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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


A Parent's Life A Parent's Life
 

Autism -- Act Early To Make a Difference


November 14, 2013

By Claire McCarthy M.D.

Boston Children's Hospital


Autism. It's such a scary word — and a poorly understood one. No parent wants to even think about the possibility that their child might be autistic because the idea is so terrifying.

But because autism, a developmental disorder of the brain, is so poorly understood, most people don't know the signs. This means that most children aren't diagnosed until the elementary school years, even though signs of autism typically appear before age 3. The late diagnosis means valuable time is lost before treatment begins.

The American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) created the Act Early Campaign to help with this problem. The campaign teaches parents and caregivers the early signs of autism so they can get children help as early as possible.

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What Are Autism Spectrum Disorders?

Autism is one of a group of developmental problems that doctors call Autism Spectrum Disorders (ASD). While we don't know the exact prevalence of autism, the numbers are rising. Doctors aren’t sure if it’s because there are really more cases of autism or because people are getting better at diagnosing it. Both may be true.

We don't yet know what causes autism. There are probably many factors, including genetics and the environment, that work together in different ways in each person who is affected.

Doctors use the word "spectrum" in the name for autism disorders because no two people with autism are alike, and problems can range from mild to severe.

People with an ASD tend to have problems in three areas:

  • Social skills. Autistic children usually have trouble interacting with people and making and keeping friends. They may shy away from other people and from making eye contact. They may be interested in contact, but be unable to make conversation, read nonverbal cues, or know how to play with others.

 

  • Communication skills. Some children with an ASD never talk at all. Some are precocious, with very large vocabularies, but have trouble having conversations. Instead they talk in monologues, respond nonsensically, or mimick phrases they've heard before. They may speak in a loud or sing-song voice, or in flat, "robotic" tones.

 

  • Repeated behaviors and routines. Children with an ASD may do things repeatedly, such as flapping their hands or rocking back and forth. They may spend hours lining up toys or other objects, putting things in careful order and getting upset if the order is disturbed. People with an ASD commonly need routines in their lives: washing, dressing, and eating in the same order each morning, doing a certain activity at a certain time every day, or sitting in a particular chair at the table. They may get very upset if something interferes with their routines.

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How Is an ASD Diagnosed?

The best way to truly know if a child has an ASD such as autism is through a careful and thorough medical, neurological, and developmental examination by an experienced doctor or team of professionals.

The first step, though, is for parents and caregivers to be watchful for early signs of developmental problems by learning about normal development. This is the major theme of the Act Early campaign, which offers an interactive tool on its Web site that lists important developmental milestones for children ages 3 months to 5 years. For example, a 2-year-old should:

  • Walk alone
  • Point to a picture or object when it's named for him
  • Begin to do make-believe play
  • Show signs of increasing independence

If the parent or caregiver of a 2-year-old notices that he or she isn't doing all of these things, they should call their doctor for an evaluation. The child may not have an ASD. But any time children aren't meeting milestones, they deserve a closer look.

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How Is an ASD Treated?

Right now, there is no cure for an ASD and no one treatment approach that is right for every person. However, there are many ways to help people with ASDs.

Experts agree that the earlier a child is identified, the better. They also agree that a structured program that specializes in ASDs can make a difference for many. The most widely accepted — and best studied — form of treatment is "behavioral management," in which desirable behaviors (such as better communication and social interactions) are reinforced and less desirable ones (such as tantrums or repetitive behaviors) are reduced. The best programs teach children communication and social skills using simple steps and lots of positive reinforcement, and get parents involved.

There are other treatment approaches as well, including diets and medications. Some of these have been studied more than others. Parents should talk with their child's doctor before choosing any treatment option.

With treatment, patience and love, people with ASDs can lead happy, meaningful lives. The sooner we stop letting the word "autism" scare us and educate ourselves about the signs of an ASD, the sooner we can make a difference.

Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.

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