CONDITIONS

Autism

What Is Autism

Autism and Autism Spectrum Disorder (ASD) are terms for a group of complex neurodevelopment disorders (i.e. disorders occurring during brain development). Autism is one disorder on the autism “spectrum”, which is viewed as a continuum of disorders, from low to high functionality in areas such as cognitive development and social-interaction difficulties. Asperger’s syndrome is one of the spectrum disorders with high cognitive development and higher social-interaction capabilities. Autism can have a range of functionality, with a range of behaviors from mild to severe, but typically involves less cognitive functionality and greater social-interaction issues, and emotional withdrawal. Speech is also often affected. Rett Syndrome, while rare, causes serious developmental regression at age 3 or 4. All of these disorders are part of the spectrum.

While every child diagnosed with autism is unique in their particular set of issues, the more prevalent symptoms include:

  • Social-interaction difficulties
  • Verbal and nonverbal communication challenges
  • The use of restricted and repetitive behaviors
  • Difficulty in regulating emotions

In addition, many children have intellectual disability, sensory sensitivities, difficulties in motor coordination and other health issues such as poor sleep and gastrointestinal distress.

With the May 2013 publication of the DSM-5 (the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, which is used as the diagnostic manual for autism,) all autism disorders were merged under the umbrella diagnosis of Autism Spectrum Disorders (ASD), rather than distinct subtypes (autism, Asperger’s syndrome, PD-NOS [pervasive development disorder-not otherwise specified], Rett Syndrome, etc.).

According to the Center for Disease Control and Prevention (CDC), 1 in 68 American children are on the spectrum, and the prevalence is increasing, from 6-15% in the period 2002 to 2010. It is not fully understood how much of this increase is due to improved awareness and diagnosis, versus net new incidences.

Autism affects all socioeconomic levels, all ethnic groups, and all ages; it typically presents itself within a child’s first 3 years of life. Boys are impacted 4 to 5 times more frequently than girls—in fact, it is estimated that 1 in 42 boys are on the spectrum. Rett Syndrome is the one exception, as it affects girls almost exclusively.

ASD affects over 3 million people in the U.S., and tens of millions worldwide. There is no prevention, medical detection test or cure. Detection is done through observation and screening, and it is a lifelong developmental condition.

What Causes Autism

Scientists are still trying to establish the definitive cause(s) of autism.

There is a genetic link. In twin studies, if one twin was autistic, the other had up to a 90% chance of being diagnosed. And if one sibling was affected, a second sibling had 35 times greater risk in being diagnosed.   Dr. Frazier of the Cleveland Clinic recently published research that showed that if one identical twin had autism spectrum disorder, the other twin had a 76 percent chance of also being diagnosed with it. Identical twins share the exact same genetic blueprints. The numbers are lower for fraternal twins, who have the same genetic concordance rate as do non-twin siblings. The percentage of fraternal twins who each share an ASD diagnosis is 34 percent for same-sex twins and 18 percent for boy-girl twins, Girls are less likely to be diagnosed with autism than boys. These rates are higher than for non-twin siblings—though fraternal twins share the same genetic concordance rate with regular siblings, it is theorized that because they did share the same prenatal environment, this impacted the higher rates of fraternal twins having autism than non-twin siblings.

Over the past several years, scientists have identified a number of gene mutations associated with greater risk of autism. There are currently over 100 of these so-called autism risk genes. Approximately 15% of diagnosed cases have a genetic basis that can be identified.

However, most people who have autism have no reported family history of it.

A combination of environmental factors and genetic influences is thought to be the cause: For the remaining cases, Autism is likely caused by a certain combination of environmental factors affecting particular genes in unique ways, either turning them off or on, or changing their activity levels or causing mutations. Scientists think that this combination of environmental factors and genes influences early brain development in some way, causing irregularities. Exactly what happens is not yet understood.

Although more studies are necessary, environmental factors that are believed to increase risk for autism are:

  • Advanced parental age of both parents (an older dad seems to have more affect on autism outcomes than does an older mom)
  • Maternal illness during pregnancy (flu, persistent fever lasting a week, use of antibiotics)
  • Premature infant (less than 26 weeks)
  • Infant with extremely low birth weight
  • Infant that was deprived of oxygen during childbirth
  • Mother exposed to pesticides or air pollution while pregnant

In a study published in the journal Pediatrics (Nov. 12, 2012) researchers at the University of Aarhus in Denmark found that a pregnant mother having the flu doubled the risk for an autistic child; a pregnant mom having a persistent fever for a week tripled the risk; and a pregnant mom using an antibiotic slightly increased the risk of an autistic child.

Many Other Causes Are Being Researched:

  • Some scientists believe that abnormal levels of neurotransmitters may be involved. Neurons in the brain trigger electrical impulses, triggering the release of neurotransmitters. These are like chemical messages that then cross between synapses and ensure a variety of normal brain activities take place, including the ability for cells to produce energy. Abnormalities in this brain circuitry need further study.
  • Other scientists are researching whether a pregnant woman’s overactive immune system may somehow be a factor. There is a good deal of research going on in this area. Many children with autism have gastrointestinal problems and about 70% of the body’s immune system is based in the gut. One study found that about 12% of mothers with autistic children had antibodies to fetal brain tissue.
  • Still another area being looked at is abnormalities in DNA methylation. Methylation is one way in which gene expression is changed through environmental exposures. As reported in 2014 in the periodical, Molecular Psychiatry, researchers from Johns Hopkins performed studies using post-mortem brain tissues from people known to have had autism, and they found that gene expression was abnormally methylated in individuals with ASD.
  •  Finally, researchers are looking at a pregnant mother’s ability to manufacture glutathione, which is an important defense against toxic metals. Folinic acid (a type of folic acid) has been found to potentially reduce autism risk. Research has also shown that there may be less risk of autism if the mother took a prenatal vitamin containing folic acid prior to conception and during the pregnancy.

What Does Not Cause Autism?

As with everything about Autism, no one agrees completely on what does not cause it.

The mainstream medical community, however, has agreed on two things that do not cause autism: Poor parental practices and vaccinations. The issue of vaccinations, however, is widely questioned in parenting public health forums and autism support circles.

Poor parental practices: There is no science-based data that states that poor parenting results in an autistic child. This viewpoint first appeared in the 1940’s partly due to the lack of any science-based data on a physiological cause. Mom’s cold, distant, and rejecting personality and behavior toward a child was deemed the cause—termed the “schizophrenogenic mother.” The vast majority of the medical and scientific community has discounted this viewpoint.

Vaccinations: The Center for Disease Control and Prevention (CDC) has stated that vaccines do not cause autism. The mainstream medical community has generally backed this and has viewed the risks associated with not getting vaccinated as outweighing the risks of any currently unsupported link to autism.

Most of the concern about this issue has historically been focused on the mercury-based preservative, thimerosal. Thimerosal used to be utilized in all childhood vaccines. In 1998, thirty different vaccines containing thimerosal were routinely given to U.S. children. Public health officials at the time determined that the recommended schedule of vaccines could give some children mercury that exceeded the safe limit. In 2001 thimerosal was removed or reduced to trace amounts in all childhood vaccines except for some flu vaccines. Even with the removal of thimerosal, since 2003 the CDC funded 9 studies looking at whether there was any link between autism and thimerosal. The CDC found no link.

Today only childhood flu shots contain trace amounts of thimerosal, and thimerosal-free shots are available for those who are concerned with even the trace amounts.

Other vaccine ingredients have now come under scrutiny. Vaccines contain a variety of chemicals needed – in small amounts – to keep the vaccine potent, sterile, stable, and safe. These chemicals include preservatives (albumin, glycine), antibiotics, egg proteins, water, and more. You can request a detailed list of ingredients from your pharmacy or doctor prior to having your child vaccinated. The medical community, CDC, and other entities believe that not vaccinating your child is more dangerous to your child than the risk of vaccinations, given the serious nature of the many diseases, like polio that have been eradicated due to aggressive vaccinations in the US. There are also no studies showing that these other ingredients are linked to an increased risk of autism.

Most recently, in a 2015 study published in The Journal of the American Medical Association, researchers evaluated 95,727 children who had had the measles-mumps-rubella (MMR) vaccine and found no link between autism and vaccination. Many in the medical community state that it isn’t vaccinations that cause a seemingly healthy child to start displaying autistic symptoms, instead, autistic symptoms just typically occur during the time frame children are receiving multiple vaccinations.

Some autism-focused entities, however, such as the Autism Society, still believe that more research is warranted, in particular they would like to see more research related to the cumulative effect of multiple vaccinations that the recommendations suggest for children today. Some medical researchers in mainstream medicine view the vaccine-autism link as being one-in-a million case where there is a link (just like there may be such small links to any number of environmental factors for any given child).

There are still some in the alternative medicine and functional medical community that view vaccinations as dangerous. Most of this community believes that vaccinations are one more environmental factor that causes autism. There is a variety of research studies underway that still include the question of a vaccine-autism link, as part of environmental factors being analyzed. One such study is the Childhood Autism Risks From Genetics and the Environment (CHARGE) study that is currently being conducted at the University of California, Davis. This study has been funded by the National Institute of Environmental Health Sciences and involves more than 600 families with autism. The study is looking at genetic and environmental factors.

The CDC’s Centers for Autism and Developmental Disabilities Research and Epidemiology network (CADDRE) is also collecting environmental risk factor data, including vaccines; that might put children at risk of autism.

In the end, the concern over unvaccinated children’s health has most medical authorities supporting vaccinations. Every year, 2.5 million unvaccinated children worldwide die of diseases that vaccines could have prevented. The thought of polio, measles, whooping cough, diphtheria and other illnesses is alarming, and authorities have already seen increases in these diseases due to unvaccinated children in the U.S.

Risk Factors For Autism

There are no ethnic or socioeconomic risk factors. There is a genetic link, although it is not understood to what degree genes play a role independent of other environmental factors. The following factors may affect your risk of developing autism:

Family history of autism is a risk factor. Siblings of an autistic child should be aggressively screened and monitored, as they are 35 times more likely to be at risk for developing autism.

Sex: Boys are 4-5 times more likely to have autism than girls.

Preterm babies: Babies born pre-term, before 26 weeks, have greater risk, as do extremely low-weight newborns.

Children with certain medical conditions may have an increased risk for autism. There are a number of medical conditions that increase the risk of having autism:

  • Fragile X Syndrome. 1 in 25 with ASD has the mutated gene that causes Fragile X Syndrome. Family members planning to have children should be checked for the Fragile X Syndrome gene.
  • Tourette’s syndrome. While the two conditions are very different, Tourette’s syndrome is viewed to have a link to autism. Tourette’s typically has a later onset, and may be difficult to diagnosis in children having autism.
  • Tuberous sclerosis. About 45% of people with Tuberous sclerosis can be diagnosed with autism.
  • ADHD. About 30% of children with autism also are diagnosed with ADHD problems.

Mother’s health during pregnancy: The mother’s health during pregnancy can be a risk factor. Taking antibiotics, having the flu or a fever for a week may increase an infant’s risk for autism.

Diagnosing Autism

There is no definitive diagnostic test for autism.

A medical diagnosis is usually made as a result of a 2-stage observation/screening.

Stage 1: Observations/Screening by Pediatrician

The first stage is generally symptom/behavioral screening during well-child visits. The American Academy of Pediatrics (AAP) and CDC recommends pediatricians perform screening 3 times by the age of 3. This screening is done with input from the parents relating to their observations on developmental milestones (talking, interaction, and eye contact), symptoms and other behaviors.

The CDC as well as many other organizations focused on ASD have published a large variety of screening tools available online consisting of checklists, questionnaires and guidelines for parents, teachers and doctors, relating to diagnosing potential issues.

Stage 2 Observations/Screening and Related Testing by Inter-Disciplinary Medical Team

If the stage 1 screenings suggest a “possibility” of autism or other brain disorder, the pediatrician will recommend a comprehensive assessment involving other medical and behavioral professionals. This may include neurological assessment, a hearing test (to rule out hearing issues), in-depth cognitive and language testing, memory and problem solving testing, etc. It will likely also include detailed analysis of the child’s developmental progress, as well as a detailed family medical history including a review of sibling children in the family. A physical exam will be performed to rule out possible diseases and other medical issues.

The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires at least 6 developmental and behavioral characteristics are observed by medical professionals. They also require the problems present prior to age 3, and that there be no evidence of other conditions.

The 6 characteristics must be in the areas of social communication/interaction and restricted/repetitive patterns of behavior. The child must demonstrate at least two types of repetitive patterns of behavior, such as repetitive motor movements (rocking, hand-slapping), inflexible adherence to routines, highly fixated interests, or hyper- or hypo-reactivity to sensory input.

The multidisciplinary team typically includes the pediatrician, neurologist, psychiatrist, psychologist, and potentially others focused on development issues.

Although there is no cure for autism it is widely believed that early detection and treatment will result in a better outcome in reducing symptoms and behavioral challenges.

Additional testing

Doctors may wish to do additional testing to confirm the presence of issues beyond autism. An MRI may be ordered to evaluate structures in the brain to rule out other neurological issues. Genetic testing may be ordered to do a chromosomal analysis to confirm the presence of known mutations that cause related diseases. For example, 1 in 25 children with ASD have the mutation that causes a disease caused Fragile X Syndrome, which causes significant intellectual disabilities.

Symptoms of Autism

Symptoms of autism spectrum disorder may be detected at a young age. Screening should be given at well-baby check-ups at 9, 18 and 24 months. Some initial symptoms that parents may notice include:

  • Child babbles in the first year of life, but then stops doing so
  • Child fails to respond to name or other verbal attempts to gain their attention
  • Child fails to develop gestures, such as pointing to things
  • Delayed language development compared to peers
  • Child repeats words or phrases they hear, over and over (called echolalia)
  • Does child play peek-a-boo
  • Does child play appropriately with a toy (driving a toy car versus focusing on the wheels alone)
  • Does child give eye contact to someone when they speak to him/her
  • Does the child pretend

Symptoms range widely depending on where a particular child falls on the spectrum, but common symptoms fall within these general areas:

  • Social-interaction difficulties and relationship challenges
  • Verbal and nonverbal communication challenges
  • Restricted repetitive behaviors, like performing the same act again and again, repeatedly uttering the same phrase, insisting on the same routine or ritual, or obsessing on a favorite topic
  • Difficulty in regulating emotions

Social-interaction difficulties and challenges forming relationships:  An autistic child may not be able to keep eye-to-eye contact with others, may not show facial expression and may often come across as having no interest in what anyone else is saying.  Establishing friendships may be hard as a child with autism may lack empathy for others.

Verbal and nonverbal communication challenges: Many autistic children have language development challenges, with some children uttering only simple responses. Approximately 40% of children diagnosed with autism never learn to speak. Others may have more minor speech issues. Some children with autism regularly repeat phrases (called echolalia). There is a common issue in having an inability to understand body language, expressions and sarcasm. Autistic children may take a sarcastic comment literally, or not realize when someone is joking. Inappropriate responses may make it difficult for a child to fit in with peers.

Restricted repetitive behaviors: Many autistic children require extreme consistency in their environment. They may require precise routine and become emotionally upset if there is the slightest change to that routine. A child with autism may be less interested in the whole toy, and more interested in particular pieces, such as wheels of toy cars (versus enjoying the toy cars).  Sometimes the child will become fixated on a particular thing, depending on where they fall on the spectrum. Asperger’s, for example, is more likely to result in a high intellectual child with a fixation on some extremely narrow topic, often on a topic that may not be interesting to others, at least in that depth of focus. Children may rock, slap their hands, wiggle fingers in front of their faces and perform other repetitive behaviors.

Difficulty in regulating emotions: A child with autism may become emotionally upset in unfamiliar, overwhelming or frustrating situations. Grey areas may be frustrating for a child to understand and cope with.

Additional symptoms of autism: In addition to these common symptoms, many children with autism suffer from:

Savant skills: Some people with autism – about 10% – have some form of savant skills, perhaps best personified by Dustin Hoffman’s character in the award-winning movie Rain Man. These are people who have seemingly profound capacities to perform a very specific set of skills, a person viewed as a prodigy in a particular area. These skills can be math abilities, drawing, musical abilities, calculating calendar dates, and memorizing lists. Scientists cannot explain what happens to “create” an autistic savant.

Sleep Dysfunction: Many children with autism have difficulty getting a good night’s sleep. They can’t easily fall asleep, don’t get quality sleep or wake-up with night terrors. These issues affect the entire child’s family in regards to their sleep and stress levels.

Gastrointestinal disorders: GI disorders such as constipation, diarrhea, and vomiting and stomach pain are common in children having autism. 46 to 85% of autistic children have chronic constipation. It is unclear if GI disorders are a symptom of autism, or a result of autistic behavior (such as an autistic child being such a picky eater that his/her diet causes a GI problem).

Epilepsy: About a third of the people on the spectrum will develop epilepsy (seizure disorder) by adulthood.

Sensory integration dysfunction: A common issue for those on the spectrum is sensory integration dysfunction (SID). This is a hypersensitivity to touch, light, sound and even tolerance to temperatures and pain. Some children with autism do not like to be touched, or hugged. Food preferences may be limited due to food textures that bother someone with autism. Many kids with autism prefer pressure versus a light touch.

Mental health issues: 1 in 5 on the spectrum also has ADHD symptoms. Some 30% have anxiety, usually related to social phobias. These additional disorders may be more difficult to treat in a child with autism. Almost half of the children on the spectrum tend to wander off, called elopement.

Symptoms as the child ages: Depending on where a given child is on the spectrum and how they are being treated, many children have fewer symptoms and/or improved behavioral issues by the time they are teens. Puberty may be more stressful for teens having autism than for others. Emerging sexuality, the lack of strong peer bonding, and potential bullying or other negative feedback from others, may increase the risk for depression and anxiety. About a third of those on the spectrum suffer from epilepsy (seizure disorder), increasing stress and social side effects as the child ages.

In young adulthood: Some young adults having autism can lead semi-independent or even independent lives. At least 33% are able to live life with some level of independence. The degree to which any particular person can do so is dependent on their language skills and intellectual abilities, as well as local support.

Prognosis

Autism is typically not a progressive disease. Children are usually diagnosed by the age of 3, and while there is no cure, many symptoms improve with treatment and age.

Living with autism may become more challenging as a child becomes a young adult, as living independently may not be possible.

Living With Autism

Today there are many more children with autism attending regular schools, and many more adults with autism who can live semi-independently. Early behavioral interventions, physical therapy, speech therapy, and solutions that reduce symptoms (medications, diet, lifestyle changes) have all helped provide improved quality of life for those with autism and those on the spectrum.


Behavioral intervention:

Social skills-oriented training is important to improve social acceptance and reduce stress. There are many types available. Research has shown that early and intensive behavioral therapy can significantly improve language and cognitive skills in children with autism. The American Academy of Pediatrics suggests a program with the following features:

  • Provide a highly structured and specialized behavioral training consisting of at least 25 hours per week and 12 months per year
  • Have small classes with an emphasis on one-on-one time with the therapist or teacher
  • Have parents and family participate in specialized training
  • Reinforce self-help and daily living skills
  • Measure child’s progress and modify intervention program as needed
  • Maintain a highly structured and routine environment and schedule, to minimize distractions
  • Use a curriculum that includes a focus on: language and communication; social skills; cognitive skills; typical academic-readiness skills such as counting and letter recognition; and behavioral-related skills
  • Art and or dance therapy are good additional forms of therapy.

One example of behavior intervention is Applied Behavior Analysis (ABA). This is an intensive, up to 40 hours a week, one-on-one child-teacher interaction focused on shaping new behaviors such as learning to speak, and reducing negative behaviors. One example of ABA training is Pivotal Response Training. This intervention is based on parental involvement and incorporates play. The goal of pivotal response training is to focus on “pivotal skills” such as self-management.

Deep touch pressure therapy refers to a form of tactile sensory input that is often provided by hugging, firm holding, cuddling, and squeezing.

Research on autistic children has shown preference to sensory stimulation like touching, tasting, and smelling as opposed to that gotten from hearing and seeing. Autistic children will often seek out deep pressure sensations, like wrapping arms and legs in elastic bandages, sleeping under many blankets, even in warm weather, and getting under mattresses. This type of deep touch is beneficial to babies, who are very often comforted by being in a tight swaddle. Vests have been designed that can inflate to approximate the pressure of a firm hug, and some therapists even do hugging therapy to help overcome emotional boundaries in a safe physically calming manner.

There are many other types of behavior intervention. The important point is to start as soon as a child is diagnosed with autism, and to incorporate the therapy at home with parents and family members. Most children will also benefit from physical therapy (to improve coordination and motor skills) and potentially speech therapy as well.


Educational Curriculum:

It is important for parents to become informed about their child’s educational rights. Federal laws require services be provided. Your child will need to be evaluated by a teacher, school counselor or other professional. Every state has a Parent Training and Information Center and a Protection and Advocacy Agency to help your child get an evaluation.

It is likely that your child will receive an individualized education plan, or IEP, after the initial evaluation. Specific eligibility is determined under the Individuals with Disabilities Education Act (IDEA), along with the school district. If your child is not deemed eligible for special education services he or she can still attend public education. Information about the U.S. Department of Education programs for children having autism is available on their website.


Support Team:

Putting together a good team to support your child’s progress will substantially aid in your child’s ongoing treatment and quality of life. Involve teachers, doctors, teachers and family members. Reduce stress on siblings by getting family-based counseling. Join autism-focused or caregiving support groups. Maintain excellent record keeping, detailing behavioral changes, medication (side effects, improvements seen, etc.), doctor visits, meetings with schools, etc. Documentation can help you remember the different conversations and decisions, but may also be required in order to qualify for special programs. Contact your local autism advocacy group to learn more about the special programs and other support services available in your state and local community.


Living with Associated Symptoms and Disorders:

Many children having autism experience a list of other symptoms and disorders, which include:

  • Sleep dysfunction
    • Children with autism often sleep less than those without autism
    • Cause may be related to melatonin production occurring during wrong sleep-wake cycle or increased sensory sensitivities to light, sound, even textures of pajamas or bed linen
    • Have doctor check for ear, nose, and throat issues (breathing issues, infections)
    • Make lifestyle changes: no caffeine/sugar before bed; have a bedtime routine (soft lights, calm sounds, maybe massage your child); try a weighted blanket (studies have shown the pressure to be helpful in calming children with autism); talk to your doctor about using melatonin supplements or bright light therapy to get your child’s sleep-wake cycle back on track
  • Gastrointestinal disorders
    • CDC states that children with autism are 3.5 times more likely to have chronic diarrhea or constipation issues
    • Preliminary studies indicate children with autism have fewer types of gut bacteria
    • Probiotics: studies are ongoing. Talk with your child’s doctor and see if trying a Greek probiotic yogurt makes sense, and then evaluate for symptom improvements—as well, ask about probiotics supplements, as they can diversify gut bacteria
    • Poor/picky eating habits or food sensitivities/allergies can also be the cause
    • Anecdotal (parent observations) evidence indicates that probiotics and special casein or gluten free diets have helped with digestive issues and behavior
    • For constipation: increased fiber may help
    • For diarrhea: check for food allergies and lactose intolerance
  • Sensory Integration Dysfunction
    • 90% of children having autism are reported to have some sensory integration issues
    • An occupational therapist can be enlisted to focus on a variety of therapies, including tactile therapy, use of sensory rooms and a variety of play-related therapies designed to learn appropriate response to stimuli
    • Studies have shown that pressure can help calm, such as through massage or use of a weighted blanket
  • Other mental health disorders
    • 30% of children having ASD have anxiety, often related to phobias and OCD behaviors
    • 1 in 5 on the spectrum also have ADHD symptoms
    • Cognitive-behavioral therapy is a good approach to desensitize phobias and change irrational thoughts
    • Therapies can be successful, but may prove difficult for children having low language skills
  • Epilepsy
    • 1/3 of individuals on the spectrum will suffer from epileptic seizures, although the severity of seizures can differ widely
    • Early detection is key
    • Symptoms may include stiffening of muscles, twitching, regression in behavior
    • A neurologist can confirm a diagnosis of epilepsy and will likely prescribe an anti-epileptic drug

 


Understanding teens with ASD

The teenage years may be particularly difficult given peer pressure, social challenges and the risk of anxiety, depression and other mental disorders. Increased autistic or aggressive behavior may result. Teens with autism may not easily comprehend the physical and emotionally changes occurring due to puberty. It is important that you consult with your “support team” during this time. A doctor or therapist may recommend additional behavioral therapies, support groups or medications.


Your teen’s transition to adulthood

A teen with autism loses mandated public school support at the age of 22. It is important you continue to teach self-advocacy skills to your teen as they become young adults. Your teen may struggle with finding a job given language, cognitive skills or other interpersonal issues. Interesting, many companies are now seeking young adults with autism for jobs that for others might seem repetitive and mundane, such as testing electronic components and quality control tasks. Young adults with autism, assuming they have adequate language and cognitive skills, have been found to be exemplary when it comes to these types of jobs.

A young adult having autism may still need to live at home. If that isn’t possible, you may need to find other arrangements, such as within an independent group home.  Talk to your local autism community organization for recommendations and referrals that best suit your child’s set of symptoms and needs.

Here are a few examples that are available:

  • Living at home: If this is possible for you and your child, make an appointment with your local Social Security Administration (SSA) office to learn about financial assistance programs such as Social Security Disability Insurance, Supplemental Security Income, and Medicaid waivers.
  • Independent Living: You might find that your child is able to live on their own with support from family and professional agencies (government or social service agencies). Ensure there is assistance to manage personal finances, health care and safety. This option typically works best when local family can be involved.
  • Group living: There are many supervised group homes that are staffed with professionals and provide meal preparation and other services such as transportation, housekeeping and even personal care.
  • Long-term care facilities: While a difficult decision, this alternative may be the only viable solution for those with autism who need constant supervision or intensive support.

Screening

Information relating to screening can be found under the section, “Diagnosing Autism.”

A variety of screening tools are available on the Centers for Disease Control and Prevention CDC’s website

Prevention

There is no known preventative measure for autism, however with early treatment symptoms improve for most people.

Medication And Treatment

Treatment consists of the therapies noted earlier under, “Living With Autism,” such as behavioral therapies, physical and speech therapies, sensory based therapies, developing a good support team and educational plan, and addressing related symptoms and quality of life issues. In general, children respond best to highly structured and individualized treatment that is started early, upon initial detection/diagnosis of autism.


Medications

Medications are used to treat symptoms, problem behaviors and associated mental health disorders. Children with autism, however, may not respond the same way to certain medications as typically developing children. Always ask your child’s doctor about any side effects, and be sure to take an active role in monitoring and documenting any side effects your child may experience.

Antipsychotic medications: Today, the only medications approved by the FDA to treat autism are antipsychotic medications, specifically, risperidone (Risperdal) and aripripazole (Abilify). These medications are used to treat severe behavioral problems such as aggression, self-harming acts, significant irritability and temper tantrums, in children between the ages of 5 to 16 having autism. These medications may also help reduce hyperactivity and repetitive behaviors.

Other medications that have not been approved by the FDA for autism may be prescribed to address symptoms found in autism that are also found in other disorders (where the medications are used as treatment). Two examples are antidepressant medications and stimulant medications (for ADHD).

Seizure medications and drugs to provide relief for sleep disorders and GI distress are also commonly suggested for symptom relief.

Antidepressant medications: More research is required as to the effectiveness of these drugs for some children with ASD; however, they are prescribed today for anxiety, depression and also to treat repetitive behaviors seen in children with autism. Examples of these drugs include fluoxetine (Prozac) and sertraline (Zoloft). Note that the FDA has warned about possible side effects with antidepressant medications in young people, especially teens. Possible side effects may include worsening depression, including suicidal thinking or behaviors.

Stimulant medications: Methylphenidate (Ritalin) has been shown to effectively treat hyperactivity in some children with ASD, although some demonstrate side effects.

Sleep medications: Although not approved by the FDA for treating children with autism, should your child have ongoing sleep issues you should talk with their doctor about the use of over-the-counter melatonin, or prescription clonidine (Kapvay).

Gastrointestinal support: Talk with your child’s doctor about the use of daily probiotics. Some studies have shown a link (although not a cause and affect) between the gastrointestinal issues seen with so many children with autism and the lower levels of certain bacteria found in the gut. Anecdotal feedback from parents also has shown a consensus that probiotics have helped their children.  There can be side effects with probiotics such as Florastor, which use live yeast, which can sometimes cause an allergic reaction in some children.

Complementary and Alternative Treatment

There are a variety of alternative treatments being discussed in different forums that are not as yet endorsed by the mainstream medical community.  These are highlighted here only as you will likely see them mentioned elsewhere; most do not have any scientific evidence behind them, some can be dangerous. Also, as with everything related to autism, what works for one child with a particular set of symptoms may not work with another. Talk with your doctor for additional information.

Most mainstream medical professionals do not support these therapies as sole treatment options for autism.

Nutritional Supplements.  While there have been numerous studies suggesting links between nutritional supplementation and autism, the medical community has not endorsed any particular theory. High doses of B6 and Magnesium have been investigated, as well as increased levels of Omega 3s, but more research is necessary to be conclusive. Most in the medical community believe that a good diet is really the best approach to a child getting the best nutrients for optimal health. A diet with a lot of whole foods, vegetables, complex carbohydrates and healthy fats; a diet low in simple carbohydrates and sugar.

Restrictive Diets.  There is some consensus that a restrictive diet may help reduce symptoms for some. The question is, whether the symptoms are those related to autism, or whether they are related to other health issues such as food allergies or lactose intolerance. Most believe the issues are independent of autism itself. It may be worth evaluating after discussing with your doctor, as a child with milk or gluten allergies may see symptom relief if these food sensitivities are removed.

Chelation therapy.  Chelation therapy is a process to remove mercury from the body. It is an intravenous procedure, which has been largely discredited by the mainstream medical community. It has also been deemed to pose other risks, such as kidney failure.

Immune globulin therapy (IGIV).  IGIV is given to some people – those who have compromised immune systems, outside of autism – to boost their body’s natural immune response. There has been some interest in using this for children with autism under the theory that autism is somehow caused by an autoimmune abnormality. There is no current proof that it helps reduce the symptoms of autism.

Secretin.  This is another IV injection, this time of the hormone secretin, which is a hormone that stimulates the liver and pancreas. Clinical trials have found no significant improvements with secretin’s use.

Stem cells.  There are a variety of research studies that have been started in the past several years studying the applicability of stem cell transplants to address autism. To date, there has been no major breakthrough although the topic continues to be examined.

When To Contact A Doctor

Prior to Diagnosis: Your child’s pediatrician should include autism screenings at well-baby check-ups, at 9, 18 and 24 months. There are also many online screening tools on a number of websites, including the CDC and autism support organizations such as the National Autism Society and Autism Speaks. The CDC also maintains a site called, “Learn the Signs, Act Early” to help parents understand and track their child’s development.

After Diagnosis: It is important for you to develop a support team that includes your child’s pediatrician or a developmental pediatrician (specialist), along with a child psychologist or psychiatrist, therapists (may include counselors, physical or speech therapists, cognitive or occupational therapists, etc.), teachers, and others, depending on your particular child’s needs. Not every medical professional is well versed in autism; it may be beneficial to consult with local intervention programs/agencies to get referrals to specialists in your area who specifically focus on autism.

Specialists: You may need to consult with specialists such as a gastroenterologist or nutritionist (if your child experiences GI distress), behavior specialist or child neurologist (especially if your child experiences seizures).

In an emergency:  In an emergency such as a seizure go to your local hospital ER or dial 911.

Questions For Your Doctor

Typically you will want to consult with your child’s pediatrician, Primary Care Physician (PCP) or family doctor regarding any concerns about your child having autism or other developmental issues. That individual is most familiar with your child’s overall health, as well as with your family history, including the medical history for siblings.

As part of the screening/diagnosis process, your pediatrician will likely recommend a group of other medical professions to participate as part of the inter-disciplinary diagnostic team. You may wish to seek out alternative specialists focusing on autism to be part of the evaluation.

If your child does not have a pediatrician, PDP or family doctor, visit the ThirdAge.com Doctor Directory. Use one of the following “search” terms: “Pediatrician”, “General Practitioner”, or “Family Medicine”. Enter your zip code in the space provided, along with the distance you are willing to travel, and click on “Find Doctors”. You’ll be presented with a list of qualified doctors in your area.

Your local autism agency may also offer assistance. The Autism Society maintains a large online database of resources at www.AutismSource.org. You can also search online to see if the Autism Society has a local office that can offer local assistance.

Questions For A Doctor

There is a lot of excellent resource information online. Use reputable sites such as the CDC, the Autism Society, the U.S. Department of Health and Human Services, Autism Speaks and similar.

Pre-Diagnosis Questions:

  • What specific screening are you doing during my baby’s well-baby exams? What are your observations to date?
  • When is the next screening checkpoint? What do I do if I notice any particular symptoms and/or behaviors in the meantime?
  • Do you have any experience with diagnosing and treating autism?
  • This is my first child, what should I look for in regards to my child’s development milestones?
  • I have a child with autism, what additional precautions should I take with my second child?
  • My child has been developing fine, now suddenly he/she has regressed, should I be concerned?
  • My child isn’t meeting some of his/her developmental milestones, when should I be concerned?
  • Should my child be vaccinated?
  • My husband has Asperger’s. Does that increase our baby’s risk for autism?

Post-Diagnosis Questions:

  • What is my grand/child’s specific diagnosis? (Where are they on the spectrum?)
  • What criteria were used? (The 6 developmental criteria required by DSM-5 for diagnosis)
  • Should I have another child? What are the risks?
  • How can I best help my child?
  • Are there support groups for my family?
  • I don’t feel like my child has bonded with me. What can I do?
  • What should we tell our extended family and friends?
  • What local services are available?
  • Can my child go to school?
  • Should I continue to vaccinate my child?
  • My child is nonverbal, what can I do to help him/her develop language skills?
  • My child is violent or has emotional outbursts, what can we do?
  • My child won’t eat. How do we ensure he/she is getting adequate nutrition?
  • My child doesn’t sleep. What can we do to help him/her and the rest of the family?
  • There is so much information online, and lots of info on cures. What can I trust?
  • My child can’t play sports. What can I do so he/she gets exercise?