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Autistic Disorder and Asperger’s Disorder (Pervasive Developmental Disorders): Questions & Answers

Questions & Answers

What is autism?

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 three to four times more common in boys than girls and affects between one to two per 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.

What's the difference between Asperger's Disorder, Autistic Disorder, and PDD?

Basically, Autism Spectrum Disorders (ASD) and Pervasive Developmental Disorders (PDD) are two different terms for the same thing. Historically, the term ASD has been used in European countries though the United States is now adopting this convention. The term Autism is generally used to refer to a specific type of ASD, or Autistic Disorder, in which a child meets the criteria because he or she has at least six of the signs and symptoms of Autism across the three major areas of impairment - social, language, and restrictive/repetitive interests. PDD is a broad category and is different from PDD-NOS (or not otherwise specified), which is a diagnosis given when a child is clearly displaying behaviors or deficits on the Autism spectrum but doesn't meet the criteria for a specific disorder such as Autistic Disorder or Asperger Syndrome.

Children with Asperger's Disorder usually do not have the language or cognitive deficits evident in children with Autistic Disorder. Children with Asperger's Disorder may communicate verbally but you may feel they're talking at you rather than with you. In both disorders, children have difficulty grasping social situations. The two disorders can be thought of as on a continuum; at one end of the range are high functioning children with Asperger's and at the other end are children with Autistic Disorder who are more severely impaired and may be mentally retarded. Youngsters can fall anywhere on this spectrum. For example, a child diagnosed with Autistic Disorder can be mentally retarded and have severe language deficits, whereas another child with the same diagnosis can have some social and communication skills and is more likely to appear to others as a child with learning problems.

How would I know if my child has autism?

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.

If I have one child with autism, does that mean my other children will have it too?

There is a genetic component to the disorder, but the exact genetics have not as yet been determined. If one child has ASD, siblings have a greater chance of also acquiring the disorder, compared to unrelated children. But by no means is there a guarantee this will happen. A genetic counselor can be helpful in explaining the possibilities.

What causes autism?

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. Scientists calculate that there are likely 4 to 5 major genes contributing to Autism Spectrum Disorders, and there may be as many as 20 minor genes. 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 ingredient) 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.

What's the treatment for autism? Does medication help?

Children with autism will benefit most from intensive, targeted treatment of language deficits and behavior. 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.

Treatment plans are tailored to the particular type and level of severity of a child's symptoms. Usually treatment involves a combination of structured behavior work at school and at home. Controversy exists about the most effective type of behavioral treatment. Some feel applied behavioral analysis (ABA) is best. ABA involves a detailed analysis of the components of behavior and design of specific behavior techniques aimed at extinguishing unwanted behaviors and increasing desired behaviors. Other professionals find that structured multidisciplinary behavior programs, with a less analytically detailed analysis of behavior, are more successful.

Why is early intervention important?

Early intervention is critical because we are most able to make a difference in a child's development if treatment starts early. Young brains are more adaptable. The American Academy of Pediatrics recommends that pediatricians screen all children for autism at about 18 months. If there are any signs of autism, then the child should be referred simultaneously for a hearing screening, a blood lead level, an early intervention evaluation, and to a specialist experienced in diagnosing Autism Spectrum Disorders. This specialist (a child psychiatrist, a pediatric neurologist, or a developmental pediatrician) will make the diagnosis and make recommendations about each child's unique needs.

For children from infancy to age three, services are generally provided in the home through the early intervention team, which may include a special educator, a speech and language pathologist, an occupational therapist and/or a physical therapist depending on the child's needs. Young children are often taught language, social, and other skills through an intensive, one-on-one therapy called Applied Behavioral Analysis (ABA). This treatment provides repetition and reinforcement of skills. By age three, children often enter preschool. A common preschool model, TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children), is based on structured teaching and uses many visual reinforcers such as picture schedules. There are also child-centered models, such as Stanley Greenspan's Floortime approach. None of these approaches are mutually exclusive, and children can receive a combination of all of them depending on their needs.

Do children with autism grow out of it? What's the prognosis?

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. Children with ASD will struggle with some issues throughout life. However, with multidisciplinary treatment, they can make gains in social and language areas, and some children go on to lead useful lives in the mainstream.

Is autism on the increase?

It appears that the diagnosis of all the pervasive development disorders in increasing. Several studies in different communities in the US and Europe have examined this phenomena. The most likely explanation for this increase is not that the number of children with this disorder are increasing but that we are more aware of the diagnosis and so are identifying more individuals than we did previously.