A mental disorder characterized by severely abnormal development of social interaction and verbal and nonverbal communication skills. Affected individuals may adhere to inflexible, nonfunctional rituals or routine. They may become upset with even trivial changes in their environment. They often have a limited range of interests but may become preoccupied with a narrow range of subjects or activities. They appear unable to understand others' feelings and often have poor eye contact with others. Unpredictable mood swings may occur. Many demonstrate stereotypical motor mannerisms such as hand or finger flapping, body rocking, or dipping. The disorder is probably caused by organically based central nervous system dysfunction, especially in the ability to process social or emotional information or language.
Alternative Name: Autistic spectrum disorder (ASD), Pervasive developmental disorder (PDD).
Terminology related with autism:
Early infantile autism, infantile autism.
Autism is a general term used to describe a group of complex developmental brain disorders known as Pervasive Developmental Disorders (PDD). The other pervasive developmental disorders are PDD-NOS (Pervasive Developmental Disorder - Not Otherwise Specified), Asperger's Syndrome, Rett Syndrome and Childhood Disintegrative Disorder. Many parents and professionals refer to this group as Autism Spectrum Disorders.
Today, it is estimated that one in every 150 children is diagnosed with autism, making it more common than childhood cancer, juvenile diabetes and pediatric AIDS combined. An estimated 1.5 million individuals in the U.S. and tens of millions worldwide are affected by autism. Government statistics suggest the prevalence rate of autism is increasing 10-17 percent annually. There is not established explanation for this increase, although improved diagnosis and environmental influences are two reasons often considered. Studies suggest boys are more likely than girls to develop autism and receive the diagnosis three to four times more frequently. Current estimates are that in the United States alone, one out of 94 boys is diagnosed with 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, although it is unclear if 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.
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 this disorder 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 this disease are able to live with their families or in the community.
The outlook depends on the severity of the autism and the level of therapy the person receives.
There is a growing interest among researchers about the role of the functions and regulation of the immune system in autism - both within the body and the brain. Piecemeal evidence over the past 30 years suggests that autism may involve inflammation in the central nervous system. There is also emerging evidence from animal studies that illustrates how the immune system can influence behaviors related to autism. Autism Speaks is working to extend awareness and investigation of potential immunological issues to researchers outside the field of autism as well as those within the autism research community.
Autism is characterized by three distinctive behaviors. Autistic children:
Display problems with verbal and nonverbal communication.
Exhibit repetitive behaviors or narrow, obsessive interests.
Have difficulties with social interaction.
The hallmark feature of ASD is impaired social interaction. Children with ASD may fail to respond to their names and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can't understand social cues, such as tone of voice or facial expressions, and don't watch other people's faces for clues about appropriate behavior. They lack empathy.
Many children with ASD engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.” Children with ASD don't know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.
Children with ASD appear to have a higher than normal risk for certain co-occurring conditions, including Fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. About 20 to 30 percent of children with ASD develop epilepsy by the time they reach adulthood. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.
Other signs of the disorder in infants include the following:
Appears content to be alone, happier to play alone.
Displays lack of interest in toys.
Displays lack of response to others.
Does not point out objects of interest to others (called protodeclarative pointing).
Marked reduction or increase in activity level.
Appears indifferent to surroundings.
Young children with autism usually have impaired language development. They often have difficulty expressing needs (i.e., use gestures instead of words) and may laugh, cry, or show distress for unknown reasons. Some autistic patients develop rudimentary language skills that do not serve as an effective form of communication. They may develop abnormal patterns of speech that lack intonation and expression and may repeat words or phrases repetitively (called echolalia).
Other symptoms in young children include the following:
Frequent behavioral outbursts, tantrums.
Inappropriate attachments to objects.
Maintains little or no eye contact.
Over- or undersensitivity to pain, no fear of danger.
Sustained abnormal play.
Uneven motor skills.
Avoids cuddling or touching.
Causes and Risk factors:
The vast majority of cases of autism are idiopathic, which means the cause is unknown.The more complex answer is that just as there are different levels of severity and combinations of symptoms in this disease, there are probably multiple causes. The best scientific evidence available to us today points toward a potential for various combinations of factors causing autism - multiple genetic components that may cause this disorder on their own or possibly when combined with exposure to as yet undetermined environmental factors. Timing of exposure during the child's development (before, during or after birth) may also play a role in the development or final presentation of the disorder. 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 this disease.
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.
Recent studies strongly suggest that some people have a genetic predisposition to autism, meaning that a susceptibility to develop the condition may be passed on from parents to children. Researchers are looking for clues about which genes contribute to this increased vulnerability. In some children, environmental factors may also play a role. Studies of people with autism have found abnormalities in several regions of the brain, which suggest that autism results from a disruption of early brain development while still in utero.
A number of other possible causes have been suspected, but not proven. They involve dietitian, digestive tract changes, mercury poisoning, the body's inability to properly use vitamins and minerals, and vaccine sensitivity.
A diagnosis is based on observed behavior and educational and psychological testing.There is no biological test for autism. The diagnosis will often be based on very specific criteria laid out in a book called the Diagnostic and Statistical Manual IV (DSM 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 Observation Schedule (ADOS).
Childhood Autism rating Scale (CARS).
Gilliam Autism Rating Scale.
Pervasive Developmental Disorders Screening Test - Stage 3.
Autism Diagnostic Interview - Revised (ADI-R).
Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.
There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children. Most health care professionals agree that the earlier the intervention, the better.
Medications: Doctors may prescribe medications for treatment of specific ASD-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.
Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as Applied Behavioral Analysis. Family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD.
Specialized therapies: These include speech, occupational, and physical therapy. These therapies are important components of managing autism and should all be included in various aspects of the child's treatment program. Speech therapy can help a child with this disorder improve language and social skills to communicate more effectively. Occupational and physical therapy can help improve any deficiencies in coordination and motor skills. Occupational therapy may also help a child with autism to learn to process information from the senses (sight, sound, hearing, touch, and smell) in more manageable ways.
Other Therapies: There are a number of controversial therapies or interventions available for people with ASD, but few, if any, are supported by scientific studies. Parents should use caution before adopting any unproven treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child's nutritional status is carefully followed.
Medicine and medications:
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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