Mar 26, 2014 — In the United States, 1 in 88 children are affected with autism spectrum disorder. In Utah, that number is even higher at 1 in 47 children. Dr. Deborah Bilder talks about the basics of autism, from what it can do to a child’s mental and physical health, to identifying the signs and symptoms in a child that might have autism. She also tells you some of the drugs and infections that could potentially increase the chances of autism, and why it’s so critical to identify autism spectrum disorder at an early age.

Interview

Recording: Medical news and research from University of Utah physicians and specialists you can use for have a happier and healthier life. You're listening to The Scope.

Interviewer: If you are trying to understand autism a little better, this is the podcast for you. We're with Dr. Debbie Bilder. She is the medical director for the Autism Spectrum Disorder Clinic. Let's take a couple of minutes to understand autism a little better from the perspective of somebody who knows nothing, like me, for example.
First of all, what is Autism Spectrum Disorder?

Dr. Debbie Bilder: Autism Spectrum Disorder is a neurodevelopmental condition that starts in very early childhood, if not birth, and significantly affects an individual's ability to socialize with others, to communicate and interact with others, and they find themselves with non-purposeful rituals, intense interests, excessive sensitivity to sensory stimuli.

Interviewer: Yeah, to the point where it's like debilitating to functioning in the world, or how bad is it generally?

Dr. Debbie Bilder: To the point where it really interferes with their ability to develop relationships with their peers, with those around them, to follow the general social norms and expectations in their home, in school and work environment to complete tasks they realize they need to complete, but may get excessively stuck on small pieces of it and being able to take it to full completion.

Interviewer: What causes it? Do we have any idea, or are there a lot of causes at this point?

Dr. Debbie Bilder: We assume that there's a strong genetic link to Autism because we see it run in families. For example, if one child an Autism Spectrum Disorder, the chances that a subsequent child born to those parents will have an Autism Spectrum Disorder is about 20%. However, it has been quite allusive as to what genetic cause is really going on.
It's not like blue eyes, or blond hair, in which you could see how it flows through families quite clearly, it's much more difficult to understand and predict.

Interviewer: Yeah.

Dr. Debbie Bilder: As far as environmental causes, I think most of us feel there probably is something out there, but I can let you know that we have yet to find that smoking gun. We know that there are a couple of drugs that may increase the risk for an Autism Spectrum Disorder, such as thalidomide and caproic acid. We know that certain infections that occur to the mother during pregnancy, such as CMB, could cause this, but there is still so many more questions than we have answers for.

Interviewer: What about the difference between giving the defective gene to a child at conception versus, like you said, maybe the atmosphere or a drug that a woman takes while she is pregnant might mutate those genes? How does that play out?

Dr. Debbie Bilder: My background isn't as a geneticist, but my general understanding of this is that some genes may run through families, others are created, as far as gene abnormalities, at the time that the child is conceived. So just because a child has a genetic disorder doesn't mean that particular gene is also affecting the mother or the father.

Interviewer: How common is Autism Spectrum Disorder in the United States?

Dr. Debbie Bilder: The last CDC Autism and Developmental Disabilities Monitoring Network that looks at the presence of Autism Spectrum Disorder by looking at specific communities, we in Utah happen to be one of the fourteen sites in which they look for the prevalence of Autism Spectrum Disorder, was published a couple of years ago and it was about one in eighty-eight eight year old children were affected with Autism Spectrum Disorder.

Interviewer: So give me some perspective. Is that a lot? Is that not a lot?

Dr. Debbie Bilder: Do you know, that's over 1% and here in Utah, we found that one in 47 children who are eight years of age in our surveillance area were affected by Autism Spectrum Disorder. That's 2%. It's reasonable to say that this is a disorder which is not uncommon and affects 2% of our population.

Interviewer: So a family has a child, how do they know if their child has autism? Is there genetic testing, first of all that's available and the second question is, what are the symptoms?

Dr. Debbie Bilder: Genetic testing is not going to determine whether a child has autism or doesn't have Autism Spectrum Disorder, rather genetic testing done in individuals with Autism Spectrum Disorder may be able to identify the underlying genetic cause. So really what parent's need to be aware of are those first signs that lets them know that they need to act early to bring their child to the attention of their primary care provider is a good place, or if they are involved in preschool. Just getting them to the attention of a provider who can continue the screening process and refer them on for specific testing if concerns continue to arise.

Interviewer: How important is that early interaction?

Dr. Debbie Bilder: That is critical. It is absolutely critical to identify these children experiencing Autism Spectrum Disorder as soon as possible. The reason why this is critical is because that young brain is still very plastic, very malleable, and we have this amazing developmental window going on for a few years where we can make significant changes in that child's ability to learn, to function, to socialize, to speak . . .

Interviewer: Really life changing for the child.

Dr. Debbie Bilder: Life changing.

Interviewer: Gotcha.

Dr. Debbie Bilder: We want to be able to take advantage of that window in every child.

Interviewer: So I would imagine right a now a parent is like, "Give me a couple of things I can look for."

Dr. Debbie Bilder: So the CDC has a very nice Autism Spectrum Disorder fact sheet that can be Googled. It really is part of the process that they've developed called "Learn the Signs, Act Early." As far as what they will highlight, so I'll share that with you, is recognizing when a child does not have pretend play, pretending to be something else or taking on the role of something that they're not.
Also, not pointing to objects that they are interested in, such as a plane goes by and a child will point up and want to direct the parent or sibling's attention to that really cool plane that just flew over. Not looking at objects when other people point to them, avoiding eye contact and really just wanting to isolate, not seeking out the company of others, particularly those familiar to them.
Children, especially as they get a little older, having difficulty understanding other people's feelings and other people's perspective, and also, like young children, not wanting to be cuddled or held. Once again, wanting to be kind of left alone.

Interviewer: Those symptoms that you mentioned, how many of them do you need to have before you're like, this is something of concern? Just one or multiple?

Dr. Debbie Bilder: If you have one, I think it is worthwhile to see your pediatrician or family practice doctor because from there they can do a more formal screening.

Interviewer: Any final thoughts for our listeners about autism.

Dr. Debbie Bilder: Well, I think just once again reiterating how important it is to identify children with Autism Spectrum Disorder as early as possible so that we can take full advantage of that developmental window they provide us to make a difference in their life and teach them how to learn so that they can engage in a more mainstream school environment than they otherwise may require.

Recording: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.