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Autism: What we know right now

By Kelley King Heyworth, Parenting.com
April 16, 2013 -- Updated 1116 GMT (1916 HKT)
An estimated 1 in 50 kids is on the autism spectrum today, according to the Centers for Disease Control and Prevention.
An estimated 1 in 50 kids is on the autism spectrum today, according to the Centers for Disease Control and Prevention.
STORY HIGHLIGHTS
  • Great strides have been made in autism research in the last five years
  • Autism is now thought to begin before birth
  • Parents should note possible signs of delay in babies
  • Therapy can help "rewire" autistic brains

(Parenting) -- When he turned 5 in October, Spike Robinson celebrated with his parents, three siblings, and a pink cake decorated with M&M's and lollipops.

It was your standard birthday bash -- except when it was time to sing.

"Spike asked us to do it very slowly, and in a whisper," recounts his mom, Shavon Brown-Robinson, who lives in Dania, Florida. "And then he didn't want us to cut the cake. He didn't want it ruined."

He finally relented -- and then burst into tears. "But he got over it and had a big slice," says Brown-Robinson proudly.

For most kids, a birthday party is a milestone; for Spike, it was a miracle. Just a couple years before, he hated celebrations. "Whenever there was singing or clapping, he'd start screaming," says Brown-Robinson.

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By the time Spike was 3, he was struggling to make conversation and walking on his toes. Brown-Robinson made an appointment for him to be evaluated at the Miami Children's Hospital Dan Marino Center.

Spike was indeed diagnosed with autism, also known as autism spectrum disorder, which ranges from mild social awkwardness to sensory problems (trouble dealing with certain sounds or textures) to an inability to talk or take care of oneself at all.

"I was so scared for that diagnosis," Brown-Robinson confesses, "but the moment we got it, the doors started flying open."

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This story could not have been written when Spike was born. In the past five years, experts' thinking on autism has changed, myths have been busted, breakthroughs have been made, awareness has skyrocketed, and children are making the sort of rapid, meaningful progress that previously would have been unimaginable.

In a couple of years, we will learn something new that changes everything all over again. But what we know right now could change a child's life.

Autism is being called an "epidemic." Verdict: True

The "A" word is enough to rattle any parent: Nearly two-thirds of young moms and dads are concerned their child will be diagnosed with ASD, according to a recent survey by the Florida Institute of Technology.

It's no wonder, given the runaway rates. Whereas 1 in 150 kids was diagnosed with some form of autism five years ago, 1 in 50 kids is on the spectrum today.

These rising rates inspired Bob Wright, co-founder of Autism Speaks, to say, "We have an epidemic on our hands.... It is imperative that the U.S. government steps up its commitment to helping people living with autism today." Last November, the first congressional hearing on autism in 10 years was held to determine what the federal response should be. (It didn't exactly make front-page news: It aired on CSPAN-3.)

Autism only begins after birth. Verdict: False

Fifty years ago, autistic behavior was blamed on "refrigerator moms" who were too unfeeling to teach their children social skills. "Now we know there's a host of genetic and environmental factors that are likely involved," says Dr. Susan Hyman, professor of pediatrics at the University of Rochester Medical Center and chair of the American Academy of Pediatrics subcommittee on autism.

One possible contributor to autism's rise is that people are having babies later. The chance for gene glitches increases as parents -- especially dads -- age, explains Irva Hertz-Picciotto, an environmental epidemiologist at the MIND Institute at the University of California, Davis.

But delayed childbearing explains only a very small fraction of the rise in autism rates. Environmental factors may turn many autism genes "on" or "off," says Hyman.

"The best studies we have now point to things that babies are exposed to in the womb, when the brain is forming," says Hertz-Picciotto. Living in areas with high levels of air pollution (such as near a freeway), having low levels of folic acid, being overweight or diabetic, and having a high fever during pregnancy all seem to up a woman's risk of having a child with autism.

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Babies can display signs of autism starting at around 6 months. Verdict: True

Autism is notoriously tricky to spot in infants, mainly because symptoms can mimic other developmental delays. But researchers have come up with some reliable red flags.

Between 6 and 12 months, babies who go on to have autism are less likely to smile and vocalize back and forth with parents. "They aren't tuned in to people, but things," says Dr. Fred Volkmar, director of the Child Study Center at Yale University.

Certain motor-skill delays can be a tip-off even earlier. "We found that when 6-month-olds were laid on their backs and pulled up to a sitting position, nine of 1- who went on to have autism let their heads droop behind their shoulders," says Rebecca Landa, director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore.

Not all -- or even most -- babies who are stingy with smiles or have poor neck strength will go on to have autism. However, parents should note this possible sign of delay and mention it to their pediatrician so he can be more aware of other warning signs later.

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If your child shows signs at around 18 months, he should be evaluated. Verdict: True

Autism isn't usually formally diagnosed until around 18 months, when it's clearer what worrisome behavior persists. A lack of words or communicative gestures (like pointing), and repetitive behaviors such as sorting objects are red flags at this stage. These are things your child's doctor should ask about at the 18-month checkup, when the AAP recommends pediatricians screen all kids for autism.

"Once a child screens positive, he then needs to see a specialist for an evaluation," says Dr. Geraldine Dawson, professor of psychiatry at the University of North Carolina and the chief science officer for Autism Speaks.

"The earlier that delays are identified, the sooner you can help your child," says Landa. Starting at 16 months, you can fill out the M-CHAT, a free, AAP-approved screening tool. Make an appointment with your pediatrician if you're concerned over the results.

Therapy can't "rewire" the autistic brain. Verdict: False

Experts like Dawson and Landa think age 1 to 2 is prime time to start autism treatments. "The younger the brain is, the more changeable it is," says Landa. In her clinics with toddlers, Landa teaches parents to imitate the way their children play, which may help build communication circuits in the brain.

Karin Hill credits play-partner sessions for helping her daughter Natalie, who was flagged as high-risk for ASD at age 1. "All Natalie wanted to do was tap the window. I thought, 'How is this going to work?' But I started tapping the window, too," says Hill, who lives in West Chester, Pennsylvania. "All of a sudden, Natalie looked in my eyes and smiled. I felt like I could cry."

Following Spike's diagnosis, Brown-Robinson turned her fear into action. She scouted out local schools and autism services.

Through intensive one-on-one exchanges with teachers and special tools like picture cards, Spike started learning how to speak up, rather than act out, when he was uncomfortable. All of which led to the first happy birthday of his 5-year-old existence.

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