10 Things To Know About Autism
April is Autism Awareness Month, and while it would be great to share all the clinical information and research findings available on autism, that feels akin to trying to summarize the entire encyclopedia in one page. Instead, here are 10 things to know about autism.
1. If you’ve seen one child with autism, you’ve seen just that: one child with autism. You cannot generalize your experiences with that one child to all children with autism. The clinical signs, symptoms and needs of children with autism, who represent 1 in every 68 children, are extremely diverse. This is why the term “spectrum” has become part of the condition’s name. A child can have severe signs of classic autism, such as flapping and spinning, and stand out to anyone and everyone as having autism. Or the child can show no outwardly unusual behaviors to the common eye. He (usually it is a “he,” since four boys are affected for every one girl) can be bright, verbal and well-behaved. Or the child could be every combination and permutation in between. What all children with ASD have in common is that they all have social problems that impact on their day-to-day functioning, ranging from a complete lack of social interest, to limited social motivation, to lack of the social “know-how” that other children are born with.
2. We can often diagnose autism reliably by 2 years of age, but the signs can be subtle and require expertise with this age group to recognize. So, despite our ability to diagnose the condition early, many children continue to be diagnosed much later, at 4 to 5 years of age. The little boy above is a perfect example. There was no flapping, spinning, unusual movements or seeming repetitive interests – things that stand out and grab a parent’s attention. Rather, he displayed the negative signs of autism: social and communicative skills he should have but didn’t. He didn’t respond when called, make eye contact or share facial expressions, or point or follow someone else’s point. While these are glaring signs to someone who sees young children with autism all day long, they can be easily missed.
3. Autism is not caused by bad parenting. Once upon a time, autism was blamed on cold “refrigerator moms” who didn’t nurture their children. All that changed when it was recognized that children with autism are much more likely to have seizures over the course of their lifespan. No amount of non-ideal parenting causes seizures – or causes autism.
4. So what causes autism? Many things: infections (e.g. congenital rubella, herpes), metabolic problems (like those tested on the newborn screen – low thyroid, PKU), substances/medications that a mother takes during pregnancy (e.g. alcohol, certain seizure medications), brain abnormalities (impacting the structure of the brain or the function of the brain, like infantile spasms), and many genetic abnormalities and syndromes. Please note that vaccines are not on that list. What all these causes have in common is that they lead to damage in the brain as a “final common pathway.” The specifics of that pathway are not yet identified.
5. Better outcomes are associated with earlier diagnosis. That generally doesn’t mean a cure. It means better learning and communication skills, fewer behavioral issues, more adaptive/functional skills of independence and less familial stress.
6. At present, the evidence-based treatments for autism are educational/therapy related and not medical. These treatments are most effective when begun early; they’re intensive in nature and based upon behavioral principles. Parents play a critical role in nurturing social interest. As children get older other strategies come into play, including direct teaching of social skills and helping children utilize their cognitive skills to develop social “know-how.”
7. There are no biomedical treatments for the primary social impairment of autism, only some of its peripheral symptoms (such as hyperactivity, anxiety, mood symptoms and sleep problems).
8. There are other conditions that go along with autism. These include early loss of social and language skills, toe walking, intellectual disability, ADHD, sleep problems, gastrointestinal problems and wandering.
9. Above all else, children with autism are children. They’re affected by all the same things as typical children – only they may not have the communication skills to express it. So they may be irritable and throw more tantrums when they have ear infections, dental pain, constipation or with a family move, parental separation or the birth of a sibling. A change in behavior requires a good medical assessment and an investigative mindset.
10. What does the future hold for an individual child with ASD? On my desk at work, I keep a “magic 8 ball” just for when parents ask this very reasonable question. Having practiced over a quarter of a century, I’ve watched the children we diagnosed with ASD as toddlers reach young adulthood. That group includes children who received all of the recommended treatments, who came from loving homes with devoted parents. And just as we started by saying that autism is a broad spectrum, so it is that those children are now a diverse group of young adults. Some remain minimally verbal and can’t live independently, while others are college students, young adults living independently and holding down jobs. And we can’t always predict which path a given child will take – hence the magic 8 ball. But the patterns tied to best outcomes include: greater cognition, more language, less severe social impairment, fewer behavioral issues and more independence and self-care skills over time.
If you remember anything from this post, let it be this: Learn the signs, and act early.
This blog was originally posted on U.S. News & World Report.