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3. What are the autism spectrum disorders (ASDs)?

Autism is one of a spectrum of five related neurological and developmental disorders called pervasive developmental disorders (PDD) or autism spectrum disorders (ASD).

This group of disorders includes:

1. Autism- A severe form of ASD

2. Pervasive developmental disorder - not otherwise specified (PDD–NOS) - A diagnosis made when a child has symptoms of either of autism or Asperger’s syndrome, but does not meet the specific criteria for either of them

3. Asperger’s syndrome - A milder form of ASD

4. Rett syndrome - A rare, very severe neurological disorder that occurs more commonly in females

5. Childhood disintegrative disorder (CDD) – A rare and severe developmental disorder

This group of developmental disabilities is caused by one or more unknown abnormalities in the brain. All these disorders are characterized by varying degrees of impairment in communication skills, social interactions, and restricted, repetitive, and stereotyped patterns of behavior.

These children and adults can exhibit extreme rigidity in their schedules and daily activities.

They can have unusual ways of learning and paying attention.

They can sometimes react abnormally to normal situations or sensations.

ASDs are more common than many better known disorders such as diabetes, spina bifida, or Down syndrome.

ASDs occur in up to 6 out of every 1,000 children born in the United States. This is similar to the rates measured in other countries, such as the United Kingdom, Europe, and Asia.

The controversy surrounding the reports of rising rates of autism will be mention later.

Characteristic behaviors of autism begin early in life, usually in the first year. The child’s parents are usually the first to notice these behaviors, but not recognize them as a problem. Parents may report to the pediatrician that their child is unresponsive to verbal commands, or that he spends an inordinate amount of time playing with one toy, especially toys that spin. The parents may think the child has a hearing problem. Professionals can reliably diagnose autism by the age of three. In cases where the symptoms are pronounced, a diagnosis can be made by the age of 18 months. Some researchers claim that many children eventually may be accurately identified by the age of 1 year or even younger.

Some parents may report that their child appeared to be developing normally, that he or she was responsive, interactive, and had normal speech development, and then suddenly became quiet, didn’t obey commands or want to play. This phenomenon is called “autistic regression” and for many years was controversial. Some scientists claimed that this regression was actually the inaccurate recall or “wishful thinking” of parents. However, researchers have studied family videos of children whose parents reported this phenomenon. The scientists noted that these children had normal speech patterns, object pointing and interactive playing at 12 months that was not present at 24 months of age. It is not known if autistic children who experience this regressive phenomenon are different from those autistic children who don’t.

Research has shown that parents are usually correct about noticing developmental problems, although they may not realize the specific nature or degree of the problem. Therefore, when physicians and psychologists attempt to diagnose a child with autism, they will spend a lot of time asking the parents questions about the child’s behavior.

The appearance of any of the warning signs of ASD is reason to have a child evaluated by a professional specializing in these disorders. The earlier the disorder is diagnosed, the sooner the child can be helped through treatment interventions. Early intervention is associated with improved behavioral outcomes B. comment: “Our son C. was diagnosed at age 2 1/2. We first had suspicions when our son was about 1 1/2 years old. He wasn’t responding to his name, didn’t seem to understand things we said when his peers did, covered his ears at certain sounds. It wasn’t as if these things were constant; they were happening intermittently over several months.  We called our pediatrician who told us to wait another 3 months and call him then for a re-evaluation. If anyone gives you that advice, fire them. Get another doctor who is more familiar with developmental delays. Nothing is lost by having your child see a developmental specialist. The best course of action with autistic kids is early intervention, therefore waiting makes no sense. Within the next 3 months, others close to us suggested there might be a problem. We called a developmental pediatrician. The developmental pediatrician told us within 10 minutes of our visit with him that something was wrong. He was certain L. was autistic. After that statement, things seemed to blur. He spoke, but we were so shell shocked that it made comprehending anything else he said impossible. He did say something about living a fulfilling life; he gave us a few phone numbers, one to our local regional center; another to a child psychologist who could administer further testing. The following day we called him back with several questions. I asked him where on a scale of 1–10 he felt our son was (with 10 being the most severe).He answered: “around a 3 or a 4.” I asked him will it get worse. He said no, where it is, is usually where it stays. Lastly, I asked him . . . I forget. We quickly found a child psychologist who spent about 3 hours with L. and came to the same conclusion as the developmental pediatrician. Still not convinced, we then had several autism screening tests administered by a psychologist and the results were consistent with what the pediatrician told us in his 10-minute evaluation. We kind of figured by then that autism wasn’t that hard to diagnose. My wife R. parked herself in front of the computer, got on the Internet and stayed on it for what seemed like an eternity. She kept coming back to the same thing in regard to treatment: applied behavioral analysis (ABA)- the only treatment with scientific data to back up its claims. We were on the ball enough to see through the “swimming with dolphins” and “talking to horses” nonsense. We immediately sought out an intense ABA program for him. We learned that the service providers had waiting lists anywhere from 9 to 18 months to get in. We immediately found an independent therapist and began putting together programs. By some miracle, a space opened up in one of the agencies 8 weeks later. We were in.”

Terms:

Autism spectrum disorders (ASD) - A term that encompasses autism and similar disorders. More specifically, the following five disorders listed in the DSM-IV: autistic disorder, Asperger syndrome, pervasive developmental disorder–not otherwise specified, childhood disintegrative disorder, and Rett syndrome.

Pervasive developmental disorders (PDD) - These are a group of neurologic disorders of unknown cause that are marked by impairment in developmental areas such as social interaction and communication or stereotyped behavior, interests,and activities.The disorders include autistic disorder,Rett syndrome, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder–not otherwise specified.

Childhood disintegrative disorder (CDD) - A condition occurring in 3- and 4- year-olds characterized by a deterioration of intellectual, social, and language functioning from previously normal functioning. Children with this condition, which is sometimes misdiagnosed as autism, develop normally for a prolonged period of time, but then experience loss of social skills, bowel and bladder control, play behaviors, receptive and expressive language, motor skills, and nonverbal communication skills.

Down syndrome - A genetic condition in which an individual has 47 chromosomes instead of 46; typically characterized by physical anomalies and developmental delays; the most frequently occurring chromosomal disorder.

Interventions - Types of traditional or nontraditional treatments that may be effective in reducing autistic behaviors.

Early intervention - Specific services that are provided to infants and toddlers who show signs of, or are at risk of, having developmental delay. These services are often tailored to the specific needs of each child with the goal of furthering development. Early intervention services are often provided at no cost to children who qualify and their families.

Pediatrician - A medical doctor who specializes in the treatment and care of infants, children, and adolescents.

Child psychologist - A mental health professional with a doctorate in psychology who administers tests, evaluates, and treats children’s emotional disorders; cannot prescribe medication.

Applied behavioral analysis (ABA) - A system of early educational intervention first developed by Ivar Lovaas. It uses a series of trials to shape a desired behavior or response. Skills are broken down into their simplest components and then taught to the child through a system of reinforcement. It is designed to promote appropriate language and behaviors and to reduce problematic ones.

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