Autism Spectrum Disorders
January 11, 2007
Autism spectrum disorders affect one in 250 people. You might think that a problem this common would be easy to diagnose, but the symptoms can be very subtle. Dr. Mom explains why early diagnosis can make a difference in the future of those afflicted.
Autism Spectrum Disorders (ASD) covers a wide range of behaviors and abilities. Autism impacts the normal development of the brain in the areas of social interaction, communication skills, and cognitive function. A symptom might be mild in one person and severe in another person.
The Autism Spectrum Disorders include:
- Classical autism
- Asperger disorder
- Pervasive developmental disorder (PDD), and a few more rare diseases
ASD is diagnosed four times more often in boys than in girls, and affects about one in every 166 people. It is not affected by race or socio-economic status.
Possible indicators of ASD:
- Does not babble, point, or make meaningful gestures by 1 year of age
- Does not speak one word by 16 months
- Does not combine two words by 2 years
- Does not respond to name
- Loses language or social skills
Type of problems and behaviors associated with ASD:
- Poor eye contact
- Doesn't seem to know how to play with toys
- Excessively lines up toys or other objects
- Is attached to one particular toy or object
- Doesn't smile
- At times seems to be hearing impaired
Problems That May Accompany ASD
- Social Skills
- May not interact with others
- May be indifferent to others
- Prefer being alone
- May avoid eye contact
- May not want to be held or cuddled
- Do not talk about their own feelings
- Does not have the ability to interpret gestures and facial expressions
- Have difficulty regulating emotions; may have angry outbursts or cry at inappropriate times
- May be physically aggressive
- Communication Skills
- 40% of children with ASD do not talk at all
- May repeat words or phrases that have been spoken to them
- Unable to combine words into meaningful sentences
- Repetitive Behavior
- May spend a lot of time repeatedly flapping arms or walking on toes
- May suddenly freeze in one position
- Strict adherence to routine. A slight change in any routine can be extremely disturbing
- Obsessive interest in particular objects
- Sensory problems
Many ASD children are highly attuned or even painfully sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin almost unbearable. Some sounds-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 and scream.
In ASD, the brain seems unable to balance the senses appropriately. Some ASD children are oblivious to extreme cold or pain. An ASD child may fall and break an arm, yet never cry. Another may bash his head against a wall and not wince, but a light touch may make the child scream with alarm.
- Mental retardation
Many children with ASD have some degree of mental impairment. When tested, some areas of ability may be normal, while others may be especially 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 subtests.
One in four children with ASD develops seizures, often starting either in early childhood or adolescence. Seizures, caused by abnormal electrical activity in the brain, can produce a temporary loss of consciousness (a "blackout"), a body convulsion, unusual movements, or staring spells. Sometimes a contributing factor is a lack of sleep or a high fever. In most cases, seizures can be controlled by a number of medicines called "anticonvulsants." The dosage of the medication is adjusted carefully so that the least possible amount of medication will be used to be effective.
- Fragile X syndrome
This disorder is the most common inherited form of mental retardation. It was so named because one part of the X chromosome has a defective piece that appears pinched and fragile when under a microscope. Fragile X syndrome affects about two to five percent of people with ASD. It is important to have a child with ASD checked for Fragile X, especially if the parents are considering having another child. For an unknown reason, if a child with ASD also has Fragile X, there is a one-in-two chance that boys born to the same parents will have the syndrome. Other members of the family who may be contemplating having a child may also wish to be checked for the syndrome.
- Tuberous Sclerosis
Tuberous sclerosis is a rare genetic disorder that causes benign tumors to grow in the brain as well as in other vital organs. It has a consistently strong association with ASD. One to 4 percent of people with ASD also have tuberous sclerosis.
The impact of having a developmental disability is immense for the families affected and for the community services that provide intervention and support for these families. It is important that we treat common developmental delays, and especially the ASDs, as conditions of urgent public health concern, do all we can to identify children's learning needs, and begin intervention as early as possible to enable all children to reach their full potential.
Discuss developmental screening with your child's primary care physician. Kathryn Akin, M. D., specializes in Behavioral and Developmental Pediatrics, at The University of Texas Health Center at Tyler, 903-877-3451.
Child Care Provider Resource Kit
- The "Learn the Signs. Act Early" campaign has developed a free resource kit of materials on child development and autism for day care providers and teachers to share with parents of children in their care. The Child Care Provider Resource Kit, along with resources for parents and pediatricians, are available for free.