A Refresher on Autism Spectrum Disorders
by Rynae Golke
Autism is becoming increasingly more common worldwide; according to the Centers for Disease Control (CDC), one in 68 children are diagnosed with an Autism Spectrum Disorder, also referred to as ASD. ASD refers to a grouping of developmental disorders that share common characteristics, but may include a spectrum of different symptoms and levels of severity.
The prevalence of Autism Spectrum Disorder has increased tenfold in just 40 years, bringing the total to one in 68 children — more than 2 million total — diagnosed in America today. The increase is partially resulting from increased awareness and diagnosis, but this alone can’t explain the exponential increase in prevalence. More boys than girls suffer from autism; one in 42 boys have the disorder, while only one in 189 girls are diagnosed, according to Autism Speaks. Autism costs a family around $60,000 per year.
Causes, Risk Factors
The causes of ASD are largely unknown, although many scientists believe ASD is related to genetic makeup. Certain factors put a patient at higher risk of developing ASD:
- Being exposed to the prescription drugs valporic acid or thalidomide during mother’s pregnancy
- Having siblings diagnosed with ASD
- Having fragile X syndrome
- Having tuberous sclerosis
- Being born to older parents
Many non-profit and government entities continue to work to learn more about the causes of ASD; according to the CDC, one of the largest ASD studies ever conducted in the United States is in progress now.
Signs and Symptoms
Signs and symptoms of Autism Spectrum Disorder are typically noticed as infants and toddlers develop. The National Institute of Mental Health (NIMH) indicates that ASD signs and symptoms fall into two broad categories:
- Restrictive or repetitive behaviors
- Social interaction or communication behaviors
These core characteristics manifest in a number of ways and differ from patient to patient. They often interfere with the patient’s ability to function, especially at school, work and in social situations.
Repetitive or restrictive behaviors include intense focus on one or few interests or topics and displaying repetitive behaviors, such as rocking or clapping. Social interaction and communication behaviors may include any of the following:
- Resistance to change
- Lack of eye contact with others
- Becoming upset about being in a setting that is overly stimulating
- Facial expressions, gestures and body language that don’t match the words being said
- A robotic or sing-song tone of voice
- Carrying on about a subject of intense interest without noticing that others are disengaged
- Failure to respond to others calling them
- Difficulty relating to others or understanding how others feel
- Repeating words or phrases that have been said to them
- React to smells, tastes, textures or sounds
- Struggling to express needs
- May prefer not to be held/cuddled
Additional characteristics of ASD include a strong memory, strong ability to learn, excellence in science, math, art, or music, and above-average intelligence.
Reliable diagnosis of ASD is usually possible by age 2. Initial screening can be performed by a primary care, family practice, or pediatric physician, nurse practitioner, or physician’s assistant. If a provider suspects ASD, the patient should be referred to a developmental pediatrician, child neurologist, child psychologist or child psychiatrist for further evaluation.
There is no diagnostic test for ASD; rather, the disorder is diagnosed based on the child’s development and behavior. Diagnosis is most common between age 18 months and 2 years, but it’s often not received until much later.
While ASD cannot be cured, therapy, lifestyle changes and management of symptoms can assist the child in developing important skills for home, school and work and leading a healthy life. A treatment plan may include:
- Medications to manage symptoms, such as depression, seizures or hyperactivity
- Regular doctor and dental appointments to screen for underlying problems, since ASD children may have difficulty expressing pain or changes
- Dietary changes, such as removing certain foods from the diet or supplementing with certain vitamins and minerals; these approaches have not been thoroughly studied, but many parents report improvement
- Facilitated communication, which teaches the child to communicate through letters, symbols or pictures
- Occupational therapy, which helps the child learn skills that can promote independence, such as eating and dressing
- Speech therapy, which aims to improve the patient’s ability to communicate with others
- Physical therapy to improve the physical symptoms of ASD, such as poor muscular strength or motor skills
- Sensory integration, which aims to help patients with ASD cope with sensory sensitivities
- Applied behavior analysis, which is a treatment approach that encourages acceptable behaviors and discourages unacceptable behaviors
As many as one-third of parents of children with Autism Spectrum Disorder also report seeking treatment through alternative or complementary medicine. While some of these treatments may be harmless or even beneficial, as many as 10 percent of these treatments may be harmful to the child’s health. Having an open dialogue with parents regarding alternative treatments may prevent harm.
With the increased prevalence of ASD and the evidence that early intervention is critical, it has become more and more important to keep all members of the healthcare team educated and updated on the signs, symptoms, diagnosis and treatment of ASD.