April is National Autism Awareness Month, and there has been much talk lately in the news and other sources about autism and related disorders, but in order to understand the conversations, we must know the basics of what are termed ”autism spectrum disorders.” According to the Autism Society of America, 1 in 150 children are diagnosed with autism; this means approximately 1 – 1.5 million Americans have this disorder. There is no difference in rates of diagnosis based on racial, ethnic, or socioeconomic factors, but autism is much more common in boys than in girls.

What is autism and what does ”autism spectrum disorder” mean?

Autism spectrum disorders are a group of related conditions that begin in childhood and cause deficits in social and communication development in association with unusual/atypical behaviors. These findings range from mild to severe based on how they affect an individual in day-to-day life. In the current way that these disorders are diagnosed, autism is the term used to describe those who are more significantly affected and often implicates some degree of intellectual deficiency.

What is Asberger syndrome?

Asberger syndrome is the diagnostic term used for individuals on the autism spectrum who have primarily social and behavioral concerns. Typically, these individuals are higher functioning-intellect is in the normal to near-normal range-and have intact language skills although there may be subtle deficits in social (pragmatic) language development.

How are autism spectrum disorders diagnosed?

There is no medical test for autism spectrum disorders. Rather, they are diagnosed based on a comparison to typically developing children using specific criteria/descriptions of social, communication, and behavioral development. Information is gathered about a child from those that know him/her (parents, family members, teachers, and others). In addition, questionnaires may be completed, and psychological tests may be administered. Ideally, the child is observed in play and other developmental activities. The professional who is evaluating the child must decide whether the child meets or exceeds enough characteristic features to be definitively diagnosed.

Who is qualified to diagnose an autism spectrum disorder?

Usually this is a professional in child development or a clinical team that has experience in evaluation of children with autism spectrum disorders.

Examples of these professionals include medical specialists in pediatrics, pediatric development, child neurology, and child and adolescent psychiatry.

Some child psychologists, teachers, and therapists may also be qualified.

However, the pool of people who are experienced in this type of diagnosis is relatively small. As a result, there are usually waiting lists for specialized evaluations.

What is the usual age of diagnosis?

Subtle social deficits and unusual behaviors may be apparent as early as 14 months of age, and speech/language delays may be apparent by 18-24 months of age. So, the diagnosis of autism is often between 2 and 3 years of age.

Diagnosis can be delayed if children are not referred for assessment in a timely manner. This happens when the characteristic findings of autism spectrum disorders are denied or not acknowledged by parents, teachers, and child health and developmental providers. Another reason is that milder forms of autism spectrum disorders such as Asberger syndrome may not be definitively diagnosed until school-age.

Is early diagnosis important?

Yes, it is. Research in the autism spectrum field supports the fact that early diagnosis leading to early developmental treatment services can improve the overall outcome of a child with any of the autism spectrum conditions.

Are there associated conditions?

It is currently estimated that about half of individuals with autism spectrum disorders function with some degree of intellectual deficit. Learning disorders are also related. Many individuals have unusual responses or reactions to stimulus of their senses (sensory integration disorders).

Behavior disorders frequently co-occur and there are disorders of eating and sleeping. Finally, individuals on the autism spectrum have a 25% chance of having a seizure during their lifetime.

What causes autism spectrum disorders?

The basic cause of these disorders is not known, but a lot of research is being done. There are some exciting developments in the fields of genetics and neurology. It has been long known that there is an increased risk for autism spectrum disorders in families when one child is already diagnosed. In addition, there are several genetic conditions and syndromes associated with autism, and it is becoming better known that very premature babies may be at greater risk as they age into toddler and preschool years. There are also other influences that are more poorly understood; however, research is ongoing in these areas.

Are vaccines to blame?

There are no credible research studies that link autism spectrum to vaccinations or any other environmental exposure, but this does not stop some people from believing that children develop autism spectrum conditions for these reasons. The controversy occurs, in part, because more children are being diagnosed with autism spectrum disorders now than in the past, but also, the diagnostic criteria for these disorders are much more broadly considered now than before. Since there is still no definitive cause known for autism spectrum disorders, there are many theories and speculation that is passed off as fact without being tested or proven. It is hard, but necessary, for parents and professionals in the field to critically analyze any claims of cause, ask specific questions, and look for the evidence that supports the claim.

What kinds of treatment are available?

In the same way that there is no known cause for the autism spectrum disorders, there is no definitive treatment for these conditions.

Nevertheless, it is strongly felt and proven by research that children who are treated in educational and therapy settings (infant/toddler programs, preschool, school, special programs, and specialized therapies) will have improved outcomes. Family involvement is crucial. There is no research at this time that proves the effectiveness of specialized diets, supplements, and other complementary-alternative treatments, but many parents and family members of children on the autism spectrum pursue these therapies in the hopes of achieving successful outcomes. There is no medication treatment, although individuals on the autism spectrum may be treated with certain types of medicines for associated behavioral and neurologic complications.

Contribution by Kurt Klinepeter, MD
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