Autism in children

Posted at 12:35 pm on 05/24/2016 by Powlin Manuel MD, MS (Psychol
Autism, an issue of grave concern: Powlin Manuel MD, MS (Psychology). Message of hope for parents with autism! Most parents are extremely discouraged when the diagnosis of autism is presented. This is especially true for parents of a young child. For more information Click here.

Reason for optimism for parents of chidlren with autism

 The optimistic side of the story is that fact that:
  • children with autism get better in their performance over period of time as they get older!
  •  Eye contact develops later! 
  • Language issues – such as echolalia seen as repeating other’s statements vanish! Proper language usage is achieved as they grow!
  •  Reading skills will develop as they grow older! Repetitive compulsive behavior reduces in frequency!
  •  Abnormal food aversions slowly disappear! Sensory hyper-sensitivity (intolerance to loud noises) diminish!
  •  Behavior issues such as abnormal level of tantrums get better!  
  • Autism is a disorder of mind,  more common in males, characterized by impaired socialization, unusual expressive language, repetitive behavior, strange response to sensory stimuli, withdrawn personality, and limited eye contact with others.  As a pediatrician in practice for 38 years, with a special interest in psychology, I have observed this rapid  progression in awareness of parents about this condition.  This does not mean that there is an increase in incidence. The reported increase in its presence is due to the changes in laws. Autism presents in different clinical variations and hence known by different names. These include: Autistic Disorder, Asperger’s Syndrome, ChildhoodIntegrativeDisorder, Rett’s  Disorder, and Pervasive Developmental Disorder not otherwise specified. All of these presentations can be grouped into Autism Spectrum Disorders. The main features autism include: abnormal eye contact, language disorders such as repetition of the words talked by others (echolalia), monotonous tone, pitch, volume, and tone, repetitive behavior showing up as spinning, toe walking, and lining up of toys, and unusual sensory responses presenting as intolerance to sounds of vacuum cleaners, and unusual food preferences. Autistic disorder Autistic disorder causes difficulty in social interaction, purposeless repetitive behavior, and mild to moderate intellectual deficiency. Asperger Syndrome Children with Asperger Syndrome have higher intelligence and better language skills and communication skills. They present with impairment in social functioning behavior, and impairment in communication without a language component (language is close to normal). Childhood Dis-integrative Disorder Childhood Dis-integrative Disorder starts later in childhood and is associated with seizure and mental retardation. Rett’s Disorder Rett’s Disorder affects more girls while the other three are more common in boys. The children develop normally for the first 1-2 years. These children develop mental retardation. Pervasive Developmental Disorder Pervasive Developmental Disorder is milder form of autistic disorder: has impairment in social interaction, impairment in communication; does not always have any stereotypic (repetitive) behavior. How do you suspect if you child is likely to suffer from Autism?  Suspect Autism if you observe the following at different ages: Early Signs of Autism  Autism is a communication disorder which can be detected by experienced pediatricians very early in life as early as five months of age.  One of the earliest to detect is lack of interaction with people around. with mother, shown as lack of eye contact, could be a reason to suspect. Lack of interaction with mother could be an early warning sign. Children with autism fail to respond to expression of others, an indication that something could be not normal. Autism is considered a disorder of mind in the sense that children with autism cannot interpret the emotional states of people around them. Early Signs of Autism  With close observation the signs of autism becomes more apparent  becomes more apparent after the age of eight months: If there is no exchange of sounds by nine months of age. Not turning when parents say baby’s name. Not turning to look when parents direct the child to do so. Lack of recognition of parent’s voice. Does not speak one word. Cannot point to something to mother if he likes to get. By one year of age the child does not babble, point or make intentional gestures. By one year of age the child has difficulty following a pointed finger to look at something. Evaluating a child for presence of autism An evaluation can be done by a pediatrician experienced in treating autistic children. Psychiatrists and neurologists also perform assessment of children with autism. Evaluation of children with autism is aimed at assessing the degree of impairment in areas of socialization, abnormal language expression, repetitive behavior, and unusually sensory stimuli. Abnormality in language includes repeating words that are spoken to the child instead of providing an answer maintaining a monotonous tone, and usually staying fixed on a topic during a conversation. Understanding other’s expression is a very common problem for these children. It is often difficult to understand what others are expressing in their talk as well as gestures. They have difficulties in getting an overall picture of a situation they encounter. Learning by observation is very difficult for children with autism. One typical feature revealed on evaluation of autistic children is the lack of imaginative play. What you can expect with outcome for children with autism? Many of the behaviors exhibited by children with autism improve with age: echolalia disappears. Language and communication skills improve with age. Intolerance to noises diminishes. Food idiosyncrasies vanish, reading skills improve, and tantrums decrease. The patients, however, continue to have deficiencies in general cognition and continue to suffer from significant difficulties, which can interfere with attaining a normal adult life.  Treatment of autism spectrum disorder There is no specific treatment for autism. There are many therapies and and behavior treatment modalities that may be helpful for the conditions associated with autism thereby improving the quality of life. Co-morbid (associated)  conditions are depression,  anxiety, adhd and aggressive behavior are treated with appropriate medications. The role of occupational and physical therapy is not clear as they undergo treatment for years. Most children will show improvement in their behaviors as they get older. School will provide special accommodation to facilitate learning after they undergo evaluation by the team of school system based specialists. Medications used in Autism
Behavioral Treatment in Autism
Recent research suggests that behavioral therapy is the cornerstone of treatment for autism. 
Various measures have been studied. Recently a technique called Pivotal response training is gaining popularity.
In this technique treatment of areas of the patients interest and choice is facilitated and it increases participation by patients and hence positive results.

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