Understanding Autism

With a rise in diagnosed cases and a sea of conflicting information, autism is a condition that leaves many parents terrified. Yet affected families have every reason to be hopeful about the future.
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Jenny Risher

When he was a toddler, Donald didn't seem to care whether his parents came or went. Before turning 2, he'd already memorized Psalm 23 ("The Lord is my shepherd...") and could recite the catechism from memory, but never paid attention to a fully costumed Santa Claus during the winter holidays. He soon became obsessed with watching spinning objects and would have explosive temper tantrums if he was interrupted. Worried, Donald's father sent a 33-page typed letter recounting these and other unusual behaviors to a young psychiatrist named Leo Kanner at Johns Hopkins Hospital, in Baltimore.

The year was 1938, and Donald would later become the first American child ever diagnosed with autism. For decades afterward, it was believed that the condition was rare. Times have certainly changed. Today, according to the Centers for Disease Control and Prevention, roughly 1 in 88 children are diagnosed with autism spectrum disorders, or ASDs, and it's four to five times more likely to occur in boys than in girls.

boy

Jenny Risher

The almost fivefold jump in schoolchildren diagnosed with autism between 1993 and 2003 has prompted some authorities and politicians to proclaim that we're in the midst of an "autism epidemic." Bombarded with news about autism (as I write this, Google reports that 4,470 new stories mentioned the condition in the past 24 hours), parents of babies and toddlers are understandably alarmed and confused. I've been there myself. As a pediatrician and first-time father, I followed my son Jake's growth and development with anticipation, and eagerly awaited his first smile and steps. But when he was almost 2, back in 2003, he was saying only a few words. According to a checklist known as the Denver Scale that was used at the time, he should have known more words. Naturally, my wife and I were very worried.

One reason that autism frightens mothers and fathers so deeply is because its cause is unclear. Parents also fear that a diagnosis of autism virtually guarantees a difficult life -- not only for their child, but for their entire family. But researchers are more encouraged than ever about early intervention, which can be enormously beneficial. "We can do so much to help children manage their challenges," explains Patricia Wright, Ph.D., M.P.H., national director of autism services for Easter Seals, which provides support for people with disabilities. "Wherever your child is now, he or she can make significant progress over time."

What Do We Know About the Causes?

Simply put, autism is a defect of brain development that impairs social skills. The condition can occur on a spectrum from mild to severe. Experts still don't know the cause, but there are many theories. "'We are sure that genetics plays a role," says Parents advisor Philip Landrigan, M.D., M.Sc., a pediatrician and director of the Children's Environmental Health Center at Mount Sinai Medical Center, in New York City. In fact, a new study in Pediatrics of babies who have an older sibling with autism found that nearly 19 percent of them were diagnosed with the disorder by age 3. The link was almost three times stronger for boys: Twenty-six percent of the male infants developed autism, compared with only 9 percent of female infants.

Many scientists, including Dr. Landrigan, also suspect a direct connection between a child's exposure to certain industrial chemicals, particularly in utero, and the risk of brain disorders including autism. Another possible cause: a parent's age. A study in Autism Research in 2010 found that while mothers have a steadily increasing risk of having a child with autism as they get older, the age of the fathers only seems to contribute to that risk when the mother is younger than 30. But it's possible that older parents are just more attuned to the warning signs of developmental problems in their children.

Vaccines are incorrectly believed by many to be another risk factor. A full 25 percent of parents think that some immunizations can cause autism in otherwise healthy infants, found a 2010 survey from the University of Michigan. (That may explain why nearly 10 percent of kids ages 19 to 35 months are not up to date on their immunizations.) However, at least two dozen studies in medical journals have refuted any connection between autism and vaccines -- particularly the MMR vaccine protecting against measles, mumps, and rubella.

Beyond the cause, researchers also aren't entirely sure why there seems to have been such a rise in the prevalence of the condition. But changes in how it is defined are certainly a factor. Between 1980 and 1994 the American Psychiatric Association defined three new forms of autism, including pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger's syndrome. These changes essentially expanded the criteria. What's more, the Individuals With Disabilities Education Act of 1990 clarified the already existing federal law and specifically named autism as a category for special education, which caused an apparent jump in rates. Many kids who may previously have been labeled as learning disabled or mentally retarded are now diagnosed with autism.

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