autistic disorder, PDD
Autism is a condition that affects development of the brain. Autism severely affects a person's social, mental, emotional, and communications skills.
What is going on in the body?
Autism is the most severe form of the pervasive developmental disorders, which affect a person's ability to interact with others. Autism is characterised by extreme difficulty in responding to social interactions and communicating with others. Autism is usually obvious before the age of 3 years old. It occurs four times more frequently in boys than in girls. It appears to be prevalent equally among all parts of society. It appears in about 5 out of 10,000 people.
Some people who have autism may also have other disorders that affect the brain. These include epilepsy, Down syndrome, fragile X syndrome, and Turner syndrome.
What are the signs and symptoms of the condition?
A person with autism may have many symptoms. Autism can vary in degree, from mild symptoms to more severe forms with intense symptoms that may affect every part of a person's life.
All of the symptoms can vary in degree. Not every symptom is seen in every person who has autism. The symptoms include:
Difficulty communicating. Spoken language usually develops slowly or not at all. Words are often used inappropriately. A person with autism may use gestures more than words. He or she may also tend to repeat words or phrases. A person who has autism may have a short attention span.
Difficulty in social interaction. A person with autism often has little interest in interacting with others. He or she may not smile in response to others, and may not make eye contact during social interaction. A person with autism often spends a lot of time alone and makes little effort to form friendships.
Senses that are diminished or highly reactive. Some persons with autism have little response to any of the five senses. Others may have heightened senses. For example, an individual may hear a loud noise and cover his or her ears for a long time. An infant or child with autism may avoid hugging or any kind of touching.
Difficulty in play. A child with autism may lack interest in playing with others. He or she may not be able to engage in imaginative play.
Extremes in behaviour. A person with autism may be overactive or extremely passive. Or he or she may go from one extreme to the other. Some may show an obsessive interest in a single item, idea, or activity. Someone with autism may use repeated body movements, such as flapping arms, rocking back and forth, or head banging. The person may lack common sense and be aggressive to themselves or to others.
What are the causes and risks of the condition?
The causes of autism are not well known. The cause may be genetic. What is known is that bad parenting, mental illness, or "that a kid just doesn't want to behave" does not cause autism. Psychological factors have not been found to contribute to autism.
Some cases of autism have been associated with trauma, disease, or structural abnormalities before or during birth including:
There is no validated scientific evidence to support the misguided notion that childhood vaccination is associated with an increase in autism.
- the mother having rubella, or German measles, while she was pregnant
- untreated phenylketonuria, a problem in the body's ability to handle certain chemicals named phenylketones
- lack of oxygen during birth
- encephalitis or other serious infections affecting the brain as an infant
What can be done to prevent the condition?
Since the cause of autism is not known, autism is cannot be prevented. Early recognition and treatment may decrease the effects of autism.
How is the condition diagnosed?
A team of healthcare professionals should evaluate the person with symptoms of autism. The team may include a developmental physician, a psychologist, a neurologist, a speech therapist, and learning consultant. Diagnosis begins with a history and physical examination. Further testing is then needed to identify other possible causes of the symptoms. These may include blood tests, cranial CT scans, cranial MRI scans, and electroencephalograms (EEGs).
What are the long-term effects of the condition?
Long-term effects of autism depend on how severe the symptoms are. Long-term effects also depend on how soon a person starts treatment. The symptoms of autism may last a lifetime, but can often be improved with careful intervention and treatment.
An individual with autism may develop seizure disorders and depression.
What are the risks to others?
Autism is not contagious. It is not yet clear if some causes of autism are genetic. Genetic counselling may be helpful if a couple has a family history of autism.
What are the treatments for the condition?
Treatment for autism first focuses on education. This should be tailored to each person's specific needs and symptoms. Some of the treatments include:
Treatment may also include teaching the person how to handle new situations. This can include asking for help, directions, and other needs. An individual with autism often needs guidance in getting jobs and handling the daily work routine.
- behavioural therapy to help the person handle his or her environment
- "inclusion programs" to help the person adapt to the outside world as much as possible
- providing a structured environment for the person
- audio-visual therapies, which provide structured cues
- dietary review
- medications, including antipsychotic medications
- music therapy
- speech therapy
The families and friends of people with autism need support as well. The more support they have, the better the adjustment to living with a person with autism. Sometimes the person may need to go to a group home if the family is not able to function and treat the person with autism.
What are the side effects of the treatments?
Side effects depend on the treatments used. Behavioural therapy can cause frustration for the person and the family going through it. Medications may cause stomach upset, rash, irritability, depression, and allergic reactions.
What happens after treatment for the condition?
Treatment for autism will usually last a lifetime. A person with a mild form of autism may need to monitor himself or herself for new or worsening symptoms. A person with a more severe form of autism may need assistance with treatment and therapy programs.
How is the condition monitored?
Autism needs to be monitored closely. Treatments need to be adjusted over time. Someone with a mild form of autism may improve as he or she matures. An individual with a more severe form of autism may worsen over time and may need adjustments to the treatment program. The person may also have to rely on a caregiver to monitor behaviour and help with activities of daily living.
Author: Eileen McLaughlin, RN, BSN
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request