Autism Health Article

Signs and tests

All children should have routine developmental exams by their pediatrician. Further testing may be needed if there is concern on the part of the doctor or parents. This is particularly true whenever a child fails to meet any of the following language milestones:

• Babbling by 12 months
• Gesturing (pointing, waving bye-bye) by 12 months
• Single words by 16 months
• Two-word spontaneous phrases by 24 months (not just echoing)
• Loss of any language or social skills at any age.

These children might receive a hearing evaluation, a blood lead test, and a screening test for autism (such as the Checklist for Autism in Toddlers (CHAT) or the Autism Screening Questionnaire).

A health care provider experienced in the diagnosis and treatment of autism is usually necessary for the actual diagnosis. Because there is no biological test for autism, the diagnosis will often be based on very specific criteria laid out in a book called the Diagnostic and Statistical Manual IV.

An evaluation of autism will often include a complete physical and nervous system (neurologic) examination. It may also include a specific screening tool, such as:

• Autism Diagnostic Interview - Revised (ADI-R)
• Autism Diagnostic Observation Schedule (ADOS)
• Childhood Autism rating Scale (CARS)
• Gilliam Autism Rating Scale
• Pervasive Developmental Disorders Screening Test - Stage 3

Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.

Autism encompasses a broad spectrum of symptoms. Therefore, a single, 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

Sometimes people are reluctant to have a child diagnosed because of concerns about labeling the child. However, failure to get a diagnosis can lead to failure to get the treatment and services the child needs.

Treatment

An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. Most programs will build on the interests of the child in a highly structured schedule of constructive activities. Visual aids are often helpful.

Treatment is most successful when geared toward the child's particular needs. An experienced specialist or team should design the program for the individual child. A variety of therapies are available, including:

• Applied behavior analysis (ABA)
• Medications
• Occupational therapy
• Physical therapy
• Speech-language therapy

Sensory integration and vision therapy are also common, but there is little research supporting their effectiveness. The best treatment plan may use a combination of techniques.

APPLIED BEHAVIORAL ANALYSIS (ABA)

This program is for younger children with an autism spectrum disorder. It can be effective in some cases. ABA uses a one-on-one teaching approach that reinforces the practice of various skills. The goal is to get the child close to normal developmental functioning.

ABA programs are usually conducted within a child's home, under the supervision of a behavioral psychologist. Unfortunately, these programs can be very expensive and have not been widely adopted by school systems. Parents often must seek funding and staffing from other sources, which can be hard to find in many communities.

TEACCH

Another program is called the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH). TEACCH, developed as a statewide program in North Carolina, uses picture schedules and other visual cues. These help the child work independently and organize and structure their environments.

Though TEACCH tries to improve a child's adaptation and skills, it also accepts the problems associated with autism spectrum disorders. Unlike ABA programs, TEACCH programs do not expect children to achieve typical development with treatment.

MEDICINE

Medicines are often used to treat behavior or emotional problems that people with autism may have, including:

• Aggression
• Anxiety
• Attention problems
• Extreme compulsions that the child find impossible to stop
• Hyperactivity
• Impulsiveness
• Irritability
• Mood swings
• Outbursts
• Sleep difficulty
• Tantrums

Currently, only risperidone is approved for the treatment of children ages 5 - 16 with irritability and aggression associated with autism. There is no medicine that treats the underlying problem of autism.

DIET

Some children with autism appear to respond to a gluten-free or casein-free diet. Gluten is found in foods containing wheat, rye, and barley. Casein is found in milk, cheese, and other dairy products. Not all experts agree that dietary changes will make a difference, and not all reports studying this method have shown positive results.

If you are considering these or other dietary changes, talk to both a doctor who specializes in the digestive system (gastroenterologist) and a registered dietitian. You want to be sure that the child is still receiving enough calories, nutrients, and a balanced diet.

OTHER APPROACHES

Beware that there are widely publicized treatments for autism that do not have scientific support, and reports of "miracle cures" that do not live up to expectations. If your child has autism, it may be helpful to talk with other parents of children with autism and autism specialists, and follow the progress of research in this area, which is rapidly developing.

At one time, there was enormous excitement about using secretin infusions. Now, after many studies have been conducted in many laboratories, it's possible that secretin is not effective after all, but research is ongoing.