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early 40s after difficult pregnancy, with an induced labor at 36 weeks due to
fetal distress. As an infant, Brett was undemanding and relatively placid; he
did not have colic, and motor development proceeded appropriately, but
language development was delayed.
Brett’s parents first became concerned about his development when he was
18 months of age and still not speaking; however, upon questioning, they
noted that, in comparison to other toddlers in his play group, Brett had
seemed less uninterested in social interaction and the social games with
toddlers and adults.
Brett’s pediatrician initially reassured his parents that he was a “late talker”;
however, when Brett was 24 months old he was referred for developmental
evaluation.
At 24 months, motor skills were age appropriate. His language and social
development, however, was severely delayed, and he was noted to be
resistant to changes in routine and unusually sensitive to aspects of the
inanimate environment. Brett’s play skills were quite limited, and he played
with toys in repetitive and idiosyncratic ways.
His younger sister, now 12 months, was beginning to say a few words, and
the family history was negative for language and developmental disorders.
He would then become upset and throw all of his books off his desk in a
rage, sometimes inadvertently hitting other students. It took him up to 2
hours to calm down. At home, Brett would fly into a tantrum if anyone
touched his things, and he would become stubborn and belligerent when
asked to do anything that he was not expecting. Brett’s tantrum behavior
continued into middle school, and by the 8th grade, when he was 13 years old,
these behaviors became so severe that the school warned his parents that he
was becoming unmanageable.
When interviewed one-on-one, Adam mumbled when asked questions about school,
classmates and his family. When asked if he like toy cars, however, Adam lit up. He
pulled out several cars, trucks and airplanes from his backpack. He did not make
good eye contact but talked at length about the vehicles, using their correct names,
such as front-end loader, B-52 and Jaguar.
Adam spoke his first word at age 11 months and began to use short sentences by
age 3. He had always been very focused on trucks, cars and trains. His mother said
that he had always been “very shy” and had never had a best friend. He struggled
with childhood jokes and banter because “he takes things so literally.” Adam’s
mother had always seen this behavior as “a little odd.” She added that this behavior
was like that of Adam’s father, a successful lawyer, who had the same focus in his
interests. Both of them were “sticklers for routine” who “lacked a sense of humor.”
During the exam, Adam was shy and made below-average eye contact. The doctor
diagnosed him with autism spectrum disorder without intellectual impairment. Adam
has trouble interacting with classmates and holding a conversation — both
symptoms of social communication problems. Adam also has fixed interests — he is
interested in cars and trains and little else. Perhaps because his autism spectrum
symptoms were like his father’s behavior, his mother viewed Adam as “a little odd”
but did not seek an evaluation and diagnosis.
ASD is usually first diagnosed in childhood with many of the most-obvious signs
presenting around 2-3 years old, but some children with autism develop normally
until toddlerhood when they stop acquiring or lose previously gained
skills. According to the CDC, one in 59 children is estimated to have autism. Autism
spectrum disorder is also three to four times more common in boys than in girls, and
many girls with ASD exhibit less obvious signs compared to boys. Autism is a
lifelong condition. However, many children diagnosed with ASD go on to live
independent, productive, and fulfilling lives. The information here focuses primarily
on children and adolescents.
Characteristics of Autism Spectrum Disorders
Autism differs from person to person in severity and combinations of symptoms.
There is a great range of abilities and characteristics of children with autism
spectrum disorder — no two children appear or behave the same way. Symptoms
can range from mild to severe and often change over time.
Also, while many people with autism have normal intelligence, many others
have mild or significant intellectual delays. Also, those with ASD are at greater risk
for some medical conditions such as sleep problems, seizures and mental illnesses.
f you have concerns that your infant or toddler is not developing normally, it is
important to bring that concern to your primary care provider. The Centers for
Disease Control and Prevention (CDC) have identified possible red flags for autism
spectrum disorder in young children, including:
Scientists do not clearly understand what causes autism spectrum disorder. Several
factors probably contribute to autism, including genes a child is born with or
environmental factors. A child is at greater risk of autism if there is a family member
with autism. Research has shown that it is not caused by bad parenting, and it is not
caused by vaccines.
Treatment
While children are not typically cured nor do they outgrow autism, studies have
shown that symptoms can improve with early diagnosis and treatment. There is no
single treatment for autism. Treatments can include intensive skill-building and
teaching educational sessions, known as applied behavior analysis (ABA), and many
more interactive, child-centered versions of behavior treatments. Treatment may also
involve special training and support for parents, speech and language therapy,
occupational therapy and/or social skills training.
Also, some children and adults with ASD have other kinds of psychological
difficulties at some point in their lives, such as anxiety, ADHD, disruptive behaviors
or depression. These difficulties can be treated with therapy or with medication.
There are currently no medications that directly treat the core features of ASD.