Who, what, when, where, why and how?http://www.ncbi.nlm.nih.gov/pubmedhealth/

Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism.

A number of possible causes have been suspected, but not proven. They involve:

Genetics
Diet
Digestive tract changes
Mercury poisoning
The body's inability to properly use vitamins and minerals
Vaccine sensitivity

SYMPTOMS

Most parents of autistic children suspect that something is wrong by the time the child is 18 months old and seek help by the time the child is age 2. Children with autism typically have difficulties in:

Pretend play
Social interactions
Verbal and nonverbal communication

Some children with autism appear normal before age 1 or 2 and then suddenly "regress" and lose language or social skills they had previously gained. This is called the regressive type of autism.

PEOPLE WITH AUTISM MAY:

Be overly sensitive in sight, hearing, touch, smell, or taste (for example, they may refuse to wear "itchy" clothes and become distressed if they are forced to wear the clothes)
Have unusual distress when routines are changed
Perform repeated body movements
Show unusual attachments to objects

The symptoms may vary from moderate to severe.

Communication problems may include:
Cannot start or maintain a social conversation
Communicates with gestures instead of words
Develops language slowly or not at all
Does not adjust gaze to look at objects that others are looking at
Does not refer to self correctly (for example, says "you want water" when the child means "I want water")
Does not point to direct others' attention to objects (occurs in the first 14 months of life)
Repeats words or memorized passages, such as commercials
Uses nonsense rhyming

SOCIAL INTERACTION:

Does not make friends
Does not play interactive games
Is withdrawn
May not respond to eye contact or smiles, or may avoid eye contact
May treat others as if they are objects
Prefers to spend time alone, rather than with others
Shows a lack of empathy

RESPONSE TO SENSORY INFORMATION:

Does not startle at loud noises
Has heightened or low senses of sight, hearing, touch, smell, or taste
May find normal noises painful and hold hands over ears
May withdraw from physical contact because it is overstimulating or overwhelming
Rubs surfaces, mouths or licks objects
Seems to have a heightened or low response to pain

PLAY:

Doesn't imitate the actions of others
Prefers solitary or ritualistic play
Shows little pretend or imaginative play

BEHAVIORS:

"Acts up" with intense tantrums
Gets stuck on a single topic or task (perseveration)
Has a short attention span
Has very narrow interests
Is overactive or very passive
Shows aggression to others or self
Shows a strong need for sameness
Uses repetitive body movements


Autism includes 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, without a diagnosis the child may not get the necessary treatment and services.

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 it is 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.

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 studies of 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. 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. However, research continues.

EXPECTATIONS (prognosis)

Autism remains a challenging condition for children and their families, but the outlook today is much better than it was a generation ago. At that time, most people with autism were placed in institutions.

Today, with the right therapy, many of the symptoms of autism can be improved, though most people will have some symptoms throughout their lives. Most people with autism are able to live with their families or in the community.

The stresses of dealing with autism can lead to social and emotional complications for family and caregivers, as well as the person with autism.