If you’re concerned about the rising rates of autism in this country, you’re far from alone. Even doctors and scientists are still working hard to figure out exactly what causes the developmental disorder and why the numbers are increasing. I learned about the condition early on in my career, in residency, when I was faced with new patients who each had unique challenges and sometimes complex medical issues. Ever since then, and still today, my patients have helped me learn more about this disease. I’ve met hundreds of children at varying points in their journey—some with mild developmental and social delays, others much more severe—and had many conversations with the leading researchers in this field about this disease. We all want answers.
So, in light of April being National Autism Awareness Month, I wanted to take the time to shine a light on autism and help others understand more about it.
What is autism?
Autism spectrum disorder (ASD) is a complex developmental disability that expresses itself as a distinct set of characteristics in both children and adults and varies greatly among its patients. Known as the “spectrum,” autism affects individuals very differently and to varying degrees, which is what’s always made it extremely difficult to diagnose. To date, around 1 in every 68 infants in the United States are born with some degree of autism, according to the Centers for Disease Control and Prevention (CDC). This is nearly twice the rate from 2004, when 1 in 125 infants born were expected to be born with autism. While the numbers are certainly startling, one thing to keep in mind is that some experts attribute this increased rate to be the result of more awareness of the disorder, as a wider range of developmental disorders are falling under the increasing net of the autism spectrum.
As I work with more and more children with autism, I become more aware of the many factors that play into this disease. At some level, I suspect that one of the many factors playing into autism is some sort of inflammatory bowel disease, maybe one that we have not quite identified yet. This could be a reason why certain diets work well on some children with autism.
Another common pattern is poor detoxification pathways in our children with autism. It is hard for them to filter toxins, heavy metals and chemicals as well as their non-autistic counterparts.
Lastly, there are genetic links, that seem to predispose children to autism and to gut and detoxification issues. Screening parents and children within a family may be helpful to understand the potential risks and chemistry of their autistic children.
What are the signs of autism?
While the signs of autism are wide-ranging, not always consistent from patient to patient and highly dependent on where an individual falls on the autism spectrum, one thing that’s clear is the signs don’t seem to just suddenly appear. In fact, there is some thought that autism can even be identified in utero, with limited movement or responsiveness. Symptoms become more obvious around 18 months of age when a parent or medical professional may notice more obvious developmental delays in a child, including delayed speech, limited eye contact, or regression of previously acquired developmental milestones. According to the American Academy of Pediatrics (AAP), here are some key signs:
At 12 Months
- A child might not turn to look if he hears his name being called, even after repeated attempts, though he will respond to other sounds.
At 18 Months
- A child might have delayed speech but make no attempt to compensate for it with pointing, gestures or facial expressions.
At 24 Months
- A child might attempt to open a bottle of bubbles to play with, but won’t look at his mom or dad’s face when she attempts to play, showing she is not associating the concept of playing together.
Some other signs to look out for at any age- even in the first year of life:
- Does not make or keep eye contact
- Does not respond to smiles or facial expressions
- Doesn’t look at objects or events when they’re being pointed to
- Doesn’t show concern or empathy for others
- Does not show interest in making friends or bonding to family members
- Appears to have more sensory issues- including sensitivity to noise, light, or texture
How is autism diagnosed?
Unlike other conditions, autism cannot be diagnosed by a simple blood test or x-ray. Diagnosis is ultimately made based off your description of your child’s behavior to your pediatrician, as well as careful observation by autism experts and medical exams. Because so much of your child’s diagnosis will be based upon your feedback, it’s crucial to have an open dialogue with your child’s pediatrician. You should feel comfortable bringing up any concerns you may have about your child’s development or behavior. If your child does have autism, the earlier he or she is diagnosed, the better, so he can get the help he needs sooner. This is why the AAP recommends all children be screened for autism at their scheduled 18- and 24-month checkups or earlier.
This screening typically involves your pediatrician observing your child doing fairly normal things—giggling, communicating with you, pointing or waving, as well as how he responds to his name. Most offices will have you, or the parent, complete a Modified Checklist for Autism in Toddlers (also known as M-CHAT), a 23-point questionnaire. This will help prompt your pediatrician to start certain conversations about any language delays, behavior concerns or additional testing.
What happens if my child screens positive for autism?
Remember that just because your child has a positive screen, doesn’t mean he or she has autism or will be diagnosed anywhere on the spectrum. Screening tests are meant to screen—not diagnose. The next step would be to see an autism expert or developmental specialist for a complete assessment.
If your child is suspected to have autism spectrum disorder, he or she will be referred for early intervention services (EI), a federal grant program run by individual states under the Individuals with Disability Education Act. This program works with children ages 0-3 who show a delay in cognitive, social or communication skills or have a delay in physical or motor abilities or self-care skills.
For more on autism and how you can help your child, read my four concepts that I believe play a role in development and progression.