April 2, 2011

April 2 is autism awareness day, and being an autism therapist, I know how ignorant people, especially parents, are about it. I thought this would be the best time to let people know what autism is and how we can accommodate the autistic.

Autism is a developmental disorder that appears in the first three years of life, and affects the brain's normal development of social and communication skills. Most autistic children are perfectly normal in appearance, but they spend their time engaged in puzzling and indulge in disturbing behaviour which is markedly different from those of typical children.

Autism and Vaccines

Many parents are worried that some vaccines are not safe and may harm their baby or young child. They may ask their doctor or nurse to wait, or even refuse to have the vaccine. However, it is important to also think about the risks of not having the vaccination.

Some people believe that the small amount of mercury (called thimerosal) that is a common preservative in multidose vaccines causes autism or ADHD. However, studies have NOT shown this risk to be true.

Occurence of autism

Autism affects boys three to four times more often than girls. Family income, education, and lifestyle do not seem make any difference to the risk of developing autism. Some doctors believe the increase in the number of autism cases is due to newer definitions of autism. The term "autism" now includes a wider spectrum of children. For example, a child who is diagnosed with high-functioning autism today may have been thought to be simply odd or strange 30 years ago.

Symptoms

Most parents of autistic children suspect that something is wrong by the time the child is 18 months old and seek help by the time the child is age two. Children with autism typically have difficulties in:

Pretend play
Social interactions
Verbal and non-verbal communication

Some children with autism appear normal before age one or two and then suddenly "regress" and lose the language or social skills they had previously gained. This is called regressive type of autism.

People with autism may:

Be overly sensitive in sight, hearing, touch, smell, or taste (for example, they may refuse to wear "itchy" clothes and become distressed if they are forced to wear them),
Have unusual distress when routines are changed,
Perform repeated body movements
Show unusual attachments to objects.

The symptoms may vary from moderate to severe.

Communication problems may include:

Inability to start or maintain a social conversation
Communication with gestures instead of words
Developing language slowly or not at all
Inability to adjust gaze to look at objects that others are looking at
Inability to refer to self correctly (for example, says "you want water" when the child means "I want water")
Inability to direct others' attention to objects (occurs in the first 14 months)
Repeatition of words or memorized passages, such as commercials
Usage of nonsense rhyming

Social interaction

Does not make friends
Does not play interactive games
Is withdrawn
May not respond to eye contact or smiles, or may avoid eye contact
May treat others as if they were objects
Prefers to spend time alone, rather than with others
Shows a lack of empathy

Response to sensory information

Does not startle at loud noises
Has heightened or low senses of sight, hearing, touch, smell, or taste
May find normal noises painful and hold hands over ears
May withdraw from physical contact because it is overstimulating or overwhelming
Rubs surfaces, mouths or licks objects
Seems to have a heightened or low response to pain

Play

Doesn't imitate the actions of others
Prefers solitary or ritualistic play
Shows little pretend or imaginative play

Behaviour

"Acts up" with intense tantrums
Gets stuck on a single topic or task (perseveration)
Has short attention span
Has very narrow interests
Is overactive or very passive
Shows aggression to others or self
Shows a strong need for sameness
Uses repetitive body movements

Signs and tests

All children should have routine developmental exams done. Further testing may be needed if the doctor or parents are concerned. This is particularly true if a child fails to meet any of the following language milestones:

Babbling by 12 months
Gesturing (pointing, waving bye-bye) by 12 months
Saying single words by 16 months
Saying two-word spontaneous phrases by 24 months (not just echoing)
Or, losing any language or social skills at any age

These children might receive a hearing evaluation and screening test for autism (such as the Checklist for Autism in Toddlers [CHAT] or CARS. An evaluation of autism will often include a complete physical and nervous system (neurologic) examination. It may also include a specific screening tool, such as:

Autism Diagnostic Interview - Revised (ADI-R)
Autism Diagnostic Observation Schedule (ADOS)
Childhood Autism rating Scale (CARS)
Gilliam Autism Rating Scale (GARS)

Sometimes people are reluctant to have a child diagnosed because of concerns about labelling the child. However, without a diagnosis the child may not get the necessary treatment and services.

Treatment

An early, intensive, appropriate treatment programme will greatly improve the outlook for most young children with autism. Most programmes will build on the interests of the child in a highly structured schedule of constructive activities. Visual aids are often helpful.

Treatment is most successful when it is geared toward the child's particular needs. An experienced specialist or team should design the programme for the individual child. A variety of therapies are available, including:

Occupational therapy
Physical therapy
Speech-language therapy
Sensory integration and vision therapy
Applied Behavioural Analysis (ABA)

Expectations (Prognosis)

Autism remains a challenging condition for children and their families, but the outlook today is much better than it was a generation ago. At that time, most people with autism were placed in institutions.

Today, with the right therapy, many of the symptoms of autism can be improved, though most people will have some symptoms throughout their lives. Most people with autism are able to live with their families or in the community.

Calling your healthcare provider

Parents usually suspect that there is a developmental problem long before a diagnosis is made. Call your healthcare provider with any concerns about autism or if you think that your child is not developing normally.