Autistic Spectrum Disorders

What are autistic spectrum disorders?

Autistic spectrum disorders (ASD) are related to autism. Autism is a disorder in which children have problems with language and getting along with others. ASD may also be called pervasive developmental disorders (PDD). There are 5 ASD disorders:

• Autism: A disorder in which a person has problems with language, social skills, and repetitive, restricted behaviors.
• Asperger syndrome: A form of high-functioning autism in which a child may have good language skills, but has trouble being around others and other behavior problems.
• PDD-NOS (pervasive developmental disorder not otherwise specified): This is the general diagnosis given if a child has some symptoms of autism or Asperger syndrome, but does not meet the specific criteria for either.
• Rett syndrome: A very rare disorder affecting only girls in which autistic-like symptoms start 6 to 18 months after birth.
• Childhood disintegrative disorder: A rare disorder in which a child develops normally until about age 3 or 4 and then begins to show autistic-like symptoms.

What is the cause?

Children with these disorders have a problem in the brain. Brain scans show that the structure or shape of the brain is slightly different than other children. There are many possible causes, but the exact cause is not known.

Autism and similar disorders sometimes run in families. There may be certain genes linked to autism. Researchers are also studying if a problem during pregnancy or environmental factors, such as exposure to chemicals, may be a cause.

Children with other brain problems and genetic syndromes such as congenital rubella syndrome, neurofibromatosis, and fragile X syndrome, are more likely to have an autistic disorder.

What are the symptoms?

All children with ASD have problems with:

• social skills
• verbal and/or nonverbal communication
• repetitive behaviors or interests

Social Skills

Most children with ASD seem to have a lot of trouble learning the give-and-take of dealing with people. Even in the first few months of life, many do not interact and they avoid eye contact. They may seem indifferent to other people and often like being alone. They may resist attention or passively accept hugs and cuddling. They may not seek comfort or respond to anger or affection in a normal way. Children with ASD also are slower in learning to interpret what others are thinking and feeling. They have trouble seeing things from another person's point of view.

They also have trouble controlling their emotions. This can take the form of "immature" behavior such as crying in class or verbal outbursts that seem inappropriate to those around them.

Communication Problems

There is a wide range of communication problems. Some children with ASD never talk. Some talk or make noises at first and then stop. Others are just slow to start and don't start to talk until age 5 to 9. Those who do speak often use language in unusual ways. They seem unable to combine words into meaningful sentences. Some speak only single words, while others repeat the same phrase over and over. Some ASD children echo what they hear.

Some children only have slight delays in language. Others with milder ASD often have great verbal abilities and have a very large vocabulary. However, they have trouble keeping a conversation. The "give and take" of normal conversation is hard for them. They often can talk about a favorite subject and not give anyone else a chance to comment. They also don't always understand tone of voice or sarcastic comments. Also, nonverbal communication, such as a smile, a wink, or a frown, may have little meaning.

Repetitive Behaviors

Children with ASD sometimes repeat movements. This may be extreme or more subtle. Some flap their arms or walk on their toes a lot. They also might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of the toys, they may get very upset. It is also hard for them to change their routine. Sometimes the child is very focused on a certain subject such as learning all about vacuum cleaners, train schedules, or lighthouses. Often they have a great interest in numbers, symbols, or science topics.

Other problems

ASD children may also have problems with their senses. Many are very sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin almost unbearable. Some sounds, such as a vacuum cleaner, a ringing telephone, a sudden storm, even the sound of waves lapping the shoreline, will cause these children to cover their ears.

Another common problem is some degree of mental retardation. When tested, some areas of ability may be normal, while others may be weak. For example, a child with ASD may do well on the parts of the test that measure visual skills but earn low scores on the language tests.

How is an ASD diagnosed?

Parents are usually the first to notice unusual behaviors in their child. The earlier ASD is diagnosed, the earlier treatment can begin. To help watch for problems, your healthcare provider will have you fill out a questionnaire about your child's development at each well child visit. Also, tell your provider about anything that seems unusual or that you are concerned about.

If your healthcare provider thinks your child may have ASD, he or she will recommend that your child see some specialists. These may include a psychologist, psychiatrist, speech therapist, or neurologist. They can do more testing and recommend treatment. Your child's healthcare provider will probably do lab tests to rule out other medical problems. Your child will also have a hearing test. Because it can be inherited, your healthcare provider may want to screen your other children for symptoms.

The sooner a diagnosis is made, the better. Sadly, healthcare providers, child care providers, teachers, and parents may at first ignore signs of ASD, thinking the child is just a little slow and will "catch up." Early treatment helps reduce symptoms. It increases a child's ability to grow and learn new skills.

What is the treatment?

There is no single best treatment for all children with ASD. Before you make decisions on your child's treatment, you will want to get information about the various options available. Learn as much as you can, look at all the options, and make your choice for your child's treatment based on your child's needs. You may want to visit public schools in your area to see the type of program they offer to special needs children.

A good treatment program will:

• build on the child's interests
• offer a predictable schedule
• teach tasks as a series of simple steps
• actively hold the child's attention in highly structured activities
• provide regular evaluation of educational and behavior goals

Treatment includes doing activities at home as well as at school. Usually children are placed in public schools and the school district pays for all necessary services. These will include working with a speech therapist, occupational therapist, school psychologist, social worker, school nurse, or aide.

By law, the public schools must prepare and carry out a teaching plan designed to help children in a special education program to reach instruction goals or learn specific skills. The list of skills is known as the child's Individualized Education Program (IEP). The IEP is an agreement between the school and the family about the child's goals. Parents play an important part in creating the program, as they know their child and his or her needs best. If your child is under 3 years of age and has special needs, he or she should be eligible for an early intervention program.

Medicine is often used to treat behavioral problems, anxiety, or other problems.

Where can my family get help and support?

When parents hear that their child has ASD, they may feel fear, anger, guilt, and other difficult emotions. Many families find that seeing a mental health professional helps them to cope.

Having a child with ASD can be stressful for the whole family. It can affect all activities and family finances. It can also strain your marriage and relationships between siblings.

Support groups can help by sharing common concerns and solutions to problems with other families in the same situation. You can find these services through your healthcare provider, schools, therapy programs, and local and national support organizations.