Katy Moretz, MD
April is Autism Awareness Month, and as a local pediatric neurologist, I am happy to take this opportunity to help spread the word about autism and how it affects our community.
Both autism spectrum disorder (ASD) and autism are terms used interchangeably to describe a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. As clinicians, there is now one “diagnosis” we use that includes all patients on the autistic spectrum, whereas previously we distinguished between subtypes such as childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. As clinicians, our common goal, regardless of where the child may be on the “spectrum,” is to help maximize a child’s potential in school and daily life.
Autism appears to have its roots in very early brain development. However, the most obvious signs of autism and symptoms of autism tend to emerge between 2 and 3 years of age. There continues to be extensive research on effective methods for earlier diagnosis, as we know that early intervention with proven behavioral therapies can improve outcomes. Clinicians are getting better at recognizing the early signs of autism and seeking early intervention services. Research has confirmed that appropriate screening can determine whether a child is at risk for autism as young as one year. While every child develops differently, we also know that early treatment improves outcomes, often dramatically. Studies have proven that early intensive behavioral intervention improves learning, communication, and social skills in young children with autism spectrum disorders (ASD).
One of the most important things you can do as a parent or caregiver is to learn the early signs of autism and become familiar with the typical developmental milestones that your child should be reaching. Warning signs include:
- No big smiles or other warm, joyful expressions by six months or thereafter
- No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
- No babbling by 12 months
- No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
- No words by 16 months
- No meaningful, two-word phrases (not including imitating or repeating) by 24 months
- Any loss of speech, babbling or social skills at any age
The M-CHAT (Modified Checklist for Autism in Toddlers) can help you determine if a professional should evaluate your child. This simple online autism screen takes only a few minutes. If the answers suggest your child is at risk for autism, please consult with your child’s doctor. Likewise, if you have any other concerns about your child’s development, don’t wait. Speak to your doctor now about screening your child for autism.
Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have intellectual disability (IQ less than 70), and many have normal to above average intelligence. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means. In addition to the Early Intervention Services, it’s important to make sure each autistic child has a knowledgeable and reputable healthcare team. This means finding doctors, therapists, psychologists and teachers who understand and have experience with autism and can respond to shifting needs appropriately.
Autism statistics from the U.S. Centers for Disease Control and Prevention (CDC) identify around 1 in 88 American children as on the autism spectrum–a ten-fold increase in prevalence in 40 years. Careful research shows that this increase is only partly explained by improved diagnosis and awareness. Studies also show that autism is four to five times more common among boys than girls. An estimated 1 out of 54 boys and 1 in 252 girls are diagnosed with autism in the United States.
ASD affects over 2 million individuals in the U.S. and tens of millions worldwide. Moreover, government autism statistics suggest that prevalence rates have increased 10 to 17 percent annually in recent years. There is no established explanation for this continuing increase, although improved diagnosis and environmental influences are two reasons often considered. With continued research, we are starting to find a few answers. First and foremost, we now know that there is no one cause of autism just as there is no one type of autism. Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by themselves. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development.
In the presence of a genetic predisposition to autism, a number of nongenetic, or “environmental,” stresses appear to further increase a child’s risk. The clearest evidence of these autism risk factors involves events before and during birth. They include advanced parental age at time of conception (both mom and dad), maternal illness during pregnancy and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the baby’s brain. It is important to keep in mind that these factors, by themselves, do not cause autism. Rather, in combination with genetic risk factors, they appear to modestly increase risk.
A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception. Researchers are also looking at the role of the immune system in autism.
Many studies have been conducted to determine if a link exists between immunizations and increased prevalence of autism, with particular attention to the measles-mumps-rubella (MMR) vaccine and vaccines containing the preservative thimerosal. These studies have found no link between vaccines and autism. As do most pediatricians, I strongly encourage parents to have their children vaccinated, because this will protect them against serious diseases. It remains possible that, in rare cases, immunization might trigger the onset of autism symptoms in a child with an underlying medical or genetic condition. Some parents may still have concerns about vaccines, especially those who already have a child or relative with an autism spectrum disorder. Because parents and guardians differ in their sensitivity and concern about this issue, they should seek to find a pediatrician or other health practitioner who will partner with them to consider their concerns and help them ensure the optimal well-being of their child. Establishing open communication and trust with a physician who understands each child and his or her family is the best strategy for keeping a child healthy.
As a specialist who has the pleasure of treating children with autism on a daily basis, I appreciate the opportunity to share and educate regarding this diagnosis. Thank you.
Katy Moretz, MD
Some statistics regarding ASD:
- Autism now affects 1 in 88 children and 1 in 54 boys
- Autism prevalence figures are growing
- Autism is the fastest-growing serious developmental disability in the U.S.
- Autism costs a family $60,000 a year on average
- Autism receives less than 5% of the research funding of many less prevalent childhood diseases
- Boys are nearly five times more likely than girls to have autism
- There is no medical detection or cure for autism
National Institutes of Health Funds Allocation
- Total 2012 NIH budget: $30.86 billion
- Of this, only $169 million goes directly to autism research. This represents 0.55% of total NIH funding.