What is Autism

Autism spectrum disorder is the name for a group of developmental and neurological disorder that begins early in childhood and lasts throughout a person’s life ¹. Autism spectrum disorder affects how a person acts and interacts with others, communicates, and learns. It includes what used to be known as Asperger syndrome and pervasive developmental disorders.

It is called a “spectrum” disorder because people with autism spectrum disorder can have a range of symptoms skills, and levels of disability. There is often nothing about how people with autism spectrum disorder look that sets them apart from other people, but people with autism spectrum disorder may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with autism spectrum disorder can range from gifted to severely challenged. Some people with autism spectrum disorder need a lot of help in their daily lives; others need less.

A diagnosis of autism spectrum disorder now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified and Asperger syndrome. These conditions are now all called autism spectrum disorder ².

People with autism spectrum disorder often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with autism spectrum disorder also have different ways of learning, paying attention, or reacting to things. Signs of autism spectrum disorder begin during early childhood and typically last throughout a person’s life. For example, people with autism spectrum disorder might have problems talking with you, or they might not look you in the eye when you talk to them. They may also have restricted interests and repetitive behaviors. They may spend a lot of time putting things in order, or they may say the same sentence again and again. They may often seem to be in their “own world.”

People with autism spectrum disorder often have these characteristics ¹:

• Ongoing social problems that include difficulty communicating and interacting with others
• Repetitive behaviors as well as limited interests or activities
• Symptoms that typically are recognized in the first two years of life
• Symptoms that hurt the individual’s ability to function socially, at school or work, or other areas of life

Some people are mildly impaired by their symptoms, while others are severely disabled. Treatments and services can improve a person’s symptoms and ability to function. Families with concerns should talk to their pediatrician about what they’ve observed and the possibility of autism spectrum disorder screening. According to the Centers for Disease Control and Prevention (CDC) around 1 in 68 children has been identified with some form of autism spectrum disorder ³.

At well-child checkups, your health care provider should check your child’s development. If there are signs of autism spectrum disorder, your child will have a comprehensive evaluation. It may include a team of specialists, doing various tests and evaluations to make a diagnosis.

• The causes of autism spectrum disorder are not known. Research suggests that both genes and environment play important roles.
• There is currently no one standard treatment for autism spectrum disorder. There are many ways to increase your child’s ability to grow and learn new skills. Starting them early can lead to better results. Treatments include behavior and communication therapies, skills training, and medicines to control symptoms.

Prevalence of Autism spectrum disorder

• About 1 in 68 children has been identified with autism spectrum disorder according to estimates from the Center for Disease Control and Prevention (CDC’s) Autism and Developmental Disabilities Monitoring Network ⁴.
• Autism spectrum disorder is reported to occur in all racial, ethnic, and socioeconomic groups ⁴.
• Autism spectrum disorder is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189) ⁴.
• Studies in Asia, Europe, and North America have identified individuals with autism spectrum disorder with an average prevalence of between 1% and 2% ⁵.
• About 1 in 6 children in the United States had a developmental disability in 2006-2008, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism ⁶.

If You’re Concerned Your Child Might have Autism spectrum disorder

If you think your child might have autism spectrum disorder or you think there could be a problem with the way your child plays, learns, speaks, or acts, contact your child’s doctor, and share your concerns.

If you or the doctor is still concerned, ask the doctor for a referral to a specialist who can do a more in-depth evaluation of your child. Specialists who can do a more in-depth evaluation and make a diagnosis include:

• Developmental Pediatricians (doctors who have special training in child development and children with special needs)
• Child Neurologists (doctors who work on the brain, spine, and nerves)
• Child Psychologists or Psychiatrists (doctors who know about the human mind)

At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

• If your child is not yet 3 years old, contact your local early intervention system.
  • You can find the right contact information for your state by calling the Early Childhood Technical Assistance Center (ECTA) or visit the ECTA website ⁷.
• If your child is 3 years old or older, contact your local public school system.
  • Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
  • If you’re not sure who to contact, call the Early Childhood Technical Assistance Center (ECTA) or visit the ECTA website
  • ⁷.

Research shows that early intervention services can greatly improve a child’s development ⁸, ⁹. In order to make sure your child reaches his or her full potential, it is very important to get help for an autism spectrum disorder as soon as possible.

What is the difference between Asperger’s syndrome and autism spectrum disorder ?

In the past, Asperger’s syndrome and Autistic Disorder were separate disorders. They were listed as subcategories within the diagnosis of “Pervasive Developmental Disorders.” However, this separation has changed. The latest edition of the manual from the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), does not highlight subcategories of a larger disorder. The manual includes the range of characteristics and severity within one category. People whose symptoms were previously diagnosed as Asperger’s syndrome or Autistic Disorder are now included as part of the category called Autism Spectrum Disorder.

What causes autism

Autism spectrum disorder is a developmental disability caused by differences in the brain. Scientists do not know yet exactly what causes these differences for most people with autism spectrum disorder. However, some people with autism spectrum disorder have a known difference, such as a genetic condition. There are multiple causes of autism spectrum disorder, although most are not yet known.

In recent years, the number of children identified with autism spectrum disorder has increased. Experts disagree about whether this shows a true increase in autism spectrum disorder since the guidelines for diagnosis have changed in recent years as well. Also, many more parents and doctors now know about the disorder, so parents are more likely to have their children screened, and more doctors are able to properly diagnose autism spectrum disorder, even in adulthood.

Risk Factors for Autism spectrum disorder

• Studies have shown that among identical twins, if one child has autism spectrum disorder, then the other will be affected about 36-95% of the time. In non-identical twins, if one child has autism spectrum disorder, then the other is affected about 0-31% of the time ¹⁰, ¹¹, ¹², ¹³.
• Parents who have a child with autism spectrum disorder have a 2%–18% chance of having a second child who is also affected ¹⁴.
• Autism spectrum disorder tends to occur more often in people who have certain genetic or chromosomal conditions. About 10% of children with autism are also identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and chromosomal disorders ¹⁵.
• Almost half (about 44%) of children identified with autism spectrum disorder has average to above average intellectual ability ⁴.
• Children born to older parents are at a higher risk for having autism spectrum disorder ¹⁶. Having older parents (a mother who was 35 or older, and/or a father who was 40 or older when the baby was born).
• A small percentage of children who are born prematurely or with low birth weight are at greater risk for having autism spectrum disorder ¹⁷.
• Autism spectrum disorder commonly co-occurs with other developmental, psychiatric, neurologic, chromosomal, and genetic diagnoses. The co-occurrence of one or more non-autism spectrum disorder developmental diagnoses is 83%. The co-occurrence of one or more psychiatric diagnoses is 10% ¹⁸.

Early signs of autism

A person with autism spectrum disorder might:

• Not respond to their name by 12 months of age
• Not point at objects to show interest (point at an airplane flying over) by 14 months
• Not play “pretend” games (pretend to “feed” a doll) by 18 months
• Avoid eye contact and want to be alone
• Have trouble understanding other people’s feelings or talking about their own feelings
• Have delayed speech and language skills
• Repeat words or phrases over and over (echolalia)
• Give unrelated answers to questions
• Get upset by minor changes
• Have obsessive interests
• Flap their hands, rock their body, or spin in circles
• Have unusual reactions to the way things sound, smell, taste, look, or feel

Social Skills

Social issues are one of the most common symptoms in all of the types of autism spectrum disorder. People with an autism spectrum disorder do not have just social “difficulties” like shyness. The social issues they have cause serious problems in everyday life.

Examples of social issues related to autism spectrum disorder:

• Does not respond to name by 12 months of age
• Avoids eye-contact
• Prefers to play alone
• Does not share interests with others
• Only interacts to achieve a desired goal
• Has flat or inappropriate facial expressions
• Does not understand personal space boundaries
• Avoids or resists physical contact
• Is not comforted by others during distress
• Has trouble understanding other people’s feelings or talking about own feelings

Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving “bye bye”. Typical toddlers also show interests in social games like peek-a-boo and pat-a-cake. But a young child with an autism spectrum disorder might have a very hard time learning to interact with other people.

Some people with an autism spectrum disorder might not be interested in other people at all. Others might want friends, but not understand how to develop friendships. Many children with an autism spectrum disorder have a very hard time learning to take turns and share—much more so than other children. This can make other children not want to play with them.

People with an autism spectrum disorder might have problems with showing or talking about their feelings. They might also have trouble understanding other people’s feelings. Many people with an autism spectrum disorder are very sensitive to being touched and might not want to be held or cuddled. Self-stimulatory behaviors (e.g., flapping arms over and over) are common among people with an autism spectrum disorder. Anxiety and depression also affect some people with an autism spectrum disorder. All of these symptoms can make other social problems even harder to manage.

Communication

Each person with autism spectrum disorder has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an autism spectrum disorder do not talk at all. About 25%–30% of children with autism spectrum disorder have some words at 12 to 18 months of age and then lose them ¹⁹. Others might speak, but not until later in childhood.

Examples of communication issues related to autism spectrum disorder:

• Delayed speech and language skills
• Repeats words or phrases over and over (echolalia)
• Reverses pronouns (e.g., says “you” instead of “I”)
• Gives unrelated answers to questions
• Does not point or respond to pointing
• Uses few or no gestures (e.g., does not wave goodbye)
• Talks in a flat, robot-like, or sing-song voice
• Does not pretend in play (e.g., does not pretend to “feed” a doll)
• Does not understand jokes, sarcasm, or teasing

People with autism spectrum disorder who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with autism spectrum disorder say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with autism spectrum disorder, “Do you want some juice?” he or she might repeat “Do you want some juice?” instead of answering your question. Although many children without an autism spectrum disorder go through a stage where they repeat what they hear, it normally passes by three years of age. Some people with an autism spectrum disorder can speak well but might have a hard time listening to what other people say.

People with autism spectrum disorder might have a hard time using and understanding gestures, body language, or tone of voice. For example, people with autism spectrum disorder might not understand what it means to wave goodbye. Facial expressions, movements, and gestures may not match what they are saying. For instance, people with an autism spectrum disorder might smile while saying something sad.

People with autism spectrum disorder might say “I” when they mean “you,” or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with an autism spectrum disorder might stand too close to the person they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the “kid-speak” that is common with other children.

Unusual Interests and Behaviors

Many people with autism spectrum disorder have unusual interest or behaviors.

Examples of unusual interests and behaviors related to autism spectrum disorder:

• Lines up toys or other objects
• Plays with toys the same way every time
• Likes parts of objects (e.g., wheels)
• Is very organized
• Gets upset by minor changes
• Has obsessive interests
• Has to follow certain routines
• Flaps hands, rocks body, or spins self in circles

Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with an autism spectrum disorder might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or “stimming.”

People with autism spectrum disorder often thrive on routine. A change in the normal pattern of the day—like a stop on the way home from school—can be very upsetting to people with autism spectrum disorder. They might “lose control” and have a “melt down” or tantrum, especially if in a strange place.

Some people with autism spectrum disorder also may develop routines that might seem unusual or unnecessary. For example, a person might try to look in every window he or she walks by a building or might always want to watch a video from beginning to end, including the previews and the credits. Not being allowed to do these types of routines might cause severe frustration and tantrums.

Other Symptoms

Some people with autism spectrum disorder have other symptoms. These might include:

• Hyperactivity (very active)
• Impulsivity (acting without thinking)
• Short attention span
• Aggression
• Causing self injury
• Temper tantrums
• Unusual eating and sleeping habits
• Unusual mood or emotional reactions
• Lack of fear or more fear than expected
• Unusual reactions to the way things sound, smell, taste, look, or feel

People with autism spectrum disorder might have unusual responses to touch, smell, sounds, sights, and taste, and feel. For example, they might over- or under-react to pain or to a loud noise. They might have abnormal eating habits. For instance, some people with an autism spectrum disorder limit their diet to only a few foods. Others might eat nonfood items like dirt or rocks (this is called pica). They might also have issues like chronic constipation or diarrhea.

People with autism spectrum disorder might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.

Development

Children with autism spectrum disorder develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with an autism spectrum disorder might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a “b” makes.

Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill. But, there are age-specific developmental milestones used to measure a child’s social and emotional progress in the first few years of life.

• To learn more about developmental milestones, visit “Learn the Signs. Act Early” ²⁰ a campaign designed by CDC and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible “red flags” for autism spectrum disorders.

Signs and Symptoms of Autism spectrum disorder

Autism spectrum disorder begins before the age of 3 and last throughout a person’s life, although symptoms may improve over time. Some children with autism spectrum disorder show hints of future problems within the first few months of life. In others, symptoms may not show up until 24 months or later. Some children with an autism spectrum disorder seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had. Studies have shown that one third to half of parents of children with an autism spectrum disorder noticed a problem before their child’s first birthday, and nearly 80%–90% saw problems by 24 months of age.

Parents or doctors may first identify autism spectrum disorder behaviors in infants and toddlers. School staff may recognize these behaviors in older children. Not all people with autism spectrum disorder will show all of these behaviors, but most will show several. There are two main types of behaviors: “restricted / repetitive behaviors” and “social communication / interaction behaviors.”

It is important to note that some people without autism spectrum disorder might also have some of these symptoms. But for people with autism spectrum disorder, the impairments make life very challenging.

Children or adults with autism spectrum disorder might:

• not point at objects to show interest (for example, not point at an airplane flying over)
• not look at objects when another person points at them
• have trouble relating to others or not have an interest in other people at all
• avoid eye contact and want to be alone
• have trouble understanding other people’s feelings or talking about their own feelings
• prefer not to be held or cuddled, or might cuddle only when they want to
• appear to be unaware when people talk to them, but respond to other sounds
• be very interested in people, but not know how to talk, play, or relate to them
• repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
• have trouble expressing their needs using typical words or motions
• not play “pretend” games (for example, not pretend to “feed” a doll)
• repeat actions over and over again
• have trouble adapting when a routine changes
• have unusual reactions to the way things smell, taste, look, feel, or sound
• lose skills they once had (for example, stop saying words they were using)

Restrictive / repetitive behaviors may include:

• Repeating certain behaviors or having unusual behaviors
• Having overly focused interests, such as with moving objects or parts of objects
• Having a lasting, intense interest in certain topics, such as numbers, details, or facts.

Social communication / interaction behaviors may include:

• Getting upset by a slight change in a routine or being placed in a new or overly stimulating setting
• Making little or inconsistent eye contact
• Having a tendency to look at and listen to other people less often
• Rarely sharing enjoyment of objects or activities by pointing or showing things to others
• Responding in an unusual way when others show anger, distress, or affection
• Failing to, or being slow to, respond to someone calling their name or other verbal attempts to gain attention
• Having difficulties with the back and forth of conversations
• Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
• Repeating words or phrases that they hear, a behavior called echolalia
• Using words that seem odd, out of place, or have a special meaning known only to those familiar with that person’s way of communicating
• Having facial expressions, movements, and gestures that do not match what is being said
• Having an unusual tone of voice that may sound sing-song or flat and robot-like
• Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions.

People with autism spectrum disorder may have other difficulties, such as being very sensitive to light, noise, clothing, or temperature. They may also experience sleep problems, digestion problems, and irritability.

Autism spectrum disorder is unique in that it is common for people with autism spectrum disorder to have many strengths and abilities in addition to challenges.

Strengths and abilities may include:

• Having above-average intelligence – the Centers for Disease Control and Prevention (CDC) reports 46% of autism spectrum disorder children have above average intelligence ³.
• Being able to learn things in detail and remember information for long periods of time
• Being strong visual and auditory learners
• Excelling in math, science, music, or art.

Diagnosis of Autism spectrum disorder

• Research has shown that a diagnosis of autism at age 2 can be reliable, valid, and stable ²¹, ²².
• Even though autism spectrum disorder can be diagnosed as early as age 2 years, most children are not diagnosed with autism spectrum disorder until after age 4 years. The median age of first diagnosis by subtype is as follows ⁴.
  • Autistic disorder: 3 years, 10 months
  • Pervasive developmental disorder-not otherwise specified: 4 years, 1 month
  • Asperger disorder: 6 years, 2 months
• Studies have shown that parents of children with autism spectrum disorder notice a developmental problem before their child’s first birthday. Concerns about vision and hearing were more often reported in the first year, and differences in social, communication, and fine motor skills were evident from 6 months of age ²³, ²⁴.

Doctors diagnose autism spectrum disorder by looking at a child’s behavior and development. Young children with autism spectrum disorder can usually be reliably diagnosed by age two.

Older children and adolescents should be evaluated for autism spectrum disorder when a parent or teacher raises concerns based on watching the child socialize, communicate, and play.

Diagnosing autism spectrum disorder in adults is not easy. In adults, some autism spectrum disorder symptoms can overlap with symptoms of other mental health disorders, such as schizophrenia or attention deficit hyperactivity disorder (ADHD). However, getting a correct diagnosis of autism spectrum disorder as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help.

Diagnosis in young children is often a two-stage process:

Stage 1: General Developmental Screening During Well-Child Checkups

Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The Centers for Disease Control and Prevention (CDC) recommends specific autism spectrum disorder screening be done at the 18- and 24-month visits.

Earlier screening might be needed if a child is at high risk for autism spectrum disorder or developmental problems. Those at high risk include children who:

• Have a sister, brother, or other family member with autism spectrum disorder
• Have some autism spectrum disorder behaviors
• Were born premature, or early, and at a low birth weight.

Parents’ experiences and concerns are very important in the screening process for young children. Sometimes the doctor will ask parents questions about the child’s behaviors and combine this information with his or her observations of the child.

Children who show some developmental problems during this screening process will be referred for another stage of evaluation.

Stage 2: Additional Evaluation

This evaluation is with a team of doctors and other health professionals with a wide range of specialties who are experienced in diagnosing autism spectrum disorder. This team may include:

• A developmental pediatrician—a doctor who has special training in child development
• A child psychologist and/or child psychiatrist—a doctor who knows about brain development and behavior
• A speech-language pathologist—a health professional who has special training in communication difficulties.

The evaluation may assess:

• Cognitive level or thinking skills
• Language abilities
• Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting.

Because autism spectrum disorder is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include:

• Blood tests
• Hearing test

The outcome of the evaluation will result in recommendations to help plan for treatment.

Diagnosis in older children and adolescents

Older children whose autism spectrum disorder symptoms are noticed after starting school are often first recognized and evaluated by the school’s special education team. The school’s team may refer these children to a health care professional.

Parents may talk with a pediatrician about their child’s social difficulties including problems with subtle communication. These subtle communication issues may include understanding tone of voice, facial expressions, or body language. Older children may have trouble understanding figures of speech, humor, or sarcasm. Parents may also find that their child has trouble forming friendships with peers. The pediatrician can refer the child for further evaluation and treatment.

Diagnosis in adults

Adults who notice the signs and symptoms of autism spectrum disorder should talk with a doctor and ask for a referral for an autism spectrum disorder evaluation. While testing for autism spectrum disorder in adults is still being refined, adults can be referred to a psychologist or psychiatrist with autism spectrum disorder expertise. The expert will ask about concerns, such as social interaction and communication challenges, sensory issues, repetitive behaviors, and restricted interests. Information about the adult’s developmental history will help in making an accurate diagnosis, so an autism spectrum disorder evaluation may include talking with parents or other family members.

Treatments and Therapies for Autism spectrum disorder

No cure exists for autism spectrum disorder, and  because of the very wide range of issues facing those on “autism spectrum disorder” means that there is no single best treatment for autism spectrum disorder and there is no one-size-fits-all treatment.

The goal of treatment is to maximize your child’s ability to function by reducing autism spectrum disorder symptoms and supporting development and learning. Early intervention during the preschool years can help your child learn critical social, communication, functional and behavioral skills.

The range of home-based and school-based treatments and interventions for autism spectrum disorder can be overwhelming, and your child’s needs may change over time. Your health care provider can recommend options and help identify resources in your area. Working closely with a doctor or health care professional is an important part of finding the right treatment program.

If your child is diagnosed with autism spectrum disorder, talk to experts about creating a treatment strategy and build a team of professionals to meet your child’s needs. There are many treatment options, social services, programs, and other resources that can help.

Early treatment for autism spectrum disorder and proper care can reduce individuals’ difficulties while helping them learn new skills and make the most of their strengths.

Here are some tips.

• Keep a detailed notebook. Record conversations and meetings with health care providers and teachers. This information helps when its time to make decisions.
• Record doctors’ reports and evaluations in the notebook. This information may help an individual qualify for special programs.
• Contact the local health department, school, or autism advocacy groups to learn about their special programs.
• Talk with a pediatrician, school official, or physician to find a local autism expert who can help develop an intervention plan and find other local resources.
• Find an autism support group. Sharing information and experiences can help individuals with autism spectrum disorder and/or their caregivers learn about options, make decisions, and reduce stress.

Treatment options may include:

• Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with autism spectrum disorder. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or communicate better with others. Applied behavior analysis (ABA) can help children learn new skills and generalize these skills to multiple situations through a reward-based motivation system.
• Educational therapies. Children with autism spectrum disorder often respond well to highly structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.
• Family therapies. Parents and other family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.
  Other therapies. Depending on your child’s needs, speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance may be beneficial. A psychologist can recommend ways to address problem behavior.

Camel milk and Autism

Autism spectrum disorder (ASD) is a severe neurodevelopment disorder characterized by impairments in social orientation, communication, and repetitive behaviors ²⁵. Camel milk provides many benefits, especially for autistic children. Camel milk is traditionally used in autism treatment in some areas of the world. A study published in the 2005 observed the effects of camel milk consumption, instead of cow milk, on several cases of children and adults with autism. Researchers discovered that, when a 4-year-old female participant consumed camel milk for 40 days, a 15-year-old boy consumed camel milk for 30 days, and several 21-year-old autistics consumed camel milk for two weeks, their autism symptoms disappeared. The patients were also observed to be quieter and less self-destructive. The authors reported in another study that camel milk consumption in children under 15 has been effective in controlling some of the symptoms, especially in the group under 10 years ²⁶. Some parents report that their children were suffering from autism; then the children used camel milk, some of their symptoms improved such as better sleep; increased motor planning and spatial awareness; increased eye contact; better language and improved gastrointestinal function. In a study ²⁷ conducted on 60 patients with autism (2 to 12 years old) in Saudi Arabia, the effects of camel and cow’s milk were evaluated when 500 ml of milk twice daily for 2 weeks were given to children. In the analysis, the baseline level of antioxidants of all the children was low. Results after two weeks showed significant improvement in cognitive and behavioral tests due to camel milk and lowered effects of oxidative stress. The researchers showed that camel milk plays an important role and reduces the effects of oxidative stress by adjusting the antioxidant enzymes and nonenzymatic antioxidant materials levels and improves psychological symptoms ²⁷. In a case report published in 2013, a boy had been introduced in the third year of his life to recognize autism. The mother of this boy started, from the age of nine years, to give him a glass of camel milk at night. He was observed for six years (2007–2013) to see if camel milk would control the symptoms of autism ²⁸. This report agreed with the results reported by Y. Shabo ²⁶ that camel milk is especially useful for autistic children (Autism Spectrum Disorder). Another clinical study investigated the effect of camel milk on biochemical markers. Forty-five children diagnosed with autism were randomly assigned to receive boiled camel milk for group I (n = 15), raw camel milk for group II (n = 15), and a placebo for group III (n = 15) for 2 weeks. Camel milk administered for 2 weeks significantly improved clinical symptoms of autism and decreased serum level of “thymus and activation-regulated chemokine” in autistic children ²⁹.

These findings revealed that camel milk is safer for children and may be effective in the treatment of Autism Spectrum Disorder and improves general well-being. However, a large scale randomized double blind clinical trials are needed to support these early positive findings.

Medication

No medication can improve the core signs of autism spectrum disorder, but specific medications can help control symptoms. For example, certain medications may be prescribed if your child is hyperactive; antipsychotic drugs are sometimes used to treat severe behavioral problems; and antidepressants may be prescribed for anxiety. Keep all health care providers updated on any medications or supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.

A doctor may use medication to treat some difficulties that are common with autism spectrum disorder. With medication, a person with autism spectrum disorder may have fewer problems with:

• Irritability
• Aggression
• Repetitive behavior
• Hyperactivity
• Attention problems
• Anxiety and depression.

Managing other medical and mental health conditions

In addition to autism spectrum disorder, children, teens and adults can also experience:

• Medical health issues. Children with autism spectrum disorder may also have medical issues, such as epilepsy, sleep disorders, limited food preferences or stomach problems. Ask your child’s doctor how to best manage these conditions together.
• Problems with transition to adulthood. Teens and young adults with autism spectrum disorder may have difficulty understanding body changes. Also, social situations become increasingly complex in adolescence, and there may be less tolerance for individual differences. Behavior problems may be challenging during the teen years.
• Other mental health disorders. Teens and adults with autism spectrum disorder often experience other mental health disorders, such as anxiety and depression. Your doctor, mental health professional, and community advocacy and service organizations can offer help.

Planning for the future

Children with autism spectrum disorder typically continue to learn and compensate for problems throughout life, but most will continue to require some level of support. Planning for your child’s future opportunities, such as employment, college, living situation, independence and the services required for support can make this process smoother.

Coping and support

Raising a child with autism spectrum disorder can be physically exhausting and emotionally draining. These suggestions may help:

• Find a team of trusted professionals. A team, coordinated by your doctor, may include social workers, teachers, therapists, and a case manager or service coordinator. These professionals can help identify and evaluate the resources in your area and explain financial services and state and federal programs for children and adults with disabilities.
• Keep records of visits with service providers. Your child may have visits, evaluations and meetings with many people involved in his or her care. Keep an organized file of these meetings and reports to help you decide about treatment options and monitor progress.
• Learn about the disorder. There are many myths and misconceptions about autism spectrum disorder. Learning the truth can help you better understand your child and his or her attempts to communicate.
• Take time for yourself and other family members. Caring for a child with autism spectrum disorder can put stress on your personal relationships and your family. To avoid burnout, take time out to relax, exercise or enjoy your favorite activities. Try to schedule one-on-one time with your other children and plan date nights with your spouse or partner — even if it’s just watching a movie together after the children go to bed.
• Seek out other families of children with autism spectrum disorder. Other families struggling with the challenges of autism spectrum disorder may have useful advice. Some communities have support groups for parents and siblings of children with the disorder.
• Ask your doctor about new technologies and therapies. Researchers continue to explore new approaches to help children with autism spectrum disorder. See the Centers for Disease Control and Prevention website ³⁰ on autism spectrum disorders for helpful materials and links to resources.

Alternative medicine

Because autism spectrum disorder can’t be cured, many parents seek alternative or complementary therapies, but these treatments have little or no research to show that they’re effective. You could, unintentionally, reinforce negative behaviors. And some alternative treatments are potentially dangerous.

Talk with your child’s doctor about the scientific evidence of any therapy that you’re considering for your child.

Examples of complementary and alternative therapies that may offer some benefit when used in combination with evidence-based treatments include:

• Creative therapies. Some parents choose to supplement educational and medical intervention with art therapy or music therapy, which focuses on reducing a child’s sensitivity to touch or sound. These therapies may offer some benefit when used along with other treatments.
• Sensory-based therapies. These therapies are based on the unproven theory that people with autism spectrum disorder have a sensory processing disorder that causes problems tolerating or processing sensory information, such as touch, balance and hearing. Therapists use brushes, squeeze toys, trampolines and other materials to stimulate these senses. Research has not shown these therapies to be effective, but it’s possible they may offer some benefit when used along with other treatments.
• Massage. While massage may be relaxing, there isn’t enough evidence to determine if it improves symptoms of autism spectrum disorder.
  Pet or horse therapy. Pets can provide companionship and recreation, but more research is needed to determine whether interaction with animals improves symptoms of autism spectrum disorder.

Some complementary and alternative therapies may not be harmful, but there’s no evidence that they’re helpful. Some may also include significant financial cost and be difficult to implement. Examples of these therapies include:

• Special diets. There’s no evidence that special diets are an effective treatment for autism spectrum disorder. And for growing children, restrictive diets can lead to nutritional deficiencies. If you decide to pursue a restrictive diet, work with a registered dietitian to create an appropriate meal plan for your child.
• Vitamin supplements and probiotics. Although not harmful when used in normal amounts, there is no evidence they are beneficial for autism spectrum disorder symptoms, and supplements can be expensive. Talk to your doctor about vitamins and other supplements and the appropriate dosage for your child.
• Acupuncture. This therapy has been used with the goal of improving autism spectrum disorder symptoms, but the effectiveness of acupuncture is not supported by research.

Some complementary and alternative treatments do not have evidence that they are beneficial and they’re potentially dangerous. Examples of complementary and alternative treatments that are not recommended for autism spectrum disorder include:

• Chelation therapy. This treatment is said to remove mercury and other heavy metals from the body, but there’s no known link with autism spectrum disorder. Chelation therapy for autism spectrum disorder is not supported by research evidence and can be very dangerous. In some cases, children treated with chelation therapy have died.
• Hyperbaric oxygen treatments. Hyperbaric oxygen is a treatment that involves breathing oxygen inside a pressurized chamber. This treatment has not been shown to be effective in treating autism spectrum disorder symptoms and is not approved by the Food and Drug Administration (FDA) for this use.
• Intravenous immunoglobulin (IVIG) infusions. There is no evidence that using IVIG infusions improves autism spectrum disorder, and the FDA has not approved immunoglobulin products for this use.

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