Signs and symptoms

Your child may appear normal for the first few months of life, then become less responsive to other people, including yourself. The hallmark characteristic of autism is impaired social skills. The condition also affects language and behavior. Autism may cause your child to exhibit a wide variety of signs and symptoms in these areas, and they can occur with a wide degree of severity.

If your child has autism, you may recognize the following signs in the areas of social skills, language and behavior:

Social skills

• Fails to respond to name
  
  
• Avoids eye-to-eye contact
  
  
• Resists cuddling and holding — screams to be let down
  
  
• Appears unaware of others' feelings
  
  
• Wants to play alone — retreats into own world or has very abnormal social interaction

Language

• Starts speaking later than other children
  
  
• Loses previous ability to say words or sentences
  
  
• Uses an abnormal tone and rhythm in speech — may use a singsong voice
  
  
• Can't start a conversation or keep one going
  
  
• May repeat words or phrases verbatim, but doesn't understand how to use them

Behavior

• Performs repetitive movements, such as rocking or hand-twisting
  
  
• Develops specific routines or rituals
  
  
• Becomes disturbed at the slightest change in routines or rituals, such as if you move objects that your child has lined up
  
  
• Engages in self-injury, such as head-banging or biting
  
  
• Hyperactive
  
  
• May be fascinated by parts of an object, such as the spinning wheels of a toy car

In some autistic children, signs and symptoms improve as they mature. Some people, usually those with the least severe symptoms, eventually may lead normal or near-normal lives. For others, however, there's little improvement in language or social skills, and the adolescent years can mean a worsening of behavior problems.

Many autistic children also have mental retardation, which means they're slow to acquire new knowledge or skills. However, some autistic children have normal to high intelligence. These children learn quickly yet have trouble communicating, applying what they know in everyday life and adjusting in social situations.

Causes

Autism has no single cause. Researchers are actively investigating the role of several genetic and environmental factors that may contribute to the development of the disorder. Different children may have autism for different reasons.

Studies of people with autism have found abnormalities in several regions of the brain. Neurons in these regions appear to be smaller than normal and have stunted nerve fibers.

When to seek medical advice

If your infant or toddler is uncommunicative, doesn't interact well with others, seems to be in his or her own world, throws uncontrollable tantrums, has trouble speaking or understanding speech, and becomes focused on repetitive and compulsive routines, talk to your doctor to see if autism might be the cause. If you suspect autism, it's best to have your child evaluated by a doctor as early as possible. Autism most often appears between 18 months and 30 months of age.

Screening and diagnosis

Because autism varies widely in severity and symptoms, making a diagnosis may be difficult. Autism may be missed if your child's signs and symptoms are mild or if your child has other diseases or conditions. Your doctor will make a diagnosis based on observing your child and talking to you about how your child's social skills, language skills and behavior have changed over time. To help reach a diagnosis, your doctor may also have your child undergo a number of developmental tests covering speech, language and psychological issues.

It's possible your child has a condition that resembles autism. Asperger's syndrome, another pervasive developmental disorder, is a term sometimes used to describe people with autistic behavior but with well-developed language skills. Children who appear normal during their first several years and then lose their language and social skills and show autistic behavior may have childhood degenerative disorder (CDD), rather than autism. Other metabolic and genetic syndromes may have characteristics similar to those of autism.

Treatment

There's no cure for autism, but many therapies and interventions aimed at remedying specific signs and symptoms have been developed. The best-studied therapies include educational-behavioral and medical interventions. The success of treatment may depend on how severe your child's signs and symptoms are.

Some children with very mild impairment may improve quite well with early and persistent intervention. Children with more severe signs and symptoms likely won't respond as well to treatment, but still are likely to function better with intensive behavioral treatment than without it.

Educational-behavioral therapies

These include strategies that emphasize highly structured and intensive skill training that is tailored to your child. Therapists can work to help your autistic child develop social skills and language. Because your child learns most effectively and rapidly when he or she is young, educational-behavioral therapy should begin as soon as possible.

Drug therapies

These include a variety of medications to reduce behaviors that can cause self-injuries or other problems. Your doctor likely won't prescribe medication for your child unless your child's behavior is potentially dangerous or unless your child is unable to take advantage of educational programs because of his or her behavior. Most of these medications used to treat autism affect the levels of serotonin — a brain chemical responsible for mood — or other brain chemicals.

Children's Health Center

Coping skills

Having a child with autism can place great stress on you, your family and your marriage. You may benefit by sharing your concerns in a support group of other families who have children with autism. You can locate support groups through your doctor, psychologist, psychiatrist, school or national organizations that deal with autism.

— June 5, 2002 —