Autism: What to Watch For

Autism. It’s probably the single most hotly-debated, intensely-discussed topic in pediatrics. The internet is rife with misconceptions about the topic, and it’s difficult for parents to know where to turn for accurate information–whether they have a child with autism, or are developing concerns about a child’s development. Many parents have a significant amount of anxiety about their children’s development because of the press that this topic has received. And why wouldn’t they? Unlike a lot of other disorders, autism spectrum disorders (ASD) occur in children that look like every other child. The face of autism is the same as the face of the typically-developing child. Compared to asthma, ADHD, and a lot of other common childhood diseases, we understand very little about the causes, risk factors, and treatment for this disorder. Another reason people have become alarmed about ASD is that they happen–a lot. The most recent CDC studies have shown that autism spectrum disorders occur in 1 in 88 American children. That’s a lot–so many, in fact, that if you don’t have a child with autism, you probably know someone that does…or will. This estimate was a drastic increase from previous estimates (up 78% since 2002).

So why the huge change? Like so many other questions about ASD, we don’t really know. A large part of it is probably redefining the diagnostic criteria for ASD (it’s “easier” to diagnose now than it used to be), as well as increased awareness (a lot of kids with milder symptoms probably slipped by years ago before autism received so much attention–both in the public eye and in medical training). Many people are skeptical that those reasons are enough to account for the entire difference, and studies are ongoing to try to determine other cause for this increased incidence. Many possibilities have been looked into already, with little success–heavy metal poisoning, dietary factors, vaccines (especially the MMR vaccine), and many other potential risk factors have been researched, and none has proven to contribute significantly to the development of ASD. One interesting theory that is actually showing some promise is that children born to fathers at older ages have a higher risk; because the average age of fathers is rising, the incidence of ASD goes up as well. Heavy research into genetic causes is also underway, but at this time, we are only able to find mutations linked to autism in about 20% of children with ASD–and many typically-developing children share these same mutations without the symptoms.

Despite our lack of knowledge about the causes of autism (I say “causes” because there does not appear to be a single unifying factor), we have made significant progress in treatment. In fact, if children are diagnosed early enough and get the recommended therapies, many of them show significant improvement–some may not even meet the criteria for ASD by the time they enter school. In those children diagnosed later (school-age children or adolescents), the symptoms seem are far more difficult to correct…at least for now. This is the reason for the push to evaluate children at the first concern; and the reason why a “watch-and-wait” approach to children with a concern for autism is no longer acceptable. You pediatrician should be performing developmental screening at your child’s regular visits, but don’t be afraid to bring it up any time. The first symptom for multitudes of children with ASD was a concerned parent. You know your child better than anyone–so if you are worried, say something. If your child doesn’t seem to share the social development of his/her peers (or of an older sibling), look closer. Or if you happen to have an older child with ASD and a younger sibling seems to be following a similar trajectory, don’t hesitate to say something–siblings of children with ASD have about a 1 in 5 chance of sharing the diagnosis.

What to look for (from autismspeaks.org):

  • No big smiles or other warm, joyful expressions by six months or thereafter
  • No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
  • No babbling by 12 months
  • No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
  • No words by 16 months
  • No meaningful, two-word phrases (not including imitating or repeating) by 24 months
  • Any loss of speech, babbling or social skills at any age

What to do if you’re concerned:

  • Talk to your pediatrician.
  • Learn all you can from reputable sources; be careful what you read online–there’s a lot of misinformation. autismspeaks.org is a great place to start.
  • Get your child involved with your state’s early intervention program (in SC, that’s BabyNet).
  • Get involved with parent groups in your area or online.
  • Be your child’s advocate. It makes a difference.