About Autism

Symptoms

With the advancement in diagnostic tools, most children with ASD can be reliably diagnosed by the age of 3, although earlier diagnosis is possible, even as young as 12 months. Parents are usually the first to notice the difference in their child. These children do not follow the typical patterns of child development. Some of these differences are noted as early as the first few months after birth, but most often are noted between the ages of 1 and 3. Some parents report a sudden regression and onset of social withdrawal, while other parents report a lack of progress after the child has reached certain developmental milestones. In her paper, Practice Parameter: Screening & Diagnosis of Autism, Dr. Filipek, et al., listed some indicators warranting further evaluation:

• No Babbling, Pointing, or Other Gestures by 12 Months
• No Single Words by 16 Months
• No 2-Word Spontaneous (Not Echolalic) Phrases by 24 Months
• Any Loss of Any Language or Social Skills at Any Age

The six items in the Modified Checklist for Autism in Toddlers (M-CHAT) that are found to have the best discriminability between children diagnosed with and without autism/PDD are:

• Lack of Interest in Other Children
• Not Using the Index Finger to Point or Indicate Interest in Anything
• Not Bringing Objects over to Parents to Show Them
• Lack of Imitation
• Failure to Respond to His/Her Name When Called
• Not Following Others Pointing at a Toy across the Room by Looking at It

Young children who are noted to have these symptoms urgently need comprehensive professional evaluation to rule out the diagnosis of ASD.

Prevalence

The US Centre for Disease Control, in 2007, reported a prevalence of Autistic Spectrum Disorder (ASD) at 6.7 children per 1,000, significantly higher than other conditions affecting children, including childhood cancer and Down’s Syndrome. Boys are affected by autism at a much higher rate than girls, for reasons that are not entirely clear. A similar pattern is seen in other childhood disorders such as Attention Deficit Disorder.

It is generally believed that the prevalence is similar across countries and cultures, although the numbers obtained in prevalence studies vary according to the methodology and diagnostic criteria used. In the UK, the National Autistic Society estimates between 5.5 and 9.1 children per 1,000 have ASD, depending on the diagnostic criteria used. A 2007 study, published in Hong Kong, found a prevalence rate of 1.6 per 1,000 children. In Canada, the prevalence rate was reported to be 5 per 1,000 in 2003.

There are a variety of factors that appear to contribute to the increase in ASD. The diagnostic criteria for ASD has widened significantly over the years. Fifteen years ago if a child was conversational or affectionate, it was unlikely they would have received a diagnosis of ASD. More recently, there is an understanding that autism occurs in many forms and, therefore, children who present as “high functioning” should still receive the diagnosis of ASD. In previous years, many children received the diagnosis of mental retardation; however, today these children are properly diagnosed with ASD. Another factor contributing to higher reported prevalence is the increased availability of diagnosticians who are qualified to provide an appropriate diagnosis. Finally, due to massive media attention, there is a greater awareness of ASD among parents and professionals.

Recovery

The notion of “recovery” was first described in the work conducted by Dr Ivar Lovaas and colleagues at UCLA. Nineteen children received intensive and comprehensive intervention based upon Applied Behaviour Analysis (ABA). Follow-up evaluations showed that nine of these 19 children successfully completed first grade in regular education classes with no support and IQs improved an average of more than 40 points, and were slightly above average. Six years later, Dr John McEachin, a co-founder of Autism Partnership, conducted an extensive follow-up study. It showed intervention gains were maintained since the end of intervention and they achieved scores similar to their peers in measurements of IQ, adaptive skills, and emotional functioning. Seven of the nine had continued to progress in regular education classes. These children were classified as ‘best outcome’ and also referred to as “recovered”.

Many people disagree with using the term “recovery” in reference to children with Autism Spectrum Disorder (ASD). This is partly due to a lack of belief that children can actually progress to a level of functioning where they become indistinguishable from their peers. We are careful not to use the word “cure” because that term implies that the cause has been identified and removed.

A second reason why people object to discussions of recovery for children with ASD is a fear that it will cause parents to become desperate in their quest for successful intervention of their child’s disorder. Parents are often over-optimistic about their child’s progress in interventions and can set themselves up for incredible disappointment and heartache. If one examines the Lovaas studies, it is clear that the majority of children did not completely recover, despite having received intervention under optimal circumstances, i.e. they began intervention before the age of four and received intensive intervention that continued as long as necessary in all environments by well-trained staff. Less than half of the children were able to successfully complete regular education on their own.

At Autism Partnership, we believe expectations need to be balanced. Parents need to have hope because intensive behavioural intervention is demanding and requires hard work for a long time. But we think the goal of intervention is for each child to obtain “his/her own best outcome”, and we know this is achievable. It is no different than it is with our non-ASD children – when they are young, we cannot know what they will grow up to become – a pilot? Doctor? Chef? We have to be satisfied knowing that they have become the best person they can be, that they are happy and productive, and that they will make good choices for themselves.

Of course, there are things we can and should do to enable best outcome. For children with ASD this means not only making sure they get the proper number of hours of intervention, but from the Lovaas 1987 study, we also know there are a number of factors that contribute to successful outcomes. We consider the following factors the most important:

• Intensity
• Consistency of Intervention
• Early Intervention
• Utilising Quality ABA
• Not Incorporating Other Interventions That Would Dilute the Impact of ABA
• Intensive Supervision and Consultation
• Parental Expertise

Causes of Autism

The cause of Autism Spectrum Disorder (ASD) is unknown, although unproven theories abound. Autism is a complicated disorder, and most likely a set of disorders for which easy answers to the cause are not likely to be found. It is now clearly understood that it is not an emotional disorder, as some of the early clinicians believed (e.g. Kanner, Bettelheim). The one theory that does have strong scientific evidence is that genetics can contribute to the occurrence of ASD. Studies show the concordance rate for identical twins is much higher than for fraternal twins, and ongoing research is beginning to identify genes that may put an individual at risk.

In the last decade, there has been increased theorising about the role of environmental toxins and vaccinations, but there is no convincing evidence that ASD is caused by either of these. With or without the use of the preservative Thimerosal, there are numerous scientific studies showing no association between vaccines and ASD. Moreover, there is not one scientific study that has shown a causal link. Adherence to these speculative beliefs is tragic because many more children are harmed by not receiving life-saving vaccines. Unsurprisingly, we are seeing increases in these illnesses that can be prevented through childhood vaccination.

Finding the answer will require long-term, painstaking, rigorous, and sophisticated scientific investigation. Professional responsibility and ethics demand that care be taken not to over-speculate, misrepresent, nor present mere hypotheses as facts about the causes of autism.