Autism Spectrum Disorders

Autism | Asperger's Disorder | Rett Syndrome | Childhood Disintegrative Syndrome

Autism spectrum disorders (ASD) are a group of disorders whose symptoms include delays in basic skills development. (The term pervasive developmental disorders or PDD is also used.) Individuals with ASD often have emotional, behavioral, language or social skills issues. Examples of ASD are - Autism, Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) also known as atypical autism, Asperger's Disorder, Rett Syndrome and Childhood Disintegrative Syndrome.

Autism is the best known and the most studied of the developmental disorders. It is often confusing and frightening for those who don't understand it. Here we'll explore autism as well as several other developmental disorders that have similar symptoms.

Autism

Autism is a disorder of the brain (Read about "The Brain"), not a disease. It is a complicated developmental disability that most commonly appears before age three. According to the Centers for Disease Control and Prevention (CDC), autism is four times more common in boys than in girls. The likelihood of having autism isn't influenced by ethnic origin, social background, lifestyle, income or level of education. People with autism tend to have problems with communication, social skills or play activities, and often have trouble relating to the "outside world."

The Autism Society of America (ASA) describes autism as a spectrum disorder, meaning that symptoms can appear in many different combinations and at different levels of severity. This means that two people with the diagnosis of autism may respond and act very differently and have very different skills and adaptations.

Symptoms of autism

The symptoms of autism can be mild or severe and can be very different from person to person. The American Academy of Family Physicians (AAFP) states that common signs of autism can be:

• avoiding cuddling or eye contact
• staring; not responding to voices or sounds
• not talking or using just a monotone when talking
• rocking back and forth, spinning, or banging head
• not understanding hand gestures or body language or playing make-believe
• focusing on ritual, routine or order
• being unafraid of danger or causing injury to themselves

According to ASA, people with autism may have unusual responses to others or become aggressive. They may also have sensitivities in any of the five senses of sight, hearing, touch, smell and taste. Some people with autism are highly intelligent or have special skills with memory or numbers, but have trouble communicating or relating socially.

Diagnosing autism

Although autism isn't diagnosed by a medical test, some tests may be ordered to rule out other medical problems that could account for the symptoms. According to the National Institute of Neurological Disorders and Stroke (NINDS), symptoms usually show up by age three, and continue throughout life. Autism is sometimes suspected when babies or toddlers don't behave or develop as would be expected for their age. (Read about "Child Development") Children living within this spectrum often appear relatively normal in their development until the age of two or so. Parents may start to notice delays in language, play or social skills. These symptoms alone don't confirm a diagnosis of autism, but are taken into consideration when evaluating children. ASA recommends a comprehensive evaluation that can include consultation with a neurologist, specialized pediatrician, psychologist, speech/language therapist or any other professional skilled in the diagnosis or treatment of autism and its effects.

In addition to observing a child, professionals attempting to make a diagnosis may ask for specific input from parents or other caregivers. ASA states that it is important to distinguish between autism and other developmental disabilities, behavior disorders, hearing problems (Read about "The Ear and Hearing") or eccentric behavior so that an appropriate treatment program can be started as soon as possible. Unfortunately, these disorders can also be present in the child with autism, making diagnosis that much more difficult.

AAFP explains that babies and children who seem to be developing normally sometimes lose abilities they already had, like talking. This is called a regression. According to AAFP it can be hard to test autistic children, since they don't respond to questions and situations the same way other children do.

Causes of autism

According to the National Institute of Child Health and Human Development (NICHD), there is rarely a specific underlying cause for autism. Currently there is a lot of research to try to figure out what causes autism and there are many theories being explored including genetics, infections, metabolic and environmental factors and the immune system. (Read about "The Immune System") According to NICHD, studies have shown that autism may be caused by a disruption in the developing brain of a fetus. (Read about "Healthy Pregnancy") Autism sometimes runs in families (Read about "Family Health History"), which suggests that genetics may sometimes play a role. (Read about "Genetics") One known infection that can cause autism is when the mother contracts rubella, commonly known as German measles, during pregnancy. (Read about "Childhood Illnesses") Multiple birth defects (Read about "Birth Defects") have been traced to rubella during the early part of pregnancy. In addition, a genetic condition called fragile X syndrome (Read about "Fragile X Syndrome") is known to result in autistic spectrum disorder behaviors.

There has been some concern that the measles-mumps-rubella (MMR) vaccine (Read about "Immunizations") might cause autism. CDC supports use of the vaccine as a public health tool that prevents nearly 400,000 cases of measles each year in the United States. CDC considers this significant, since measles caused over one million deaths worldwide last year.

Because of the concern and confusion about the relationship between autism and the MMR vaccine, the CDC and the National Institutes of Health (NIH) had another agency, the Institute of Medicine (IOM) study this question. This group did research and determined that there was no link between autism and the MMR vaccine, although they encouraged ongoing research. AAFP says there is no link and feels strongly that immunizations are important. If you have questions or concerns about the MMR vaccine, talk to your child's healthcare provider.

Autism treatment

Although there isn't any cure for autism, there are many ways to help people with autism adapt to their specific needs and grow to their full potential. According to ASA, autistic individuals can learn, once their unique way of processing information is understood. With appropriate treatment, some symptoms of autism may diminish over time, although communication and social issues will probably continue throughout a person's life. Intense behavior and language therapy may help some children. ASA explains that many people with autism enjoy their lives and contribute to their communities. AAFP states that although there is no medicine to treat autism, various medications can help alleviate some of the potential symptoms like aggressive behavior or trouble sleeping. Adults with autism benefit from social programs, recreational programs and vocational training.

According to NINDS, people with autism have normal life expectancies and can lead normal or near normal lives, depending on the severity of their symptoms.

Pervasive Developmental Disorder - not otherwise specified (PDD-NOS)

This is also known as atypical autism. It is usually the name given to a disorder if a child doesn't fit into an exact category but still suffers from a condition that seems to limit their ability for normal behaviors.

Asperger's Disorder

According to the American Academy of Child and Adolescent Psychiatry (AACAP), Asperger's Disorder is characterized by problems with behavior and development of social skills. Someone with Asperger's may use words very literally and have problems dealing with irony or language subtleties, or they may exhibit unusual nonverbal behaviors such as facial expressions or body postures. Because of similarities to symptoms of autism, children with these symptoms need careful evaluation. AACAP draws the following similarities and differences between autism and Asperger's Disorder:

• A child with Asperger's Disorder typically functions at a higher level than a child with autism.
• It is common for a child with Asperger's Disorder to have normal to above normal intelligence.
• Although children with Asperger's Disorder may have unusual speech patterns, there is usually no delay in language development, according to the Autism Society. Someone with Asperger's, however, may use language in different ways, or their speech may not have natural inflections. They may also have issues understanding things like irony or humor.
• Children with Asperger's Disorder may have trouble interacting with children their age. They are often loners and may show behavior that some people may consider eccentric.
• Many children with Asperger's Disorder have problems with coordination.

According to AACAP, a specific cause is not yet known, although there may be a tendency for the condition to run in families, suggesting a genetic link. AACAP states that children with this disorder are at risk for psychiatric problems including depression, attention deficit hyperactivity disorder, schizophrenia and obsessive-compulsive disorder. (Read about "Depressive Illnesses" "Attention Deficit Hyperactivity Disorder" "Schizophrenia" "Obsessive Compulsive Disorder")

Treatment for Asperger's Disorder involves a combination of psychotherapy, special education, behavior therapy and family support. Many children with this disorder finish high school and attend college, and can develop healthy relationships with family and friends.

Rett Syndrome

Rett Syndrome almost always affects girls. It is a developmental disorder where previously normal development is replaced by a loss of developmental skills and a variety of motor symptoms. According to the International Rett Syndrome Association (IRSA) Rett Syndrome is present in every 10,000-23,000 live female births worldwide. (Read about "Birth Defects") IRSA says that a genetic mutation has been found in up to 75 percent of Rett Syndrome cases.

IRSA gives the following symptoms for the diagnosis of Rett Syndrome (after ruling out other conditions):

• normal development until 6-18 months
• slowed rate of head growth with age (3 months-4 years)
• loss of purposeful hand skills and impaired language skills; this makes it difficult to assess levels of understanding and intelligence.
• repetitive hand movements like washing, wringing or clapping
• unsteady, stiff-legged walk

Other symptoms that may also be present include:

• breathing problems like hyperventilation, apnea, breath holding or air swallowing
• abnormal EEG (Read about "EEG - Electroencephalograph")
• seizures (Read about "Seizures")
• muscle rigidity
• scoliosis (Read about scoliosis in "Curvature of the Spine")
• grinding of teeth
• small feet in relation to height

Childhood Disintegrative Syndrome

Children with childhood disintegrative syndrome have normal development during their first two years, but then significantly lose their skills in at least two of the following areas before their tenth birthday, according to ASA:

• communication
• social skills
• toilet training
• play patterns
• motor skills

Doctors differentiate this condition from autism by the later age of onset of symptoms.

Diagnosing developmental disorders

If you have any concerns about a child's development, talk to your healthcare provider. A diagnosis of a developmental disorder is usually made only after other possible causes for physical, emotional or behavioral symptoms are ruled out.

Early intervention however is important. The earlier treatment can begin the likelihood of higher function increases.

Related Information:

    Child Development