Todd Kopelman, PhD, Scott Lindgren, PhD, and David Wacker, PhD
Center for Disabilities and Development
University of Iowa Children’s Hospital
Causes
No one knows for sure what causes autism, but scientists believe both genes and the environment play a role. Research has shown that autism tends to run in families. Among identical twins, if one child has autism then the other is likely to be affected 75 to 90 percent of the time. Some parents worry that vaccines cause autism, but scientific evidence doesn’t support this theory. There is some evidence that prenatal exposure to factors in the environment (such as viruses or infections) may play a role in causing some forms of autism. It is important to recognize that autism is a brain-based disorder and is not caused by inadequate parenting.
Identification
There are no specific medical tests for diagnosing autism, although there are genetic tests for disorders that may be associated with behaviors on the autism spectrum. An accurate diagnosis is based on observation of the child’s communication, social interaction, behavior, and developmental level. Many signs of ASD can be observed by 18 months of age or even earlier. Some early signs that a child may have an ASD include:
- Lack of or delay in spoken language
- Repetitive use of language
- Little or no eye contact
- Lack of interest in other children
- Lack of spontaneous or make-believe play
- Persistent fixation on parts of objects
- Poor response to his/her name
- Fails to imitate caregivers
- Motor mannerisms (e.g., hand-flapping)
- Fails to point or show joint attention
Treatment
Each person with ASD is unique and intervention plans must be individualized, based on the needs of the individual and family. Early intervention can make a significant difference in improving cognitive and social development for children with ASD, and intensive, highly structured educational programs based on the principles of applied behavior analysis (ABA) are the gold standard for autism treatment. The primary focus should be on the child’s acquisition of communication, social, play, and academic skills. Structured programming should be provided throughout the year at an intensity of at least 25 hours per week.
When evaluating treatments, parents should consider the following issues (as recommended by the Autism Society of America):
- Will the treatment result in harm to my child?
- How will the failure of the treat- ment affect my child and family?
- Has the treatment been validated scientifically?
- Are the assessment procedures specified?
- How will the treatment be integrated into my child’s current program?
Treatments supported by scienftic evidence
- Early intensive behavioral intervention programs
- Applied Behavior Analysis (ABA), including Discrete Trial Training and Functional Communication Training
- Cognitive Behavior Therapy (CBT ), especially self-management
- Social skills training, including peer-based strategies, social sto- ries, and social skills groups
- Visual supports and schedules
- PECS when taught through ABA strategies
- Medication for attention, mood, aggression, and rigid behavior
Promising or emerging treatments
- Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH)
- Technology-based treatments, using computers or other electronic devices
- Music therapy
- Developmental relationship-based therapies, such as Floortime
Treatments with limited supporting scientific evidence
- Sensory Integration Therapy
- Gluten and casein-free diets
- Facilitated communication
- Auditory integration training
Treatments that are not recommended
- Chelation to remove presumed heavy metals from the body
- Very high doses of vitamins