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Michael Chiklis 'protects and serves' those with autism

By Mike Falcon, Spotlight Health, with medical adviser Stephen A. Shoop, M.D.

Starring on The Shield, Michael Chiklis plays a streetwise detective whose son is autistic. But Chiklis knows that having an autistic child is in reality a daily challenge for millions of parents.

		Chiklis: "So little is really known about the disease."

"So little is really known about the disease," says the Emmy-nominated Chiklis, "and it affects so many that Cure Autism Now is not only a great fund for research, but for the awareness that pushes the research."

Autism is a severe, lifelong neurological disorder that usually strikes some time in the first two years of life and can cause severe impairment in language, cognition, and communication.

Cure Autism Now (CAN) estimates that autism affects 500,000-1,500,000 families and costs the USA over $13 billion a year. The organization notes that as many as one in every 250 children born today will be on the autistic spectrum, including those with Asperger's Syndrome, a milder disorder that can also prompt major problems in socialization and learning.

Last Sunday Chiklis took a swing at raising money and awareness for autism at a sold-out golf tournament to benefit CAN. "I really feel compelled to be here for the kids," says Chiklis.

The "ER/CAN" golf tourney teed up ER stars Anthony Edwards, Alex Kingston, Paul McCrane, Ming-Na, and Goran Visnjic with other celebrity linksters, including The West Wing's NiCole Robinson. The event raised over $335,000 to fund autism research. CAN targets likely innovative scientific research that will have the most immediate applications in curing the disease.

"CAN has made tremendous contributions," says reigning Ms. America Susan Jeske, who sang the National Anthem to officially open play. "There had been so much confusion about autism for so many years. My nephew has autism and now knowing more about how to reach him and work with him, there's a huge improvement."

Early intervention

Autism victims often live in a confusing and withdrawn world where usual social cues are unrecognized and friendships nearly impossible to forge because normal conversation is all but impossible.

According to CAN, most people with autism will never marry, have a job, or live independently. Half of all autistic children will never learn to speak.

But many children with autism make great strides through early intervention.

"Until recently, only a small proportion of children with autism were expected to achieve independent functioning as adults," says director Jonathan Shestack, co-founder of CAN. "Most were expected to require life-long health, education, and social services. That expectation is now changing with evidence that outcomes for many autistic children can be dramatically improved when they receive intensive early intervention services."

"You can change the course of development because there's lot of plasticity in brain early on," says Julie Osterling, PhD, clinical director of the University of Washington's Autism Center. "There are more environmental factors coming into play at this time. Research has demonstrated that they can increase their IQ points significantly if the interventions are done at two years old, as opposed to six years old when things are more set."

But general lack of awareness, wishful thinking, and inexperience in recognizing autism can combine to make timely diagnosis a hit-or-miss proposition.

"To know that something can be wrong is a good departure point," says Chiklis, whose character discovered last season that his on-screen son had autism. "But you have to have some idea of what is usual and what is not."

We now have those tools – but they need to be used more widely.

University of Chicago researcher Catherine Lord, PhD, has tackled the challenge of early diagnosis in creating the Autism Diagnostic Observation Schedule-Generic —which Osterling says may allow accurate diagnosis in infants as young as 18 months old. It works by creating situations that normally demand interaction between the infant and others.

Lord has also developed Autism Diagnostic Interview–Revised, which asks parents about how the child acts in typical situations. This questionnaire can be filled out in a matter of minutes.

Early autism cues

Osterling notes that even children younger than 18 months may exhibit warning signs. "By the time the infant is about 12 months old you can start looking," she advises.

She and co-researcher Geraldine Dawson discovered very early autism cues by an examination of first birthday videos of children later diagnosed with autism and those of children with typical development. Coders unaware of the diagnosis counted the number of times the birthday children displayed a range of social and communication behaviors.

They identified four specific behaviors that are significant and were able to identify 10 of the 11 children with autism at one year old. These are:

• Making eye contact
• Pointing to objects
• Showing objects to others
• Responding when someone calls their name

"You're really looking for a general ability to participate in social interactions," notes Osterling. "Baby social games like peek-a-boo show that the baby is an active participant."

Parents also need to recognize what may be missing in a timely fashion.

"If they're not using a word or two by 16 months old, or the baby starts using words and then stops, not replacing the word with another, it needs to be noticed," says Osterling.

"There is a subgroup of autism – one out of every four or five," notes Osterling, "where the parents report that the child developed normally from about seven months to 15 months old, and then they reported regression."

Osterling's recent research indicates that while there was no difference initially in the child who was reported as mildly regressing in this way, "the children ended up on the autistic spectrum."

For parents with children who have autism, the challenges are complex.

Some parents may experience denial, anger, and guilt when confronted with early symptoms. Disbelief and denial are dangerous "in that the parents hope the child will get better on his own and they wait and delay getting a professional opinion," notes Osterling.

But even the diagnosis may also be delayed by some family physicians who do not recognize autism symptoms. "What sometimes happens is that the parents have overwhelming concerns, the physician wants to allay their fears, but they do not have enough knowledge to make a definitive diagnosis," explains Osterling.

Osterling advises concerned parents to "follow your instincts. You know your child, so pursue your concerns until they are satisfied. A speech and language therapist who has a lot of experience in separating unusual language components and delays from genuine problems is a first-line defense. A thorough exam can put everyone's mind to rest or prompt timely and needed treatment. In either case, it's a must."

"My character knew what he had to do," says Chiklis. "That didn't make it an easy decision or make it something that could be solved in that episode. Of course, that's one of the reasons CAN is here – autism is definitely not something that just goes away."