What is autism?

 Autism is a developmental disability that usually appears in the first three years of life. Autism is a “spectrum disorder,” meaning that it looks different in different people. Autism Spectrum disorder (ASD) is a complex developmental condition involving persistent challenges with social communication, restricted interests, and repetitive behavior. While autism is considered a lifelong disorder, the degree of impairment in functioning because of these challenges varies between individuals with autism. 

Early signs of this disorder can be noticed by parents/caregivers or pediatricians before a child reaches one year of age. However, symptoms typically become more consistently visible by the time a child is 2 or 3 years old. In some cases, the functional impairment related to autism may be mild and not apparent until the child starts school, after which their deficits may be pronounced when amongst their peers.

Social communication deficits may include:

• Decreased sharing of interests with others
• Difficulty appreciating their own & others' emotions
• Aversion to maintaining eye contact
• Lack of proficiency with use of non-verbal gestures
• Stilted or scripted speech
• Interpreting abstract ideas literally
• Difficulty making friends or keeping them
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Restricted interests and repetitive behaviors may include:

• Inflexibility of behavior, extreme difficulty coping with change
• Being overly focused on niche subjects to the exclusion of others
• Expecting others to be equally interested in those subjects
• Difficulty tolerating changes in routine and new experiences
• Sensory hypersensitivity, e.g., aversion to loud noises
• Stereotypical movements such as hand flapping, rocking, spinning
• Arranging things, often toys, in a very particular manner

Parent/caregiver/teacher concerns about the child's behavior should lead to a specialized evaluation by a developmental pediatrician, pediatric psychologist, child neurologist and/or a child & adolescent psychiatrist. This evaluation involves interviewing the parent/caregiver, observing, and interacting with the child in a structured manner, and sometimes conducting additional tests to rule out other disorders. In some ambiguous cases, the diagnosis of autism may be deferred, but otherwise an early diagnosis can greatly improve a child's functioning by providing the family early access to supportive resources in the community.

The first step is seeking an evaluation. Most parents start with their pediatrician who is checking on developmental milestones. If your child is under the age of 3 years, you can obtain an evaluation through your local early intervention system.

While there is no "cure" for autism, there are several effective interventions that can improve a child's functioning:

Applied behavioral analysis (ABA) is a therapy based on the science of learning and behavior. It is considered a medically necessary treatment for people with autism. ABA therapy can be performed at home, at school and out in the community.

ABA therapy involves working with a trained healthcare professional called a  Registered Behavior Technician (RBT), who works with the child or adult to support learning skills that are part of daily living, such as brushing teeth, getting dressed and making a meal. ABA therapy also focuses on helping to reduce challenging behaviors and build social skills.

A behavior technician is supervised by a Board Certified Behavior Analyst (BCBA). BCBAs have a master’s degree or higher in behavior analysis, psychology, or education and must pass a national certification exam.

• Social skills training: Done in group or individual settings, this intervention helps children with autism improve their ability to navigate social situations
• Speech & language therapy: It can improve the child's speech patterns and understanding of language
• Occupational therapy: This address adaptive skills deficits with activities of daily living, as well as problems with handwriting
• Parent management training: Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism
• Special education services: Under an Individual Education Plan provided by their school, which accommodates for their social communication deficits, restricted interests, and repetitive behaviors, children with autism can achieve their fullest potential academically. This includes special day classes for very young children to address language, social, and life skills.
• Treating co-occurring conditions: Children with autism experience insomnia, anxiety, and depression more often than peers without autism. They also more often have ADHD. Children with autism may have intellectual disability and this needs to be addressed. The impact of these conditions can be reduced with the proper services, which include all of the above, in addition psychotherapy and/or medication treatment
• Medication: A child psychiatrist can evaluate for co-morbid depression, anxiety, and impulsivity. If appropriate medications can be helpful. For example, autism-related irritability can be reduced by medications such as aripiprazole and risperidone (the two medications approved by the Food and Drug Administration for irritability associated with autism), prescribed judiciously by a knowledgeable clinician in collaboration with the child's parents.

Several complementary and alternative interventions involving special diets and supplements have been tried over the years by parents/caregivers seeking ways to help their child with autism function better. To date compelling evidence has not been found to clearly recommend any such specific interventions. Research into these types of interventions continues, and parents/caregivers interested in them should discuss them with their child's treating clinician.