Understanding Autism

Breaking down myths about this complex brain disorder

By Colette Bouchez
HealthScoutNews Reporter

MONDAY, April 28 (HealthScoutNews) -- The signs often show up early in a baby's life: He doesn't babble or coo like other infants. Later, he may fail to gesture, point or make eye contact.

As time passes, the child may have difficulty learning to talk or, frequently, not talk at all, even as he approaches his second birthday.

When these symptoms prevail, the diagnosis could be autism -- a complex brain disorder that can keep its victims locked in a private, silent world painfully disconnected from those who love them. In its most severe form, it can totally inhibit a child's ability to communicate, respond to his surroundings or develop the emotional connections necessary to form the most basic of relationships with others.

"When a child is finally diagnosed as autistic, most parents say they knew something was wrong, sometimes beginning shortly after birth," says Dr. Richard I. Perry, a child and adolescent psychiatrist at Bellevue/New York University Medical Center.

Unfortunately, parents don't always get the medical validation they need. And that's something experts hope to change with education campaigns, like National Autism Awareness Month, which concludes Wednesday.

"One of the biggest problems with this disorder is that parents can have a very hard time persuading pediatricians and other professionals that there is something wrong with their kids beyond a normal slow development," Perry says.

There's a popular myth -- one of several surrounding autism -- that you can't diagnose this disease until a child is well into childhood, he says.

In reality, the signs are evident as early as 18 months of age, or sometimes even sooner, Perry says.

Another popular myth holds that because there's no specific treatment and no cure for autism, parents should be in no rush to get a diagnosis.

While as recently as 10 or 15 years ago that may have been true, experts say today studies show specific behavioral therapies can have a powerful impact on the course of autism. And the sooner they begin, the more difference they can make in a child's life.

"Generally, for a portion of the population, behavior intervention can help many individuals to learn, and lead a more regular and less-dependent life. And the earlier it begins, the better," says Andy Shih, director of research and programs at the National Alliance for Autism Research.

Other treatments, including antidepressants, can sometimes help as well. Again, the earlier the diagnosis is made, the better, Perry says.

The National Institutes of Health estimates that some 400,000 Americans are diagnosed with autism. And males are diagnosed about four times more often than females.

However, a recent report by the California Department of Developmental Services puts the number much higher -- up to 1.5 million.

That figure has led to what some say is the creation of still another myth about autism -- namely, that rates are increasing and at an alarming pace. According to Shih, however, there are no concrete facts to support this conclusion.

"Officially, the jury is still out as to whether or not we are seeing a true increase. But what is more certain is that there's definitely more kids being diagnosed," Shih says. This may be due, in part, to changes in the clinical definition of autism, which now includes some children who were previously diagnosed with mental retardation, he says.

This recognition has helped to break down still another popular myth about autism -- that it is a form of mental retardation. While some experts once held this to be true, doctors today know this is not the case.

"In children with mental retardation, there is a fixed level of intelligence, usually earmarked by a low IQ. But there is also an enormous capacity to love and to interact with others," Perry says.

In autistic children, he says, the IQ can vary dramatically from low to extremely high, but there is always a serious void in terms of social interaction that you don't see in mental retardation.

While no one is sure why autism occurs, Shih says some of the newest theories focus on the brain's rapid growth shortly after birth.

Every child comes into the world with a kind of "wild flower garden" of electrical connections growing inside their brain, Shih says. As the weeks and months pass by, environmental cues help to prune down the brain's wildly expanding connections, allowing only those needed most -- for example, those governing language and hearing skills -- to develop and grow strong. As they do, communication skills and emotional development begins, as babies learn to talk and interact with others.

But in autistic children, says Shih, the brain's "garden" doesn't undergo this natural "pruning" process. Instead, all the synapses and connections continue to grow unchecked. The end result: the child's brain circuitry is bombarded with so many conflicting messages, through so many pathways, it can't make solid connections to any of them, Shih says.

"Instead, they remain locked in a very private world," he says.

Although myths also abound as to the cause of autism, no one really knows why this disorder occurs. Shih, however, believes the strongest evidence to date can be found in the gene pool, which, he says, is the only place where links to the complete spectrum of autistic behaviors can be found.

"It is really only when you look to the genetic level that you see the common denominators that universally almost every child with autism shares," says Shih.

It hasn't been determined if environmental factors exacerbate genetic tendencies. Researchers continue to explore possible links to diet, stress during pregnancy, as well as the role of childhood vaccines during the first few years of life.

Regardless of any environmental connections that may one day be ruled in or out, Shih and Perry believe that a better understanding of the genetic underpinnings of autism will ultimately lead to better treatments and, possibly, a cure.

Until that time, they say, awareness and education are a parent's best allies -- two factors that can make that critical early diagnosis possible.

According to the National Alliance for Autism Research, parents can look for the following warning signs of autistic behavior:

To learn more about autism, visit the National Alliance for Autism Research, The Autism Society of America and The National Library of Medicine.

SOURCES: Richard I. Perry, M.D., child/adolescent psychiatrist, Bellevue/New York University Medical Center, and clinical professor, psychiatry, New York University School of Medicine, both in New York City; Andy Shih, Ph.D., director, research and programs, National Alliance for Autism Research, Princeton, N.J.

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