Your Child - Autism | American Academy of Child & Adolescent Psychiatry

Excerpts from Your Child on Autism

Identifying the signs
Typically, autism is identified by the time a child is thirty months old. The disorder is often discovered when parents consult the youngster’s doctor, having become concerned that the child is not yet talking, resists cuddling, and avoids interactions with others.

Upon questioning, the parents of a child with autism often recall that even as an infant the child did not want to be cuddled. The social smile that we’ve come to associate with babies was absent or extremely delayed, and the child did not respond with the anticipatory excitement that the normal infant shows prior to being picked up by a trusted loved one.

A child with autism is generally withdrawn, aloof, and fails to respond to other people. Most children with autism will not even make eye contact. When hurt, the child will not seek the comfort of a parent’s arms. These children do not play with others but instead spend their time in solitary activities.

Certain behaviors suggest that children with autism may have abnormal responses to sensory stimuli. Children with autism may place their hands over their ears to avoid the stimulation of loud noises. Conversely, at other times they may be unresponsive to sound and thought to be deaf. They may also lick or smell objects or toys they pick up.

Children with autism often engage in odd and ritualistic behaviors that reflect a need to maintain a constant environment. They are likely to have certain routines that must be followed otherwise they will erupt into a rage. A child with autism, for example, may have to touch objects in a certain order or food must be presented to the youngster in a certain way. The child with autism may demonstrate strong taste aversions, eating a very narrow range of foods.

It is common for children with autism to engage in strange body movements such as constant rocking, whirling, teeth-grinding, and head-banging. Sometimes the behaviors are carried out to the point where injuries are sustained, suggesting an insensitivity to pain.

Many children with autism do not speak at all or may only mimic sounds. Those who do speak often will reverse their pronouns, referring to themselves as he or she. Nonsense rhyming and other idiosyncratic language also is common.

The severity of autism varies widely, from mild to sever. Some children with autism are very bright and do well in school, although they have problems with social adjustment. Others function at a much lower level. Intelligence tests conducted on children with autism reveal the majority to be in the mentally retarded range but, because many children with autism don’t communicate verbally, IQ testing should be performed by professionals with expertise in evaluating developmentally delayed children. Occasionally, a child with autism may display an extraordinary talent in art, music, or another specific area.

Causes and Consequences
The cause of autism remains unknown, although current theories indicate a problem with the function and possible structure of the central nervous system. Although conditions such as maternal rubella, encephalitis, and meningitis appear to predispose a child to autism, these are not considered causes. There is now substantial evidence that autism is a genetic disorder, although the specific mode of inheritance remains unclear. We do know, however, there is no validity to the theory that autism develops because of parents’ behavior toward the infant.

How to Respond
If your young child exhibits some of the characteristic symptoms of autism, see your child’s physician for a thorough evaluation. This evaluation usually includes a clinical history, hearing test, neuropsychiatric interview, and observational assessment. A variety of psychometric instruments are available for the assessment of children with autism such as the Childhood Autism Rating Scale (CARS), the Autistic Diagnostic Interview (ADI), and the Autism Diagnostic Observation Schedule. A few children require more extensive testing of the blood, urine, and brain, but such additional studies are usually conducted in order to confirm that the condition is not the result of a brain or metabolic disorder.

While strides in the treatment of autism have been made in recent years, this is still a difficult disorder to treat. The successes are limited and depend upon the severity of the problems. Currently, the most effective treatments involve a combination of special education, behavior modification, and sometimes the use of medications. There is no specific medication for autism so before prescribing medications, your child’s doctor will seek to identify behaviors, such as aggression, compulsivity, hyperactivity, social withdrawal, and depression, to monitor while medication is being taken. The treatment program must be carefully tailored to the needs of the individual child.

Autism may worsen as a child moves into adolescence, although a small number of youngsters with autism actually improve during the teen years. About 40 to 50 percent of children with autism develop some degree of speech. Many have some improvement in their ability to interact socially, but it is rare for a person with autism to have a sexual relationship based on intimacy or to marry. Treatment may lead to broad and positive changes in the child’s development and produce an overall reduction in autistic symptoms and behaviors.

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