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Autism Spectrum Disorder (ASD)

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Autism is defined as a brain development disorder that is characterized by impaired social interaction, impaired communication and repetitive behavior, all starting before a child is 3 years old. Autism Spectrum Disorder (ASD) encompasses a variety of autistic-like disorders (i.e. classic autism, pervasive developmental disorder not otherwise specified (PDD-NOS), Asperger’s syndrome, Rett Syndrome and childhood disintegrative disorder).

The causes of autism are unknown. Genetics (depletion or deletion of a chromosome) seem to play a key role. Environmental factors (i.e. pollution, exposure to toxic chemicals and pesticides), medical conditions (i.e. Fragile X Syndrome, Tuberous sclerosis, Rett’s syndrome, phenylketonuria, fetal alcohol syndrome, Smith-Lemli-Opitz and Angelman syndrome) and advanced maternal and paternal age have also been suggested to play a role in the development of ASD.
 
There has been much controversy surrounding the correlation between autism and childhood vaccinations. To date, the CDC and American Academy of Pediatrics state that there isn't any evidence that the MMR vaccine or the vaccine preservative thimerosal (mercury) causes autism. In 2011, the BMJ reported that the infamous 1998 study published in the Lancet that linked the MMR vaccine and autism was shown to be fraudulent. The author of the original study, Dr. Andrew Wakefield, has been stripped of his medical license and the Lancet has retracted the original study.
 
Here is what we do know about autism:
  • Boys are at higher risk than girls. 
  • Siblings of autistic children should be monitored closely since the likelihood of developing ASD increases. 
  • Symptoms can be mild to severe.
  • Unusual behaviors are noticed between 18 to 24 months. Some behaviors are apparent before this time. Observe for:
    • Lack of or delay in speech:
      • No babbling by 12 months of age.
      • Does not respond to name by 12 months.
      • No single words by 16 months.
      • No two-word spontaneous phrases by 24 months
      • Lack of expressions (i.e. uh-oh, huh, etc)
    • Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects, rocking)
    • Little or no eye contact; Lack of appropriate gaze
    • Persistent fixation on parts of objects
    • Lack of social skills
      • Little or no interest in peer relationships
      • Lack of make-believe or imitative play 
      • Lack of playing with a variety of toys
      • Lack of sharing interests, enjoyment or achievements with others
      • Lack of warm, joyful expressions
    • No gesturing (pointing, waving goodbye, etc.) by 12 months.
    • Unusual comfort objects.
    • Loss of any language or social skills, at any age.
    • Lack of recognition of caregiver's voice.
This guide, Babies Learn to Talk at an Amazing Rate, presents typical infant communication behaviors from 9-24 months of age. 
 
The American Academy of Pediatrics recommends all children be screened with a standardized developmental tool at 18- and 24-months or anytime a parent raises concerns. A new tool can be helpful in detecting autism and developmental delays in children 6-24 months of age. Parents/caregivers can complete The Communication and Symbolic Behavior Scales Developmental Profile Infant/Toddler Checklist and take the completed form to the child's primary healthcare provider for further evaluation. This checklist is also available in Spanish, Slovenian, Chinese and German. Instructions on how to complete the form can be downloaded here: Checklist Scoring Instructions and Cutoffs.
 
There is no known cure for autism and treatment is very individualized. Treatment may include:
  • Special educational programs
  • Behavioral therapy
  • Speech therapy
  • Medication
Children suspected of having developmental delays or those at risk for developmental delays should be referred to an early intervention program. Early intervention programs are federally funded state programs available to children under the age of three with disabilities and their families. To find an Early Intervention program in your state, visit the National Early Childhood Technical Assistance Center: State Part C Coordinators. For more information on Early Intervention, download the National Dissemination Center for Children with Disabilities brochure, A Parent's Guide: Finding Help for Young Children with Disabilities (Birth-5)Kids with disabilities, including autism, are entitled to free preschool services at 3 years of age under the Individuals with Disabilities Education Act (IDEA).
 
Autism resources include:

Early intervention is key in treating autism. If you feel like your child has autistic tendencies, talk to your baby's healthcare provider right away.

Sources:
American Academy of Neurology and the Child Neurology Society. Practice Parameter: Screening and Diagnosis of Autism. NEUROLOGY 2000;55:468–479
AAP Clinical Report: Identification and Evaluation of Children With Autism Spectrum Disorders. PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1183-1215. Reaffirmed December 1, 2010
Goodlee, F. (2011) Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 
2011;
342:c745. A correction of this article can be found here http://www.bmj.com/content/342/bmj.d1678
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