Gary Gaffney, MD,  medical director of the UI Hospital and Clinics' Autism Spectrum and Developmental Disorders Clinic,  talks about autism:

What is the autism spectrum disorder?

We're looking at mostly children, but we do see some adults, with a developmental disorder that has symptoms in three categories:

• They have speech and language developmental problems;
• Kids show social difficulties all the way from being aloof to being somewhat eccentric
• Is a large category that includes adherence to routines, perseverative activities, and stereotopies

How many people are affected with autism?

Years ago, or maybe even decades ago, research indicated the prevalence was two to four for 10,000. However, recent research indicates that the prevalence may be as high as one in 150 persons. Now that's somewhat debatable, why the prevalence would increase that much for autism, so we suspect that the criteria have changed and people are more aware of it, however, if the prevalence is that high, there may be over twenty thousand persons in Iowa with autism.

Are boys or girls more likely to be affected by autism?

It's generally found that there are more boys diagnosed with autism than girls. Overall, when physicians and researchers look at developmental disorders, males show more of those disorders, including attention deficient, learning disabilities, touret syndrome, and autism, so there's a preponderance of males.

However, lately, I believe more females have been diagnosed. And it may be that when a female shows symptoms of autism, she may be more seriously affected.

Is autism genetic? Or what causes autism?

That's a good question and that's a very complicated question. There may be persons with autism where it's completely genetic. They may have a mutation in their chromosomes or in the DNA, which, as you know, is the genetic material that controls all of biologic development. So there are those with repetitions or deletions where the symptoms are almost assuredly completely attributed to genetic causes. Then on the other hand, there are those that may have some genetic predisposition and in a particular environment, express the symptoms. So there's not just one cause in autism, it's a spectrum, and it's likely a contribution of genetics plus particular environments.

A wide variety there, and probably different ideas from different sides looking at some of the things that cause autism, actually.

Oh, it's very controversial, both on the genetic side and the environmental side. Genetic research is pretty hot these days and there are a number of groups, including at the University of Iowa, that are looking at some genetic causes and find some of those chromosomal deletions and repetitions that I mentioned. On the other hand, the environmental groups are incredibly controversial, from those that believe that autism may be related to mercury, to those that believe there are other toxic influences in the environment. So as you can imagine, a very hot topic not only in biology and medicine, but probably politics, too.

How is autism diagnosed and at what age?

Another good question without a simple answer. We see children as young as 18 months to adults as old as 40 or 50, and the diagnostic process is different in all groups. Generally we rely on different members of a diagnostic team where we get speech and language results; we look at educational parameters; psychological testing; and then, of course, their medical history and physical and come up with what we call a multidisciplinary team diagnosis. However, in adults we don't have as much information on their development, so that is a different process, because, as I've indicated, with the complexity of the disorder, we really need a team approach to make the diagnosis.

Does autism present itself the same in everyone affected?

That's exactly right. That's not a known in medicine, not everyone with multiple sclerosis, for instance, presents the same symptoms, as an analogy. However, with autism and our behavioral syndromes, it's very complicated; so much depends, too, upon cognitive development or IQ.

Children with a lower IQ may be more aloof, not develop speech and language, and may show a lot of what we call stereotopy, slapping and twirling. However, we've seen children with IQs of 160 who are extremely intelligent but very eccentric. They may be the chess champion of the United States, but still exhibit a form of autism called Aspergers, so you're exactly right, autism is not just a single, stereotype presentation. It's very interesting.

How is autism treated?

In much the same way that it's diagnosed. A treating facility needs a multidisciplinary team. The basis of treatment, and Iowa does a good job of this, is educational intervention. Iowa divides up the state into area education agencies and each has an autism team, they identify and treat the kids, because it would be hard to have the expertise in each individual school district, so the backbone is educational treatment, behavioral treatment, speech and language, occupational therapy -- those therapies are critical to treating autism.

Now, as physicians, we have a role, although we cannot medically treat the core of autism, we can treat symptoms such as the perseverative behaviors, we can treat the attentional problems in school, and sometimes the kids can become agitated and our medical intervention can be successful in treating those symptoms.

Is UI Hospitals and Clinics involved in any research involving autism? Could there be a cure for autism in the future?

We'd like to broaden the research horizon, but there's research into the genetics of autism, in cooperation with other major universities. There's research into speech and language functioning, and those children I mentioned with the high IQs are also involved in some research projects, the kids achieve pretty highly, but tend to show some eccentricities in their behavior. So there are some research projects, but as I mentioned, it would be our institutions in the state's goal now to increase our clinical and research enterprises.

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