Autism and Pervasive Developmental Disorders

Signs and Symptoms

Signs of ASDs are usually recognizable before a child is 3 years old. However, symptoms can range from severe to so subtle that they seem to be normal aspects of childhood development. For that reason, it can take a few years for an ASD to be fully identified. That's why the American Academy of Pediatrics (AAP) recommends pediatricians look for early signs that suggest the possibility of autism at every visit and formally screen for autism at 18 months and 24 months, and any other time there is a concern.

Early signs can include:

• trouble interacting, playing with, or relating to others
• avoiding eye contact; not looking at people
• not pointing to objects to call attention to them
• unusual movements, such as hand flapping, spinning, or tapping
• delays in developmental milestones or loss of milestones already achieved
• playing with the same toy in a way that seems odd or repetitive
• not using or understanding language
• not exploring surroundings with curiosity or interest

Kids who show a pattern of these behaviors should be evaluated by a doctor. No blood tests or brain tests (such as MRIs) can diagnose ASDs, although such tests might be done to check for other conditions that could cause the symptoms.

A child with a suspected ASD should be evaluated by a doctor with expertise in the disorders, such as a pediatric neurologist, developmental pediatrician, pediatric psychiatrist, or pediatric psychologist. Parent questionnaires, educational and cognitive assessments, language assessments, or play and behavior assessments might be used to help diagnose autism.

Causes of Autism

Causes of autism are not yet well understood. Scientists believe they're complex neurobiological (brain biology) problems, which might have a genetic basis like other conditions that stem from abnormalities in the chromosomes a child inherits.

Some studies have suggested that autism might stem from a host of causes, including food allergies, excessive amounts of yeast in the digestive tract, and exposure to environmental toxins. However, these theories aren't scientifically proven.

The vast majority of scientific studies have found no link between vaccines — or any of their ingredients — and autism. The 1998 study that suggested such a link has since been retracted by the medical journal that originally published the flawed research.

It's also important to remember that autism is not caused by parenting or bad experiences. Earlier notions that suggested this have been debunked.

Treating ASDs

Although there's no cure for autism, early intervention and treatment can help kids develop skills and achieve their best potential. No medications can cure PDDs, but sometimes they're used to treat certain symptoms, such as aggression toward self or others, problems of inattention, obsessive-compulsive behaviors, and mood swings.

Individually tailored programs can include behavior modification, and educational interventions can help shape a child's behaviors and improve speech and communication.

Therapy should be individualized because each child's disorder is distinct and presents specific needs, and ASDs can range from mild to severe. Some kids do well in small classes with lots of one-on-one attention. Others do well in standard classrooms with support.

The goal of treatment is to get kids with PDDs to a point where they can be mainstreamed into a regular classroom, although they also might require special programs and support services, including speech-language therapy.

Gluten-free and casein-free diets have been reported to show some positive results in helping some children with autism, although more research needs to be done. Other vitamin and herbal remedies have not been scientifically proven, although they may have value for some kids.

Families who are considering using these or other treatments will want to discuss any possible benefits or risks with their doctor before beginning.

Helping Your Child

Once you learn your child may have autism, it's important to get help. Even before a formal diagnosis is made, your child can begin early intervention to address language and other delays.

Kids with disabilities are entitled to free preschool services at 3 years of age under the Individuals with Disabilities Education Act (IDEA). Check out the services offered by your local school district, Intermediate Unit, or organizations such as Easter Seals and United Cerebral Palsy (UCP). Also under the IDEA, states provide services for children with disabilities from birth through age 2 through federally mandated early intervention programs.

Because the needs of kids with autism spectrum disorders vary, any education program must be tailored to the individual child. You can set up an individualized education plan (IEP) for your child though your local school district. An IEP should incorporate social skills and communication and be very structured. Maximized speech and language intervention is important, as is the use of behavior modification and rewards to try to stop problem behaviors and to encourage all types of communication. For kids younger than 3 years old, parents will work with the state's early intervention program to develop an Individualized Family Service Plan (IFSP) instead of an IEP.

As with all developmental concerns, talk with your doctor about how to find local resources for the services your child needs.

If your child is in school, talk with his or her teachers to find out what rewards and behavior modification techniques help in the classroom and try using some of these at home. That way, your child will get a consistent message at home and at school.

Reviewed by: Mary L. Gavin, MD
Date reviewed: March 2010
Originally reviewed by: Anne M. Meduri, MD, and D'Arcy Lyness, PhD