GP, Dr Howard Lee, looks at diagnosing and understanding autism – which now affects 500,000 people in the UK

The number of cases of autism diagnosed in the UK has increased tenfold over the past decade according to a recent study. In real terms this means that the previous rate of 90 people per 10,000 may now be as high as 900 per 10,000.

Dr Paul Shattock, director of the Autism Research Unit at the University of Sunderland, said there was no proof that the controversial MMR vaccine for measles, mumps and rubella was responsible for the increase. But more than 2000 British families say their child regressed developmentally and became autistic after having the MMR vaccination. A number of studies around the world have so far failed to establish any proven link between autism and MMR and Dr Shattock says that a study planned by the Medical Research Council still won’t settle the issue.

Obviously, a better understanding of the condition is leading to better diagnosis but researchers are working on a number of other theories, particularly environmental factors such as pesticides, pollution and diet.

My grandson Joshua was diagnosed ‘autistic’ just before his second birthday

He was a cherub of a baby but from the start we were aware that something wasn’t quite right. His mum taught children with ‘special needs’ and was quick to notice that he had no particular smiles just for her. He wouldn’t stop crying when she picked him up; he showed no interest at all in baby toys or rattles. At five months he was still waking every hour, and wouldn’t feed at all, unless he was given the breast.

He failed to reach most of the developmental milestones and, by 18 months, he had severe behavioural problems – and they were very severe. He would move from tantrum to tantrum. He was obsessive and spent hours at a light switch turning it on and off. Any attempts to divert him would result in another temper tantrum. Josh never played with toys – or his elder brother – and his speech was very limited.

The change, once he started speech and occupational therapy and later special needs nursery, was remarkable. His speech development soared and the number of daily tantrums dropped.

We don’t know what causes autism

It’s thought that genetic influences play a major part and this is where a lot of research is being concentrated. Family and twin studies provide strong evidence for a genetic link to autism. It’s also been shown that if a child has autism, there’s a 3–5% risk that a sibling will be affected.

What is autism?

Autism affects each child differently. No two autistic children will be the same. It’s a ‘range of disorders’ and is referred to as an Autistic Spectrum Disorder (ASD). It’s generally agreed that severe ‘core’ autism only affects about 4 in every 10,000 people whilst 50-60 in every 10,000 are affected by some disorder from the autistic spectrum. The label PDD (pervasive development disorder) is often used for children with a range of less severe symptoms but all those affected tend to show three common characteristics – known as the Triad of Impairments:

• Difficulties with speech, language and non-verbal communication
• Difficulties with social interaction
• Difficulties with imagination and inner language

Early signs before one year

• Lack of interest in people and toys.
• Poor sleep pattern.
• Lack of speech development.
• Failure to meet developmental milestones.

• Obsessive behaviour problems.
• Other severe behaviour problems.
• Apparent ‘deafness’ – this is related to sensory ‘learning’ difficulties.
• It can be hard for the child to look another person in the eye.
• Problems identifying and concentrating on an individual voice when there’s a lot of background noise.

Autistic spectrum disorders are diagnosed by assessing behaviour. The procedure can vary greatly from one health authority to another because autism is still a relatively unknown condition. One thing’s certain though – an early diagnosis (by the time the child’s three) special teaching and support will help.

Therapies and treatments

Unfortunately, although most parents of autistic children do seek assistance by their child’s second birthday, a diagnosis often isn’t made until they’re six. You may have to push for an early referral for assessment by a community paediatrician, child and adolescent mental health services, together with social services, speech and language therapists, and pre-school special educational needs teachers.

At home, parents can help their child to develop effective ways of communicating socially, often through play. Repeating and practising everyday situations, having structured routines and simple rewards help autistic children come to terms with the way the world works.

Some parent training support schemes such as ‘More than Words’, ‘Adapted Hanen Program’ and ‘Early Bird Programme’ developed by the National Autistic Society give valuable advice to parents.

Get help and support

• Seek out local support groups – you don’t need to wait for a diagnosis to learn more about autism.
• Talk to adults who are autistic. They can give real insight into the condition. Temple Gandin and Wendy Lawson are both highly successful autistic people who have written books, given lectures and run workshops, etc.
• Many parents are told that their child has severe learning difficulties as well as autism. More often than not this is not true: they do have difficulty in learning, but this is because they are autistic, not because they have a lower intelligence – not quite the same thing, is it?
• Autism is treatable and with the correct input, children can make huge strides.

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