the degree of impairment in functioning because of these challenges varies between individuals with

autism.

Diagnosis of Autism Spectrum Disord

Early signs of this disorder can be noticed by parents/caregivers or pediatricians before a child reaches
one year of age. However, symptoms typically become more consistently visible by the time a child is 2
or 3 years old. In some cases, the problems related to autism may be mild and not apparent until the
child starts school, after which their deficits may be pronounced when amongst their peers.

Social communication deficits may include1:

 Decreased sharing of interests with others.

 Difficulty appreciating their own & others' emotions.

 Aversion to maintaining eye contact.

 Lack of proficiency with use of non-verbal gestures.

 Stilted or scripted speech.

 Interpreting abstract ideas literally.

 Difficulty making friends or keeping them.

Restricted interests and repetitive behaviors may include1:

 Inflexibility of behavior, extreme difficulty coping with change.

 Being overly focused on niche subjects to the exclusion of others.

 Expecting others to be equally interested in those subjects.

 Difficulty tolerating changes in routine and new experiences.

 Sensory hypersensitivity, e.g., aversion to loud noises.

 Stereotypical movements such as hand flapping, rocking, spinning.

 Arranging things, often toys, in a very particular manner.

Parent/caregiver/teacher concerns about the child's behavior should lead to a specialized evaluation by
a developmental pediatrician, pediatric psychologist, child neurologist and/or a child and adolescent
psychiatrist. This evaluation involves interviewing the parent/caregiver, observing, and interacting with
the child in a structured manner, and sometimes conducting additional tests to rule out other disorders.
In some ambiguous cases the diagnosis of autism may be deferred, but an early diagnosis can greatly
improve a child's functioning by providing the family early access to supportive resources in the
community.

The first step is seeking an evaluation. Most parents start with their pediatrician who is checking on
developmental milestones.

 If your child is under the age of 3 years, you can obtain an evaluation through your local early
intervention system. (Learn more about early intervention and find local contact information.)

 If your child is over the age of 3, you can get an evaluation through your local school (even if
your child does not go there). Contact your local school's preschool special education team to
request an evaluation. (Learn more about requesting an evaluation.)

Risk Factors

The current science suggests that several genetic factors may increase the risk of
autism in a complex manner. People with certain specific genetic conditions such as
Fragile X Syndrome and Tuberous Sclerosis are at increased risk for being diagnosed
with autism.These two conditions together with hundreds of individually rare genetic
causes for autism explain over 30% of cases. Therefore, genetic testing may be
recommended after a diagnosis of autism. See more on genetic testing from the CDC.

Certain medications, such as valproic acid and thalidomide, when taken during
pregnancy, have been linked with a higher risk of autism as well.2 Having a sibling with
autism also increases the likelihood of a child being diagnosed with autism. Parents
being older at the time of pregnancy is additionally linked with greater risk of autism.
Vaccines on the other hand have not been shown to increase the likelihood of an
autism diagnosis, and race, ethnicity or socioeconomic status does not seem to have a
link either. Male children tend to be diagnosed with autism more often than those
assigned female sex at birth.

reatment

While there is no "cure" for autism, there are several effective interventions that can improve a child's
functioning:

 Applied behavioral analysis: Involves systematic study of the child's functional challenges,
which is used to create a structured behavioral plan for improving their adaptive skills and
decreasing inappropriate behavior

 Social skills training: Done in group or individual settings, this intervention helps children with
autism improve their ability to navigate social situations

 Speech & language therapy: Can improve the child's speech patterns and understanding of
language
  Occupational therapy: Can address adaptive skills deficits with activities of daily living, as well as
problems with handwriting

 Parent management training: Parents learn effective ways of responding to problematic

behavior and encouraging appropriate behavior in their child. Parent support groups help
parents cope with the stressors of raising a child with autism

 Special education services: Are provided by schools under an Individual Education Plan and can
include a range of services and accommodations for social communication deficits, restricted
interests and repetitive behaviors. This can include special classes for very young children to
address language, social skills and other needs.

 Treating co-occurring conditions: Children with autism are more likely to experience insomnia,
ADHD, intellectual disability, anxiety, and depression than peers without autism.
These conditional also need to be addressed. The impact of these conditions can be reduced
with the proper services, which can include any of the above, as well as psychotherapy and/or
medication. Treating these conditions typically involves coordination with a pediatrician or
primary care clinician.

 Medication: A child psychiatrist can evaluate for other mental health conditions and prescribe
medication if appropriate. For example, autism-related irritability can be reduced by
medications such as aripiprazole and risperidone (the two medications approved by the Food
and Drug Administration for irritability associated with autism), prescribed judiciously by a
knowledgeable clinician in collaboration with the child's parents. (Read more in the Parents'
Medication Guide from the American Academy of Child and Adolscent Psychiatry and APA)

Several complementary and alternative interventions involving special diets and supplements have been
tried over the years by parents/caregivers seeking ways to help their child with autism function better.
To date compelling evidence has not been found to clearly recommend any such specific interventions.
Research into these types of interventions continues, and parents/caregivers interested in them should
discuss them with their child's treating clinician.

Additional information can be found in the Expert Q&A section.

Related Conditions

 Attention-deficit/hyperactivity disorder

 Social communication disorder

 Specific learning disorder

 Intellectual disability

References
Physician Review

Amalia Londoño Tobón, M.D., IMH-E® Mentor

Perinatal, Child and Family Psychiatrist-Researcher
Assistant Professor, Georgetown University Medical Center
Department of Psychiatry, MedStar Georgetown University Hospital

Bipolar Disorder
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme
mood swings. These include emotional highs, also known as mania or hypomania, and lows, also known
as depression. Hypomania is less extreme than mania.

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most
activities. When your mood shifts to mania or hypomania, you may feel very excited and happy
(euphoric), full of energy or unusually irritable. These mood swings can affect sleep, energy, activity,
judgment, behavior and the ability to think clearly.

Episodes of mood swings from depression to mania may occur rarely or multiple times a year. Each bout
usually lasts several days. Between episodes, some people have long periods of emotional stability.
Others may frequently have mood swings from depression to mania or both depression and mania at
the same time.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other
symptoms by following a treatment plan. In most cases, healthcare professionals use medicines and talk
therapy, also known as psychotherapy, to treat bipolar disorder.

Symptoms

There are several types of bipolar and related disorders:

 Bipolar I disorder. You've had at least one manic episode that may come before or after
hypomanic or major depressive episodes. In some cases, mania may cause a break from reality.
This is called psychosis.

 Bipolar II disorder. You've had at least one major depressive episode and at least one
hypomanic episode. But you've never had a manic episode.

 Cyclothymia. You've had at least two years — or one year in children and teenagers — of many
periods of hypomania symptoms and periods of depressive symptoms. These symptoms are less
severe than major depression.

 Other types. These types include bipolar and related disorders caused by certain drugs or
alcohol, or due to a medical condition, such as Cushing's disease, multiple sclerosis or stroke.
These types may include mania, or hypomania, which is less extreme than mania, and depression.
Symptoms can cause changes in mood and behavior that can't be predicted. This can lead to a lot of
distress and cause you to have a hard time in life.

Bipolar II disorder is not a milder form of bipolar I disorder. It's a separate diagnosis. While the manic
episodes of bipolar I disorder can be severe and dangerous, people with bipolar II disorder can be
depressed for longer periods of time.

Bipolar disorder can start at any age, but usually it's diagnosed in the teenage years or early 20s.
Symptoms can differ from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are different, but they have the same symptoms. Mania is more severe than
hypomania. It causes more noticeable problems at work, school and social activities, as well as getting
along with others. Mania also may cause a break from reality, known as psychosis. You many need to
stay in a hospital for treatment.

Manic and hypomanic episodes include three or more of these symptoms:

 Being much more active, energetic or agitated than usual.

 Feeling a distorted sense of well-being or too self-confident.

 Needing much less sleep than usual.

 Being unusually talkative and talking fast.

 Having racing thoughts or jumping quickly from one topic to another.

 Being easy to distract.

 Making poor decisions. For example, you may go on buying sprees, take sexual risks or make
foolish investments.

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause you to have a hard time
doing day-to-day activities. These activities include going to work or school, as well as taking part in
social activities and getting along with others.

An episode includes five or more of these symptoms:

 Having a depressed mood. You may feel sad, empty, hopeless or tearful. Children and teens who
are depressed can seem irritable, angry or hostile.

 Having a marked loss of interest or feeling no pleasure in all or most activities.

  Losing a lot of weight when not dieting or overeating and gaining weight. When children don't
gain weight as expected, this can be a sign of depression.

 Sleeping too little or too much.

 Feeling restless or acting slower than usual.

 Being very tired or losing energy.

 Feeling worthless, feeling too guilty or feeling guilty when it's not necessary.

 Having a hard time thinking or concentrating, or not being able to make decisions.

 Thinking about, planning or attempting suicide.

Other features of bipolar disorder

Symptoms of bipolar disorders, including depressive episodes, may include other features, such as:

 Anxious distress, when you're feeling symptoms of anxiety and fear that you're losing control.

 Melancholy, when you feel very sad and have a deep loss of pleasure.

 Psychosis, when your thoughts or emotions disconnect from reality.

The timing of symptoms may be described as:

 Mixed, when you have symptoms of depression and mania or hypomania at the same time.

 Rapid cycling, when you have four mood episodes in the past year where you switch between
mania and hypomania and major depression.

Also, bipolar symptoms may happen when you're pregnant. Or symptoms can change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be hard to identify in children and teens. It's often hard to tell
whether these symptoms are the usual ups and downs or due to stress or trauma, or if they're signs of a
mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes. But the pattern
can vary from adults with bipolar disorder. Moods can shift fast during episodes. Some children may
have periods without mood symptoms between episodes.

The most noticeable signs of bipolar disorder in children and teenagers may be severe mood swings that
aren't like their usual mood swings.

When to see a doctor

Despite their mood extremes, people with bipolar disorder often don't know how much being
emotionally unstable disrupts their lives and the lives of their loved ones. As a result, they don't get the
treatment they need.

If you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of
being more productive. But an emotional crash always follows this euphoria. This crash can leave you
depressed and worn out. It could cause you to have problems getting along with others. It also could
leave you in financial or legal trouble.

If you have any symptoms of depression or mania, see your healthcare or mental health professional.
Bipolar disorder doesn't get better on its own. A mental health professional with experience in bipolar
disorder can help you get your symptoms under control.

Dementia

Dementia is a term used to describe a group of symptoms affecting memory, thinking and social abilities.
In people who have dementia, the symptoms interfere with their daily lives. Dementia isn't one specific
disease. Several diseases can cause dementia.

Dementia generally involves memory loss. It's often one of the early symptoms of the condition. But
having memory loss alone doesn't mean you have dementia. Memory loss can have different causes.

Alzheimer's disease is the most common cause of dementia in older adults, but there are other causes of
dementia. Depending on the cause, some dementia symptoms might be reversible.

Symptoms

Dementia symptoms vary depending on the cause. Common symptoms include:

Cognitive changes

 Memory loss, which is usually noticed by someone else.

 Problems communicating or finding words.

 Trouble with visual and spatial abilities, such as getting lost while driving.

 Problems with reasoning or problem-solving.

 Trouble performing complex tasks.

 Trouble with planning and organizing.

  Poor coordination and control of movements.

 Confusion and disorientation.

Psychological changes

 Personality changes.

 Depression.

 Anxiety.

 Agitation.

 Inappropriate behavior.

 Being suspicious, known as paranoia.

 Seeing things that aren't there, known as hallucinations.

Causes
Dementia is caused by damage to or loss of nerve cells and their connections in the
brain. The symptoms depend on the area of the brain that's damaged. Dementia can
affect people differently.

Dementias are often grouped by what they have in common. They may be grouped by
the protein or proteins deposited in the brain or by the part of the brain that's affected.
Also, some diseases have symptoms like those of dementia. And some medicines can
cause a reaction that includes dementia symptoms. Not getting enough of certain
vitamins or minerals also can cause dementia symptoms. When this occurs, dementia
symptoms may improve with treatment.

Progressive dementias

Dementias that are progressive get worse over time. Types of dementias that worsen
and aren't reversible include:

 Alzheimer's disease. This is the most common cause of dementia.

Although not all causes of Alzheimer's disease are known, experts do know that a
small percentage are related to changes in three genes. These gene changes can
be passed down from parent to child. While several genes are probably involved in
Alzheimer's disease, one important gene that increases risk is apolipoprotein E4
(APOE).
 People with Alzheimer's disease have plaques and tangles in their brains. Plaques
are clumps of a protein called beta-amyloid. Tangles are fibrous masses made up
of tau protein. It's thought that these clumps damage healthy brain cells and the
fibers connecting them.

 Vascular dementia. This type of dementia is caused by damage to the vessels

that supply blood to the brain. Blood vessel problems can cause stroke or affect
the brain in other ways, such as by damaging the fibers in the white matter of the
brain.

The most common symptoms of vascular dementia include problems with problem-
solving, slowed thinking, and loss of focus and organization. These tend to be
more noticeable than memory loss.

 Lewy body dementia. Lewy bodies are balloonlike clumps of protein. They have
been found in the brains of people with Lewy body dementia, Alzheimer's disease
and Parkinson's disease. Lewy body dementia is one of the more common types of
dementia.

Common symptoms include acting out dreams in sleep and seeing things that
aren't there, known as visual hallucinations. Symptoms also include problems with
focus and attention. Other signs include uncoordinated or slow movement,
tremors, and stiffness, known as parkinsonism.

 Frontotemporal dementia. This is a group of diseases characterized by the breakdown of

nerve cells and their connections in the frontal and temporal lobes of the brain. These
areas are associated with personality, behavior and language. Common symptoms affect
behavior, personality, thinking, judgment, language and movement.
 Mixed dementia. Autopsy studies of the brains of people age 80 and older who had
dementia indicate that many had a combination of several causes. People with mixed
dementia can have Alzheimer's disease, vascular dementia and Lewy body dementia.
Studies are ongoing to determine how having mixed dementia affects symptoms and
treatments.

Risk factors

Many factors can eventually contribute to dementia. Some factors, such as age, can't be changed. You
can address other factors to reduce your risk.

Risk factors that can't be changed

 Age. The risk of dementia rises as you age, especially after age 65. However, dementia isn't a
typical part of aging. Dementia also can occur in younger people.

 Family history. Having a family history of dementia puts you at greater risk of developing the
condition. However, many people with a family history never develop symptoms, and many
 people without a family history do. There are tests to determine whether you have certain
genetic changes that may increase your risk.

 Down syndrome. By middle age, many people with Down syndrome develop early-onset
Alzheimer's disease.

Risk factors you can change

You might be able to control the following risk factors for dementia.

 Diet and exercise. Research has found that people at higher risk of dementia who followed a
healthy lifestyle lowered their risk of cognitive decline. They ate a diet that included fish,
fruits, vegetables and oils. They also exercised, had cognitive training and participated in
social activities. While no specific diet is known to reduce dementia risk, research indicates
that those who follow a Mediterranean style diet rich in produce, whole grains, nuts and
seeds have better cognitive function.

 Drinking too much alcohol. Drinking large amounts of alcohol has long been known to cause
brain changes. Several large studies and reviews found that alcohol use disorders were linked
to an increased risk of dementia, particularly early-onset dementia.

 Cardiovascular risk factors. These include obesity, high blood pressure, high cholesterol, and
the buildup of fats in the artery walls, known as atherosclerosis. Diabetes and smoking also
are cardiovascular risk factors. Having diabetes can increase the risk of dementia, especially if
it's poorly controlled. Smoking might increase the risk of developing dementia and blood
vessel disease.

 Depression. Although not yet well understood, late-life depression might indicate the
development of dementia.

 Air pollution. Studies in animals have indicated that air pollution particulates can speed
degeneration of the nervous system. And human studies have found that air pollution
exposure — particularly from traffic exhaust and burning wood — is associated with greater
dementia risk.

 Head trauma. People who've had a severe head trauma have a greater risk of Alzheimer's
disease. Several large studies found that in people age 50 years or older who had a traumatic
brain injury (TBI), the risk of dementia and Alzheimer's disease increased. The risk increases in
people with more-severe and multiple TBIs. Some studies indicate that the risk may be
greatest within the first six months to two years after the TBI.

 Sleep problems. People who have sleep apnea and other sleep disturbances might be at
higher risk of developing dementia.
  Low levels of certain vitamins and nutrients. Low levels of vitamin D, vitamin B-6, vitamin B-12
and folate can increase the risk of dementia.

 Medicines that can worsen memory. These include sleep aids that contain diphenhydramine
(Benadryl) and medicines to treat urinary urgency such as oxybutynin (Ditropan XL).

Also limit sedatives and sleeping tablets. Talk to a health care professional about whether any of the
medicines you take might make your memory worse.

Complications

Dementia can affect many body systems and, therefore, the ability to function. Dementia can lead to:

 Poor nutrition. Many people with dementia eventually reduce or stop eating, affecting their
nutrient intake. Ultimately, they may be unable to chew and swallow.

 Pneumonia. Trouble swallowing increases the risk of choking. And food or liquids can enter
the lungs, known as aspiration. This can block breathing and cause pneumonia.

 Inability to perform self-care tasks. As dementia gets worse, people have a hard time bathing,
dressing, and brushing their hair or teeth. They need help using the toilet and taking
medicines as directed.

 Personal safety challenges. Some day-to-day situations can present safety issues for people
with dementia. These include driving, cooking, and walking and living alone.

 Death. Coma and death can occur in late-stage dementia. This often happens because of an
infection.

Prevention
There's no sure way to prevent dementia, but there are steps you can take that might
help. More research is needed, but it might be beneficial to do the following:

 Keep your mind active. Mentally stimulating activities might delay the onset of
dementia and decrease its effects. Spend time reading, solving puzzles and
playing word games.
 Be physically and socially active. Physical activity and social interaction might
delay the onset of dementia and reduce its symptoms. Aim for 150 minutes of
exercise a week.
 Quit smoking. Some studies have shown that smoking in middle age and beyond
might increase the risk of dementia and blood vessel conditions. Quitting smoking
might reduce the risk and improve health.
 Get enough vitamins. Some research suggests that people with low levels of
vitamin D in their blood are more likely to develop Alzheimer's disease and other
forms of dementia. You can increase your vitamin D levels with certain foods,
supplements and sun exposure.

More study is needed before an increase in vitamin D intake is recommended for

preventing dementia. But it's a good idea to make sure you get adequate vitamin
D. Taking a daily B-complex vitamin and vitamin C also might help.

 Manage cardiovascular risk factors. Treat high blood pressure, high cholesterol
and diabetes. Lose weight if you're overweight.

High blood pressure might lead to a higher risk of some types of dementia. More
research is needed to determine whether treating high blood pressure may reduce
the risk of dementia.

 Treat health conditions. See your doctor for treatment of depression or anxiety.
 Maintain a healthy diet. A diet such as the Mediterranean diet might promote
health and lower the risk of developing dementia. A Mediterranean diet is rich in
fruits, vegetables, whole grains and omega-3 fatty acids, which are commonly
found in certain fish and nuts. This type of diet also improves cardiovascular
health, which also may help lower dementia risk.
 Get good-quality sleep. Practice good sleep hygiene. Talk to a health care
professional if you snore loudly or have periods where you stop breathing or gasp
during sleep.
 Treat hearing problems. People with hearing loss have a greater chance of
developing problems with thinking, known as cognitive decline. Early treatment of
hearing loss, such as use of hearing aids, might help decrease the risk.