Autism is a developmental brain disorder that affects the way a person communicates and relates to other people and with the environment.
It is characterised by impairment in social interaction, difficulties with verbal and non-verbal communication and repetitive behaviours and obsessions.

It affects children all over the world, in all ethnic, racial, religious and economic groups. According to the Irish Society for Autism, the condition affects 15 in every 10,000 births in Ireland, with 100 new cases every year. Boys are four times more likely than girls to be affected.

Pervasive developmental disorders (PDD) is a term used to cover conditions that are similar to autism. However, the symptoms are less severe than autism and the main problem is poor social communication.

Asperger’s syndrome is a form of autism where language and intelligence are normal and autistic symptoms present later in childhood. These children have repetitive behaviours, lack of social skills and clumsy movements. They rarely have close relationships outside their family.

What causes Autism?

The cause of autism is unknown. It is generally accepted that autism is caused by abnormalities in brain development.

Genetic influences

Autism runs in families so there is a genetic component to this condition. It is thought that as many as ten genes are involved in autism but they have not yet been identified. If there is one child in a family with autism there is an increased risk of having another autistic child.

Studies of twins have shown that if one identical twin has autism the other is much more likely to be affected than is the case with fraternal twins. Also, mild impairment of social or language skills is more common in first-degree relatives of children with autism.

Brain abnormalities

Autism is also thought to be related to brain development throughout pregnancy and and after birth. Parts of the brain affected by Autism:
Hippocampus recall of recent experiences and new information.

Frontal lobes of the brain involved in problem solving, planning ahead, restraining impulses and understanding the behaviour of others.
Parietal lobes of the brain control of hearing, speech and language.
Cerebellum balance, body movements, co-ordination.

Amygdala social and emotional responses.

Corpus collossum information passes from one side of the brain to the other. Nerves cross over here so that the left side of the body connects with the right side of the brain and the right side of the body connects to the left side of the brain.

Different studies have shown abnormal activity or structural defects in these areas of the brain in some individuals with autism but much more research is required to identify the cause of autism.

Abnormal levels of some neurotransmitters such as serotonin in the brain have been identified in some people with autism, , and this may play a part in distorting messages to and from the brain.

Non-genetic causes

There may be a history of complications during the prenatal, peri-natal or post-natal periods. This may indicate an abnormal foetus rather than being the cause of the abnormality.

There have been claims that autism is caused by the MMR vaccine for measles, mumps and rubella. Recent research does not support an association between the vaccine and the risk of autism.

How can I tell if my child has autism?

Signs and symptoms differ from child to child making diagnosis difficult. Some children have severe symptoms whilst others have a much milder form of autism. The main signs and symptoms to look out for are:

• Communication difficulties

Many children with autism never learn to talk. Others may seem to develop normally, learning to coo and make other baby sounds before regressing. Of the children who do develop speech, most tend to use single words instead of sentences, repeat what is said to them in a parrot-like fashion (echolalia) and make apparently meaningless statements over and over again. These children do not use appropriate facial expressions or non-verbal gestures when they speak. They talk in a high-pitched singsong or flat toneless voice.

• Behaviour Difficulties

Children with autism may spend hours rocking back and forward or repeating certain movements. They tend to flail their arms and walk on their toes. They perform repetitive, obsessive actions such as turning a light on and off for hours and may be preoccupied with the taste, smell or feel of certain objects.

They like consistency and get very upset if there is any change in their routine. Their play lacks imagination.
Many children with autism also behave in a self-destructive fashion without appearing to feel pain. For example, they may bang their head against a wall, pull their hair or bite themselves.

They may be aggressive and violent to others when they are angry or frustrated.

• Social difficulties

Children with autism avoid eye contact and social interaction with other people. Unlike other children, they show no emotion when a parent leaves or returns to the room. They do not like physical contact such as hugging or cuddling and have difficulty expressing emotion. They are unable to form normal relationships and lack social interest.

• Special Abilities

Very rarely, a child with autism may display a special skill beyond the norm. This could be artistic ability or the ability to play a musical instrument without being taught. Exceptional mathematical or memory skills have also been identified.

Other signs and symptoms

There is a high rate of epilepsy, usually presenting in adolescence. By the time they reach adulthood about one third of people with autism have had a seizure.

Some degree of mental retardation is found in seventy-five to eighty percent of people with autism. However, it is difficult to assess IQ test results because the tests were not designed for people with the kind of problems suffered by people with autism.

How is autism diagnosed?

There is often a delay in diagnosing autism, especially with a first child as new parents may not realise that there is a problem. In addition, a number of children with autism seem to develop normally at first and then regress and some abnormalities in behaviour may be quite subtle initially, making diagnosis difficult. However, most children with autism are diagnosed by the age of three.

Before autism is diagnosed, certain other possible diagnoses have to be excluded. These include hearing problems, language disorders, mental retardation and neurological problems. However, children with these conditions do not have the social and behavioural problems seen in children with autism.

If you suspect that your child may have autism, make an appointment to see your GP, who will:

• Take a detailed history of the child’s development from birth through infancy and early childhood;
• Assess IQ and language skills;
• Observe your child playing and interacting with others.
• Genetic screening, an electroencephalogram (EEG), which looks at brain waves, and a brain scan may also be done to rule out conditions associated with autistic behaviour.

What treatment is available?

There is no cure for autism. Early diagnosis, special education and parental involvement is important in managing the condition. As each child is different the treatment must be tailored to suit the individual.

• Behavioural therapy is used to modify dangerous or inappropriate behaviour and to teach skills.
• Physical activity to improve balance and co-ordination as well as body awareness.
• Special education.
• Language therapy.
• Medication. There is no specific drug therapy for autism. Anti-epileptic therapy is used for those with seizures. Neuroleptics such as haloperidol have been used to treat self-injurious behaviour and hyperactivity but they have side effects. Research is ongoing on the use of drugs that modulate neurotransmittors e.g. serotonin, serotonin reuptake inhibitors.