it difficult to develop language skills, and they are unlikely to start up a conversation. However, it's not unusual for a person with autism to echo phrases they hear in conversation or have heard in the past.

This tendency to repeat is apparent in other behaviours associated with autism. Certain movements or motions, such as flapping the hands or twisting the body, will be repeated over and over again. Children don't participate in imaginative play but can learn and imitate actions. For instance, a child who appears to be playing telephone – dialing, talking, hanging up – will act this out in exactly the same way and order the next time. This doesn't indicate an active imagination but rather repetition of a learned behaviour. Learning also occurs in an erratic manner – what a child appears to have learned one day may be forgotten the next.

Children with autism frequently prefer to keep a strict order around themselves. Play might consist of lining up objects, or even of being fascinated by some aspect of a toy (its texture, smell, or colour) rather than its function. People with autism often prefer routines to be strictly maintained – serving a meal 5 minutes late can cause a tantrum. An object moved out of its usual place can be extremely distressing, causing a reaction that will only stop when the object is moved back to its usual place.

Other behaviours of people with autism include:

• acts of self-injury
• abnormal eating, drinking, or sleeping habits
• lack of fear, or irrational fears
• limited activities and interests
• mood abnormalities
• short attention span
• unusual responses to stimuli (lack of interest or oversensitivity)

Although people with autism can be developmentally impaired in many ways, they might also have particular strengths which differ from one person to the next. These may include a talent for music or mathematical calculations, as well as other strengths.

Autistic children often have gastrointestinal disorders (abdominal pain, constipation or diarrhea, gastroesophageal reflux) as well as other health issues, including sleep disorders (not wanting to got to bed, insomnia, altered sleep-wake cycles) and epilepsy. It is not uncommon for autistic children to self-injure.

Making the Diagnosis

Because there are no well-identified causes for autism, there's no straightforward test to determine whether or not a child has it. However, there are standardized autism-specific screening tests that can help identify children who need further evaluation. Based on a child's social difficulties, behavioural patterns, and poor ability to communicate, a physician, psychologist, or psychiatrist can identify the child as having autism. Autism is usually detected by age 3. Key in the diagnosis are:

• impaired social interaction and communication
• limited and repetitive behaviours

It is important to have a physician rule out the possibility that the repetitive behaviors are not caused by seizures, and for the proper diagnosis to be made and the correct treatment to be determined.

Treatment and Prevention (8,9)

There's no cure for autism. Medication may be used to reduce some of the symptoms, such as severe aggression or self-destructive behaviour. Because so little is understood about the causes of this disease, it's not yet possible to develop specific medication treatments.

The most effective treatment available is behavioural intervention and modification. Programs are usually highly structured and focus on developing the child's language and social skills. Therapy is most effective if it's started at an early age. Along with psychiatric care, children with autism benefit from working with a multidisciplinary team consisting of parents, teachers, psychologists, speech pathologists, and occupational therapists. Individualized treatment based on each child's needs is essential, along with sufficient access to a health care team.

Early treatment that's maintained over a long period of time may prove beneficial and some children will improve their language and social skills as they progress to adulthood. The quality of life for individuals with autism can improve as communication is enhanced and daily experiences become more meaningful.

People with ASDs are often treated with medications, including stimulants and medications designed to treat depression, mood disorders, epilepsy, and other disorders of the brain. These drugs are used to help manage specific symptoms or behavioural problems.

[references]

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