Autism Q & A: What is autism and when should you worry?

By Daniel B. Kessler, M.D.

April is Autism Awareness Month. Over the next four weeks I will be providing comments regarding various topics related to autism. The views expressed here are solely my own. They do not represent the views of Raising Arizona Kids or Southwest Human Development. They are not the official views of the American Academy of Pediatrics or the Arizona Chapter of the AAP, though I am sure most pediatricians share these views.

These are my opinions and recommendations based on my training, my reading of the literature and more than 30 years of experience taking care of hundreds of kids on the autism spectrum (but I don’t have a child with autism). I do not mean this to be “medical advice.” You should always seek the advice of your own physician. And I will admit to a personal belief that most of our real science is good science and as a medical doctor I do lean toward more traditional approaches. Other approaches, like traditional ones, have to prove themselves. Anecdotal evidence (“This helped my child so it should help yours”) does not replace scientific evidence. This is what I would do if the child under discussion were my grandchild.

What is autism?

Autism is a brain-based developmental disorder characterized by difficulties in 1) social interaction, 2) communication and 3) unusual or repetitive behaviors. Social difficulties appear to be a core challenge. People with autism handle information in their brains differently than other people.

But what is autism, really? Honestly, we don’t know. Though it is a medical diagnosis there are no reliable medical tests for it. It is a diagnosis based on the presence or absence of specific behavioral characteristics, four in each of the three areas described above. Not all 12 are needed for diagnosis.

There is no single behavior that your child must have in order to be given the diagnosis and therefore no single behavior that if he doesn’t have it means he can’t be considered “autistic.” If your child appears to be attached to you socially and affectionate to family members (but perhaps less so to others) he may still be diagnosed with autism. If your child doesn’t “walk on his toes” or “flap his hands” he may still be “autistic.” Even a child who walks on his toes may not have autism.

What are the red flags? If your child doesn’t demonstrate big smiles for you or show other joyful expressions by 6 months of age, consider additional assessment. If your child is not pointing at things to share his interest with you or looking at things that you are pointing to by 15 months, start asking questions. If your child is not using any words to communicate (not just repeat) by 16 months or has lost words, seek an assessment. The earlier the better. It doesn’t have to be an autism assessment but rather an assessment built around your concerns.

Next: What else should you be looking for and what is the autistic spectrum?

Daniel B. Kessler, M.D.

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

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