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 click here for more information about 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.
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