May 26, 2013 | 02:43 AM (BD Time)
26 May, 2013 Sunday
Identifying and managing symptoms of autism
Dr. Nasir Uddin:
(From previous issue)
Verbal and nonverbal communication. Symptoms may include:
Delay in, or lack of, learning to talk. As many as 40% of people with autism never speak.
Problems taking steps to start a conversation. Also, people with autism have difficulties continuing a conversation after it has begun.
Stereotyped and repetitive use of language. People with autism often repeat over and over a phrase they have heard previously (echolalia).
Difficulty understanding their listener's perspective. For example, a person with autism may not understand that someone is using humor. They may interpret the communication word for word and fail to catch the implied meaning.
Limited interests in activities or play. Symptoms may include:
An unusual focus on pieces. Younger children with autism often focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy.
Preoccupation with certain topics. For example, older children and adults may be fascinated by video games, trading cards, or license plates.
A need for sameness and routines. For example, a child with autism may always need to eat bread before salad and insist on driving the same route every day to school.
Stereotyped behaviors. These may include body rocking and hand flapping.
Symptoms during childhood
Symptoms of autism are usually noticed first by parents and other caregivers sometime during the child's first 3 years. Although autism is present at birth (congenital), signs of the disorder can be difficult to identify or diagnose during infancy. Parents often become concerned when their toddler does not like to be held; does not seem interested in playing certain games, and does not begin to talk. Sometimes, a child will start to talk at the same time as other children the same age, then lose his or her language skills. They also may be confused about their child's hearing abilities. It often seems that a child with autism does not hear, yet at other times, he or she may appear to hear a distant background noise, such as the whistle of a train.
With early and intensive treatment, most children improve their ability to relate to others, communicate, and help themselves as they grow older. Contrary to popular myths about children with autism, very few are completely socially isolated.
Symptoms during teen years
During the teen years, the patterns of behavior often change. Many teens gain skills but still lag behind in their ability to relate to and understand others. Puberty and emerging sexuality may be more difficult for teens that have autism than for others this age. Teens are at an increased risk for developing problems related to depression, anxiety, and epilepsy.
Symptoms in adulthood
Some adults with autism are able to work and live on their own. The degree to which an adult with autism can lead an independent life is related to intelligence and ability to communicate. At least 33% are able to achieve at least partial independence.2
Some adults with autism need a lot of assistance, especially those with low intelligence who is unable to speak. Part- or full-time supervision can be provided by residential treatment programs. At the other end of the spectrum, adults with high-functioning autism are often successful in their professions and able to live independently, although they typically continue to have some difficulties relating to other people. These individuals usually have average to above-average intelligence.
Many people with autism have symptoms similar to attention deficit hyperactivity disorder (ADHD). But these symptoms, especially problems with social relationships, are more severe for people with autism. For more information, see the topic Attention Deficit Hyperactivity Disorder.
About 10% of people with autism have some form of savant skills-special limited gifts such as memorizing lists, calculating calendar dates, drawing, or musical ability.1
Many people with autism have unusual sensory perceptions. For example, they may describe a light touch as painful and deep pressure as providing a calming feeling. Others may not feel pain at all. Some people with autism have strong food likes and dislikes and unusual preoccupations.
Sleep problems occur in about 40% to 70% of people with autism.3
Autism is one of several types of pervasive developmental disorders (PDDs), also called autism spectrum disorders (ASD). It is not unusual for autism to be confused with other PDDs, such as Asperger's disorder or syndrome, or to have overlapping symptoms. A similar condition is called pervasive developmental disorder-NOS (not otherwise specified). PDD-NOS occur when children display similar behaviors but do not meet the criteria for autism. Also, other conditions with similar symptoms may also have similarities to or occur with autism.
When a developmental delay is recognized in a child, further testing can help a doctor find out whether the problem is related to autism, another pervasive developmental disorder (PDD), or a condition with similar symptoms, such as language delays or avoidant personality disorder. If your primary care provider does not have specific training or experience in developmental problems, he or she may refer your child to a specialist-usually a developmental pediatrician, psychiatrist, speech therapist, or child psychiatrist-for the additional testing.
Behavioral assessments. Various guidelines and questionnaires are used to help a doctor determine the specific type of developmental delay a child has. These include:
Medical history. During the medical history interview, a doctor asks general questions about a child's development, such as whether a child shows parents things by pointing to objects. Young children with autism often point to items they want, but do not point to show parents an item and then check to see if parents are looking at the item being pointed out.
Diagnostic guidelines for autism. The American Association of Childhood and Adolescent Psychiatry (AACAP) have established guidelines for diagnosing autism.2 The criteria are designed so a doctor can assess a child's behavior relating to core symptoms of autism.
Other behavioral questionnaires. Additional diagnostic tests focus on children younger than age 3.
Clinical observations. A doctor may want to observe the developmentally delayed child in different situations. The parents may be asked to interpret whether certain behaviors are usual for the child in those circumstances.
Developmental and intelligence tests. The AACAP also recommends that tests be given to evaluate whether a child's developmental delays affect his or her ability to think and make decisions.
Physical assessments and laboratory tests. Other tests may be used to determine whether a physical problem may be causing symptoms. These tests include:
Physical exam, including head circumference, weight, and height measurements, to determine whether the child has a normal growth pattern.
Hearing tests, to determine whether hearing problems may be causing developmental delays, especially those related to social skills and language use.
Testing for lead poisoning, especially if a condition called pica (in which a person craves substances that are not food, such as dirt or flecks of old paint) is present. Children with developmental delays usually continue putting items in their mouth after this stage has passed in normally developing children. This practice can result in lead poisoning, which should be identified and treated as soon as possible.
Other lab tests may be done under specific circumstances. These tests include:
Chromosomal analysis, whic
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