What is autism and how is it treated?

This column is revised, updated and reprinted by popular demand

Autism is a group of brain development disorders that have a variety of manifestations. The hallmark of autism is the disability to interact normally with others using both verbal and non-verbal communication skills.

Essentially, autism interferes with the affected person’s ability to communicate, interact socially, and behave normally in social situations.

Autism affects children of all nationalities and races

A cinematic depiction of a person with autism spectrum disorder can be seen in the Academy Award-winning movie Rain Man (1988) starring Dustin Hoffman as “Ray” and Tom Cruise as his brother “Charlie.”

In 2013 physicians decided to collectively call the variations and subtypes of autism (including Asperger syndrome) “autism spectrum disorder.” There is no current way to detect autism spectrum disorder in-utero (prior to birth). There is no cure for autism spectrum disorder.

Autism spectrum disorder is characterized by any one or any combinations of the following:

• Difficulties with social interactions
• Difficulties with verbal and non-verbal communication
• Intellectual disabilities
• Difficulties with motor coordination
• Sleep disturbances
• Gastrointestinal problems
• Engagement in repetitive behaviors

Interestingly, a significant portion of people with autism spectrum disorder is extremely skilled with respect to one or more areas involving visual skills, art, music, problem-solving, memory skills and mathematics. In many cases, they harbor savant (highly gifted) skills.

Autism spectrum disorder probably begins in early brain development, but the outward manifestations become apparent between the ages of one and four. Although the development of all children can vary significantly, early detection can lead to early intervention and treatment, which can dramatically affect outcomes and the quality of life for persons with autism spectrum disorder.

Improved outcomes are seen with increased learning skills, communication skills, and social skills. Doctors say that the warning signs can be seen as early as one year of age.

Over three million persons are affected with autism spectrum disorder in the United States. Somewhere between one and two percent of all children are affected with autism spectrum disorder (approximately one in 60 births). Boys are approximately four times more likely to be affected with autism spectrum disorder than girls.

Scientists have discovered that the incidence of autism spectrum disorder has been increasing over the past few decades. It is unclear if the increased diagnosis rate is a result of better diagnostic criteria or environmental factors or both.

According to the AdCouncil, AutismSpeaks, and the Mayo Clinic, early warning signs include:

• No large smiles or other warm, joyful expressions by six months or after that
• No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months
• No babbling by 12 months
• No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
• No words by 16 months
• No meaningful, two-word phrases (not including imitating or repeating) by 24 months
• Any loss of speech, babbling or social skills at any age
• Fails to respond to one’s name when called
• Performs repetitive movements such as rocking, spinning or hand-flapping
• May be extremely sensitive to light and loud sounds or noises
• Engages in ritualistic and repetitive behaviors and may become extremely annoyed if the routine is disrupted
• Rarely makes direct eye contact
• Does not like to be touched or cuddled or hugged
• Does not engage in imaginative play behaviors
• May not have a normal pain response
• Strange vocal tones and patterns
• Delayed speech or loss of speech
• Strange or very limited food preferences
• Difficulty expressing feelings or emotions
• May become very disruptive in social situations

It is important to become familiar with these and other developmental milestones for toddlers. If a parent or caregiver suspects anything amiss, they should talk to their pediatrician about a simple screening test called the “Modified Checklist for Autism in Toddlers.”

The exact diagnosis needs to be made by a physician experienced with autism spectrum disorder. Even though there is no cure, early diagnosis and intensive intervention can improve learning abilities and behavior and increase the ability to interact socially with others. If you suspect a child has autism spectrum disorder, check with your doctor immediately for a screening examination.

What causes autism spectrum disorder?

The exact cause is not fully understood, but it is generally accepted that the cause is usually a combination of genetic mutations and environmental factors that affect early brain development.

These environmental factors include but are not limited to advanced parental age, conditions that decrease available oxygen to the developing baby, maternal illness during pregnancy, and lack of certain vitamins including folic acid. It should be noted that any one of these does not cause autism spectrum disorder, but rather a complex combination of these with the background of genetic predisposition.

Additional risk factors for autism include:

• Being male (the male-to-female ratio for autism is 4:1)
• Certain other genetic conditions (including, but not limited to, Fragile X syndrome, Tuberous sclerosis, Rett’s syndrome and Tourette’s syndrome)
• Pre-term birth
• History of other family members with autism

After exhaustive research, doctors state emphatically that there is no connection between developing autism and receiving childhood vaccines. Earlier reports linking vaccinations and autism have been completely debunked.

How is autism treated?

Every person with autism spectrum disorder is unique. As a result, every treatment plan should be customized. The goal is to improve learning skills, attention, behavior, and ability to interact socially.

The treatment will involve the entire family, physicians, teachers and skilled therapists. Both behavioral and medicinal treatments may be required, and the treatment program’s goals will evolve as the child grows. There are many great educational programs available for a person with autism spectrum disorder from toddlers to adults.

The best improvement in autism spectrum disorder symptoms is directly related to early diagnosis and behavioral intervention. Many people with autism spectrum disorder who receive appropriate intervention and guidance will live independent, rich and rewarding lives.

All persons with autism spectrum disorder deserve the opportunity to live meaningful, productive and enjoyable lives with gratifying relationships. With a better understanding of autism spectrum disorder and interventional support programs, those affected by autism spectrum disorder are living fulfilling and remunerative lives.

For more information, visit AutismSpeaks.org.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.