Pervasive Developmental Disorders
It was not until 1943 autism spectrum disorders was identified and named. Dr. Leo Kanner at Johns Hopkins Hospital studied a group of 11 children and introduced early infantile autism as a disorder. At the same time Dr. Hans Asperger, a German scientist introduced a milder form of the disorder; a disorder named for the scientist, Asperger Syndrome. These two disorders are two of five pervasive developmental disorders listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Those five disorders are referred to as autism spectrum disorders (ASD).
Rare Forms of Autism Spectrum Disorder
Two of the five disorders of ASD are relatively rare. Rett Syndrome affects one in about 10,000-15,000 and is almost exclusively found in females. Symptoms start to appear between the ages of 6-18 months. She regresses in her development; cannot control her feet and wrings her hands. If she has been speaking, she stops.
Childhood Disintegrative Disorder (CDD) is very rare, occurring in two children out of about 100,000. CDD is predominately found in males and onsets around the age of 3or 4 years old. Until that time the child develops normally; then he begins to regress. The loss of vocabulary skills is more dramatic in CDD than typical autism. In CDD children there is a loss of motor, language, and social skills. They also have a loss of bowel control and many experience seizures and a low IQ.
Signs of Autism Spectrum Disorders
ASD affect an estimated one out of every 500 children. The common characteristics in all of these disorders are varying degrees of impairment in social interaction, communication skills, and restricted, stereotyped and repetitive types of behavior. Although ASD can be detected in children by the age of three years, only about 50 percent are diagnosed before kindergarten. There is evidence that early intervention has a great impact on reducing symptoms and increasing the child’s ability to learn new skills.
Children with ASD do not follow the typical patterns of development. Often between the ages of 12 and 36 months, children with autism spectrum disorders do not react to people in the same manner as most peers do; and unusual behavior patterns start to manifest.
- Possible indicators of ASD include:
- Does not babble or make meaningful gestures by age one;
- Does not speak one word by age 16 months;
- Does not combine two words by two years of age;
- Does not respond to his or her name;
- Loses language or social skills;
- Has poor eye contact;
- Does not seem to know how to play with toys;
- Is attached to one particular toy or object;
- Does not smile;
- Excessively lines up toys or other objects; and
- Seems to be hearing impaired at times.
Children with autism do not show their attachments to others in typical fashion. Parents may feel deep disappointment when their autistic children do not return hugs or enjoy cuddling. Although research suggests there is some attachment between child and parents, the expression of it is difficult for most parents to read.
Social cues are difficult for children with autism. They are slower to interpret what others are thinking or feeling and subtle cues are often lost on children with ASD. People with ASD have difficulty empathizing with others or seeing things from another’s point of view. It is common for people with ASD to have difficulty regulating their emotions.
Repetitive behaviors are evident in people with ASD. Children may line up toys instead of playing with them and become extremely upset if one is moved. They may repeat body movements such as flapping the arms. Repetitive behavior may also take the form of preoccupation that is intense and persistent.
Other Problems That May Accompany Autism
One way children learn and grow is through accurate perceptions of their senses. For many autistic children their senses are a source of confusing information. They are highly sensitive to smells, taste, and certain textures and sounds. Sounds others might find soothing, such as the ocean waves rolling into shore, can cause some autistic children to cover their ears and scream. Some may be sensitive to hot or cold, others may bang their heads without apparent pain, yet shrink from the touch of a person.
Many children with ASD are also diagnosed with mental retardation. When tested, they may test well on some parts of an IQ test, while other areas are scored quite low. About two to five percent of those with ASD have what is called fragile x syndrome. This is the most common inherited form of retardation.
One in four ASD children develops seizures, usually starting in early childhood or adolescence. The seizure may manifest in body convulsions, a blackout, or spells of staring. One to four percent of those with ASD will develop a rare genetic disorder called tuberous sclerosis. This disorder causes benign tumors to grow in the brain and other vital organs.
Treatment Options for Autism Spectrum Disorder
Evidence indicates an improved outcome for most young children with ASD when they are given intensive early intervention in optimal educational settings for at least two years during the preschool years.
No one single type of treatment works for every person diagnosed with ASD. Most experts agree that in addition to early intervention, most ASD people respond well to highly structured, specialized programs. Before parents agree to any treatment for their children, the Autism Society of America suggests including the following questions:
- Will the treatment result in harm to my child?
- How will the treatment’s failure affect my child and family?
- Has the treatment been scientifically validated?
- How will the treatment be integrated into my child’s current program?
The National Institute of Mental Health suggests including the following questions as well:
- How successful has the treatment been for other children?
- How many children have been mainstreamed into regular class rooms and how have they performed?
- What is the training and experience level of the staff members working with my child?
- How are activities planned and organized?
- Are daily routines and schedules predictable?
- How much individual attention will my child receive?
- How will progress be measured?
- Will progress be monitored and recorded?
- Will my child be motivated and how?
- Is the environment designed to minimize distractions?
- Will the program prepare the family to extend the treatment at home?
- What are the cost, time commitment and location of the program?
In addition to programs, ASD children may be treated with other methods in conjunction with a specialized program. Applied behavioral analysis has been accepted as effective treatment for ASD.
Medication regimens are usually a part of the treatment for ASD children. Behavioral problems may be targeted and many of these types of medications are not officially FDA approved for children. However, doctors may prescribe them if they believe the medications will benefit the child. Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed for anxiety, depression, and/or obsessive-compulsive behaviors. These medications can be helpful in decreasing the repetitive behaviors. Anticonvulsants and antipsychotics may also be prescribed for ASD children. In some children with autism, stimulant medications such as Ritalin may decrease the impulsivity and hyperactivity.
With proper treatment many children with autism grow to adults who live functional and productive lives. Adults with high functioning autism or mild asperger’s can be quite successful, and many enjoy careers in mainstream jobs. However, they will always have the burden of the difficulties of social interaction and communication and will continue to need a strong support network to maintain an independent life .
National Institute of Mental Health
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