The 1.5 million-person mystery

How to recognize and treat autism in children

By Peggy Wilkins, PhD

Once thought to be relatively rare—and the result of “poor parenting”—autism affects as many as 1.5 million Americans. Although we know autism is a developmental disability based in abnormal brain development, the exact cause or causes of autism remains a mystery. Up to 5 percent of cases are related to Fragile X, an identifiable genetic disorder. However, in the majority of children, the cause of autism is thought to be a possible combination of genetics and as-yet-unidentified environmental factors.

Symptoms

Autism clearly and significantly affects a child’s social and communication skills. Typical signs of autism, usually exhibited before age 3, include:

• poor eye contact, actively looking away from people, and social withdrawal

• delayed language skills or the loss of language skills

• “echoing” or copying what others say

• using gestures instead of language

• lack of imaginary play, or using toys in an unusual manner

• flapping hands, spinning, or rocking the body

• unusual or inappropriate emotional reactions to everyday situations

• a strong need for routine and sameness

• unusual sensitivity to touch, sound or smell

Diagnosis and “red flags”

Pediatricians, psychologists, neurologists or developmental specialists typically diagnose autism. But aside from the specific test for Fragile X, there is no medical test to diagnose autism. The diagnosis depends on a thorough developmental history, as well as careful observation of the child. There are three key elements for diagnosis: impaired social interaction; impaired communication; and restricted or repetitive behaviors or interests.

Early diagnosis and intervention are essential to the successful treatment of autism. Autism is not curable, and it is considered to be a life-long developmental problem. However, early diagnosis and intervention can lead to amazing improvements in a child’s overall ability to communicate and interact with others.

Experts suggest that parents be aware of the “red flags” that can lead to early diagnosis. Red flags include warnings that the child does not…

…babble or coo by 12 months

…gesture (point or wave) by 12 months

…say a single word by 16 months

…say two-word phrases by 24 months

An additional “red flag” is the loss of language or social skills at any age, but especially before age 3.

Treatment

Assessment and treatment of the autistic child will involve many different people. Typically, the child will first be evaluated by the primary pediatrician. Further assessment will be required by a psychologist, a speech therapist, an occupational and/or physical therapist and a geneticist or neurologist. Each discipline adds vital information about the child’s level of delay and current functioning; this information can then be used to develop the best intervention for that child. As you might imagine, the process often can be quite long, stressful and tiring for the whole family.

Autistic children under age 3 can receive intervention services, such as speech therapy, occupational or physical therapy, and educational programs through state-funded early intervention systems. In Tennessee, this is called the Tennessee Early Intervention System; in Georgia, the program is called Babies Can’t Wait. (See sidebar for contact information.) Some early assessment and much of the therapy can take place in the child’s home. Therapists work directly with children and teach parents basic intervention strategies. Parents also may seek private therapies in addition to those provided by the early intervention services.

Once a child reaches age 3, therapy and educational services are available through the local school system. Personnel from the early intervention services help with the transition to the school system. Often, children are placed in specially designed, developmental classrooms. The classroom may be in a school especially for children with autism and other developmental delays, or it may be within a regular school setting. Unfortunately, due to funding limitations, available services can vary from school system to school system. As a result, some parents opt to seek outside therapies or move to a different school system.

Throughout the child’s education there will be regular reassessments to determine his or her progress and plan for future needs. Having a caring, consistent team of doctors, educators and therapists is critically important. These professionals can advise parents and provide much-needed emotional support. At the same time, parents are encouraged to be advocates for their children. While autism has no current cure, early and consistent intervention can help autistic children make great progress and become wonderful members of society.