Provided by the National Institute of Mental Health
Autism, a brain disorder that affects 1 to 2 in
1,000 Americans,1 too often results in a lifetime of impaired thinking, feeling
and social functioning—our most uniquely human attributes. Autism typically
affects a person's ability to communicate, form relationships with others, and
respond appropriately to the external world. The disorder becomes apparent in
children generally by the age of 3.2
Some people with autism can function at a relatively high level, with speech and
intelligence intact. Others have serious cognitive impairments and language
delays, and some never speak. In addition, individuals with autism may seem
closed off and shut down, or locked into repetitive behaviors and rigid patterns
of thinking. An infant with autism may avoid eye contact, seem deaf, and
abruptly stop developing language. The child may act as if unaware of the coming
and going of others, or physically attack and injure others without provocation.
Infants with autism often remain fixated on a single item or activity, rock or
flap their hands, seem insensitive to burns and bruises, and may even mutilate
themselves. Although autism is about 3 to 4 times more common in boys, girls
with the disorder tend to have more severe symptoms and greater cognitive
impairment.2
Individuals with autism often have symptoms of various co-occurring mental
disorders, including ADHD, psychoses, depressive disorders, obsessive-compulsive
disorder, and other anxiety disorders.3 About one-third of children and
adolescents with autism develop seizures.
Research Findings and Directions
The National Institute of Mental Health—in collaboration with the National
Institute of Child Health and Human Development, the National Institute of
Neurological Disorders and Stroke, and the National Institute of Deafness and
other Communication Disorders—is searching for answers about the causes,
diagnosis, prevention, and treatment of this devastating disorder. Research
findings have made it possible to identify earlier those children who show signs
of developing autism and thus to initiate early intervention, which can lead to
improved cognitive and behavioral outcomes.4,5
Improved early diagnosis and differentiation of various forms of autism is a
goal of brain imaging studies that are building a database on normal brain
development in children. Scans of the normal structural and functional
maturation of the brain will be compared with those from individuals with
autism, speeding development of targeted treatments and evaluations of their
effects. Yet even the most advanced scanners cannot substitute for post-mortem
brain tissue. Brain banks are working with families to arrange for tissue
donation following the deaths of individuals with autism.
While it is known that heredity plays a major role in complex disorders like
autism, the identification of specific genes that confer vulnerability to such
disorders has proven extremely difficult.6 Once autism-linked genes are
identified, however, scientists will bring to bear sophisticated research tools
to find out what activates them, what brain components they code for, and how
they affect behavior. The prospect of acquiring such molecular knowledge holds
great hope for the engineering of new therapies.
Evidence suggests that unaffected family members may share with their ill
relatives genes that predispose for milder behavioral characteristics that are
qualitatively similar to those of autism.7 For example, some relatives of people
with autism may have mild social, language, or reading problems. Family members
also may share telltale neurochemical signatures that may be implicated in the
disorder.8 Researchers are studying such families to characterize these
behavioral and biological traits, in hopes of tracing the variations in the
genetic blueprint that contribute to autism.
Treatments
The behavioral and cognitive functioning of individuals with autism can improve
with the help of psychosocial and pharmacological interventions.4 Among
psychosocial treatments, intensive, sustained special education programs and
behavior therapy early in life can increase the ability of children with autism
to acquire language and the ability to learn.4,5 NIMH-funded research teams are
evaluating the effectiveness of parent-training interventions that are tailored
to the particular characteristics of the child and family.
In adults with autism, some studies have found beneficial effects of the
antidepressant medications clomipramine and fluoxetine.9,10 There is also
evidence that the antipsychotic medication haloperidol can be helpful; however,
the risk of serious side effects is significant in children.11
The increasing use of psychotropic medications to treat autism in children has
spotlighted an urgent need for more studies of such drugs in youths. A network
of five NIMH-supported research centers that combine expertise in
psychopharmacology and psychiatry are evaluating the atypical antipsychotic
risperidone for reducing aggressive self-injurious behavior in children with
autism. Other NIMH research is investigating valproate for diminishing this
behavior in adolescents with autism. Studies are examining dose range and
regimen of medications, and their mechanisms of action, safety, efficacy, and
effects on cognition, behavior, and development.
--------------------------------------------------------------------------------
For More Information
Please visit the following links for information about organizations that focus
on child and adolescent mental health and autism.
--------------------------------------------------------------------------------
All material in this fact sheet is in the public domain and may be copied or
reproduced without permission from the Institute. Citation of the source is
appreciated.
NIH Publication No. 01-4590
--------------------------------------------------------------------------------
References
1 Bryson SE, Smith IM. Epidemiology of autism: prevalence, associated
characteristics, and service delivery. Mental Retardation and Developmental
Disabilities Research Reviews, 1998; 4: 97-103.
2 Fombonne E. Epidemiology of autism and related conditions. In: Volkmar FR, ed.
Autism and Pervasive Development Disorders. Cambridge, England: Cambridge
University Press, 1998; 32-63.
3 Volkmar F, Cook EH Jr, Pomeroy J, et al. Practice parameters for the
assessment and treatment of children, adolescents, and adults with autism and
other pervasive developmental disorders. American Academy of Child and
Adolescent Psychiatry Working Group on Quality Issues. Journal of the American
Academy of Child and Adolescent Psychiatry, 1999; 38(12 Suppl): 32S-54S.
4 Bristol MM, Cohen DJ, Costello EJ, et al. State of the science in autism:
report to the National Institutes Health. Journal of Autism and Developmental
Disorders, 1996; 26(2): 121-54.
5 McEachin JJ, Smith T, Lovaas OI. Long-term outcome for children with autism
who received early intensive behavioral treatment. American Journal of Mental
Retardation, 1993; 97(4): 359-72; discussion 373-91.
6 NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No.
98-4268. Rockville, MD: National Institute of Mental Health, 1998.
7 Piven J, Palmer P, Jacobi D, et al. Broader autism phenotype: evidence from a
family history study of multiple-incidence autism families. American Journal of
Psychiatry, 1997; 154(2): 185-90.
8 Cook EH. Autism: review of neurochemical investigation. Synapse, 1990; 6(3):
292-308.
9 McDougle CJ, Naylor ST, Cohen DJ, et al. A double-blind, placebo-controlled
study of fluvoxamine in adults with autistic disorder. Archives of General
Psychiatry, 1996; 53(11): 1001-8.
10 Gordon CT, State RC, Nelson JE, et al. A double-blind comparison of
clomipramine, desipramine, and placebo in the treatment of autistic disorder.
Archives of General Psychiatry, 1993; 50(6): 441-7.
11 Campbell M, Armenteros JL, Malone RP, et al. Neuroleptic-related dyskinesias
in autistic children: a prospective, longitudinal study. Journal of the American
Academy of Child and Adolescent Psychiatry, 1997; 36(6): 835-43.
Back to Mental Health Articles