What is an autism spectrum disorder (ASD) or a pervasive developmental disorder (PDD)?
Children who have difficulty with social skills, language and behavior are said to have an autism spectrum disorder (formerly known as a pervasive developmental disorder (PDD)). There may be large differences between individuals with these disorders, and symptoms and difficulties occur along a continuum, or spectrum. The continuum may include a child with autism who does not find social interaction rewarding on one end, and another child who is very sociable on the other. Some children with ASD are mentally retarded, while others have higher than average intelligence.
Most children with problems in development have only one or two areas of disability. Children with ASD, however, have problems in multiple areas, particularly:
- Social interaction
What is the difference between ASD and autism?
Autism (autistic disorder) and Asperger syndrome are types of ASD. Specific criteria must be met for a child to be diagnosed with autistic disorder or Asperger syndrome. Even though all children with autism and Asperger syndrome meet the same general criteria for these disorders, they may have very different behaviors and abilities because of their age and how severe their symptoms are.
Children who have problems in areas of development like those listed above, but who do not meet criteria for autistic disorder are diagnosed with PDD-NOS (Not Otherwise Specified). Children with PDD-NOS may be later diagnosed with autistic disorder if they develop more symptoms. Children with PDD-NOS appear to be similar to children with an ASD, but do not meet all of the criteria to be classified with autism or Asperger syndrome.
What are the symptoms?
Children with ASD may appear normal for the first few months of life, but may become less responsive to parents or other stimuli as they age. Delayed language development is a common visible reason many children with ASD are originally brought in for evaluation. Depending on the age of the child, symptoms in the following areas are common.
- Social skills
- Resists being cuddled; may scream to be put down when held.
- Struggles to form relationships with peers
- Avoids eye-to-eye contact
- Prefers to play alone
- Shows indifference to the feelings of others and to social norms
- Lacks response to social cues, hints or non-verbal body language
- Unable to fit into a group interaction
- Struggles with the give-and-take of social relationships
- Use of language and imagination
- Speaks later than other children of the same
- Speaks in a stilted or pedantic manner
- Does not understand or copy speech and/or gestures
- Excessively repeats certain phrases or words
- Abnormal rate, pitch, tone, or rhythm of speech
- Unable to start a conversation or maintain conversation
- Unable to engage in fantasy or imaginative play such as role playing and storytelling
- Responds inappropriately to sounds
- Displays immature or unimaginative acquired speech, i.e., makes up words and echoes what someone says
- Behavior, activities and interests
- Develops habit behavior and compulsive routines
- Greatly resists even the slightest change; becomes enraged if obsessive routine is altered or activities are disrupted
- Obsessed with one topic or idea
- Becomes attached to unusual objects
- Walks on tiptoe and/or flicks or twiddles fingers for long periods
- Bangs head, rocks or stares
- Displays only narrow interests
- Deliberately injures self
- Struggles to learn manual tasks
No child with ASD will have all of the above symptoms nor is this a list of all the possible symptoms. Only an evaluation with an experienced clinician can determine if your child has an ASD.
What is the cause?
Parents are not responsible for this condition. Though many years ago doctors believed that an abnormal relationship between the infant and his or her parents caused ASD, they now know this is not true.
There is no scientific evidence to link ASD to the MMR (measles, mumps, rubella) vaccine or preservatives used in vaccines (thimerosal).
Autism spectrum disorder is a brain-based disorder with a strong genetic component. The specific nature of the brain dysfunction is poorly understood. It has been found in children with brain abnormalities such as congenital rubella syndrome, neurofibromatosis, and tuberous sclerosis. It may also be present with genetic syndromes such as Fragile X Syndrome and phenylketonuria (PKU).
Your child's doctor will probably perform lab tests to rule out these and other medical problems associated with ASD. As with all children struggling to develop communication, an evaluation by an audiologist to check your child's hearing may be necessary. However, most children with ASD are found to have normal health and no medical reason for the symptoms.
There is no specific medical test to diagnose ASD. Because ASD can be inherited, your health care provider will also want to screen your other children for symptoms.
What is the treatment for Autism Spectrum Disorders?
Early intensive treatment can have a significant impact on future academic, behavioral and adaptive success.
The treatment of children with ASD focuses on educational and behavioral therapies. Even very young children can benefit from the social/language therapy and behavior development programs designed specifically for children with social and communication problems and their families. Special teachers and classrooms can help older children improve their academic performance and social skills.
Although some children with ASD are also mentally retarded, many others are within the average range of intelligence or better. Regardless, all children with ASD can learn, they simply learn differently than other children. It is important to contact your local school district before your child starts school to discuss how to meet your child’s learning needs. Children with ASD usually require special class placement or special classroom changes.
A team of professionals will help evaluate your child and put this plan together. You may also ask your doctor to review the plan. Ask and find out about all the services that may be available for your child.
Medical treatment for ASD sometimes includes the prescription of medications. Mood- or behavior-altering medications may improve behaviors that can cause self-injury or interfere with school or social ability. These medicines must be prescribed by a doctor experienced with their use in children with ASD. However, no medication has been found that will eliminate the symptoms of ASD. Don't forget that children with ASD have the same health care needs as any other child and benefit from the same health care and disease prevention activities.
Alternative treatments for ASD
Parents of children with ASD often learn of new or alternative treatments through their friends, the media or the internet. Some examples include:
- Gluten free diet
- Heavy metal detoxification
Some reports say these alternative treatments have been helpful for a very small number of children, but there is no scientific evidence that any alternative treatments is effective for the vast majority of children with ASD. Some alternative treatments may actually be harmful for your child. Consult your doctor before deciding to use these treatments as they could help or harm your child.
What can we expect in the future?
The great variety in the symptoms of ASD in children makes this a difficult question to answer. There are several factors that play into the likelihood that a child will ultimately live independently in the future.
- The degree of social distance--most experts agree that the more socially distant a child is, the less likely it is that the child will live independently as an adult. However, a child who is socially removed at age 2 may not display the same degree of social disability 20 years later.
- Intelligence--many children with ASD score in the mentally retarded range on traditional IQ tests. However, when these same children are given tests that measure visual-spatial and memory skills, many score much higher. These skills may help an autistic child become self-sufficient.
- Children with high-functioning autism or Asperger syndrome frequently have IQ's in the average to well above average range. Executive dysfunction and poor social cognition may prevent these children from demonstrating their full potential.
- Temperament--People with ASD who are calm and cooperative will be more able to adapt to new rules and situations than those who are not.
It is impossible to make precise long-range predictions for individual children with ASD. It is likely that all children with full autistic disorder (autism) will need special education. Some of these children can eventually be mainstreamed to some degree in the higher grades. Successful independent living as an adult mostly depends on several factors:
- How well the child develops social and communication skills
- Degree of mental retardation present
- Effectiveness of intervention programs
Where can my family get help and support?
When parents hear that their child has an ASD, they may feel fear, anger, guilt, and other difficult emotions. Many families find that professional guidance can help them cope with this traumatic news.
Children with ASD can create great stress on the entire family. Families report many areas of their lives are affected following the ASD diagnosis, including:
- Strain on marital relationships
- Stress on siblings of the child with ASD
Parents should explore community and governmental resources as well as local support groups composed of families who have children with similar difficulties. Parents can access these groups via their doctor, school, therapy program, or national and local support organizations. These groups share common concerns and offer solutions to problems.