AUTISM

DEFINITION

Autism is a severe disorder of brain function. It is marked by problems with social contact, intelligence, and use of language. People who suffer from autism usually exhibit behaviors that are repeated over and over again in very standard patterns.

DESCRIPTION

Autism is a lifelong disorder. It interferes with a person's ability to understand what he or she sees, hears, and touches. For this reason, a person with autism has very difficult problems knowing how to behave properly and how to interact with other people. The person has to be taught behaviors that develop normally in most people. Autism varies in its degree of severity among individuals. The disease has a full range of symptoms, ranging from mild to severe.

Autism occurs in about 1 out of every 1,000 children. It is found four times more often in boys than in girls. It occurs everywhere in the world among all races and social backgrounds. Autism is usually evident in the first three years of life. In some children, the disease is difficult to detect. It may not be diagnosed until the child enters school.

Some children with autism have an unusual form of the disease. They show a unique talent in one specific area, such as mathematics, memory, music, or art. These children are known as autistic savants (pronounced sa-VAHNT), or intellectual autistics.

CAUSES

Autism is a brain disorder that affects the way the brain uses or transmits information. This disorder almost certainly develops before the child is born. The problem may be located in parts of the brain that process information that comes from the senses, such as the eyes and ears.

Autism appears to be a genetic disorder. Identical twins are more likely to both have the disease than are fraternal twins. Identical twins have exactly the same genetic make-up. Fraternal twins do not. In a family with one autistic child, the chance of having a second autistic child is about one in twenty. That rate is fifty times greater than in the general population.

Relatives of autistic children sometimes display autistic-like behaviors. For example, they may have problems communicating with other people, or they may repeat certain behaviors over and over again. They may also have certain emotional disorders.

In a few cases, autistic behavior is caused by a disease, such as rubella (German measles; see rubella entry) in a pregnant woman, encephalitis (pronounced in-seh-fuh-LIE-tess; brain fever; see encephalitis entry), or phenylketonuria (pronounced fen-uhl-keet-n-YOOR-ee-uh, PKU) left untreated.

SYMPTOMS

The severity of autism varies among individuals. Some children have severe symptoms. They may act aggressively against other people and even try to harm themselves. Other children have mild symptoms. They may have problems getting along with others and have mild learning disorders.

The most common symptom of autism is a serious inability to relate to other people. Infants with the disorder refuse to cuddle and avoid eye contact. They do not seem to want or need physical contact or affection. They become stiff or totally relaxed when held and begin to cry when picked up. Autistic babies form no attachment to their parents and are frightened by strangers. They do not learn typical childhood games, such as peek-a-boo.

Language Problems

Autistic children may not speak at all. If they do, it is often in single words. They may repeat words or phrases over and over again. Pronouns may get reversed, as in "You go sleep" instead of "I want to go to sleep."

Restricted Interests and Activity

Autistic children usually do not play normally. They do not act out adult roles, such as pretending to be a doctor or parent. Nor do they use their imaginations to create fantasy worlds. Instead, they repeat simple behaviors of the people around them.

These behaviors may become complex and ritualistic. That is, they are repeated over and over again in a very precise way. Autistic children are also prone to strange behavior patterns such as screaming fits, rocking back and forth, arm flapping, and finger twiddling. Austic children may play with their own saliva, feces, or urine. They may be self-destructive, biting their own hands, gouging at their eyes, pulling their hair, or banging their heads.

Sensory Problems

The world of sight and sound poses a real problem to many autistic children. They may ignore objects or become obsessed by them. Or they may watch those objects very carefully or act as if they are not even there. Sounds can also be a problem. Autistic children may react to sounds by banging their heads or flapping their fingers.

Some adults who have overcome autism have written books about their childhood experiences. They report that sounds were often terribly painful to them. They were forced to withdraw into their own world to avoid dealing with the sounds of the real world.

Intellectual Problems

Most autistic children appear to be somewhat mentally challenged. They may giggle or cry for no reason. They may be very frightened of harmless objects, but have no fear of real danger.

DIAGNOSIS

There is no medical test for autism. It is diagnosed by observing a child's behavior, communication skills, and interactions with other people. The problem is that the symptoms of autism are varied, so the disease may not be recognized for a long time. It is easily confused with other diseases with similar symptoms, such as fragile X syndrome and untreated phenylketonuria.

The first step in diagnosing autism is a series of medical tests to rule out other diseases. Then mental health experts use various signs to diagnose the disease. These include:

• Problems in developing friendships
• Problems with make-believe or social play
• Endlessly repeated words or phrases
• Difficulty in carrying on a conversation
• Obsessions with rituals
• Fascination with parts of objects

Some children have some, but not all, of the symptoms of autism. For example, some children exhibit autistic behaviors, but have no problems with language. This condition is known as Asperger syndrome. Some children seem normal at first, but develop autism as they grow older. This condition is known as childhood disintegrative disorder (CDD).

TREATMENT

There is no cure for autism. Treatments are aimed at reducing specific symptoms. Since symptoms differ from person to person, no single treatment program works for every patient. Some of the treatments used include training in music, listening, vision, speech, and language. Special diets and medication may also be prescribed.

People with autism can improve significantly with proper treatment. A child with autism learns best in a well organized environment with a single specially trained teacher. The two treatments used most often include educational or behavior treatment and medication.

Educational or Behavioral Treatment

In this form of treatment, autistic children are rewarded for correct (good) behaviors. A child who speaks correctly, for example, might be given a piece of candy or other favorite food. Over time, correct behaviors become more common and incorrect behaviors less common. This form of treatment should be started as early as possible. It seems to affect the way the child's brain develops, making autistic behavior less likely.

Educational and behavioral treatments seem to work best when carried out at home. In many cases, however, these treatments occur in specialized schools, at day care, or in psychiatric hospitals.

Medication

No single medication has been found to work with all features of autism. A combination of drugs can be used, however, to treat the most serious symptoms.

Autistic children sometimes respond to behavioral and educational treatments in schools such as this one in Salt Lake City, Utah, that offer teachers specially trained to work with autistic children. (Reproduced by permission of

AP/Wide World Photos

.)

These symptoms include aggressiveness and the tendency to injure oneself. Drugs can also be used to control epilepsy (see epilepsy entry), which affects about 20 percent of patients with autism.

Five types of drugs are used to treat autism:

• Stimulants, such as methylphenidate (pronounced meth-uhl-FEN-uh-date, trade name Ritalin)
• Antidepressants, such as fluroxamine (trade name Luvox)
• Opiate blockers, such as naltrexone (pronounced nal-TREK-sone, trade name ReVia)
• Antipsychotics
• Tranquilizers

Most experts recommend a combination of drug therapies that begins early and continues through the teenage years. Behavioral treatments are used in combination with medications.

Alternative Treatments

Many parents report success with megavitamin therapy. Megavitamin therapy involves the use of very large doses of vitamins. Vitamin B₆ seems to improve eye contact and speech. It may also reduce tantrums. Vitamin B₆ has few side effects and is considered safe to use. However, many health practitioners are not convinced by parent reports or scientific studies reported thus far.

Dimethylglycine (DMG)

DMG is chemically similar to glycine, a naturally occurring amino acid. It is available in many health food stores. Some people believe that it improves speech in autistic children. Those who respond to DMG usually do so within a week. Again, many doctors are not convinced about the effectiveness of this compound.

Exercise

One research study has found that vigorous exercise decreases some of the symptoms of autism. Additional research is needed to confirm this finding.

PROGNOSIS

People with autism have a normal life expectancy, but there is no available cure. However, many of its symptoms can be relieved by treatment. At one time, autistic children were placed in institutions, from which they might never be released. Today, most autistic children can be treated at home, in special schools, and in other more comfortable and familiar settings. Some eventually come to understand the world better and to learn how to interact with other people. They can go on to lead nearly normal lives. Some may be able to handle a job. The best work settings for autistic people are those with structure in which the same task is repeated over and over again.

PREVENTION

There is currently no known way of preventing autism.

FOR MORE INFORMATION

Books

Barron, Sean, and Judy Barron. There's a Boy in Here. New York: Simon & Schuster, 1992.

Bratt, Berneen. No Time for Jello. Cambridge, MA: Brookline Books, 1989.

Cohen, Shirley. Targeting Autism: What We Know, Don't Know, and Can Do to Help Young Children with Autism and Related Disorders. Berkeley: University of California Press, 1998.

Grandin, Temple, and Oliver Sacks. Thinking in Pictures: And Other Reports from My Life With Autism. New York: Vintage Books, 1996.

Grandin, Temple, and Margaret M. Scariano. Emergence: Labeled Autistic. New York: Warner Books, 1996.

Greenfield, Josh. A Child Named Noah. New York: Holt, Rinehart and Winston, 1971.

Hart, Charles. A Parent's Guide to Autism: Answers to the Most Common Questions. New York: Pocket Books, 1993.

Kaufman, Barry Neil. Son-Rise. New York: Harper & Row, 1976.

Williams, Donna. Nobody Knows. New York: Times Books, 1992.

Periodicals

Roeder, Jason, "Can Medication Change Behavior in Autism?" The Exceptional Parent (November 1995): pp. 50–54.

Shapiro, Joseph, "Beyond the Rain Main: A Singular Woman Changes the Cattle Industry and Our Image of Autism." U.S. News & World Report (May 27, 1996): pp. 78–79.

Organizations

Autism Network International. PO Box 448, Syracuse, NY 13210.

Autism Research Institute. 4182 Adams Avenue, San Diego, CA 92116. (619) 281–7165.

Autism Society of America. 7910 Woodmont Avenue, Suite 650, Bethesda, MD 20814. (301) 657–0881; (800) 3AUTISM. http://www.autism-society.org.

Center for the Study of Autism. P.O. Box 4538, Salem, OR 97302. http://www.autism.org

National Autism Hotline. c/o Autism Services Center, PO Box 507, 605 Ninth Street, Huntington, WV 25710. (304) 525–8014.

Web sites

National Alliance for Autism Research. http://www.naar.org (accessed on October 18, 1999).

National Information Center for Children and Youth with Disabilities. http://www.nichcy.org (accessed on October 18, 1999).

"Autism." Drkoop.com Medical Encyclopedia. [Online] http://www.drkoop.com/conditions/encyclopedia/articles/025000a/autism.html?id=avkey.autism.lk (accessed on October 18, 1999).