Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because autism symptoms vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, severe autism is marked by a complete inability to communicate or interact with other people.

Some children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life but then suddenly become withdrawn, become aggressive or lose language skills they've already acquired. Though each child with autism is likely to have a unique pattern of behavior, these are some common autism symptoms:

Social skills

• Fails to respond to his or her name
• Has poor eye contact
• Appears not to hear you at times
• Resists cuddling and holding
• Appears unaware of others' feelings
• Seems to prefer playing alone — retreats into his or her "own world"

Language

• Starts talking later than age 2, and has other developmental delays by 30 months
• Loses previously acquired ability to say words or sentences
• Doesn't make eye contact when making requests
• Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
• 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, spinning or hand-flapping
• Develops specific routines or rituals
• Becomes disturbed at the slightest change in routines or rituals
• Moves constantly
• May be fascinated by parts of an object, such as the spinning wheels of a toy car
• May be unusually sensitive to light, sound and touch and yet oblivious to pain

Young children with autism also have a hard time sharing experiences with others. When read to, for example, they're unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.

As they mature, some children with autism become more engaged with others and show less marked disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the adolescent years can mean a worsening of behavioral problems.

Most children with autism are slow to gain new knowledge or skills, and some have signs of lower than normal intelligence. Other children with autism 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. A small number of children with autism are "autistic savants" and have exceptional skills in a specific area, such as art, math or music.

When to see a doctor
Babies develop at their own pace, and many don't follow exact timelines found in some parenting books. But children with autism usually show some signs of delayed development by 18 months. If you suspect that your child may have autism, discuss your concerns with your doctor. The earlier treatment begins, the more effective it will be.

Your doctor may recommend further developmental tests if your child:

• Doesn't babble or coo by 12 months
• Doesn't gesture — such as point or wave — by 12 months
• Doesn't say single words by 16 months
• Doesn't say two-word phrases by 24 months
• Loses previously acquired language or social skills at any age

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Autism has no single, known cause. Given the complexity of the disease, the range of autistic disorders and the fact that no two children with autism are alike, there are likely many causes. These may include:

• Genetic problems. A number of genes appear to be involved in autism. Some may make a child more susceptible to the disorder; others affect brain development or the way brain cells communicate. Still others may determine the severity of symptoms. Each problem in genes may account for a small number of cases, but taken together, the influence of genes may be substantial. Some genetic problems seem to be inherited, whereas others happen spontaneously.
• Environmental factors. Many health problems are due to both genetic and environmental factors, and this is likely the case with autism as well. Researchers are currently exploring whether viral infections and air pollutants, for example, play a role in triggering autism.

No link between vaccines and autism
One of the greatest controversies in autism is centered on whether a link exists between autism and certain childhood vaccines, particularly the measles-mumps-rubella (MMR) vaccine. No reliable study has shown a link between autism and the MMR vaccination. A study published in 1998 that theorized there could be a link has been retracted because there's little evidence to support that theory.

Avoiding childhood vaccinations can place your child in danger of catching serious diseases, including whooping cough (pertussis), measles or mumps.

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Autism affects children of all races and nationalities, but certain factors increase a child's risk. They include:

• Your child's sex. Boys are three to four times more likely to develop autism than girls are.
• Family history. Families who have one child with autism have an increased risk of having another child with the disorder. It's also not uncommon for the parents or relatives of an autistic child to have minor problems with social or communication skills themselves or to engage in certain autistic behaviors.
• Other disorders. Children with certain medical conditions have a higher than normal risk of having autism. These conditions include fragile X syndrome, an inherited disorder that causes intellectual problems; tuberous sclerosis, a condition in which benign tumors develop in the brain; the neurological disorder Tourette syndrome; and epilepsy, which causes seizures.
• Parents' ages. Having an older father (being 40 or older) may increase a child's risk of autism. There may also be a connection between children being born to older mothers and autism, but more research is necessary.

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Your child's doctor will look for developmental problems at regular checkups. If he or she shows any autism symptoms, your child will likely be referred to a pediatric neurologist or developmental pediatrician for a thorough clinical evaluation.

It's a good idea to be well prepared for your child's appointment. Here's some information that may help you get ready.

What you can do

• Write down all the changes that you and others have observed in your child's behavior. The specialist will examine your child carefully and monitor growth and development, but your daily observations are also extremely important.
• Make a list of any medications, including vitamins, herbs and over-the-counter medicines, that your child is taking.
• If possible, bring a family member or friend with you. This is important not just to help you remember information but also for emotional support.
• If you have a baby book record of developmental milestones for your child, bring that record.
• If your child has unusual behaviors or movements recorded on a video, bring the video.
• If your child has siblings, try to remember when his or her siblings began talking and reaching other developmental milestones, and share that information with your child's doctor.
• Tell your child's doctor about any observations from other adults and caregivers, such as baby sitters and teachers.

Write down questions that you want to ask your child's doctor. Don't be afraid to ask questions or to speak up when you don't understand something that's said. And if you run out of time, ask to speak with a nurse or physician assistant, or leave a message for the doctor. Questions to ask might include:

• Why do you think my child does (or doesn't) have autism?
• Is there a way to confirm the diagnosis?
• If my child does have autism, is there a way to tell how severe it is?
• What changes can I expect to see in my child over time?
• Can I take care of my child at home, or will I need to look for outside care?
• What kind of special therapies do children with autism need?
• How much and what kinds of regular medical care will my child need?
• What kind of support is available to families of children with autism?
• How can I learn more about autism?

What to expect from your child's doctor
Your child's doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your child's doctor may ask:

• What specific behaviors prompted your visit today?
• When did you first notice these symptoms in your child?
• Have these behaviors been continuous or occasional?
• Does your child have a family history of autism, language delay, Rett's syndrome, obsessive-compulsive disorder, anxiety or other mood disorders?
• Does your child have any other symptoms that might seem unrelated to autism, such as gastrointestinal problems?
• Does anything seem to improve your child's symptoms?
• What, if anything, appears to worsen your child's symptoms?
• When did your child first crawl? Walk? Say his or her first word?
• What are some of your child's favorite activities? Is there one that he or she favors?
• Have you noticed a change in his or her level of frustration in social settings?

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Your child's doctor will look for signs of developmental delays at regular checkups. If your child shows some signs of autism, you may be referred to a specialist in treating children with autism. This specialist, working with a team of professionals, can perform a formal evaluation for the disorder.

Because autism varies widely in severity, making a diagnosis may be difficult. There isn't a specific medical test to pinpoint the disorder. Instead, an autism specialist will observe your child and talk to you about how your child's social skills, language skills and behavior have developed and changed over time. To help reach a diagnosis, your child may undergo a number of developmental tests covering speech, language and psychological issues.

Although the signs of autism often appear by 18 months, the diagnosis sometimes isn't made until age 2 or 3, when there may be more obvious delays in language development and social interactions. Early diagnosis is important because early intervention — preferably before age 3 — appears to be the most helpful.

Diagnostic criteria for autism
For your child to be diagnosed with autism, he or she must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

To be diagnosed with autism, your child must have six or more of the following symptoms and two or more of those symptoms must fall under the social skills category.

Social skills

• Has difficulty with nonverbal behaviors, such as making eye contact, making facial expressions or using gestures
• Has difficulty forming friendships with peers and seems to prefer playing alone
• Doesn't share experiences or emotions with other people, such as sharing achievements or pointing out objects or other interests
• Appears unaware of others' feelings

Communication skills

• Starts talking later than age 2 and has other developmental delays by 30 months, and doesn't make an attempt to communicate with gestures or miming
• Can't start a conversation or keep one going
• May repeat words or phrases verbatim, but doesn't understand how to use them
• Doesn't play make-believe or doesn't imitate the behavior of adults when playing

Behavior

• Develops interests in objects or topics that are abnormal in intensity or focus
• Performs repetitive movements, such as rocking, spinning or hand-flapping
• Becomes disturbed at the slightest change in routines or rituals
• May be fascinated by parts of an object, such as the spinning wheels of a toy car

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No cure exists for autism, and there is no "one-size-fits-all" treatment. The range of home-based and school-based treatments and interventions for autism can be overwhelming.

Your doctor can help identify resources in your area that may work for your child. Treatment options may include:

• Behavior and communication therapies. Many programs have been developed to address the range of social, language and behavioral difficulties associated with autism. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or how to communicate better with other people. Though children don't always outgrow autism, they may learn to function well with the disorder.
• Educational therapies. Children with autism often respond well to highly structured education programs. Successful programs often include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions show good progress.
• Medications. No medication can improve the core signs of autism, but certain medications can help control symptoms. Antidepressants may be prescribed for anxiety, for example, and antipsychotic drugs are sometimes used to treat severe behavioral problems.

Managing other medical conditions
Autistic children may also have other medical conditions, such as epilepsy or gastrointestinal problems. Talk to your child's doctor about how to best manage your child's conditions together, and always tell each of your child's health care providers all the medications and supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.

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Because autism is an incurable disease, many parents seek out alternative therapies. Though some families have reported good results with special diets and other complementary approaches, researchers aren't sure how useful the treatments are. Some of the most common alternative therapies include:

• Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy, music therapy or sensory integration, which focuses on reducing a child's sensitivity to touch or sound.
• Special diets. Several diet strategies have been suggested as possible treatments for autism, including restriction of food allergens; probiotics; a yeast-free diet; a gluten-free, casein-free diet; and dietary supplements such as vitamin A, vitamin C, vitamin B-6 and magnesium, folic acid, vitamin B-12, and omega-3 fatty acids. One popular diet eliminates gluten — a protein found in most grains, including wheat — and casein (a milk protein), but more research is necessary to see if the diet has any effect on autism signs and symptoms. To find out more, talk to a registered dietitian with special expertise in autism.
• Chelation therapy. This treatment is said to remove mercury and other heavy metals from the body. However, there's no known link between mercury and autism, and chelation therapy can be very dangerous. Chelation therapy can cause kidney failure. Some people who have participated in chelation therapy studies have died.

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Raising a child with autism can be physically exhausting and emotionally draining. These ideas may help:

• Find a team of trusted professionals. You'll need to make important decisions about your child's education and treatment. Find a team of teachers and therapists who can help look at the options in your area and explain the resources for children with disabilities. Make certain this team includes a case manager or service coordinator, who can help access financial services and government programs.
• Take time for yourself and other family members. Caring for a child with autism can be a round-the-clock job that puts stress on your marriage and your whole family. To avoid burnout, take time out to relax, exercise or enjoy your favorite activities. Try to schedule one-on-one time with your other children and plan date nights with your spouse — even if it's just watching a movie together after the children go to bed.
• Seek out other families of autistic children. Other families struggling with the challenges of autism can be a source of useful advice. Many communities have support groups for parents and siblings of children with autism.
• Learn about the disorder. There are many myths and misconceptions about autism. Learning the truth can help you better understand your child and his or her attempts to communicate. With time, you'll likely be rewarded by seeing your child grow and learn and even show affection — in his or her own way.

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There's no way to prevent autism. Autism can be treated, and children can have improved language and social skills with treatments. If your child is diagnosed with autism, talk to your child's doctors about creating a treatment strategy for your child. Keep in mind that you may need to try several different treatments before finding the best combination of therapies for your child.

©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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