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Topic Overview


What is autism?
Autism is a brain disorder that often interferes with a person's ability to communicate with and relate to others.

Signs of autism almost always develop before a child is 3 years old, although the condition is sometimes not diagnosed until later. Typically, parents first become concerned when they notice that their toddler does not begin to talk or does not respond and interact like other children of the same age. Toddlers with autism do not usually develop speech normally and may seem to be deaf although hearing tests are normal.

Autism also affects how a child perceives and processes sensory information.

The severity of autism varies. Some individuals need assistance in almost all aspects of their daily lives, while others are able to function at a very high level and can even attend school in a regular classroom. While this is a lifelong condition that typically results in some degree of social isolation, treatment can make a major difference in the lives of people with autism. Early diagnosis and comprehensive treatment has resulted in increasing numbers of people with autism being able to live independently as adults..

What causes autism?
Autism tends to run in families, suggesting a genetic link. Because people with autism can be vastly different, scientists suspect a number of genes are responsible. Ongoing research is targeted at pinpointing these genes. Some experts also believe that environmental factors may play a part in causing autism, although scientists have studied several factors, including vaccines, and have yet to identify such a cause.

Brain scans of people with autism have shown abnormalities in several areas of the brain, including those responsible for emotion and social relations. Other studies suggest that people with autism have high levels of the neurotransmitter serotonin, a chemical that sends messages in the brain. However, these findings are preliminary, and ongoing studies seek to explain the brain and autism.1

What are the symptoms?
All people with autism have difficulty with social interactions and relationships. Parents often describe their child with autism as preferring to play alone and making little eye contact with other people. Other symptoms of autism include:

Difficulties with verbal and nonverbal communication. Language development in children with autism is almost always delayed.
Limited, repetitive, and overused (stereotyped) patterns of behavior, interests, and play. Many typical behaviors—such as repetitive body rocking, unusual attachments to objects, and holding fast to routines and rituals—are driven by the need for sameness and resistance to change.

There is no “typical” person with autism. Although autism is defined by the above characteristics, people with autism can have many different combinations of behaviors in mild to severe forms.

Do any other conditions occur with autism?
Although it is difficult to determine, studies show that below-normal intelligence occurs in about 70% of children with autism. Teenagers with autism often become depressed and have increased anxiety, especially if they have average or above-average intelligence. In addition, about a third of children with autism develop a seizure disorder (such as epilepsy) by their teen years.

How is autism diagnosed?
Your health professional will use diagnostic guidelines, established by the American Academy of Child and Adolescent Psychiatry (AACAP), to determine whether your child has core symptoms.4 A child may also have hearing and other tests to make sure developmental delays aren't the result of another condition with similar symptoms. Early diagnosis and treatment of autism is important to make the most of the child's potential.

How is it treated?
Behavioral training, speech and occupational therapy, and parent education and support can often improve a child's problem behaviors, communication skills, and socialization. Medications are sometimes helpful as well. A child with autism responds best to a highly structured, specialized educational program tailored to his or her individual needs. However, specific treatment varies depending on the range of individual symptoms, which can combine in many different ways and change over time.

Parents, school staff, and health professionals are usually all involved in planning a child's treatment.



Symptoms


Core symptoms
The severity of symptoms varies greatly between individuals; however, all people with autism have some core symptoms in the areas of:

Social interactions and relationships. Symptoms may include:
- Significant problems developing nonverbal communication skills, such as eye-to-eye gazing, facial expressions, and body posture.
-Failure to establish friendships with children the same age.
-Lack of interest in sharing enjoyment, interests, or achievements with other people.
-Lack of empathy. People with autism may have difficulty understanding another person's feelings, such as pain or sorrow.

Verbal and nonverbal communication. Symptoms may include:
- Delay in, or lack of, learning to talk. As many as 50% of people with autism never speak.
- Problems taking steps to start a conversation. Also, people with autism have difficulties continuing a conversation once it has begun.
- Stereotyped and repetitive use of language. People with autism often repeat over and over a phrase they have heard previously (echolalia).
- Difficulty understanding their listener's perspective. For example, a person with autism may not understand that someone is using humor. They may interpret the communication word for word and fail to catch the implied meaning.

Limited interests in activities or play. Symptoms may include:
- An unusual focus on pieces. Younger children with autism often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy.
- Preoccupation with certain topics. Older children and adults are often fascinated by train schedules, weather patterns, or license plates.
- A need for sameness and routines. For example, a child with autism may always need to eat bread before salad and insist on driving the same route every day to school.
- Stereotyped behaviors. These include body rocking and hand flapping.

Symptoms during childhood
Symptoms of autism are usually first noticed by parents and other caregivers sometime during the child's first 3 years. Although autism is present at birth (congenital), signs of the disorder can be difficult to identify or diagnose during infancy. Parents often become concerned when their toddler does not like to be held; does not seem interested in playing certain games, such as peekaboo; and does not begin to talk. They also may be confused about their child's hearing abilities. It often seems that a child with autism does not hear, yet at other times, he or she may appear to hear a distant background noise, such as the whistle of a train.

With early and intensive treatment, most children improve their ability to relate to others, communicate, and help themselves as they grow older. Contrary to popular myths about children with autism, very few are completely socially isolated or “live in a world of their own.”

Symptoms during adolescent and teen years
During the teen years, the patterns of behavior often change. Many teens gain skills but still lag behind in their ability to relate to and understand others. Puberty and emerging sexuality may be more difficult for adolescents and teens with autism than for others this age. Teens are at a slightly increased risk for developing problems related to depression, anxiety, and epilepsy.

Symptoms in adulthood
Some adults with autism are able to work and live on their own. The degree to which an adult with autism can lead an independent life is related to intelligence and ability to communicate. Approximately 33% are able to achieve at least partial independence.4

Some adults with autism need a lot of assistance, especially those with low intelligence who are unable to speak. Part- or full-time supervision can be provided by residential treatment programs. At the other end of the spectrum, adults with high-functioning autism are often successful in their professions and able to live independently, although they typically continue to have some difficulties relating to other people. These individuals usually have average to above-average intelligence.

Other symptoms
About 10% of people with autism have some form of savant skills—special limited gifts such as memorizing lists, calculating calendar dates, drawing, or musical ability.2

Many people with autism have unusual sensory perceptions. For example, they may describe a light touch as painful and deep pressure as providing a calming feeling. Others may not feel pain at all. Some people with autism have strong food likes and dislikes and unusual preoccupations.

Other conditions
Autism is one of several types of pervasive developmental disorders (PDDs), also called autism spectrum disorders (ASD). It is not unusual for autism to be confused with other PDDs, such as Asperger's disorder or syndrome, or to have overlapping symptoms. A similar condition is called pervasive developmental disorder-NOS (not otherwise specified). PDD-NOS occurs when children display similar behaviors but do not meet the criteria for autism. It is commonly called just PDD. In addition, other conditions with similar symptoms may also have similarities to or occur with autism.

Exams and Tests


The American Academy of Pediatrics (AAP) recommends screening children for autism during regularly scheduled well child visits. This policy helps health professionals identify signs of autism early in its course. Early diagnosis and treatment can help the child reach his or her full potential.

When a developmental delay is recognized in a child, further testing can help a health professional determine whether the problem is related to autism, another pervasive developmental disorder (PDD), or a condition with similar symptoms, such as language delays or avoidant personality disorder. If your primary care provider does not have specific training or experience in developmental problems, he or she may refer your child to a specialist—usually a developmental pediatrician, psychiatrist, speech therapist, or child psychiatrist— for the additional testing.

Behavioral assessments. Various guidelines and questionnaires are used to help a health professional determine the specific type of developmental delay a child has. These include:4
- Medical history. During the medical history interview, a health professional asks general questions about a child's development, such as whether a child shows parents things by pointing to objects. Young children with autism often point to items they want, but do not point to show parents an item and then check to see if parents are looking at the item being pointed out.
- Diagnostic guidelines for autism. These guidelines are the main assessment criteria for autism and were established by the American Association of Child and Adolescent Psychiatry (AACAP). They are designed for children age 3 and older.
- Other behavioral questionnaires. Additional diagnostic tests focus on children younger than age 3.
- Clinical observations. A health professional may want to observe the developmentally delayed child in different situations. The parents may be asked to interpret whether certain behaviors are usual for the child in those circumstances.
- Developmental and intelligence tests. The AACAP also recommends that tests be given to evaluate whether a child's developmental delays affect his or her ability to think and make decisions.

Physical assessments and laboratory tests. Other tests may be used to determine whether a physical problem may be causing symptoms. These tests include:
- Physical examination, including head circumference, weight, and height measurements, to determine whether the child has a normal growth pattern.
- Hearing tests, to determine whether hearing problems may be causing developmental delays, especially those related to social skills and language use.
- Testing for lead poisoning, especially if a condition called pica (in which a person craves substances that are not food, such as dirt or flecks of old paint) is present. Children with developmental delays usually continue putting items in their mouth after this stage has passed in normally developing children. This practice can result in lead poisoning, which should be identified and treated as soon as possible.

Additional laboratory tests may be done under specific circumstances. These tests include:
- Chromosomal analysis, which may be done if mental retardation is present or there is a family history of mental retardation. For example, fragile X syndrome, which causes a range of below-normal intelligence problems as well as autisticlike behaviors, can be identified with this analysis.
- An electroencephalograph (EEG), which is done if there are symptoms of seizures, such as a history of staring spells or if a person reverts to less mature behavior (developmental regression).

Early detection
All health professionals who see infants and children for well child visits should watch for early signs of developmental disorders. Developmental screening tools, such as the Ages and Stages Questionnaire or the Minnesota Child Development Inventory, can help assess behavior.

If a health professional discovers the following obvious signs of developmental delays, the child should immediately be evaluated:

- No babbling, pointing, or other gestures by 12 months
- No single words by 16 months
- No 2-word spontaneous phrases by 24 months, with the exception of repeated phrases (echolalic)
- Any loss of any language or social skills at any age

If there are no obvious signs of developmental delays or any unusual indications from the screening tests, most infants or children do not need further evaluation until the next well child visit.

However, children who have a sibling with autism should continue to be closely monitored, because they are at increased risk for autism and other developmental problems. In addition to the evaluations at well child visits, these children should undergo testing for language delays, learning problems, poor socialization skills, and any symptoms that might suggest they have anxiety or depression.

When socialization, learning, or behavior problems develop in a person at any time or at any age, he or she should also be evaluated.

Treatment Overview

Early diagnosis and treatment helps young children with autism develop to their full potential. The primary goal of treatment is to improve the overall ability of the child to function.

Symptoms and behaviors of autism can combine in many ways and vary in severity. In addition, individual symptoms and behaviors often change over time. For these reasons, treatment strategies are tailored to individual needs and available family resources. In general, however, children with autism respond best to highly structured and specialized treatment. A program that addresses helping parents and improving communication, social, behavioral, adaptive, and learning aspects of a child's life will be most successful.

The American Academy of Pediatrics (AAP) recommends the following strategies for helping a child to improve overall function and reach his or her potential:

- Behavioral training and management. Behavioral training and management uses positive reinforcement, self-help, and social skills training to improve behavior and communication. Many types of treatments have been developed, including Applied Behavioral Analysis (ABA), Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), and sensory integration.
- Specialized therapies. These include speech, occupational, and physical therapy.
- Medications. Medications are most commonly used to treat related conditions, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.
- Community support and parent training. Talk to your doctor or contact an advocacy group for support and training.

Stories about alternative therapies, such as secretin and auditory integration training, have circulated in the media and other information sources. When considering any type of treatment, it is important to know the source of information and to ensure that studies are scientifically sound. Accounts of individual success are not sufficient evidence to support using a treatment. Look for large, controlled studies to validate claims.

Experts have not yet identified a way to prevent autism. Public concern over stories linking autism and childhood vaccines has persisted. However, numerous studies have failed to show any evidence of a link between autism and the measles-mumps-rubella (MMR) vaccine. If you avoid having your children immunized, you put them and others in your community at risk for developing serious diseases, which can cause serious harm or even death.


Home Treatment

Having a child with autism requires taking a proactive approach to learn about the condition and its treatment while working closely with others involved in your child's care. You also need to take care of yourself so that you are able to face the many challenges of having a child with autism.

Educate yourself about autism
Ask your health professional or contact autism organizations to find training about autism and how to manage symptoms. This type of training has been shown to reduce family stress and improve a child's functioning. Understanding the condition and knowing what to expect is an important part of helping your child develop independence.

Become informed about your child's educational rights. Federal laws require services for handicapped children, including those with autism. In addition, there may be state and local laws or policies to aid children with autism. Find out what services are available for your child in your area.

Learning about autism will also help prepare you for when your child reaches adulthood. Some adults with autism can live by themselves, work, and be as independent as other people their age. Others need continued support.

Work closely with others who care for your child
Close communication with others involved in your child's education and care will help all concerned. The best treatment for children with autism is a team approach and a consistent, structured program. Everyone involved needs to work together to set goals for:

- Education.
- Identifying and managing symptoms of autism and any related conditions.
- Behavior and interactions with family and peers, adjustment to different environments, and social and communication skills.

In addition, work closely with the health professionals involved in your child's care. It is important that they take time to listen to your concerns and be willing to work with you.

Take care of yourself
Learn ways to handle the normal range of emotions, fears, and concerns that go along with raising a child with autism. The daily and long-term challenges put you and your other children at an increased risk for depression or stress-related illness. The way you handle these issues influences other family members.

- Get involved in a hobby, visit with friends, and learn ways to relax.
- Seek and accept support from others. Consider using respite care, which is a family support service that provides a break for parents and siblings. In addition, support groups for parents and siblings are generally available; people who participate in support groups often benefit from others' experiences. For more information on support groups in your area, contact the Autism Society of America at http://www.autism-society.org.
- Talk with a health professional about whether counseling would help if you or one of your children is having trouble handling the strains related to having a family member with autism.


Other Places To Get Help

Books
Educating Children With Autism
Author/Editor: Committee on Educational Interventions for Children with Autism
Publisher: National Academy Press

Washington, D.C.
Publication Date: 2001

This book is a summary of research by the Committee on Educational Interventions for Children with Autism. This committee designed their research to answer questions on how best to help children with autism using all available resources. Parents, teachers, health professionals, and policy makers should find helpful information. Specifically, the book discusses the following areas related to autism:

- Diagnosis, assessment, and prevalence
- Role of families
- Goals for educational services
- Characteristics of effective programs
- Public policies
- Training for people who work with autistic children
- Areas where more research is needed




Healthcare for Children on the Autism Spectrum: A Guide to Medical, Nutritional, and Behavioral Issues
Author/Editor: F. R. Volkmar

L. A. Wiesner
Publisher: Woodbine House
6510 Bells Mill Road
Bethesda, MD 20817
Publication Date: 2004

This book provides practical information to help you manage your child's medical care. Parents can find answers to help them understand autism symptoms and behaviors, evaluate medications or alternative therapies, communicate with health professionals, and deal with many other health care concerns.

Online Resource
PediatricNeurology.com
Pediatric Neurological Associates
Web Address: http://www.pediatricneurology.com

This Web site is produced by Pediatric Neurological Associates and has information on many different types of behavioral, psychological, and other neurologically based disorders. Links to specific disorders are available, such as autistic spectrum disorders, learning disabilities, and tics and Tourette's.


Organizations
Autism Society of America
7910 Woodmont Avenue
Suite 300
Bethesda, MD 20814-3067
Phone: 301-657-0881

1-800-3AUTISM
Web Address: http://www.autism-society.org

The Autism Society of America connects more than 20,000 members through a network of over 200 chapters in nearly every state. The Web site includes links to these chapters. The Society provides information and advocacy for autism-related issues. Members receive the ASA's quarterly magazine, the Advocate; online users can sign up for ASA-Net, a free e-newsletter that is e-mailed twice a month.

National Alliance for Autism Research (NAAR)
99 Wall Street, Research Park
Princeton, New Jersey 08540
Phone: (609) 430-9160

1-888-777-NAAR (1-888-777-6227)
Fax: (609) 430-9163
E-mail: naar@naar.org
Web Address: http://www.naar.org

The National Alliance for Autism Research (NAAR) is a national nonprofit organization for autism spectrum disorders (ASD). The NAAR supports research to find the causes of ASDs and to prevent, treat, and ultimately cure them. The Web site provides information and current research about ASDs, as well as many links to other organizations.

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Frequently Asked Questions (click vô đây http://my.webmd.com/hw/m...152186.asp?pagenumber=5) để vô link tiện hơn!

Learning about autism:
- What is autism?
- What causes autism?
- What are the symptoms?
- Who is affected?
- What are other types of developmental disorders?
- What is the difference between autism and Asperger's syndrome?
- Can vaccinations cause autism?

Being diagnosed:
- How is autism diagnosed?
- Are there any tests to screen for general developmental disorders?
- What questions are asked regarding my child's medical history?
- Are there any diagnostic guidelines specifically for autism?
- How is behavior assessed?
- What will my child's doctor look for during a physical examination for autism?

Getting treatment:
- What are the general treatment goals for autism?
- What are some steps parents can take to help a child with autism?
- Are there any medications to help treat autism?
- How do I know if an alternative therapy is good for my child?

Ongoing concerns:
- What kinds of training programs can help a child with autism?
- Are there any specific therapies to help a child with autism?

Living with autism:
- What kind of support will I need?
- How can I help my child in school?
- What kind of care is available for adults with autism?

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