Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures and gestures, to regulate social interaction
     

Failure to develop peer relationships appropriate to developmental level
     

Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest)
     

Lack of social or emotional reciprocity
  2. Qualitative impairment in communication, as manifest by at least one of the following:
     

Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
     

In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
     

Stereotyped and repetitive use of language, or idiosyncratic languag
     

Lack of varied, spontaneous make-believe, or social imitative play appropriate to developmental level
  3. Restrictive repetitive and stereotypic patterns of behavior, interests, and activities, as manifested by at least one of the following:
     

Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
     

Apparently inflexible adherence to specific nonfunctional routines or rituals
     

Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
     

Persistent preoccupation with parts of objects.

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

  1. Social interaction
  2. Language as used in social communication
  3. Symbolic or imaginative play

C. The disturbance is not better accounted for by Rett’s disorder or childhood disintegrative disorder.

DIAGNOSTIC EVALUATION

The other pervasive developmental disorders include:

 
• Asperger’s syndrome  
• Rett syndrome  
• Childhood disintegrative disorder  
• Pervasive developmental disorder - not otherwise specified (PDD-NOS), also called atypical Autism.

The diagnostic evaluation of Autism will often include a complete physical and neurologic examination, as well as the use of a specific diagnostic instrument such as the Gilliam Autism Rating Scale, the Pervasive Developmental Disorders Screening Test-Stage 3, the Childhood Autism Rating Scale (CARS), or the Autism Diagnostic Observation Schedule-Generic. Children with known or suspected Autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.

Because Autism encompasses such a broad spectrum, a brief observation in a single setting cannot predict an individual’s true abilities. Ideally, a multidisciplinary team will evaluate the child. This evaluation might include a comprehensive speech-language-communication evaluation, a cognitive and adaptive behavior evaluation, a sensorimotor and occupational therapy evaluation, and neuropsychological, behavioral and academic assessments.

Sometimes people are reluctant to make the diagnosis of Autism because of concerns about labeling the child. Although pigeonholing in a way that suggests limits is inappropriate due to the wide range of autistic spectrum conditions, failure to make a diagnosis can lead to failure to get the treatment and services the child needs.

Treatment

Intensive, appropriate early intervention greatly improves the outlook for most young children with Autism. Most programs will build on the interests of the child in a highly structured schedule of constructive activities. Visual aids are often helpful.

Treatment is most successful when geared toward the individual’s particular needs. An experienced specialist or team should design the individualized program. A variety of effective therapies are available, including applied behavior analysis, medications, music therapy, occupational therapy, physical therapy, sensory integration, speech/language therapy, and vision therapy. The best treatment plan uses a combination of techniques

One very successful educational program is called the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH).

In addition, there have been case reports of children with Autism seeing improvement in behavior by following a gluten-free or a casein-free diet. Gluten is found in foods containing wheat, rye, and barley. Casein is found in milk, cheese, and other dairy products. Not all experts agree that dietary changes will make a difference, and not all reports studying this method have shown positive results.

If considering these or other dietary changes, it is important to seek guidance from both a gastroenterologist (doctor who specialized in the digestive system) and a registered dietitian, who can be sure that the child is still receiving adequate calories, necessary nutrients, and a balanced diet.

Beware that there are widely publicized treatments for Autism that do not have scientific support, and reports of “miracle cures” that do not live up to expectations. If your child has this condition, it may be helpful to talk with other parents of children with Autism, talk with Autism specialists, and follow the progress of research in this area, which is rapidly developing.

Support Groups
For organizations that can provide additional information and help on Autism, see Autism resources.

Expectations (prognosis)

Autism remains a challenging condition for individuals and their families, but the outlook today is much better than it was a generation ago. At that time, most people with Autism were placed in institutions. Today, with appropriate therapy, many of the symptoms of Autism can be improved, though most people will have some symptoms throughout their lives. Most people with Autism are able to live with their families or in the community.

Autism varies from quite mild to quite severe. The outlook for individuals depends on the degree of their disabilities and on the level of therapy they receive.

Complications

Autism can be associated with other disorders that affect the functioning of the brain, such as tuberous sclerosis, mental retardation, or fragile X syndrome. Up to 30% of people with Autism will develop seizures.

The stresses that Autism places on individuals and their families can also lead to social and psychological complications for all involved. However, some autistic individuals have spectacular talents in particular areas (“autistic savants”) such as art or mathematics.

Calling your health care provider
Parents usually suspect Autism long before a diagnosis is made. Call your health care provider with any concerns about Autism or if you are concerned that your child is not developing normally.

Medical Encyclopedia

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.