At 18 months, Colton Rose was shy and a little late in walking but seemed to be progressing fine—laughing, smiling, talking. Several months later, however, his mother Angela started to worry. He was talking less and less, didn't engage with others as much, and hadn't yet started using a spoon or taking off his own shoes. "He kind of started slipping more and more into his own world," says Rose, a former marketing and communications manager. Sure enough, shortly after turning 2, Colton was diagnosed with autism. Yet a mere 15 months later, says Rose, "he's an entirely different child."
Soon after Colton's diagnosis, the toddler began intensive treatment through Nationwide Children's Hospital in Columbus, Ohio, near home. Each week, he receives 35 hours of behavioral therapy, sometimes at home and sometimes at preschool. It breaks tasks like asking for food into steps (point to ice cream, say "ice cream," request some politely), encourages him to imitate the steps, and reinforces the behaviors with rewards and encouragement. His mother, now a "full-time autism mom," practices with him for several hours a day herself and has weekly planning sessions with a Nationwide case supervisor and Colton's team of five aides. The family also meets periodically with a psychologist to track Colton's developmental progress. And it's good. In many ways, he's now "in a total normal category," says Rose. He's made impressive gains in social skills and is testing at or above average for speech.
Nationwide's approach to treatment demonstrates perhaps the best hope for children with an autism spectrum disorder: starting early—even as young as 12 months—and deploying a team of experts, from neurologists and physical therapists to psychologists and gastroenterologists, to tackle any aggravating issues. The latest research, which has taken on heightened urgency as estimates of prevalence have risen (in March, the Centers for Disease Control and Prevention put the rate at 1 in 88 children, up from 1 in 110 two years earlier), indicates that early intervention can make a big difference in cognitive and communication skills, language development, and anxiety and aggressiveness. Many such programs, including Colton's, are based around 25 to 40 hours a week of Applied Behavior Analysis, which lasers in on teaching specific behaviors using repetition and rewards.
A number of drug treatments, too, are suddenly showing promise at improving some symptoms. And many clinicians are finding that managing conditions commonly associated with autism, like epilepsy and gastrointestinal distress, can significantly improve behavior and allow other treatments to have a greater impact. Parents can address "whole body" issues by improving a child's diet, reducing exposure to potentially harmful chemicals, and eliminating stressors, suggests Martha Herbert, an assistant professor of neurology at Harvard Medical School and author of the new book The Autism Revolution. "If we could reduce the overwhelm" of other conditions, she says, "then we might not have so much of this."
While autism's causes remain a mystery, it's now widely believed that the symptoms result from a combination of genetics—perhaps involving hundreds of genes—and environmental factors around the time of conception or birth, such as advanced parent age and living near a freeway, that might affect brain development and function. The CDC reports that currently most kids aren't diagnosed until age 4, though researchers and clinicians agree that the earlier treatment starts, the better. "Basically, as soon as you can get in there and do it," advises Fred Volkmar, director of the Yale Child Study Center in New Haven, Conn., who notes that autism's effects appear to be cumulative. A 2011 review of treatment studies over the previous decade found that the most effective interventions are intensive and start as young as age 2; data on children younger than that, though preliminary, were "promising." Brain development "is really a very plastic process," says Sally Rogers, professor of psychiatry and behavioral sciences with the MIND Institute at the University of California–Davis. "Experiences across your life, but particularly in the first five years, actively sculpt the brain."