Early-onset autism

What is early-onset autism?

Early-onset autism, also known as Kanner’s autism or Kanner’s syndrome, is a profound developmental disorder that forms part of the autism spectrum disorders (ASD) and manifests itself in the first few years of life. Early-onset autism is one of the most severe forms of autism.

The disorder manifests itself before the age of three and is characterised by abnormalities in the three areas of ‘social interaction’, ‘communication’ and ‘behaviour’.

A particularly typical feature is the absence or severe delay in normal language development, which often remains impaired. Intelligence is also often impaired. People with early-onset autism have great difficulty forming relationships with others and leading a normal life. Due to their impairments, they usually require lifelong support.

Early-onset autism cannot be cured, but intensive support measures introduced as early as possible can lead to improvements in the social skills of those affected and, consequently, greater independence.

How common is early-childhood autism?

This developmental disorder has been diagnosed with increasing frequency in recent years. According to current studies, the proportion of people with the condition in the general population is 0.3 per cent, with boys being about two to three times more likely than girls to have autism spectrum disorders.

What are the causes and risk factors?

As with all autism spectrum disorders, early-childhood autism is primarily attributed to genetic causes. Research suggests that those affected have changes in specific sections of their genes. Hereditary factors play a major role in the development of the disorder: for example, the risk is significantly higher for children of parents who have the condition, and in the case of identical twins, both are often affected.

Disruptions during brain development can also be a cause of early-onset autism. For example, it has been shown that brain growth in affected children progresses more rapidly in the womb and that their brain volume is also larger than that of their peers.

Other risk factors include older parental age, infectious diseases in the mother during pregnancy (such as rubella) or the use of certain medicines, such as valproic acid, during pregnancy.

Symptoms in babies and toddlers

There are a number of possible signs that a child may have autism. In babies and toddlers, these may include the following symptoms:

• Refusal to breastfeed and problems with complementary feeding (e.g. the child is rigidly fixated on certain foods)
• apparent contentment with being alone
• severe disturbances in the sleep-wake cycle
• No eye contact
• no reaction to their own name or familiar voices
• No imitative behaviour
• no smiling
• no babbling, no baby talk
• motor stereotypies
• rigid focus on specific objects
• no creative use of toys
• Echolalia (stereotypical repetition of words)
• Constant repetition of certain behaviours
• No interest in other children
• Fear of change

Symptoms in nursery and school-age children

Over time, the signs become more varied: the children affected generally show little social competence, have increasing difficulty understanding or using non-verbal communication, and their behaviour is often rigid and stereotypical. They also have difficulty understanding or talking about their feelings and generally appear uninterested in their surroundings. The development of linguistic peculiarities is also typical: they repeat the same words and sentences over and over again, confuse ‘you’ and ‘I’, often fail to understand simple questions or requests, and have no sense of humour or irony. They themselves use few gestures, and their facial expressions often do not match the current situation. Instead, they often follow a rigid routine and frequently focus intensely on a very narrow area of interest. Self-stimulatory behaviour, such as rocking their upper body or spinning round, is also typical. Many autistic children are also afraid of being touched and may find this painful.

Why is an early diagnosis important?

Although autism spectrum disorders cannot be cured, it is now widely accepted that, with timely therapeutic intervention, many of the difficulties experienced by those affected can be significantly reduced. Early autism-specific therapy can help to compensate for missing skills and build on existing strengths. For this, a diagnosis as early as possible is necessary. This is often possible as early as the age of two.

Early diagnosis and subsequent treatment are also important for parents of children with autism, as they need to be involved in the therapeutic process and can learn to interpret their child’s behaviour correctly and understand them better.

Which doctor should you see?

The first point of contact if early childhood autism is suspected may be the paediatrician. They can carry out an initial assessment and, if necessary, refer the child to more specialised services. These include child and adolescent psychiatrists or outpatient clinics for developmental psychology and neurology.

What treatment options are available?

There is no cure for autism, but with appropriate therapy, improvements in quality of life and opportunities for social participation can often be achieved. Experts also emphasise that therapeutic measures should only be undertaken following a thorough and differentiated diagnosis. The goals of such therapy must be clearly defined, realistic and tailored to the individual. It is also important to involve the family in the therapy. Furthermore, therapeutic measures should neither under- nor over-challenge the individual.

As regards specific therapeutic approaches, there is now a wide range of methods, quite a few of which are also controversial. The focus is on promoting social interaction, communication, play behaviour and perception, as well as on expanding functional skills and treating the behavioural problems and medical conditions that often accompany autism.

Established autism-specific methods include, amongst others:

• ABA (Applied Behaviour Analysis): This involves training self-directed behaviour, language and communication, imitative behaviour, attention, social behaviour, play behaviour, motor skills and independence on the basis of individually tailored support programmes. ABA can be used from as early as one year of age.
• TEACCH (Treatment and Education of Autistic and Related Communication-Handicapped Children): This focuses primarily on the individual visual structuring of learning and social environments, based on the assumption that this provides orientation, helps children recognise connections and enables them to better understand their own and others’ behaviour. Close collaboration with parents and other caregivers is a key aspect of TEACCH.

Other therapeutic approaches include, amongst others:

• Speech and language therapy
• Occupational therapy
• Physiotherapy
• Music therapy

A structured daily routine and stable social contacts are also important, as are opportunities for social support in everyday life, such as assistance at school. Parents and other carers can also seek support – for example, through parental counselling or a self-help group.

Managing co-occurring conditions

Autism spectrum disorders are often accompanied by so-called comorbidities, i.e. co-occurring conditions. These include, in particular, ADHD, sleep disorders, obsessive-compulsive disorder, anxiety disorders and epilepsy. (Self-)aggressive behaviour may also occur. Experts emphasise that it is important to take such comorbid conditions into account and treat them where necessary. Furthermore, if autism-specific therapy begins at an early stage, this can help to prevent these comorbid conditions from occurring, or at least reduce their severity.

Tips for interacting with autistic children

• Structure and routine: Even more than others, children with autism need clear structures, fixed rules and routines.
• Avoiding sensory overload: It can be helpful to create a sensory-adapted environment and take individual needs into account.
• Explain behaviour and feelings: Children with an autism spectrum disorder find it difficult to understand other people’s feelings and needs. It is therefore helpful to explain one’s own behaviour and feelings.
• Explain to those around you what autism means
• Encouraging individual strengths