Autism spectrum disorder (ASD), also known as just autism, is an umbrella term for a group of complex brain development disorders.

Unlike cerebral palsy, which mostly affects a child’s motor functioning, autism affects the normal development of the brain in areas such as social interaction, problem-solving and communication.

Causes and Risk Factors

Autism is a complex disorder that can be caused by an array of factors. ASDs have no single known cause, but there are at least three aspects that researchers agree contribute to the development of autism, including:

• Genetics
• Environmental factors
• Maternal illness during pregnancy

Genetics

There are several biological differences in children with ASDs compared to children who do not have autism. Some of these genes can affect brain development and the ways in which brain cells communicate. Some genetic problems appear to be inherited, while others can occur spontaneously.

Due to the relationship between genetics and autism, parents who have one child with autism have an increased risk that their next child will also have an ASD. Additionally, if you have two children with autism, the chances that your third child will have autism increase to about 35%.

Environmental Factors

Environmental factors have recently been recognized as a potential cause of autism. Researchers are currently investigating the connection between things such as viral infections and air pollutants and the subsequent development of autism.

Maternal Conditions

There are various maternal conditions or illnesses that have been tied to autism in children. These include diabetes, hypertension and obesity during pregnancy. Additionally, a mother’s use of drugs or alcohol while pregnant has been linked as a potential cause of autism in children.

Risk Factors For Developing Autism

Autism can affect individuals of every gender, race and socioeconomic status. However, there are certain aspects that can increase the likelihood that a child will develop an ASD.

Some risk factors that increase the chances of developing an ASD are:

• Family history – Families who have one child or more with an ASD have an increased risk of having a second or third child with the disorder.
• A child’s sex – Males are four times more likely to develop an ASD than females.
• The parent’s age – Children born to older parents have a higher chance of developing an ASD.
• A premature birth – Babies born before 26 weeks have an increased risk of developing an ASD.

Types of Autism Spectrum Disorders

Individuals with an ASD have different ways of learning, paying attention and reacting to sensations and situations. The comprehension and learning capabilities of individuals with an ASD can vary from being extremely gifted in one field to severely challenged in others.

The five general types of ASDs are:

• Autistic Disorder
• Asperger’s Syndrome
• Pervasive developmental disorder
• Rett syndrome
• Childhood disintegrative disorder

Autistic Disorder

Autistic disorder is a brain development disorder that is often present during early childhood. This type of ASD is characterized by difficulty communicating and forming relationships with others, as well as trouble grasping language and abstract concepts.

Signs of autistic disorder include:

• Failure to respond to his or her name, or not hearing people speaking to them
• Has poor eye contact and lacks facial expression
• Resists cuddling or holding and seems to prefer playing alone
• Delayed speech and language development
• Speaks with an abnormal tone or rhythm – may use a “singsong voice” or robot-like speech
• Performs repetitive movements, such as rocking, spinning or hand-flapping
• Being fascinated by details of an object, such as the wheels of a toy car, but doesn’t understand the “big picture” of the subject

Asperger’s Syndrome

Also referred to as Asperger’s disorder, Asperger’s syndrome is a developmental disorder that involves a delay in the development of many basic skills. While Asperger’s syndrome is similar to autistic disorder, there are a few distinct differences.

Children with Asperger’s syndrome are typically higher functioning than those with autism, and they usually have normal intelligence and language development.

Signs of Asperger’s syndrome include:

• Slow development of social skills
• Eccentric or repetitive behaviors, such as hand wringing or finger twisting
• Unusual preoccupations or rituals
• Limited range of interest
• Poor coordination
• Exceptional skills or talents, such as in music, art or math

Pervasive Development Disorder

Individuals who meet some, but not all, of the criteria for autistic disorder and Asperger’s syndrome may be diagnosed with Pervasive Development Disorder, or PDD. Children with PDD usually have fewer and milder symptoms of autistic behavior and development. The symptoms of PDD mostly cause challenges in regards to social interaction and communication.

Signs of Pervasive Development Disorder include:

• Difficulty with verbal communication and understanding spoken language
• Challenges exhibiting nonverbal gestures, such as hand motions and facial expressions
• Difficulty with social interaction, relating to others and their surroundings
• Repetitive body movements or patterns of behavior, such as spinning or head banging
• Temper tantrums
• Aggressive behavior
• Trouble sleeping or staying asleep
• Difficulty adjusting to changes in routine or familiar surroundings

Rett Syndrome

Rett syndrome is a rare neurological disorder that occurs almost exclusively in girls, however it is possible in boys as well. This condition can lead to severe impairments that affect nearly every aspect of a child’s life. Rett syndrome can hinder a child’s ability to speak, walk, eat and even breathe easily on their own. A distinct symptom associated with this syndrome is constant, repetitive hand movements.

Signs of Rett syndrome include:

• A slowing of head growth between 6 and 18 months of age
• Loss of muscle tone
• Habitually wringing or rubbing hands together
• Deteriorating language skills
• Development of extreme social anxiety or withdrawing from others
• A jerky, stiff-legged walk
• Uncoordinated breathing
• Seizures

Childhood Disintegrative Disorder (CDD)

Childhood disintegrative disorder, or Heller’s syndrome, is a rare condition characterized by a gradual decrease in development. Children with PDD usually show signs of a typical development up until the age of 3 or 4. Then, over usually a few months, children lose language, motor, social and other skills that they have already acquired. For example, a child who previously spoke in phrases of a few words will gradually or abruptly lose the ability to communicate altogether.

Signs of Childhood Disintegrative Disorder include:

• Delay or regression of spoken language
• Impairment in nonverbal behaviors
• Inability to start or maintain conversations
• Lack of bowel or bladder control
• Loss of motor skills
• Problems forming relationships with other children or family members

Surgery

There are multiple surgical treatments that can help correct movement problems in children with cerebral palsy. However, parents should keep in mind that surgery isn’t right for every child with cerebral palsy.

Surgery is most commonly prescribed for those with spastic cerebral palsy because their increased muscle tone can be reduced to relieve restricted movement. For example, a child who walks on their toes due to high muscle tone in their legs can have those muscles or tendons lengthened, allowing for more normal walking.

Surgeries that can improve mobility in children with high muscle tone include:

• Muscle and tendon lengthening – A procedure used to correct contracted muscles or tendons, freeing up movement to walk or use hands.
• Tendon transfer – Transferring tendons from one bone to another is intended to give better alignment and motor control, especially in the feet and ankles.
• Tenotomy/myotomy – Cutting the tendon/muscle can relieve pain and restrictive movement caused by contractures—a permanent tightening of tendons or muscles.
• Neurectomy – Cutting the nerve that controls a specific muscle group can reduce spasticity or rigidity in that area. It is generally used to correct hip dislocations.
• Osteotomy – A procedure to realign joints by removing part of the bone.
• Arthrodesis – Fusing two bones together can produce stability in some cases.
• Selective dorsal rhizotomy – This aggressive procedure involves cutting specific nerves in the spinal column to correct spasticity in various muscle groups throughout the body.

Surgery is most effective when the child is old enough that doctors can determine where their movement issues are stemming from but young enough that there is still time to correct movement. This window is usually between 3-8 years of age.

Surgery may also be used to treat other conditions associated with cerebral palsy, such as hearing impairment and difficulties with feeding.

Treatments for Other Conditions Associated with CP

Many children with cerebral palsy develop co-occurring conditions as a result of their brain injury or movement problems. Each of these conditions must be treated as vigilantly as the child’s movement issues to ensure they get the best quality of life possible.

Seizures

Seizures are a disorder characterized by convulsions and sometimes a loss of consciousness. Approximately 41 percent of children with cerebral palsy have seizures. As with cerebral palsy, seizures come in varying levels of severity. Each case requires a specific approach to management. This requires surgery in some instances, but medication is the most common treatment.

Intellectual disabilities

Cerebral palsy itself does not affect intelligence. It is strictly a movement disorder. However, the brain injuries that cause CP can sometimes damage parts of the brain responsible for cognition. Some estimates suggest 25 to 60 percent of children with CP have a form of mental retardation. Estimates vary because some children with CP can’t speak or control their bodies well enough to complete an IQ test. The severity of these intellectual disability also varies. Treatment usually involves a combination of medication and behavioral therapy.

Hydrocephalus

This is a rare condition characterized by an unusual buildup of cerebrospinal fluid (CSF) within the skull. CSF has several functions, including nourishing the brain and removing waste from its surface. The buildup of CSF causes a disproportional increase in the size of the head that may be fatal. It is treated by implanting valves that allow excess CSF to drain off. The incidence of hydrocephalus is approximately less than two thousandths of a percent for every birth in the country, according to some estimates.

Gastrointestinal issues

The gastrointestinal system is complex and includes the stomach, intestines, esophagus and liver. The gastrointestinal system relies on a variety of muscles to work effectively. Children with problems chewing and swallowing often require therapy to learn how to eat effectively. Acid reflux is also a problem because the lower muscle in the esophagus isn’t strong enough to keep food in the stomach. Untreated acid reflux can be serious for children with CP. It can lead to complications such as pneumonia or esophagitis. Acid reflux can usually be controlled with special eating techniques and medication, but may require surgery in severe circumstances.

Urinary infections

Urinary tract infections are very common in children with cerebral palsy. Children with CP often struggle with bladder control and constipation because these movements require the coordination of multiple muscle groups. Many children soil themselves frequently because of a lack of normal muscle control. Parents can help prevent urinary infections by giving frequent baths and diaper changes.

Vision/hearing impairment

Brain injuries before, during or after birth may also cause  vision or hearing loss. Damage to the motor cortex can cause problems with sight. Treatment may involve removing cataracts, correcting crossed eyes or simply prescribing glasses. Up to 15 percent of children with cerebral palsy have a hearing impairment. Hearing issues are treated with surgery or hearing aids.

Dental issues

Children with athetoid cerebral palsy may experience dental issues. The inability to control muscle movement in the mouth can cause problems such as overbites, underbites, tooth decay and enamel defects.