Autism Definition:

Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood

It 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.

Currently, the autism spectrum disorder category includes: Autistic disorder (also called classic autism) Asperger syndrome Pervasive Developmental Disorder Not Otherwise Specified (or atypical autism)

In some cases, health care providers use a broader term, pervasive developmental disorder, to describe autism. This category includes the autism spectrum disorders above, plus Childhood Disintegrative Disorder and Rett syndrome.

What Causes Autism?

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 small number of cases can be linked to genetic disorders such as Fragile X, Tuberous Sclerosis, and Angelman's Syndrome, as well as exposure to environmental agents such as infectious ones (maternal rubella or cytomegalovirus) or chemical ones (thalidomide or valproate) during pregnancy.

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.

Pathophysiology:
Autism is considered a lifelong neurodevelopmental disorder with a brain basis, due to the association with disordered development, and in some children impaired cognitive skills (mental retardation), epilepsy, and macrocephaly. While a genetic basis is recognised, the pathophysiology of autism is unknown. The association with increased head size is now clear, but the functional reasons for this at the neuroanatomical level remain less defined. Neuropathological studies have been dominated by the hippocampal/amygdala and the cerebellar accounts, suggesting that autistic symptomatology may be a consequence of abnormal function in these structures, in addition to less well-defined effects on the development and function of other brain regions. In parallel with the evolution of neuroanatomical models, 3 neurocognitive theories of autism have emerged: Executive function (difficulties with problem solving and forward planning in order to achieve a goal) Weak central coherence (the failure to integrate information into meaningful wholes) The theory of mind hypothesis (difficulties in the consideration of how other people might think and react to a particular situation). Neurocognitive theories may underlie some aspects of the autism phenotype, rather than the phenotype as a whole.

Signs & 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

Repetitive behavior Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows. A young boy with autism, and the precise line of toys he made Stereotypy is repetitive movement, such as hand flapping, making sounds, head rolling, or body rocking. Compulsive behavior is intended and appears to follow rules, such as arranging objects in stacks or lines.

Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.

All children should have routine developmental exams done by their pediatrician. Further testing may be needed if the doctor or parents are concerned. ASD varies widely in severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps.

Very early indicators that require evaluation by an expert include: no babbling or pointing by age 1 no single words by 16 months or two-word phrases by age 2 no response to name loss of language or social skills poor eye contact excessive lining up of toys or objects no smiling or social responsiveness. Later indicators include: impaired ability to make friends with peers impaired ability to initiate or sustain a conversation with others absence or impairment of imaginative and social play stereotyped, repetitive, or unusual use of language restricted patterns of interest that are abnormal in intensity or focus preoccupation with certain objects or subjects inflexible adherence to specific routines or rituals.

Diagnosis:
Health care providers will often use a questionnaire or other screening instrument to gather information about a childs development and behavior. Some screening instruments rely solely on parent observations, while others rely on a combination of parent and doctor

observations. If screening instruments indicate the possibility of an ASD, a more comprehensive evaluation is usually indicated. A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for an ASD, children with delayed speech development should also have their hearing tested. Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and may have metabolic testing.

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 Children with some symptoms of an ASD but not enough to be diagnosed with classical autism are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Much rarer are children who may be diagnosed with childhood disintegrative disorder, in which they develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors. 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 Ritualistic behavior involves an unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.

Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program, toy, or game.

Self-injury includes movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging. A 2007 study reported that self-injury at some point affected about 30% of children with ASD.

No single repetitive or self-injurious behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.

Management:
There is no cure for autism, nor is there one single treatment for autism spectrum disorders. But there are ways to help minimize the symptoms of autism and to maximize learning. Behavioral therapy and other therapeutic options Behavior management therapy helps to reinforce wanted behaviors, and reduce unwanted behaviors. It is often based on Applied Behavior Analysis (ABA).

Speech-language therapists can help people with autism improve their ability to communicate and interact with others.

Occupational therapists can help people find ways to adjust tasks to match their needs and abilities.

Physical therapists design activities and exercise to build motor control and improve posture and balance.

Educational and/or school-based options Public schools are required to provide free, appropriate public education from age 3 through high school or age 21, whichever comes first.

Typically, a team of people, including the parents, teachers, caregivers, school psychologists, and other child development specialists work together to design an Individualized Education Plan (IEP) to help guide the childs school experiences.

Medication options Currently there are no medications that can cure autism spectrum disorders or all of the symptoms. The U.S. Food and Drug Administration has not approved any medications specifically for the treatment of autism, but in many cases medication can treat some of the symptoms associated with autism.

Selective serotonin reuptake inhibitors (SSRIs), tricyclics, psychoactive/anti-psychotics, stimulants, and anti-anxiety drugs are among the medications that a health care provider might use to treat symptoms of autism spectrum disorders.

Secretina hormone that helps digestionis not recommended as a treatment for

autism.