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    Namrata
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    What Does Autism Mean?
    Autism causes kids to experience the world differently from the way most other kids do. It’s hard for kids with autism to talk with other people and express themselves using words. Kids who have autism usually keep to themselves and many can’t communicate without special help.

    They also may react to what’s going on around them in unusual ways. Normal sounds may really bother someone with autism — so much so that the person covers his or her ears. Being touched, even in a gentle way, may feel uncomfortable.

    Kids with autism often can’t make connections that other kids make easily. For example, when someone smiles, you know the smiling person is happy or being friendly. But a kid with autism may have trouble connecting that smile with the person’s happy feelings.

    A kid who has autism also has trouble linking words to their meanings. Imagine trying to understand what your mom is saying if you didn’t know what her words really mean. It is doubly frustrating then if a kid can’t come up with the right words to express his or her own thoughts.

    Autism causes kids to act in unusual ways. They might flap their hands, say certain words over and over, have temper tantrums, or play only with one particular toy. Most kids with autism don’t like changes in routines. They like to stay on a schedule that is always the same. They also may insist that their toys or other objects be arranged a certain way and get upset if these items are moved or disturbed.

    If someone has autism, his or her brain has trouble with an important job: making sense of the world. Every day, your brain interprets the sights, sounds, smells, and other sensations that you experience. If your brain couldn’t help you understand these things, you would have trouble functioning, talking, going to school, and doing other everyday stuff. Kids can be mildly affected by autism, so that they only have a little trouble in life, or they can be very affected, so that they need a lot of help.

    Causes, incidence, and risk factors

    Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism.

    Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism. Similarly, language abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other nervous system (neurological) problems are also more common in families with autism.

    A number of other possible causes have been suspected, but not proven. They involve:

    Diet

    Digestive tract changes

    Mercury poisoning

    The body’s inability to properly use vitamins and minerals

    Vaccine sensitivity

    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.

    The American Academy of Pediatrics, and The Institute of Medicine (IOM) agree that no vaccine or component of any vaccine is responsible for the number of children who are currently being diagnosed with autism. They conclude that the benefits of vaccines outweigh the risks.

    All of the routine childhood vaccines are available in single-dose forms that do not contain added mercury.

    The Centers for Disease Control and Prevention website provides further information.

    HOW MANY CHILDREN HAVE AUTISM?

    The exact number of children with autism is not known. A report released by the U.S. Centers for Disease Control and Prevention (CDC) suggests that autism and related disorders are more common than previously thought. It is unclear whether this is due to an increasing rate of the illness or an increased ability to diagnose the illness.

    Autism affects boys 3 – 4 times more often than girls. Family income, education, and lifestyle do not seem to affect the risk of autism.

    Some doctors believe the increased incidence in autism 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 simply be odd or strange 30 years ago.

    Other pervasive developmental disorders include:

    Asperger syndrome (like autism, but with normal language development)

    Rett syndrome (very different from autism, and only occurs in females)

    Childhood disintegrative disorder (rare condition where a child learns skills, then loses them by age 10)

    Pervasive developmental disorder – not otherwise specified (PDD-NOS), also called atypical autism

    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 2. Children with autism typically have difficulties in:

    Pretend play

    Social interactions

    Verbal and nonverbal communication

    Some children with autism appear normal before age 1 or 2 and then suddenly “regress” and lose language or social skills they had previously gained. This is called the 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 the clothes)

    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:

    Cannot start or maintain a social conversation

    Communicates with gestures instead of words

    Develops language slowly or not at all

    Does not adjust gaze to look at objects that others are looking at

    Does not refer to self correctly (for example, says “you want water” when the child means “I want water”)

    Does not point to direct others’ attention to objects (occurs in the first 14 months of life)

    Repeats words or memorized passages, such as commercials

    Uses 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 are 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

    Behaviors:

    “Acts up” with intense tantrums

    Gets stuck on a single topic or task (perseveration)

    Has a 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 by their pediatrician. 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)

    Losing any language or social skills at any age

    These children might receive a hearing evaluation, blood lead test, and screening test for autism (such as the Checklist for Autism in Toddlers [CHAT] or the Autism Screening Questionnaire).

    A health care provider experienced in diagnosing and treating autism is usually needed to make the actual diagnosis. Because there is no biological test for autism, the diagnosis will often be based on very specific criteria from a book called the Diagnostic and Statistical Manual IV.

    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

    Pervasive Developmental Disorders Screening Test – Stage 3

    Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and may have metabolic testing.

    Autism includes a broad spectrum of symptoms. Therefore, a single, brief evaluation cannot predict a child’s true abilities. Ideally, a team of different specialists will evaluate the child. They might evaluate:

    Communication

    Language

    Motor skills

    Speech

    Success at school

    Thinking abilities

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

    Treatment

    An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. Most programs 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 program for the individual child. A variety of therapies are available, including:

    Applied behavior analysis (ABA)

    Medications

    Occupational therapy

    Physical therapy

    Speech-language therapy

    Sensory integration and vision therapy are also common, but there is little research supporting their effectiveness. The best treatment plan may use a combination of techniques.

    APPLIED BEHAVIORAL ANALYSIS (ABA)

    This program is for younger children with an autism spectrum disorder. It can be effective in some cases. ABA uses a one-on-one teaching approach that reinforces the practice of various skills. The goal is to get the child close to normal developmental functioning.

    ABA programs are usually done in a child’s home under the supervision of a behavioral psychologist. These programs can be very expensive and have not been widely adopted by school systems. Parents often must seek funding and staffing from other sources, which can be hard to find in many communities.

    TEACCH

    Another program is called the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH). TEACCH was developed as a statewide program in North Carolina. It uses picture schedules and other visual cues that help the child work independently and organize and structure their environments.

    Though TEACCH tries to improve a child’s adaptation and skills, it also accepts the problems associated with autism spectrum disorders. Unlike ABA programs, TEACCH programs do not expect children to achieve typical development with treatment.

    MEDICINE

    Medicines are often used to treat behavior or emotional problems that people with autism may have, including:

    Aggression

    Anxiety

    Attention problems

    Extreme compulsions that the child cannot stop

    Hyperactivity

    Impulsiveness

    Irritability

    Mood swings

    Outbursts

    Sleep difficulty

    Tantrums

    Currently, only risperidone is approved to treat children ages 5 – 16 for the irritability and aggression that can occur with autism. Other medicines that may also be used include SSRIs, divalproex sodium and other mood stabilizers, and possibly stimulants such as methylphenidate. There is no medicine that treats the underlying problem of autism.

    DIET

    Some children with autism appear to respond to a gluten-free or casein-free diet. Gluten is found in foods containing wheat, rye, and barley. Casein is found in milk, cheese, and other dairy products. Not all experts agree that dietary changes will make a difference, and not all studies of this method have shown positive results.

    If you are considering these or other dietary changes, talk to both a doctor who specializes in the digestive system (gastroenterologist) and a registered dietitian. You want to be sure that the child is still receiving enough calories, nutrients, and a balanced diet.

    Living With Autism
    Some kids with mild autism will grow up and be able to live on their own. Those with more serious problems will always need some kind of help. But all kids with autism have brighter futures when they have the support and understanding of doctors, teachers, caregivers, parents, brothers, sisters, and friends.

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