In the United States, approximately 5.5 to 6.5 children out of 1,000 are diagnosed with autism. The exact cause of this disorder, which strikes four times more often in boys than in girls, remains unknown.

While some media coverage has focused on a possible link between childhood vaccines and autism, scientific research has not established such a connection. For example, a study of all children in Denmark (who are all covered by the same universal health care system) showed that there was no difference in the rate of autism between the children who received thimerosal preservative-based vaccines and children who received the thimerosal-free vaccines. There is a higher rate of autism, however, in individuals whose siblings or other relatives have autism or other mental health disorders. So genetics do play a role, with 5 percent of autism cases having a known genetic cause.

The number of reported cases of autism is on the rise, though it's unclear whether the true numbers have increased, or that it's diagnosed more frequently by physicians who have become more sophisticated in their understanding of autism over the past 20 years.

Physicians now refer to "autism spectrum disorders" as a more comprehensive description of these disorders of brain development. The term encompasses autistic disorder, Asperger syndrome and one form of "pervasive developmental disorder." ASD can range from severe cases, in which a child is

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completely unable to communicate with other people, to milder ones, where children of normal to high intelligence exhibit a few developmental delays.

In general, however, children with ASD have impairments in not one, but three crucial areas of development: behavior, communication (language) and social interaction.

While it can be very difficult to diagnose autism before a baby is 18 months old, early signs of the disorder can be observed. An infant's babbling actually represents an important stage in his or her eventual ability to talk. Babies who do not make proper babbling sounds by their first birthdays should be watched carefully.

Likewise, children who have not formed any words by the time they are 16 months old (or who may have spoken only one or two words), also bear close observation. Parents should definitely have their children checked by a pediatrician if they show such problems with verbal skills, although some of these children will eventually develop normally.

Further, a consultation with a pediatrician is also warranted if children do not recognize their names by the time they are 12 months; if they do not seek out parental approval or want to be hugged; if they do not smile or wave goodbye; or if they have poor eye contact.

Regression, or loss of social and communication skills between 15 and 24 months is particularly troubling, and should lead to a visit with the child's physician.

By the time a baby is 18 months, pediatricians can begin to close in on a diagnosis of autism by using a tool called "Modified Checklist for Autism in Toddlers," or M-CHAT. When a child is between 18 and 24 months, pediatricians can administer the M-CHAT, which consists of a list of 23 questions to parents about their children's behavior and development, such as:

  • Does the child take an interest in other children?

  • Does the child use her index finger to point to things of interest?

  • Does the child bring objects to show to a parent?

  • When the parent points to a toy does the child look at it and respond to the pointing?

    In addition to the M-CHAT questions, pediatricians will also interact with children in various ways to evaluate their development. In some cases, they may also order a hearing test and possibly refer the child to a speech and language therapist for testing. Genetic testing may also be useful.

    By getting early treatment and therapy, children with autism can improve dramatically. The most common types of therapy fall under the umbrella of "Applied Behavior Analysis," which is a combination of psychological and educational interventions that are used to alter the child's behavior, learning performance and social interaction skills. This type of therapy requires 20 to 30 hours of work per week when the child is between the ages of 2 and 5. For children diagnosed with ASD, the importance of early entry into therapy ensures the most positive impact on their quality of life.

    Behavioral programs seek to build social skills because children with autism do not pick up on social cues or read facial expressions, and they miss other signs of normal communications.

    In addition to behavioral and educational approaches, psychoactive medications such as risperidone or the antidepressants Prozac, Paxil and Celexa have proved useful in managing severe cases of autism.

    Because it is such a complex condition, treatment for autism does not lend itself to a "one-size-fits-all" approach. Parents need to work together with pediatricians to identify resources and find a treatment plan that will work best for their children.

    Dr. Wells is a board-certified pediatrician and is affiliated with Eden Medical Center in Castro Valley. For more information on autism visit the American Academy of Pediatrics web site at www.aap.org.