• Autistic symptoms, Autism causes of Children Diagnosed & Treated

Autistic symptoms, Autism causes of Children Diagnosed & Treated

Autistic symptoms, Autism causes of Children Diagnosed & Treated. Autism spectrum disorders (ASD) are characterized by social-interaction difficulties, communication challenges and a tendency to engage in repetitive behaviors. However, symptoms and their severity vary widely across these three core areas. Taken together, they may result in relatively mild challenges for someone on the high functioning end of the autism spectrum. For others, symptoms may be more severe, as when repetitive behaviors and lack of spoken language interfere with everyday life.

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Causes of Autism
Experts are still uncertain about all the causes of autism. In all likelihood, there are multiple causes – rather than just one. It appears to be that a number of different circumstances — including environmental, biologic, and genetic factors – set the stage for autism and make a child more likely to have the disorder.

Causes of Autism

There is reason to believe that genes play a major role in the development of autism. It has been found that identical twins are more likely to both be affected than twins who are fraternal (not genetically identical). In a family with one autistic child, the chance of having another child with autism is about 5 percent – or one in 20 – much higher than in the normal population.

Sometimes, parents or other relatives of an autistic child have mild social impairments (such as repetitive behaviors and social or communication problems) that look very much like autism. Research also has found that some emotional disorders (such as manic depression) occur more often in families of a child with autism.

At least one group of researchers has found a link between an abnormal gene and autism. The gene may be just one of three to five or more genes that interact in some way to cause the condition. Scientists suspect that a faulty gene or genes might make a person more likely to develop autism when there are also other factors present, such as a chemical imbalance, viruses or chemicals, or a lack of oxygen at birth.

In a few cases, autistic behavior is caused by:
- Rubella (German measles) in the pregnant mother
- Tuberous sclerosis (a rare genetic disorder that causes benign tumors to grow in the brain as well as in other vital organs)
- Fragile X syndrome (the most common inherited form of intellectual disability)
- Encephalitis (brain inflammation)
- Untreated phenylketonuria (PKU) – when the body lacks an enzyme needed for normal metabolism

In the past several years, there has been interest in a theory that suggested a link between autism and the use of thimerosal, a mercury-based preservative used in the measles-mumps-rubella (MMR) vaccine. Although mercury is no longer found in childhood vaccines in the United States, some parents still have concerns about vaccinations.

Causes of Autism

However, many well-done, large-scale studies have now been performed that have failed to show a link between thimerosal and autism. A panel from the Institute of Medicine is now examining these studies. The reports include a large Danish study that concluded that there was no causal relationship between childhood vaccination using thimerosal-containing vaccines and the development of an autism spectrum disorder and a U.S. study looking at exposure to mercury, lead, and other heavy metals. Both the American Academy of Pediatrics and the Centers for Disease Control and Prevention asert that there is no link between autism and the MMR vaccine or any other vaccine.

Other potential causes of autism are environmental toxins, including pesticides and heavy metals such as mercury. Heavy metals are certainly more commonly encountered in the environment now than they were in the past. It may be that people with autism or those at higher risk for developing it are more sensitive than others to these toxins.

How is Autism Diagnosed ?
All children with autism have problems with:
- Social Interaction – they way they relate to others
- Verbal and Nonverbal Communication
- Repetitive Behaviors or Interests

Infants with the disorder won’t cuddle; they avoid eye contact and don’t seem to want or need physical contact or affection. They may become rigid or limp when they are held, cry when picked up, and show little interest in human contact. These children don’t smile or lift their arms in anticipation of being picked up. They form no attachment to parents and do not show any normal anxiety toward strangers. They do not learn the typical games of childhood, such as peek-a-boo.

How is Autism Diagnosed

As children with autism get older they often have unusual responses to sensory experiences, such as certain sounds or the way objects look. These symptoms can range from mild to severe – and will be different in different children. For instance, a child may find it easy to learn to read, but have trouble in social situations. However, with autism, each child will display communication, social, and behavioral patterns that are individual but fit into the overall diagnosis of autism.

Children with autism do not follow the typical patterns of child development. In some children, hints of future problems may be apparent from birth. In most cases, the problems in communication and social skills become more noticeable as the child gets older (between 12 and 36 months) and starts lagging behind other children of the same age.

Some parents report the changes as taking place over a short period of time. They notice that their children suddenly start to reject people, act strangely, and lose language and social skills they had before. In other cases, there is a slowing in the level of progress so that the difference between the child with autism and other children the same age becomes more and more noticeable over a longer period of time.

How is Autism Diagnosed

While a person with autism can have symptoms ranging from mild to severe, about 10% of these children have an extraordinary ability in one area, such as mathematics, memory, music, or art. Such children are known as “autistic savants.”

Although there are many concerns about labeling a young child with autism, the earlier the diagnosis of autism is made, the sooner actions to help the child can begin. Evidence over the last 15 years has shown that intensive early intervention in optimal educational settings for at least two years during the preschool years results in improved outcomes in most young children with Autism Spectrum Disorder .2

In order to diagnose autism, medical professionals look at a child’s specific behaviors. Some of these behaviors may be obvious in the first few months of a child’s life, or they may appear at any time during the early years.

In order to be diagnosed with autism the child must have had problems in at least one of these areas: communication, socialization, or restricted behavior before the age of three.

The diagnosis has two stages. The first stage is a developmental screening during “well child” check-ups. The second stage involves a thorough evaluation by a multidisciplinary team.

As illustrated by the graph below, the basic symptoms of autism are often accompanied by other medical conditions and challenges. These, too, can vary widely in severity.

While autism is usually a life-long condition, all children and adults benefit from interventions, or therapies, that can reduce symptoms and increase skills and abilities. Although it is best to begin intervention as soon as possible, the benefits of therapy can continue throughout life.

How is Autism Diagnosed

Social Challenges 
Typically developing infants are social by nature. They gaze at faces, turn toward voices, grasp a finger and even smile by 2 to 3 months of age. By contrast, most children who develop autism have difficulty engaging in the give-and-take of everyday human interactions. By 8 to 10 months of age, many infants who go on to develop autism are showing some symptoms such as failure to respond to their names, reduced interest in people and delayed babbling. By toddlerhood, many children with autism have difficulty playing social games, don’t imitate the actions of others and prefer to play alone. They may fail to seek comfort or respond to parents' displays of anger or affection in typical ways.

Research suggests that children with autism are attached to their parents. However the way they express this attachment can be unusual. To parents, it may seem as if their child is disconnected. Both children and adults with autism also tend to have difficulty interpreting what others are thinking and feeling. Subtle social cures such as a smile, wave or grimace may convey little meaning. To a person who misses these social cues, a statement like “Come here!” may mean the same thing, regardless of whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world can seem bewildering.

Many persons with autism have similar difficulty seeing things from another person's perspective. Most five year olds understand that other people have different thoughts, feelings and goals than they have. A person with autism may lack such understanding. This, in turn, can interfere with the ability to predict or understand another person’s actions.

It is common – but not universal – for those with autism to have difficulty regulating emotions. This can take the form of seemingly “immature” behavior such as crying or having outbursts in inappropriate situations. It can also lead to disruptive and physically aggressive behavior. The tendency to “lose control” may be particularly pronounced in unfamiliar, overwhelming or frustrating situations. Frustration can also result in self-injurious behaviors such as head banging, hair pulling or self-biting.

Communication Difficulties
By age three, most children have passed predictable milestones on the path to learning language. One of the earliest is babbling. By the first birthday, most typically developing toddlers say a word or two, turn and look when they hear their names, point to objects they want or want to show to someone (not all cultures use pointing in this way). When offered something distasteful, they can make clear – by sound or expression – that the answer is “no.”

By contrast, young children with autism tend to be delayed in babbling and speaking and learning to use gestures. Some infants who later develop autism coo and babble during the first few months of life before losing these communicative behaviors. Others experience significant language delays and don’t begin to speak until much later. With therapy, however, most people with autism do learn to use spoken language and all can learn to communicate.

Many nonverbal or nearly nonverbal children and adults learn to use communication systems such as pictures (image at left), sign language, electronic word processors or even speech-generating devices.

When language begins to develop, the person with autism may use speech in unusual ways. Some have difficulty combining words into meaningful sentences. They may speak only single words or repeat the same phrase over and over. Some go through a stage where they repeat what they hear verbatim (echolalia).

Some mildly affected children exhibit only slight delays in language or even develop precocious language and unusually large vocabularies – yet have difficulty sustaining a conversation. Some children and adults with autism tend to carry on monologues on a favorite subject, giving others little chance to comment. In other words, the ordinary “give and take” of conversation proves difficult. Some children with ASD with superior language skills tend to speak like little professors, failing to pick up on the “kid-speak” that’s common among their peers.

Another common difficulty is the inability to understand body language, tone of voice and expressions that aren’t meant to be taken literally. For example, even an adult with autism might interpret a sarcastic “Oh, that's just great!” as meaning it really is great.

Conversely, someone affected by autism may not exhibit typical body language. Facial expressions, movements and gestures may not match what they are saying. Their tone of voice may fail to reflect their feelings. Some use a high-pitched sing-song or a flat, robot-like voice. This can make it difficult for others know what they want and need. This failed communication, in turn, can lead to frustration and inappropriate behavior (such as screaming or grabbing) on the part of the person with autism. Fortunately, there are proven methods for helping children and adults with autism learn better ways to express their needs. As the person with autism learns to communicate what he or she wants, challenging behaviors often subside.

Repetitive Behaviors
Unusual repetitive behaviors and/or a tendency to engage in a restricted range of activities are another core symptom of autism. Common repetitive behaviors include hand-flapping, rocking, jumping and twirling, arranging and rearranging objects, and repeating sounds, words, or phrases. Sometimes the repetitive behavior is self-stimulating, such as wiggling fingers in front of the eyes.

The tendency to engage in a restricted range of activities can be seen in the way that many children with autism play with toys. Some spend hours lining up toys in a specific way instead of using them for pretend play. Similarly, some adults are preoccupied with having household or other objects in a fixed order or place. It can prove extremely upsetting if someone or something disrupts the order. Along these lines many children and adults with autism need and demand extreme consistency in their environment and daily routine. Slight changes can be extremely stressful and lead to outbursts

Repetitive behaviors can take the form of intense preoccupations, or obsessions. These extreme interests can prove all the more unusual for their content (e.g. fans, vacuum cleaners or toilets) or depth of knowledge (e.g. knowing and repeating astonishingly detailed information about Thomas the Tank Engine or astronomy). Older children and adults with autism may develop tremendous interest in numbers, symbols, dates or science topics.

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Associated Medical Conditions
Thanks to donor support, Autism Speaks continues to fund research into the causes and treatment of the medical conditions associated with ASD. You can explore these studies here. This research is reflected in the comprehensive care model at the heart of our Autism Treatment Network(ATN) clinics. To find out if there is an ATN clinic close to you, click here. For in depth information on medical conditions, please see our website’s related pages: “Treatments for Associated Medical Conditions” and “What Treatments are Available for Speech, Language and Motor Impairments,” in addition to the information below.

Genetic Disorders 
Some children with autism have an identifiable genetic condition that affects brain development. These genetic disorders include Fragile X syndrome, Angelman syndrome, tuberous sclerosis and chromosome 15 duplication syndrome and other single-gene and chromosomal disorders. While further study is needed, single gene disorders appear to affect 15 to 20 percent of those with ASD. Some of these syndromes have characteristic features or family histories, the presence of which may prompt your doctor to refer to a geneticist or neurologist for further testing. The results can help guide treatment, awareness of associated medical issues and life planning.

Gastrointestinal (GI) Disorders 
GI distress is common among persons with autism, and affects up to 85 percent of children with ASD. These conditions range in severity from a tendency for chronic constipation or diarrhea to inflammatory bowel disease. Pain caused by GI issues can prompt behavioral changes such as increased self soothing (rocking, head banging, etc) or outbursts of aggression or self-injury. Conversely, appropriate treatment can improve behavior and quality of life. Please see our treatment section on “Gastrointestinal Disorders.” It includes discussion of popular dietary interventions. Thanks to donor support, Autism Speaks continues to fund research into causes and treatments.

Seizure Disorders 
Seizure disorders, including epilepsy, occur in as many as 39 percent of those with autism. It is more common in people with autism who also have intellectual disability than those without. Someone with autism may experience more than one type of seizure. The easiest to recognize is the grand mal, or tonic-clonic, seizure. Others include “petit mal” seizures (when a person temporarily appears “absent”) and subclinical seizures, which may be apparent only with electroencephalogram (EEG) testing.

Seizures associated with autism tend to start in either early childhood or adolescence. But they may occur at any time. If you are concerned that you or your child may be having seizures, it is important to raise the issue with your doctor for possible referral to a neurologist for further evaluation.

Sleep Dysfunction
Sleep problems are common among children and adolescents with autism and may likewise affect many adults. For more information and helpful guidance, see our ATN Sleep Strategies Tool Kit (available for free download).

Sensory Processing Problems 
Many persons with autism have unusual responses to sensory input. They have difficulty processing and integrating sensory information, or stimuli, such as sights, sounds smells, tastes and/or movement. They may experience seemingly ordinary stimuli as painful, unpleasant or confusing. (Explore our donor-funded research on causes and treatments here.)

Some of those with autism are hypersensitive to sounds or touch, a condition also known as sensory defensiveness. Others are under-responsive, or hyposensitive. An example of hypersensitivity would be the inability to tolerate wearing clothing, being touched or being in a room with normal lighting. Hyposensitivity can include failure to respond when one’s name is called. Many sensory processing problems can be addressed with occupational therapy and/or sensory integration therapy. (More information on these therapies, here.)

Pica is a tendency to eat things that are not food. Eating non-food items is a normal part of development between the ages of 18 and 24 months. However, some children and adults with autism and other developmental disabilities continue to eat items such as dirt, clay, chalk or paint chips. For this reason, it is important to test for elevated blood levels of lead in those who persistently mouth fingers or objects that might be contaminated with this common environmental toxin.

How Is Autism Treated ?
Each child or adult with autism is unique and, so, each autism intervention plan should be tailored to address specific needs.

Intervention can involve behavioral treatments, medicines or both. Many persons with autism have additional medical conditions such as sleep disturbance, seizures and gastrointestinal (GI) distress. Addressing these conditions can improve attention, learning and related behaviors.

How Is Autism Treated

Early intensive behavioral intervention involves a child's entire family, working closely with a team of professionals. In some early intervention programs, therapists come into the home to deliver services. This can include parent training with the parent leading therapy sessions under the supervision of the therapist. Other programs deliver therapy in a specialized center, classroom or preschool.

Typically, different interventions and supports become appropriate as a child develops and acquires social and learning skills. As children with autism enter school, for example, they may benefit from targeted social skills training and specialized approaches to teaching.

Adolescents with autism can benefit from transition services that promote a successful maturation into independence and employment opportunities of adulthood.

What Early Intervention Therapies Are Currently Available ?
Objective scientific studies have confirmed the benefits of two methods of comprehensive behavioral early intervention. They are the Lovaas Model based on Applied Behavior Analysis (ABA) and the Early Start Denver Model. Parents and therapists also report success with other commonly used behavioral therapies, including Floortime, Pivotal Response Therapy and Verbal Behavior Therapy.

What Early Intervention Therapies Are Currently Available

Treatment Options for Toddlers and Preschool Children
Scientific studies have demonstrated that early intensive behavioral intervention improves learning, communication and social skills in young children with autism. While the outcomes of early intervention vary, all children benefit. Researchers have developed a number of effective early intervention models. They vary in details, but all good early intervention programs share certain features. They include:

√ The child receives structured, therapeutic activities for at least 25 hours per week.

√ Highly trained therapists and/or teachers deliver the intervention. Well-trained paraprofessionals may assist with the intervention under the supervision of an experienced professional with expertise in autism therapy.

√ The therapy is guided by specific and well-defined learning objectives, and the child’s progress in meeting these objectives is regularly evaluated and recorded.

√ The intervention focuses on the core areas affected by autism. These include social skills, language and communication, imitation, play skills, daily living and motor skills.

Treatment Options for Toddlers and Preschool Children

√ The program provides the child with opportunities to interact with typically developing peers.

√ The program actively engages parents in the intervention, both in decision making and the delivery of treatment.

√ The therapists make clear their respect for the unique needs, values and perspectives of the child and his or her family.

√ The program involves a multidisciplinary team that includes, as needed, a physician, speech-language pathologist and occupational therapist.

Do Children or Adults Diagnosed with Autism Ever Move Off "the Spectrum" ?
Growing evidence suggests that a small minority of persons with autism progress to the point where they no longer meet the criteria for a diagnosis of autism spectrum disorder (ASD). Various theories exist as to why this happens. They include the possibility of an initial misdiagnosis, the possibility that some children mature out of certain forms of autism and the possibility that successful treatment can, in some instances, produce outcomes that no longer meet the criteria for an autism diagnosis.

You may also hear about children diagnosed with autism who reach “best outcome” status. This means they have scored within normal ranges on tests for IQ, language, adaptive functioning, school placement and personality, but still have mild symptoms on some personality and diagnostic tests.

 Some children who no longer meet the criteria for a diagnosis of autism spectrum disorder are later diagnosed with attention deficit and hyperactivity disorder (ADHD), anxiety disorder or a relatively high-functioning form of autism such as Asperger Syndrome.

Do Children or Adults Diagnosed with Autism Ever Move Off "the Spectrum"

Currently, we don’t know what percentage of persons with autism will progress to the point where they “lose their diagnosis.” We likewise need further research to determine what genetic, physiological or developmental factors might predict who will achieve such outcomes.

We do know that significant improvement in autism symptoms is most often reported in connection with intensive early intervention—though at present, we cannot predict which children will have such responses to therapy.

We also know that many people with autism go on to live independent and fulfilling lives, and that all deserve the opportunity to work productively, develop meaningful and fulfilling relationships and enjoy life. With better interventions and supports available, those affected by autism are having better outcomes in all spheres of life.

What Does the Future Hold For Someone With Autism ?
One of the first questions that parents ask after their child has been diagnosed with autism concerns the prognosis or outlook. They also want to know what factors might influence that prognosis over the child’s lifetime. There is no one answer that every doctor can hand out to every parent who is concerned about the outlook. That is because there is no one kind of autism that covers every diagnosis. Each child with autism is unique. The causes of the disorder vary from child to child, and therefore the prognosis will vary as well. Another consideration is the presence of any other conditions that the child may have. For example, if the child has epilepsy or some other medical problem that can be identified and treated effectively, that might improve the prognosis.

What Does the Future Hold For Someone With Autism

Still, there is no known cure for autism. In some cases, children do seem to recover – so much so that the diagnosis of ASD is withdrawn. Sometimes this happens after intensive treatment but not always. In some instances, children aged five or older who have not previously spoken do acquire speech. For most children, symptoms frequently become milder as the child gets older. However, the core problems – such as difficulties with social interactions – generally remain. According to some experts, the following factors suggest a better prognosis:

- Having an I.Q. above 50
- Ability to speak before age six
- Having a useful skill

Although autism continues to be a difficult disorder for children and their families, today’s prognosis is a far improvement over what it was 30 years ago. At that time, it was not unusual for people with autism to be placed in institutions. These days, with the proper diagnosis and early initiation of treatment, many of the symptoms of autism can be reduced — although the majority of people will never be entirely free of symptoms. Just how well the person functions depends on the degree of the disorder as well as the timing and level of treatment.

Some adults with autism, especially those who are high-functioning or who have Asperger syndrome, are able to work successfully in mainstream jobs. However, communication and social problems often cause difficulties in many areas of life. These people will continue to need encouragement and moral support in their struggle for an independent life.
What Does the Future Hold For Someone With Autism

Many others with autism are able to work in special environments especially if they are supervised by managers trained in working with persons with disabilities. A nurturing environment at home, at school, and later in job training and at work, helps persons with autism continue to learn and to develop throughout their lives.

The public schools’s responsibility for providing services ends when the person with autism reaches the age of 22. The family is then faced with the challenge of finding living arrangements and employment to match the particular needs of their adult child, as well as the programs and facilities that can provide support services to achieve these goals.