an interview with Glenn S. Hirsch, M.D.
AboutOurKids.org asked Glenn S. Hirsch, M.D., Medical Director of the NYU Child Study Center and Assistant Professor of Child and Adolescent Psychiatry at the NYU School of Medicine, to answer the most commonly asked questions about Autism and other Pervasive Development Disorders.
Q: What is autism?
A: Autism is part of a spectrum of disorders defined by varying degrees of impairments in social communications and interaction. These impairments can manifest themselves in problems with eye contact, limited facial expression, a restricted range of interests including repetitive behaviors, and preoccupation with unusual things such as the train schedule or the location of every police station in the city. Individuals with autism often have severe language deficits characterized by problems with the use of language for social purposes. Autistic disorder is at the severe end of the spectrum termed the pervasive developmental disorders (PDD) or autism spectrum disorders. These terms include high functioning autism and Aspergers disorder which are not accompanied by language delays or mental retardation. This group of disorders is 3-4 times more common in boys than girls and affects between 1-2 thousand individuals. A majority of children with autistic disorder are mentally retarded, but up to 30% are in the average or above average range of intelligence.
Q: How would I know if my child has autism?
A: Several features may help identify children between the ages of two and three who may be at risk for autism: lack of a social smile, poor social interactions, preference for aloneness, lack of appropriate gestures such as pointing and showing objects, minimal or nonexistent imaginative play and the need for sameness. In addition, delays in language development should never be neglected. Any of these concerns should prompt a parent to request an evaluation.
Q: What causes autism?
A: A small number of cases have an underlying medical disorder such as tuberous sclerosis or Fragile X. However, as with many disorders, in most cases we do not know what causes autism. We do know that there is a strong genetic component and that psychological factors are not a cause. There have been some excellent studies that clearly indicate autism is not caused by vaccinations such as the measles, mumps and rubella (MMR) vaccine or by thimersol (a mercury preservative) that has been used in the past as a preservative in vaccinations. There is also no evidence that other environmental issues such as food allergies can cause or trigger the onset of autism.
Q: Does autism run in families?
A: Yes, genetic factors play an important role. Some relatives of children with autism may have mild problems with socialization and language.
Q: Can autism occur with any other disorders?
A: A majority of children with PDD have some form of learning difficulty. Symptoms of impulsivity, ADHD, anxiety and depression can be present as well. A small minority of children with autism will develop epilepsy in adolescence.
Q: What's the treatment for autism? Does medication help?
A: The best treatment for children with autism is intensive, targeted education. In a large percentage of children with autism, other symptoms may interfere with their ability to utilize these interventions. These symptoms include oppositional, impulsive, aggressive and self injurious behaviors along with anxiety, obsessive-compulsive symptoms. Recent research has shown that medications can often be of help in reducing these distressing symptoms.
Q: Are there special schools for children with autism?
A: It is important to identify children with autism as early as possible and provide them with a specialized program. There are special schools and programs within the public education sector. One of the most important aims of these programs for young children is to help increase interest in other people. Next is an emphasis on learning language, and finally the use of functional assessments and treatments of behaviors. These are all variations of a type of treatment called applied behavioral analysis (ABA).
Q: Is autism on the increase?
A: It appears that the diagnosis of all the pervasive developmental disorders is increasing. Several studies in different communities in the US and Europe have examined this phenomena. The most likely explanation for this increase in not that the number of children with this disorder are increasing but that the we are more aware of the diagnosis and so are identifying more individuals than we did previously.
Q: Do children with autism grow out of it? What's the prognosis?
A: While some of the features of autism are lifelong, the best predictor of how well children will do as an adult is their verbal IQ.
Q: When should I bring my child to a doctor for an autism evaluation?
A: According to the guidelines of the National Institute of Child Health and Human Development (NICHD) a doctor should immediately evaluate a child if s/he:
• Does not babble or coo by 12 months of age
• Does not gesture (point, wave, grasp, etc.) by 12 months of age
• Does not say single words by 16 months of age
• Does not say two-word phrases on his/her own (rather than just repeating what someone else says) by 24 months of age
• Has any loss of any language or social skill at any age
Q: What is involved when a child is evaluated for autism?
A: There is no medical test that results in the diagnosis, but the evaluation of a child includes many components. Careful history gathering and observation are critical, and a psychiatric and neuropsychological evaluation should be included. Often a neurological evaluation and genetic testing/counseling may be useful.
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