Patient information from BMJ

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1 Patient information from BMJ Last published: Dec 01, 2016 Autism Finding out that your child has autism can be very upsetting. But getting treatment early on can make a difference to your child's life. We've brought together the best and most up-to-date research about autism to see what treatments work.you can use our information to talk to your doctor and decide which treatments are best for your child. What is it? If your child has autism, it means their brain doesn't work in the same way as other children s brains. This affects how your child develops. On the outside, children with autism usually grow like, and look like, other children. But children with autism don't develop the skills they need to get along well with others or to keep up in school. You may have noticed that your child was different, even as a small baby. Most children with autism show clear signs of their condition by the time they're 3 years old. Autism affects different children in different ways. Some children need help all their life. Other children can learn the skills they need to live independently. Doctors aren't sure what causes autism, but it seems to run in families. Researchers haven't found a single gene for autism. Instead it may be down to a combination of genes. If your child has autism, you may worry that something you have done has caused it. But there s no evidence to show this could be true. And there s no evidence that vaccinations, including the measles, mumps and rubella (MMR) vaccine, can cause autism. What are the symptoms? If your child has autism, you will probably notice signs between the ages of 18 months and 2 years, or even earlier. You may notice that your baby: Doesn't look when you call them, even if they seem to hear other sounds page 1 of 5

2 May not look you in the eye, smile at you, or notice when you enter or leave a room Often seems to be in their own world. Usually, from when babies are about 9 months, they will follow your finger when you point to something. And they will point to something they want from when they're about 12 months old. But children with autism may not do this. Your child may also have a lot of tantrums. You may notice that your child plays differently from other children. Children with autism prefer to play alone, and don t play with toys in the usual way. Usually children start to play pretend games from when they're 2 years old, but children with autism don t often do this. Some children with autism always want to be holding the same thing. For example, they may carry an everyday object such as a torch with them all the time. Doctors look for problems in three main areas, before diagnosing autism. People with autism tend to have problems talking, find it hard to take part in social situations, and behave in an unusual way. Most children can use simple phrases by the time they're 2 years old. But if your child has autism, this might take much longer. Children with autism who are going to speak usually begin to do so by the time they're 5 years old. Some only speak a few words, which they keep repeating. Some children learn to talk in the first year, then stop talking in their second year. Children with autism often don t like social activities, such as playing with other children, or showing affection through smiles and cuddles. This can be very upsetting for their parents or carers. If your child has autism, they may constantly repeat certain activities, and be interested in only a few things. For example, your child may want to run a toy car backwards and forwards over and over. They may get angry if you try to join in or change the game. They may want to have exactly the same routines every day. Other signs of autism include having problems with learning, getting very upset by loud noise, being overactive, having problems with writing, and having physical problems, including seizures (fits). Only a specialist doctor can diagnose autism. If you think your child may have problems, talk to your GP first. They should be able to refer your child to a specialist. What treatments work? There isn't a cure for autism. But treatment may help your child talk and do better at school. The main treatments use special ways to teach your child and help change how they behave. These treatments seem to help the most if you start them while your child is still young. Lots of other types of treatments have been tried, including special diets. But there hasn't been much research to show how well they work. page 2 of 5

3 Different children need different types of treatment, depending on their abilities and problems. For example, a child who doesn't speak may need different treatments from those children who do speak. Your doctor should look at your child's strengths and weaknesses before suggesting a particular treatment. Most children with autism don t need medicines. But doctors may use some medicines if your child has particular problems with their behaviour. Education Early teaching by parents means giving your child extra help with learning basic skills, such as speaking, before they start school. So you start working on your child's problems early on. You will get training in how to help your child. You learn how to recognise different types of behavior in your child, and how to help them to communicate. In studies, children having early teaching from their parents seemed to.understand language better, had improvement in some autism behaviours, and interacted better with their parents. However, early teaching by parents didn't seem to help in improving other aspects of the children's communication, and helping children adapt to different environments and situations. There are other educational programmes that research has shown may help your child learn. One programme is called applied behavioural analysis (ABA for short) and the other is Treatment and Education of Autistic and related Communication handicapped CHildren (TEACCH for short). You can use TEACCH at home (to learn more, see In ABA, a trained therapist works with your child to teach skills step-by-step. In TEACCH, children learn by using visual aids such as picture cards and posters, rather than spoken words. Research has suggested that having ABA may help children speak better, do better on intelligence tests, gain social skills, and learn how to adapt to different environments and situations. Three other educational programmes that may be helpful are called Child's Talk, More Than Words, and the Picture Exchange and Communication System (PECS for short). All of them encourage communication between parents and children. Doctors agree these can be helpful, although there hasn't been much research to show this. Diets and supplements Several types of diets and supplements have been suggested as treatments for autism. But there hasn't been enough research to tell us if any of them work. You should always talk to your doctor or a dietitian before changing what your child eats or before giving your child supplements. Here are some of the diets and supplements that have been studied in autism. page 3 of 5

4 Gluten-free or casein-free diets. This means not eating regular bread, pasta, and other foods with wheat in them, and no milk, yoghurt, cheese, and other dairy products. Fish oil capsules and probiotics ('friendly bacteria'). Vitamin A, vitamin B6, magnesium, vitamin C and zinc capsules or tablets. There are many other diets and supplements that parents and some professionals try for children with autism. But there hasn't been much research to say whether they can help. Medicines Most children with autism don t need medicines. But doctors sometimes use medicines for children with autism plus a particular type of problem. They all have side effects. Children who are overactive may be prescribed methylphenidate (Ritalin). It may make them less active and irritable. But higher doses might make children more irritable, and make them want to be left alone. Studies in children without autism show methylphenidate can cause other side effects, including loss of appetite, weight loss, and problems with sleeping. Children with autism who get into fights, have tantrums or hurt themselves are sometimes given risperidone (Risperdal). Risperidone is an antipsychotic drug used to treat people with schizophrenia. About 7 in 10 children who have these problems and take risperidone show improvement. Side effects include putting on weight, getting shaky hands and feeing sleepy. We don t know enough about the long-term side effects in children with autism. But we know from studies of risperidone used for schizophrenia that it may cause serious side effects, including diabetes and being unable to control how the body moves. Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that are usually used to treat depression. But doctors may prescribe them for children with autism who also have depression or anxiety, or do the same actions over and over. SSRI drugs include fluoxetine (Prozac) and fluvoxamine (Faverin). But there hasn't been much research to show if they help children with autism. SSRI antidepressants have been linked to an increase in suicidal thoughts among children taking them for depression. We don t know whether this affects children taking them for autism. Doctors have tried other drugs, including immunoglobulin and memantine. But there hasn't been enough research to say if they work. Injections of a hormone called secretin have been tested. But they don't work any better than a dummy treatment (placebo). A treatment called chelation has also been tried. But there's no evidence that it works, and it may be harmful. Some children have died after this treatment. page 4 of 5

5 Autism What will happen to my child? Many parents of children with autism worry about what will happen to their child in the future. In particular, you may worry about what will happen if you can't look after your child any more. It's hard to say what will happen, as autism affects each child differently. Some people with autism can live on their own. Others will always need a lot of help. The right support, education and training now may help your child have fewer problems later on. Studies of people with autism show: About 15 in 100 children with autism grow up to live on their own About 15 in 100 to 20 in 100 live alone but with help Many adults with autism need full-time care for the rest of their life. How well your child copes on their own is linked to how well they can speak and learn. Some children have a good chance of living alone and holding down a job later on. But many adults with autism need to live in homes that provide long-term care. Where to get more help The National Autistic Society is a UK charity offering help and support to people with autism and their families. You can visit the website at The patient information from BMJ Best Practice from which this leaflet is derived is regularly updated. The most recent version of Best Practice can be found at bestpractice.bmj.com This information is intended for use by health professionals. It is not a substitute for medical advice. It is strongly recommended that you independently verify any interpretation of this material and, if you have a medical problem, see your doctor. Please see BMJ's full terms of use at: bmj.com/company/legal-information. BMJ does not make any representations, conditions, warranties or guarantees, whether express or implied, that this material is accurate, complete, up-to-date or fit for any particular purposes. BMJ Publishing Group Ltd All rights reserved. Last published: Dec 01, 2016 page 5 of 5