Autism is a neurological disorder that predominantly manifests in speech, language, socialization and behavior. While there aren’t different “types” of autism, each child with the disorder has a different degree, says Dr. Walter J. Molofsky, Associate Chairman of the Mirken Department of Neurology at Beth Israel Medical Center. “There is now what we call the ‘autism spectrum,’ because every patient is affected by the core features of autism to a varying degree,” he says. “Some of the common impairments are with social skills, engagement and interaction, and communication. There are also varying degrees of stereotyped and repetitive behaviors.”
Some high-functioning children with autism were previously diagnosed as having Asperger’s syndrome, a designation that is now included under autism spectrum disorder, or ASD. Since each of the core features can exist with varying degrees of severity, it can take time to correctly diagnose autism in children.
Q. At what age does autism become apparent?
A. In some cases, autism can be diagnosed within the first year of life. Other children may seem to be developing normally for a year or two of life, experience a developmental decline and begin to exhibit core features. Early indicators include:
- The failure to babble within the first year of life
- The failure to gesture, such as waving hello and goodbye
- The lack of expressive words (single words) by 16 months or two-word phrases by age 2
- Poor eye contact
- Poor social skills
“If a child has one of these symptoms, it may indicate a developmental delay but not autism. That’s why it’s important to investigate in order to distinguish between the two,” Dr. Molofsky says. “If there are early language delays, it’s important to make sure those children don’t have hearing problems.” As children age and exhibit poor social interaction, it may be autism because that is a hallmark of the disorder.
Q. What causes autism?
A. While autism has been recognized for more than 100 years, understanding its causes has taken some time.
Initially, it was thought to be an acquired syndrome based on parenting techniques. More recently, there were concerns about whether vaccinations caused autism. Both suspected causes were proven untrue, and autism is now considered a genetically associated neurodevelopmental disorder. “There are questions about abnormalities in brain development in utero, and whether environmental factors such as a maternal infection play a role,” says Dr. Molofsky. “Although it manifests after birth, it is generally considered a congenital syndrome that children are born with and that expresses itself in various ways after birth.”
Q. How is autism diagnosed?
A. It is standard practice for a pediatrician to review a child’s developmental milestones and listen to concerns during annual doctor visits. Teachers of school-aged children may notice social or behavioral signs that they may address during a parent conference. To definitively diagnose a child with autism, a preliminary screening will be done prompted by observations of parents, teachers and the child’s regular doctor. A team of specialists, including pediatric neurologists and pediatric developmental specialists, may further evaluate the child. This will include assessments for speech and language, physical therapy, occupational therapy or neuropsychology. Tests and lab work may also be done to rule out other medical conditions.
Q. How is autism treated?
A. There are many treatment options for parents to consider, including specialized preschool education programs that help children work on their speech, language and socialization skills. Applied behavior analysis therapy provides one-on-one instruction that can help teach autistic children how to behave and relate to others, which gives them tools to function better as they grow up. An autistic child and his or her family need a neurologist or pediatric developmentalist in addition to a pediatrician to guide them through their therapeutic choices.
The core features of autism aren’t treated with medications, but medication might be useful to treat peripheral issues such as seizures, trouble sleeping, hyperactivity and trouble eating. Dr. Molofsky wants parents to be cautious about alternative treatments like acupuncture or aromatherapy because they are unproven and may cause a delay in the use of behavioral, medical or neurological therapy.
“Autism can be a difficult diagnosis, but there is plenty of help and support out there for autistic children and their families,” says Dr. Molofsky.
For more information about the diagnosis and treatment of autism, call 1-855-411-LWNY (5969) or visit The Mirken Department of Neurology website.