Social and Language Disorders DTW

Pervasive Developmental Disorders

Asperger's Disorder

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• joint attention: As the name implies, joint attention is the ability to focus attention, through pointing, eye contact and other verbal and non-verbal actions, on an object or experience with another person. This skill first appears at age 9 months with pointing and is more fully developed by age 18 months, when children often bring objects to their caregivers to show them.
  As the name implies, joint attention is the ability to focus attention, through pointing, eye contact and other verbal and non-verbal actions, on an object or experience with another person. This skill first appears at age 9 months with pointing and is more fully developed by age 18 months, when children often bring objects to their caregivers to show them.
• Non-Verbal Social Cognition: Page: 1 Non-verbal social cognitive abilities include (1)Greeting skill: ability to sense the prevailing tone emanating from a group of children and produce a behavior that fits in with it effectively; (2) Reinforcing and reciprocal behavior: ways of acting to make another person feel good about herself; (3) Nonverbal cueing: making eye contact and regulating body movements to present a friendly, attractive, and compatible image to peers; (4) Timing and staging: understanding how to pace relationships; (5) Social feedback sensitivity: able to know how a relationship is going; (6) Awareness of impacts: ability to gauge her overall reputation or standing within a group; (7) Conflict resolution: the skill to deal with interpersonal conflicts; (8) Social control level: neither too dominant or bossy, nor totally submissive or passive; (9) Recuperative strategies: recover readily without excessive brooking after a setback, embarrassing incidents or disappointing outcome; (10) Self-marketing skill: develop an image that is reasonably appealing to the outside world.
  Page: 1 Non-verbal social cognitive abilities include (1)Greeting skill: ability to sense the prevailing tone emanating from a group of children and produce a behavior that fits in with it effectively; (2) Reinforcing and reciprocal behavior: ways of acting to make another person feel good about herself; (3) Nonverbal cueing: making eye contact and regulating body movements to present a friendly, attractive, and compatible image to peers; (4) Timing and staging: understanding how to pace relationships; (5) Social feedback sensitivity: able to know how a relationship is going; (6) Awareness of impacts: ability to gauge her overall reputation or standing within a group; (7) Conflict resolution: the skill to deal with interpersonal conflicts; (8) Social control level: neither too dominant or bossy, nor totally submissive or passive; (9) Recuperative strategies: recover readily without excessive brooking after a setback, embarrassing incidents or disappointing outcome; (10) Self-marketing skill: develop an image that is reasonably appealing to the outside world.
• Trigger questions for all PDDs: As suggested by the AAP Committee on Children with Disabilities (2001) there are simple questions that can be asked to ascertain risk for PDDs or to identify possible PDD symptomatology. "Does your child... - not speak as well as his or her peers?" - have poor eye contact?" - not respond selectively to his or her name?" - act as if he or she is in his or her own world?" - seem to 'tune others out'?" - not have a social smile that can be elicited reciprocally?" - seem unable to tell you what he or she wants, thus preferring to lead you by the hand or get desired objects on his or her own, even at risk of danger?" - have difficulty following simple commands?" - not bring things to you to simply `show' you?" - not point to interesting objects to direct your attention to objects or events of interest?" - have unusually long and severe temper tantrums?" - have repetitive, odd, or stereotypic behaviors?" - show an unusual attachment to inanimate objects, especially hard ones (eg, a flashlight or a chain vs a teddy bear or a blanket)?" - prefer to play alone?" - demonstrate an inability to play with toys in the typical way?" not engage in pretend play (if older than 2 years)?"
  As suggested by the AAP Committee on Children with Disabilities (2001) there are simple questions that can be asked to ascertain risk for PDDs or to identify possible PDD symptomatology. "Does your child... - not speak as well as his or her peers?" - have poor eye contact?" - not respond selectively to his or her name?" - act as if he or she is in his or her own world?" - seem to 'tune others out'?" - not have a social smile that can be elicited reciprocally?" - seem unable to tell you what he or she wants, thus preferring to lead you by the hand or get desired objects on his or her own, even at risk of danger?" - have difficulty following simple commands?" - not bring things to you to simply `show' you?" - not point to interesting objects to direct your attention to objects or events of interest?" - have unusually long and severe temper tantrums?" - have repetitive, odd, or stereotypic behaviors?" - show an unusual attachment to inanimate objects, especially hard ones (eg, a flashlight or a chain vs a teddy bear or a blanket)?" - prefer to play alone?" - demonstrate an inability to play with toys in the typical way?" not engage in pretend play (if older than 2 years)?"
• neurobiological origin: Due to the course of CDD, EEG abnormalities, seizures and a host of medical conditions that commonly co-occur with CDD (e.g., tuberose sclerosis, neurolipidoses).
  Due to the course of CDD, EEG abnormalities, seizures and a host of medical conditions that commonly co-occur with CDD (e.g., tuberose sclerosis, neurolipidoses).
• Diagnosis of exclusion: Other diagnoses that may resemble PDD-NOS: Other PDDs (Asperger's Disorder, Autism, Childhood Disintegrative Disorder), Other Developmental Disorders (Developmental Language Disorder, Mental Retardation, Semantic-Pragmatic Disorder), Other disorders with childhood onset (ADHD, Avoidant Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Overanxious
  Other diagnoses that may resemble PDD-NOS: Other PDDs (Asperger's Disorder, Autism, Childhood Disintegrative Disorder), Other Developmental Disorders (Developmental Language Disorder, Mental Retardation, Semantic-Pragmatic Disorder), Other disorders with childhood onset (ADHD, Avoidant Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Overanxious
• : Including Autism, Asperger's, CDD, Rett's and PDD-NOS
  Including Autism, Asperger's, CDD, Rett's and PDD-NOS
• Trigger questions (AAP, 2001a) (trigger Questions borrowed from AAP, 2004): Does your child: - Not speak as well as other children his/her age? - Have poor eye contact? - Act as if he/she is in his/her own world? - Seem to "tune out" others? - Not smile when smiled at? - Seem unable to tell you what he/she wants, and so takes your hand and leads you to what he/she wants, or gets it him/herself? - Have trouble following simple directions? - Not play with toys in a usual way? - Not bring things to you to "show" you something? - Not point to interesting things or direct your attention to items of interest? - Have unusually long or severe temper tantrums? - Show an unusual attachment to objects, especially "hard" ones, such as a flashlight or key chain, instead of "soft" ones, such as a blanket or stuffed animal? - Prefer to play alone? - Not pretend or play "make believe" (if the child is older than age two)?.
  Does your child: - Not speak as well as other children his/her age? - Have poor eye contact? - Act as if he/she is in his/her own world? - Seem to "tune out" others? - Not smile when smiled at? - Seem unable to tell you what he/she wants, and so takes your hand and leads you to what he/she wants, or gets it him/herself? - Have trouble following simple directions? - Not play with toys in a usual way? - Not bring things to you to "show" you something? - Not point to interesting things or direct your attention to items of interest? - Have unusually long or severe temper tantrums? - Show an unusual attachment to objects, especially "hard" ones, such as a flashlight or key chain, instead of "soft" ones, such as a blanket or stuffed animal? - Prefer to play alone? - Not pretend or play "make believe" (if the child is older than age two)?.
• Developmental assessments: Including socio-emotional, language, motor and cognitive skills.
  Including socio-emotional, language, motor and cognitive skills.
• appropriate assessments or referrals should be initiated: When in doubt refer. Differences in referral rates have been found to vary by patient gender, physician type and physician gender. Sices et al. (2004) found that girls were more likely than boys to be referred for audiology concerns, pediatricians were more likely than family physicians to refer for developmental delays, that a patient with avoidant behavior was more likely to be referred than disruptive behavior, and that female physicians were more likely to refer than male physicians.
  When in doubt refer. Differences in referral rates have been found to vary by patient gender, physician type and physician gender. Sices et al. (2004) found that girls were more likely than boys to be referred for audiology concerns, pediatricians were more likely than family physicians to refer for developmental delays, that a patient with avoidant behavior was more likely to be referred than disruptive behavior, and that female physicians were more likely to refer than male physicians.
• immediately enrolled in early intervention or special educational programs: Do not wait for diagnosis to be confirmed before starting services.
  Do not wait for diagnosis to be confirmed before starting services.
• IDEA: The Individuals with Disabilities Education Act (IDEA) is a Federally mandated program that assures a free and appropriate public education for children with diagnosed learning deficits. Usually children are placed in public schools and the school district pays for all necessary services. These will include, as needed, services by a speech therapist, occupational therapist, school psychologist, social worker, school nurse, or aide.
  The Individuals with Disabilities Education Act (IDEA) is a Federally mandated program that assures a free and appropriate public education for children with diagnosed learning deficits. Usually children are placed in public schools and the school district pays for all necessary services. These will include, as needed, services by a speech therapist, occupational therapist, school psychologist, social worker, school nurse, or aide.
• Recommended treatment strategies: An effective treatment program will build on the child's interests, offer a predictable schedule, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior. Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home. Sustained and continuous programming is more effective than episodic programming, as PDD children often regress in the absence of intervention services.
  An effective treatment program will build on the child's interests, offer a predictable schedule, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior. Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home. Sustained and continuous programming is more effective than episodic programming, as PDD children often regress in the absence of intervention services.
• Behavioral management: Among the many methods available for treatment and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment. The goal of behavioral management is to reinforce desirable behaviors and reduce undesirable ones.
  Among the many methods available for treatment and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment. The goal of behavioral management is to reinforce desirable behaviors and reduce undesirable ones.
• daily stress: High levels of stress in families of children with autism have been documented, with mothers showing more stress than fathers.
  High levels of stress in families of children with autism have been documented, with mothers showing more stress than fathers.
• Atypical antipsychotics: Placebo-controlled studies of the newer "atypical" antipsychotics are being conducted on children with autism. The first such study, conducted by the NIMH-supported Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, was on risperidone (Risperdal®). Results of the 8-week study were reported in 2002 and showed that risperidone was effective and well tolerated for the treatment of severe behavioral problems in children with autism. The most common side effects were increased appetite, weight gain and sedation. Further long-term studies are needed to determine any long-term side effects. Other atypical antipsychotics that have been studied recently with encouraging results are olanzapine (Zyprexa®) and ziprasidone (Geodon®)
  Placebo-controlled studies of the newer "atypical" antipsychotics are being conducted on children with autism. The first such study, conducted by the NIMH-supported Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, was on risperidone (Risperdal®). Results of the 8-week study were reported in 2002 and showed that risperidone was effective and well tolerated for the treatment of severe behavioral problems in children with autism. The most common side effects were increased appetite, weight gain and sedation. Further long-term studies are needed to determine any long-term side effects. Other atypical antipsychotics that have been studied recently with encouraging results are olanzapine (Zyprexa®) and ziprasidone (Geodon®)
• SSRIs: Including clomipramine, fluvoxamine, fluoxetine and sertraline. This class of medications can be helpful in controlling aggressive and repetitive behaviors and for some patients improving social functioning.
  Including clomipramine, fluvoxamine, fluoxetine and sertraline. This class of medications can be helpful in controlling aggressive and repetitive behaviors and for some patients improving social functioning.
• Buspirone: Clinical trial for children 2-6 years of age began in 2004.
  Clinical trial for children 2-6 years of age began in 2004.
• Anticonvulsants: Seizures are found in one in four persons with ASD, most often in those who have low IQ or are mute. Commonly used medications are carbamazepine (Tegretol®), lamotrigine (Lamictal®), topiramate (Topamax®), and valproic acid (Depakote®).
  Seizures are found in one in four persons with ASD, most often in those who have low IQ or are mute. Commonly used medications are carbamazepine (Tegretol®), lamotrigine (Lamictal®), topiramate (Topamax®), and valproic acid (Depakote®).
• Fenfluramine: Fenfluramine has been shown to produce possibly irreversible changes in 5-HT neurons and has not been demonstrated to be any better than placebo treatment in controlling autisic symtomatology.
  Fenfluramine has been shown to produce possibly irreversible changes in 5-HT neurons and has not been demonstrated to be any better than placebo treatment in controlling autisic symtomatology.
• MMR vaccine: Although mercury is no longer found in childhood vaccines in the United States, some parents still have concerns about vaccinations. Many well-done, large-scale studies have now been done that have failed to show a link between thimerosal and autism. A panel from the Institute of Medicine is now examining these studies, including a large Danish study that concluded that there was no causal relationship between childhood vaccination using thimerosal-containing vaccines and the development of an autism spectrum disorder and a U.S. study looking at exposure to mercury, lead, and other heavy metals.
  Although mercury is no longer found in childhood vaccines in the United States, some parents still have concerns about vaccinations. Many well-done, large-scale studies have now been done that have failed to show a link between thimerosal and autism. A panel from the Institute of Medicine is now examining these studies, including a large Danish study that concluded that there was no causal relationship between childhood vaccination using thimerosal-containing vaccines and the development of an autism spectrum disorder and a U.S. study looking at exposure to mercury, lead, and other heavy metals.
• walking: Physical therapy and orthopedic interventions/devices are usually needed to treat motor skill difficulties, ataxia and apraxia. Hydrtherapy may be helpful in increasing range of motion.
  Physical therapy and orthopedic interventions/devices are usually needed to treat motor skill difficulties, ataxia and apraxia. Hydrtherapy may be helpful in increasing range of motion.
• Speech and language therapy is usually beneficial: Receptive language is usually more advanced than expressive, although it may not immediately appear so. "Augmentive communication systems" including signing, gestures, eye pointing and computer aided systems can be very helpful and even lead to a reduction in hand stereotypies.
  Receptive language is usually more advanced than expressive, although it may not immediately appear so. "Augmentive communication systems" including signing, gestures, eye pointing and computer aided systems can be very helpful and even lead to a reduction in hand stereotypies.
• social awkwardness: Unlike autistic children, AS children are more aware or interested in others, they just don't know how to connect.
  Unlike autistic children, AS children are more aware or interested in others, they just don't know how to connect.
• Normal early language development: As AS children get older their formal language skills are maintained while their language usage or pragmatics falls behind.
  As AS children get older their formal language skills are maintained while their language usage or pragmatics falls behind.
• Limited ability to have a reciprocal conversation: Children with AS may appear to be a walking encyclopedia and often try to talk to others a in one-sided, tangential conversation.
  Children with AS may appear to be a walking encyclopedia and often try to talk to others a in one-sided, tangential conversation.
• genetic: A high incidence of AS features are observed in relatives of children with AS
  A high incidence of AS features are observed in relatives of children with AS
• perinatal factors: Approximately half of all cases have some form of cerebral dysfunction arising from pre-, peri-, or postnatal distress
  Approximately half of all cases have some form of cerebral dysfunction arising from pre-, peri-, or postnatal distress
• definition of AS is still widely debated: Validity and definition of the diagnostic concept of AS is still under considerable review and research. Various alternative , and not necessarily mutually exclusive, diagnoses have been proposed including schizoid personality, nonverbal learning disability, semantic-pragmatic disorder, and right-hemisphere learning disorder.
  Validity and definition of the diagnostic concept of AS is still under considerable review and research. Various alternative , and not necessarily mutually exclusive, diagnoses have been proposed including schizoid personality, nonverbal learning disability, semantic-pragmatic disorder, and right-hemisphere learning disorder.
• psychological testing: This may include assessment of: developmental history, psychosocial functioning, IQ, communication, academic performance and motor and sensory skills.
  This may include assessment of: developmental history, psychosocial functioning, IQ, communication, academic performance and motor and sensory skills.
• Non-Verbal Learning Disability: Constellation of neuropsychological deficits associated with difficulty dealing with novel or complex situations. Poor visual-spatial skills are a hallmark of this disorder, unlike autism. Clinical experience suggests that AS is often related to NLD but not vice versa
  Constellation of neuropsychological deficits associated with difficulty dealing with novel or complex situations. Poor visual-spatial skills are a hallmark of this disorder, unlike autism. Clinical experience suggests that AS is often related to NLD but not vice versa
• Cognitive Delay: May lead to unusual social behavior
  May lead to unusual social behavior
• Gifted/Talented: Children with IQ in the superior range can consider social play as boring, acquire considerable knowledge in specific areas and appear eccentric, yet their profile of social and linguistic skills is within the normal range
  Children with IQ in the superior range can consider social play as boring, acquire considerable knowledge in specific areas and appear eccentric, yet their profile of social and linguistic skills is within the normal range
• Semantic-pragmatic language disorder: May lead to social withdrawal and immature social play.
  May lead to social withdrawal and immature social play.
• Autism (esp. high functioning, non-retarded): Aspergers differs in that the onset is usually later, social deficits not as severe, there is a lack of stereotyped behaviors but more common motor awkwardness, more common in-depth interests and better long term outcomes.
  Aspergers differs in that the onset is usually later, social deficits not as severe, there is a lack of stereotyped behaviors but more common motor awkwardness, more common in-depth interests and better long term outcomes.
• Schizoid personality : Associated with schizophrenia later in life; Asperger's children have more pervasive social deficits and worse long-term outcomes than children with schizoid personality.
  Associated with schizophrenia later in life; Asperger's children have more pervasive social deficits and worse long-term outcomes than children with schizoid personality.
• Catatonia: Signs of catatonia have been identified in association with autism and AS. With catatonia, the person develops odd hand postures and the momentary interruption of ongoing movements.
  Signs of catatonia have been identified in association with autism and AS. With catatonia, the person develops odd hand postures and the momentary interruption of ongoing movements.
• Securing educational services: Depending on a child's exact diagnosis they may be pushed into already existing programs that are either for much lower functioning children (autistic) or programs for conduct or learning disordered children that do not address deficits social understanding (which is the core deficit of Asperger's). Also the appearance of an Asperger child's dysfunction can vary greatly depending on the setting "with the best appearance in structured academic settings and the worst functioning in unstructured peer interactions", thus causing an inaccurate picture of the child's needs.
  Depending on a child's exact diagnosis they may be pushed into already existing programs that are either for much lower functioning children (autistic) or programs for conduct or learning disordered children that do not address deficits social understanding (which is the core deficit of Asperger's). Also the appearance of an Asperger child's dysfunction can vary greatly depending on the setting "with the best appearance in structured academic settings and the worst functioning in unstructured peer interactions", thus causing an inaccurate picture of the child's needs.
• effective behavior management strategies: This will almost always involve professional consultation in assessing the function of problematic behavior and then establishing a complementary individualized behavior management program that specifically addresses each problem behavior (e.g. perseverative vocalizations, repetitive motions, interrupting etc.). Consistency across cargivers and professionals involved with the child is critical to the success of any behavioral program. "Off the cuff" solutions are apt to result in reinforcement of the maladaptive behavior
  This will almost always involve professional consultation in assessing the function of problematic behavior and then establishing a complementary individualized behavior management program that specifically addresses each problem behavior (e.g. perseverative vocalizations, repetitive motions, interrupting etc.). Consistency across cargivers and professionals involved with the child is critical to the success of any behavioral program. "Off the cuff" solutions are apt to result in reinforcement of the maladaptive behavior
• Individual therapy: Cognitive-behavioral or similarily goal directed and structured psychotherpay can be very helpful for dealing with depression and anxiety, as well as family issues, social relatedness/social skills and vocational goals. Insight-oriented thereapy is generally not helpful for Asperger's individuals.
  Cognitive-behavioral or similarily goal directed and structured psychotherpay can be very helpful for dealing with depression and anxiety, as well as family issues, social relatedness/social skills and vocational goals. Insight-oriented thereapy is generally not helpful for Asperger's individuals.
• Social Interaction: Subtle differences in social interactions are usually evident early as infancy -- especially a lack of pointing, lack of eye contact, and not responding to social interaction such as being called. Autistic children will not display joint attention at the normative age of 6-8 months (looks back and forth between object and the eyes of a caretaker, attempting to share emotion) and are disinterested in imitating others. However some social behaviors directed at getting their needs met (such as crying on separation and proximity seeking on return or bringing adults hand to something child wants) may be present.
  Subtle differences in social interactions are usually evident early as infancy -- especially a lack of pointing, lack of eye contact, and not responding to social interaction such as being called. Autistic children will not display joint attention at the normative age of 6-8 months (looks back and forth between object and the eyes of a caretaker, attempting to share emotion) and are disinterested in imitating others. However some social behaviors directed at getting their needs met (such as crying on separation and proximity seeking on return or bringing adults hand to something child wants) may be present.
• Communication: Diminished or absent verbal expression or gestures and poor comprehension of others' speech and body language; impaired "pragmatics" of initiating/sustaining conversation; Stereotyped, "robotic" or idiosyncratic speech; Echolalia and rote imitation of words; Unusual prosody of speech (sing-song, monotone)
  Diminished or absent verbal expression or gestures and poor comprehension of others' speech and body language; impaired "pragmatics" of initiating/sustaining conversation; Stereotyped, "robotic" or idiosyncratic speech; Echolalia and rote imitation of words; Unusual prosody of speech (sing-song, monotone)
• Play: Autistic children may be more interested in the physical aspects (spinning etc.), than symbolic or may repeat same scenarios over and over.
  Autistic children may be more interested in the physical aspects (spinning etc.), than symbolic or may repeat same scenarios over and over.
• Restricted interests: Circumscribed range of interests evidenced by intense preoccupations with certain topics (e.g., trains, schedules); difficulty with transitions and a strong need for predictable routines; and stereotyped behaviors such as hand flapping
  Circumscribed range of interests evidenced by intense preoccupations with certain topics (e.g., trains, schedules); difficulty with transitions and a strong need for predictable routines; and stereotyped behaviors such as hand flapping
• Unsual perceptual behaviors: May inspect objects through peripheral vision, stare at edges, spinning object, shiny surfaces, or particular shapes, tuning into irrelevant sounds and ignoring socially relevant ones, sniffing, overreaction to textures of foods or sensations of clothing.
  May inspect objects through peripheral vision, stare at edges, spinning object, shiny surfaces, or particular shapes, tuning into irrelevant sounds and ignoring socially relevant ones, sniffing, overreaction to textures of foods or sensations of clothing.
• Self-injurious: head banging, body slapping, self-pinching or self-biting, compulsive touching of certain textures
  head banging, body slapping, self-pinching or self-biting, compulsive touching of certain textures
• symbolic: fascination with letters, schedules, weather, numbers, classifications e. g., cars or dinosaurs
  fascination with letters, schedules, weather, numbers, classifications e. g., cars or dinosaurs
• Hyperlexia: apparent advanced reading skills without much understanding
  apparent advanced reading skills without much understanding
• Comforted: Different from obsessions and compulsions in that autistic children do not have a normal ability to comment on their own state of mind and express distress which is a central criteria of OCD.
  Different from obsessions and compulsions in that autistic children do not have a normal ability to comment on their own state of mind and express distress which is a central criteria of OCD.
• Splinter: e. g. able to calculate day of week to dates but unable to do simple calculations to determine the bill, hyperlexia
  e. g. able to calculate day of week to dates but unable to do simple calculations to determine the bill, hyperlexia
• Touch - unusual preferences and aversions: may be oversensitive to light touch, while being calmed by deep touch, may seem to have insensitivity to pain
  may be oversensitive to light touch, while being calmed by deep touch, may seem to have insensitivity to pain
• Smell and Taste - unusual preoccupations: e.g., sniffing or licking nonfoods and insistence on types of foods or food textures
  e.g., sniffing or licking nonfoods and insistence on types of foods or food textures
• Self-Injurious Behavior: e.g., biting hands, banging head, picking at skin; hitting self, esp. when frustrated
  e.g., biting hands, banging head, picking at skin; hitting self, esp. when frustrated
• Parents may be the first to notice problems: In some cases, the baby seemed "different" from birth, unresponsive to people or focusing intently on one item for long periods of time. The first signs of autism can also appear in children who seem to have been developing normally. When an engaging, babbling toddler suddenly becomes silent, withdrawn, self-abusive, or indifferent to social overtures, something is wrong. Research has shown that parents are usually correct about noticing developmental problems, although they may not realize the specific nature or degree of the problem
  In some cases, the baby seemed "different" from birth, unresponsive to people or focusing intently on one item for long periods of time. The first signs of autism can also appear in children who seem to have been developing normally. When an engaging, babbling toddler suddenly becomes silent, withdrawn, self-abusive, or indifferent to social overtures, something is wrong. Research has shown that parents are usually correct about noticing developmental problems, although they may not realize the specific nature or degree of the problem
• Recent studies show higher rates: Several factors may be driving higher rates including greater awareness, better diagnostic tools, inclusion of milder symptom profiles and possibly a true increase due to as of yet unknown and unidentified causes.
  Several factors may be driving higher rates including greater awareness, better diagnostic tools, inclusion of milder symptom profiles and possibly a true increase due to as of yet unknown and unidentified causes.
• MMR vaccine: Although mercury is no longer found in childhood vaccines in the United States, some parents still have concerns about vaccinations. Many rigorous, large-scale studies have now been done that have failed to show a link between thimerosal and autism. A panel from the Institute of Medicine is now examining these studies, including a large Danish study that concluded that there was no causal relationship between childhood vaccination using thimerosal-containing vaccines and the development of an autism spectrum disorder and a U.S. study looking at exposure to mercury, lead, and other heavy metals.
  Although mercury is no longer found in childhood vaccines in the United States, some parents still have concerns about vaccinations. Many rigorous, large-scale studies have now been done that have failed to show a link between thimerosal and autism. A panel from the Institute of Medicine is now examining these studies, including a large Danish study that concluded that there was no causal relationship between childhood vaccination using thimerosal-containing vaccines and the development of an autism spectrum disorder and a U.S. study looking at exposure to mercury, lead, and other heavy metals.
• Neurophysiologic differences: Abnormal cells in limbic system and cerebellum; PET shows disrupltions between cortical and subcortical. Abnormal hemispheric lateralization
  Abnormal cells in limbic system and cerebellum; PET shows disrupltions between cortical and subcortical. Abnormal hemispheric lateralization
• Mental Retardation: In MR, social and communicative skills are at levels commensurate with nonverbal IQ. With severe MR, some autistic-like features may be noted (stereotypies). Note that MR and low IQ may be co-occur with autism.
  In MR, social and communicative skills are at levels commensurate with nonverbal IQ. With severe MR, some autistic-like features may be noted (stereotypies). Note that MR and low IQ may be co-occur with autism.
• Obsessive-Compulsive Disorder: Can present with unusual interests and behaviors, however social skills and language/communication skills are preserved.
  Can present with unusual interests and behaviors, however social skills and language/communication skills are preserved.
• Anxiety: Especially Selective Mutism (child's ability to speak is preserved in some situations, but mute in others) and Social Anxiety Disorder
  Especially Selective Mutism (child's ability to speak is preserved in some situations, but mute in others) and Social Anxiety Disorder
• Schizoid personality disorder: Child is relatively isolated but has the ability to relate normally in some contexts
  Child is relatively isolated but has the ability to relate normally in some contexts
• Reactive attachment disorder: Typically due to a history of neglect with social deficits remitting dramatically in response to more responsive caregivers.
  Typically due to a history of neglect with social deficits remitting dramatically in response to more responsive caregivers.
• Chromosomal and single gene abnormalities: Fragile X syndrome , Other X chromosome abnormalities, Down Syndrome, Duchenne muscular dystrophy; Approximately 1/100 people with autism exhibits the Fragile X anomaly.
  Fragile X syndrome , Other X chromosome abnormalities, Down Syndrome, Duchenne muscular dystrophy; Approximately 1/100 people with autism exhibits the Fragile X anomaly.
• Neurocutaneous disorders: Tuberous sclerosis, Neurofibromatosis, Hypomelanosis of Ito, Inborn errors of metabolism, PKU, Lesch-Nyhan syndrome
  Tuberous sclerosis, Neurofibromatosis, Hypomelanosis of Ito, Inborn errors of metabolism, PKU, Lesch-Nyhan syndrome
• Infections: Congenital rubella, Congenital cytomegalovirus, Postnatal herpes simplex
  Congenital rubella, Congenital cytomegalovirus, Postnatal herpes simplex
• Perinatal disorders: Hypoxic, encepthalopathy, Prematurity
  Hypoxic, encepthalopathy, Prematurity
• Other disorders: De Lange syndrome Leber amaurosis, Moebius syndrome
  De Lange syndrome Leber amaurosis, Moebius syndrome
• multiple domains: Behavioral adjustment; adaptive skills; academic skills; social/communicative skills; social interaction with family members and peers; medication (efficacy and side effects)
  Behavioral adjustment; adaptive skills; academic skills; social/communicative skills; social interaction with family members and peers; medication (efficacy and side effects)
• .behavior modification procedures and applied behavior analysis: Behavior modification strategies should be tailored specifically for each child's strengths, weaknesses and behavior goals as documented in an intervention plan
  Behavior modification strategies should be tailored specifically for each child's strengths, weaknesses and behavior goals as documented in an intervention plan
• The Autism Sourcebook: Contains a comprehensive listing of alternative treatments, international and national organizations, internet resources and recommended readings.
  Contains a comprehensive listing of alternative treatments, international and national organizations, internet resources and recommended readings.