Autism Spectrum 

Disorders 

Pervasive Developmental Disorders 

DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH 
N

ot until the middle of 

the twentieth century 

was there a name for 

a disorder that affects 

thousands of children,

a disorder that causes 

disruption in families and unfulfilled lives for many 

children. In 1943 Dr. Leo Kanner of the Johns 

Hopkins Hospital studied a group of 11 children 

and introduced the label early infantile autism into 

the English language. At the same time a German 

scientist, Dr. Hans Asperger, described a milder form 

of the disorder that became known as Asperger 

syndrome. Thus these two disorders were described 

and are today listed in the Diagnostic and Statistical 

Manual of Mental Disorders DSM-IV-TR (fourth 

edition, text revision)

1 as two of the fi ve pervasive 

developmental disorders (PDD), more often referred 

to today as autism spectrum disorders (ASD). All 

these disorders are characterized by varying degrees 

of impairment in communication skills, social 

interactions, and restricted, repetitive and stereotyped 

patterns of behavior. 
The autism spectrum disorders can often be reliably detected by 

the age of 3 years, and in some cases as early as 18 months.2 Studies 

suggest that many children eventually may be accurately identifi ed 

by the age of 1 year or even younger. The appearance of any of 

the warning signs of ASD is reason to have a child evaluated by a 

professional specializing in these disorders. 

Parents are usually the first to notice unusual behaviors in 

their child. In some cases, the baby seemed “different” from birth, 

unresponsive to people or focusing intently on one item for long periods 

of time. The first signs of an ASD can also appear in children who seem 

to have been developing normally. When an engaging, babbling toddler 

suddenly becomes silent, withdrawn, self-abusive, or indifferent to 

social overtures, something is wrong. Research has shown that parents 

are usually correct about noticing developmental problems, although 

they may not realize the specific nature or degree of the problem. 

The pervasive developmental disorders, or autism spectrum 

disorders, range from a severe form, called autistic disorder, to a milder 

form, Asperger syndrome. If a child has symptoms of either of these 

disorders, but does not meet the specific criteria for either, the diagnosis 

is called pervasive developmental disorder not otherwise specifi ed 

(PDD-NOS). Other rare, very severe disorders that are included in 

the autism spectrum disorders are Rett syndrome and childhood 

disintegrative disorder. This brochure will focus on classic autism, 

PDD-NOS, and Asperger syndrome, with brief descriptions of Rett 

syndrome and childhood disintegrative disorder on page 4. 

2 
Prevalence
 

In 2007—the most recent government survey on the rate of autism—the 

Centers for Disease Control (CDC) found that the rate is higher than the 

rates found from studies conducted in the United States during the 1980s 

and early 1990s (survey based on data from 2000 and 2002). The 

CDC survey assigned a diagnosis of autism spectrum disorder based on 

health and school records of 8 year olds in 14 communities throughout 

the U.S. Debate continues about whether this represents a true increase 

in the prevalence of autism. Changes in the criteria used to diagnose 

autism, along with increased recognition of the disorder by professionals 

and the public may all be contributing factors. Nonetheless, the CDC 

report confirms other recent epidemiologic studies documenting that more 

children are being diagnosed with an ASD than ever before. 

Data from an earlier report of the CDC’s Atlanta-based program 

found the rate of autism spectrum disorder was 3.4 per 1,000 for children 

3 to 10 years of age. Summarizing this and several other major studies 

on autism prevalence, CDC estimates that 2–6 per 1,000 (from 1 in 

500 to 1 in 150) children have an ASD. The risk is 3–4 times higher 

in males than females. Compared to the prevalence of other childhood 

conditions, this rate is lower than the rate of mental retardation (9.7 per 

1,000 children), but higher than the rates for cerebral palsy (2.8 per 

1,000 children), hearing loss (1.1 per 1,000 children), and vision 

impairment (0.9 per 1,000 children).3 The CDC notes that these studies 

do not provide a national estimate. 

For additional data, please visit the autism section of the CDC 

Web site. 

3 
Rare Autism Spectrum Disorders 

Rett Syndrome: Rett syndrome is relatively rare, affecting 

almost exclusively females, one out of 10,000 to 15,000. After 

a period of normal development, sometime between 6 and 18 

months, autism-like symptoms begin to appear. The little girl’s 

mental and social development regresses—she no longer responds 

to her parents and pulls away from any social contact. If she has 

been talking, she stops; she cannot control her feet; she wrings her 

hands. Some of the problems associated with Rett syndrome can be 

treated. Physical, occupational, and speech therapy can help with 

problems of coordination, movement, and speech. 

Scientists sponsored by the National Institute of Child Health 

and Human Development have discovered that a mutation in the 

sequence of a single gene can cause Rett syndrome. This discovery 

may help doctors slow or stop the progress of the syndrome. It may 

also lead to methods of screening for Rett syndrome, thus enabling 

doctors to start treating these children much sooner, and improving 

the quality of life these children experience.* 

Childhood Disintegrative Disorder: Very few children who 

have an autism spectrum disorder (ASD) diagnosis meet the criteria 

for childhood disintegrative disorder (CDD). An estimate based on 

four surveys of ASD found fewer than 2 children per 100,000 with 

ASD could be classified as having CDD. This suggests that CDD 

is a very rare form of ASD. It has a strong male preponderance.** 

Symptoms may appear by age 2, but the average age of onset 

is between 3 and 4 years. Until this time, the child has ageappropriate skills in communication and social relationships. 

The long period of normal development before regression helps 

differentiate CDD from Rett syndrome. 

The loss of such skills as vocabulary are more dramatic in CDD 

than they are in classical autism. The diagnosis requires extensive 

and pronounced losses involving motor, language, and social 

skills.*** CDD is also accompanied by loss of bowel and bladder 

control and oftentimes seizures and a very low IQ. 

* Rett syndrome. NIH Publication No. 01-4960. Rockville, MD: National Institute of 

Child Health and Human Development, 2001. Available at http://www.nichd.nih.gov/ 

publications/pubskey.cfm?from=autism 

** Frombonne E. Prevalence of childhood disintegrative disorder. Autism, 2002; 6(2): 

149-157. 

*** Volkmar RM and Rutter M. Childhood disintegrative disorder: Results of the 

DSM-IV autism fi eld trial. Journal of the American Academy of Child and Adolescent 

Psychiatry, 1995; 34: 1092-1095. 

4 
What Are the Autism 


Spectrum Disorders?
 

The autism spectrum disorders are more common in the pediatric 

population than are some better known disorders such as diabetes, 

spinal bifida, or Down syndrome.2 The earlier the disorder is diagnosed, 

the sooner the child can be helped through treatment interventions. 

Pediatricians, family physicians, daycare providers, teachers, and parents 

may initially dismiss signs of ASD, optimistically thinking the child is just 

a little slow and will “catch up.” 

All children with ASD demonstrate deficits in 1) social interaction, 

2) verbal and nonverbal communication, and 3) repetitive behaviors or 

interests. In addition, they will often have unusual responses to sensory 

experiences, such as certain sounds or the way objects look. Each of 

these symptoms runs the gamut from mild to severe. They will present 

in each individual child differently. For instance, a child may have little 

trouble learning to read but exhibit extremely poor social interaction. 

Each child will display communication, social, and behavioral patterns 

that are individual but fit into the overall diagnosis of ASD. 

Children with ASD do not follow the typical patterns of child 

development. In some children, hints of future problems may be 

apparent from birth. In most cases, the problems in communication and 

social skills become more noticeable as the child lags further behind 

other children the same age. Some other children start off well enough. 

Oftentimes between 12 and 36 months old, the differences in the way 

they react to people and other unusual behaviors become apparent. 

Some parents report the change as being sudden, and that their children 

start to reject people, act strangely, and lose language and social skills 

they had previously acquired. In other cases, there is a “plateau,” or 

5 
leveling, of progress so that the difference between the child with autism 

and other children the same age becomes more noticeable. 

ASD is defined by a certain set of behaviors that can range from 

the very mild to the severe. The following possible indicators of ASD 

were identified on the Public Health Training Network Webcast, Autism 

Among Us.

4 

Possible Indicators of Autism Spectrum Disorders 

■	 Does not babble, point, or make meaningful gestures by 1 year of 

age 

■	 Does not speak one word by 16 months 

■	 Does not combine two words by 2 years 

■	 Does not respond to name 

■	 Loses language or social skills 

Some Other Indicators 

■	 Poor eye contact 

■	 Doesn’t seem to know how to play with toys 

■	 Excessively lines up toys or other objects 

■	 Is attached to one particular toy or object 

■	 Doesn’t smile 

■	 At times seems to be hearing impaired 

6 
Social Symptoms 

From the start, typically developing infants are social beings. Early in life, 

they gaze at people, turn toward voices, grasp a finger, and even smile. 

In contrast, most children with ASD seem to have tremendous 

difficulty learning to engage in the give-and-take of everyday human 

interaction. Even in the first few months of life, many do not interact 

and they avoid eye contact. They seem indifferent to other people, and 

often seem to prefer being alone. They may resist attention or passively 

accept hugs and cuddling. Later, they seldom seek comfort or respond 

to parents’ displays of anger or affection in a typical way. Research has 

suggested that although children with ASD are attached to their parents, 

their expression of this attachment is unusual and difficult to “read.” 

To parents, it may seem as if their child is not attached at all. Parents 

who looked forward to the joys of cuddling, teaching, and playing with 

their child may feel crushed by this lack of the expected and typical 

attachment behavior. 

Children with ASD also are slower in learning to interpret what 

others are thinking and feeling. Subtle social cues—whether a smile, a 

wink, or a grimace—may have little meaning. To a child who misses 

these cues, “Come here” always means the same thing, whether the 

speaker is smiling and extending her arms for a hug or frowning and 

planting her fists on her hips. Without the ability to interpret gestures 

and facial expressions, the social world may seem bewildering. 

To compound the problem, people with ASD have diffi culty seeing 

things from another person’s perspective. Most 5-year-olds understand 

that other people have different information, feelings, and goals than 

they have. A person with ASD may lack such understanding. This 

inability leaves them unable to predict or understand other people’s 

actions. 

7 
Although not universal, it is common for people with ASD also 

to have difficulty regulating their emotions. This can take the form of 

“immature” behavior such as crying in class or verbal outbursts that 

seem inappropriate to those around them. The individual with ASD 

might also be disruptive and physically aggressive at times, making 

social relationships still more difficult. They have a tendency to “lose 

control,” particularly when they’re in a strange or overwhelming 

environment, or when angry and frustrated. They may at times break 

things, attack others, or hurt themselves. In their frustration, some bang 

their heads, pull their hair, or bite their arms. 

Communication Diffi culties 

By age 3, most children have passed predictable milestones on the path 

to learning language; one of the earliest is babbling. By the fi rst birthday, 

a typical toddler says words, turns when he hears his name, points when 

he wants a toy, and when offered something distasteful, makes it clear 

that the answer is “no.” 

Some children diagnosed with ASD remain mute throughout their 

lives. Some infants who later show signs of ASD coo and babble during 

the first few months of life, but they soon stop. Others may be delayed, 

developing language as late as age 5 to 9. Some children may learn to 

use communication systems such as pictures or sign language. 

Those who do speak often use language in unusual ways. They 

seem unable to combine words into meaningful sentences. Some speak 

only single words, while others repeat the same phrase over and over. 

Some ASD children parrot what they hear, a condition called echolalia. 

Although many children with no ASD go through a stage where they 

repeat what they hear, it normally passes by the time they are 3. 

8 
Some children only mildly affected may exhibit slight delays 

in language, or even seem to have precocious language and 

unusually large vocabularies, but have great difficulty in sustaining a 

conversation. The “give and take” of normal conversation is hard for 

them, although they often carry on a monologue on a favorite subject, 

giving no one else an opportunity to comment. Another diffi culty 

is often the inability to understand body language, tone of voice, or 

“phrases of speech.” They might interpret a sarcastic expression such as 

“Oh, that’s just great” as meaning it really IS great. 

While it can be hard to understand what ASD children are saying, 

their body language is also difficult to understand. Facial expressions, 

movements, and gestures rarely match what they are saying. Also, their 

tone of voice fails to reflect their feelings. A high-pitched, sing-song, 

or flat, robot-like voice is common. Some children with relatively good 

language skills speak like little adults, failing to pick up on the “kidspeak” that is common in their peers. 

Without meaningful gestures or the language to ask for things, 

people with ASD are at a loss to let others know what they need. As a 

result, they may simply scream or grab what they want. Until they are 

taught better ways to express their needs, ASD children do whatever 

they can to get through to others. As people with ASD grow up, they 

can become increasingly aware of their difficulties in understanding 

others and in being understood. As a result they may become anxious 

or depressed. 

Repetitive Behaviors 

Although children with ASD usually appear physically normal and have 

good muscle control, odd repetitive motions may set them off from other 

children. These behaviors might be extreme and highly apparent or more 

9 
subtle. Some children and older individuals spend a lot of time repeatedly 

flapping their arms or walking on their toes. Some suddenly freeze in 

position. 

As children, they might spend hours lining up their cars and trains 

in a certain way, rather than using them for pretend play. If someone 

accidentally moves one of the toys, the child may be tremendously 

upset. ASD children need, and demand, absolute consistency in their 

environment. A slight change in any routine—in mealtimes, dressing, 

taking a bath, going to school at a certain time and by the same 

route—can be extremely disturbing. Perhaps order and sameness lend 

some stability in a world of confusion. 

Repetitive behavior sometimes takes the form of a persistent, 

intense preoccupation. For example, the child might be obsessed with 

learning all about vacuum cleaners, train schedules, or lighthouses. 

Often there is great interest in numbers, symbols, or science topics. 

Problems that May Accompany ASD 

Sensory problems. When children’s perceptions are accurate, 

they can learn from what they see, feel, or hear. On the other hand, if 

sensory information is faulty, the child’s experiences of the world can 

be confusing. Many ASD children are highly attuned or even painfully 

sensitive to certain sounds, textures, tastes, and smells. Some children 

find the feel of clothes touching their skin almost unbearable. Some 

sounds—a vacuum cleaner, a ringing telephone, a sudden storm, even 

the sound of waves lapping the shoreline—will cause these children to 

cover their ears and scream. 

In ASD, the brain seems unable to balance the senses appropriately. 

Some ASD children are oblivious to extreme cold or pain. An ASD child 

may fall and break an arm, yet never cry. Another may bash his head 

10 
against a wall and not wince, but a light touch may make the child 

scream with alarm. 

Mental retardation. Many children with ASD have some degree of 

mental impairment. When tested, some areas of ability may be normal, 

while others may be especially weak. For example, a child with ASD 

may do well on the parts of the test that measure visual skills but earn 

low scores on the language subtests. 

Seizures. One in four children with ASD develops seizures, often 

starting either in early childhood or adolescence.5 Seizures, caused by 

abnormal electrical activity in the brain, can produce a temporary loss of 

consciousness (a “blackout”), a body convulsion, unusual movements, 

or staring spells. Sometimes a contributing factor is a lack of sleep or 

a high fever. An EEG (electroencephalogram—recording of the electric 

currents developed in the brain by means of electrodes applied to the 

scalp) can help confirm the seizure’s presence. 

In most cases, seizures can be controlled by a number of medicines 

called “anticonvulsants.” The dosage of the medication is adjusted 

carefully so that the least possible amount of medication will be used to 

be effective. 

Fragile X syndrome. This disorder is the most common inherited 

form of mental retardation. It was so named because one part of the 

X chromosome has a defective piece that appears pinched and fragile 

when under a microscope. Fragile X syndrome affects about two to fi ve 

percent of people with ASD. It is important to have a child with ASD 

checked for Fragile X, especially if the parents are considering having 

another child. For an unknown reason, if a child with ASD also has 

Fragile X, there is a one-in-two chance that boys born to the same 

parents will have the syndrome.6 Other members of the family who may 

be contemplating having a child may also wish to be checked for the 

syndrome. 

11 
A distinction can be made between a father’s and mother’s 

ability to pass along to a daughter or son the altered gene on the X 

chromosome that is linked to fragile X syndrome. Because both males 

(XY) and females (XX) have at least one X chromosome, both can pass 

on the mutated gene to their children. 

A father with the altered gene for Fragile X on his X chromosome 

will only pass that gene on to his daughters. He passes a Y chromosome 

on to his sons, which doesn’t transmit the condition. Therefore, if the 

father has the altered gene on his X chromosome, but the mother’s X 

chromosomes are normal, all of the couple’s daughters would have 

the altered gene for Fragile X, while none of their sons would have the 

mutated gene. 

Because mothers pass on only X chromosomes to their children, 

if the mother has the altered gene for Fragile X, she can pass that gene 

to either her sons or her daughters. If the mother has the mutated gene 

on one X chromosome and has one normal X chromosome, and the 

father has no genetic mutations, all the children have a 50-50 chance of 

inheriting the mutated gene. 

The odds noted here apply to each child the parents have.7 In 

terms of prevalence, the latest statistics are consistent in showing that 

5% of people with autism are affected by fragile X and 10% to 15% of 

those with fragile X show autistic traits. 

Tuberous Sclerosis. Tuberous sclerosis is a rare genetic disorder 

that causes benign tumors to grow in the brain as well as in other 

vital organs. It has a consistently strong association with ASD. One to 

4 percent of people with ASD also have tuberous sclerosis.8 

12 
The Diagnosis of Autism 

Spectrum Disorders 

Although there are many concerns about labeling a young child with 

an ASD, the earlier the diagnosis of ASD is made, the earlier needed 

interventions can begin. Evidence over the last 15 years indicates that 

intensive early intervention in optimal educational settings for at least 

2 years during the preschool years results in improved outcomes in most 

young children with ASD.2 

In evaluating a child, clinicians rely on behavioral characteristics to 

make a diagnosis. Some of the characteristic behaviors of ASD may be 

apparent in the first few months of a child’s life, or they may appear at 

any time during the early years. For the diagnosis, problems in at least 

one of the areas of communication, socialization, or restricted behavior 

must be present before the age of 3. The diagnosis requires a two-stage 

process. The first stage involves developmental screening during ‘well 

child” check-ups; the second stage entails a comprehensive evaluation 

by a multidisciplinary team.9 

Screening 

A “well child” check-up should include a developmental screening test. 

If your child’s pediatrician does not routinely check your child with such 

a test, ask that it be done. Your own observations and concerns about 

your child’s development will be essential in helping to screen your child.9 

Reviewing family videotapes, photos, and baby albums can help parents 

remember when each behavior was first noticed and when the child 

reached certain developmental milestones. 

13 
Several screening instruments have been developed to quickly 

gather information about a child’s social and communicative 

development within medical settings. Among them are the Checklist 

of Autism in Toddlers (CHAT),10 the modified Checklist for Autism in 

Toddlers (M-CHAT),11 the Screening Tool for Autism in Two-Year-Olds 

(STAT),12 and the Social Communication Questionnaire (SCQ)13 (for 

children 4 years of age and older). 

Some screening instruments rely solely on parent responses to a 

questionnaire, and some rely on a combination of parent report and 

observation. Key items on these instruments that appear to differentiate 

children with autism from other groups before the age of 2 include 

pointing and pretend play. Screening instruments do not provide 

individual diagnosis but serve to assess the need for referral for possible 

diagnosis of ASD. These screening methods may not identify children 

with mild ASD, such as those with high-functioning autism or Asperger 

syndrome. 

During the last few years, screening instruments have been devised 

to screen for Asperger syndrome and higher functioning autism. The 

Autism Spectrum Screening Questionnaire (ASSQ),14 the Australian 

Scale for Asperger’s Syndrome,15 and the most recent, the Childhood 

Asperger Syndrome Test (CAST),16 are some of the instruments that are 

reliable for identification of school-age children with Asperger syndrome 

or higher functioning autism. These tools concentrate on social and 

behavioral impairments in children without significant language delay. 

If, following the screening process or during a routine “well child” 

check-up, your child’s doctor sees any of the possible indicators of ASD, 

further evaluation is indicated. 

14 
Comprehensive Diagnostic Evaluation 

The second stage of diagnosis must be comprehensive in order to 

accurately rule in or rule out an ASD or other developmental problem. 

This evaluation may be done by a multidisciplinary team that includes 

a psychologist, a neurologist, a psychiatrist, a speech therapist, or other 

professionals who diagnose children with ASD. 

Because ASD’s are complex disorders and may involve other 

neurological or genetic problems, a comprehensive evaluation should 

entail neurologic and genetic assessment, along with in-depth cognitive 

and language testing.9 In addition, measures developed specifi cally for 

diagnosing autism are often used. These include the Autism Diagnosis 

Interview-Revised (ADI-R)17 and the Autism Diagnostic Observation 

Schedule (ADOS-G).18 The ADI-R is a structured interview that contains 

over 100 items and is conducted with a caregiver. It consists of four 

main factors—the child’s communication, social interaction, repetitive 

behaviors, and age-of-onset symptoms. The ADOS-G is an observational 

measure used to “press” for socio-communicative behaviors that are 

often delayed, abnormal, or absent in children with ASD. 

Still another instrument often used by professionals is the 

Childhood Autism Rating Scale (CARS).19 It aids in evaluating the child’s 

body movements, adaptation to change, listening response, verbal 

communication, and relationship to people. It is suitable for use with 

children over 2 years of age. The examiner observes the child and also 

obtains relevant information from the parents. The child’s behavior is 

rated on a scale based on deviation from the typical behavior of children 

of the same age. 

Two other tests that should be used to assess any child with a 

developmental delay are a formal audiologic hearing evaluation and 

a lead screening. Although some hearing loss can co-occur with ASD, 

some children with ASD may be incorrectly thought to have such a 

15 
loss. In addition, if the child has suffered from an ear infection, transient 

hearing loss can occur. Lead screening is essential for children who 

remain for a long period of time in the oral-motor stage in which they 

put any and everything into their mouths. Children with an autistic 

disorder usually have elevated blood lead levels.9 

Customarily, an expert diagnostic team has the responsibility of 

thoroughly evaluating the child, assessing the child’s unique strengths 

and weaknesses, and determining a formal diagnosis. The team will 

then meet with the parents to explain the results of the evaluation. 

Although parents may have been aware that something was 

not “quite right” with their child, when the diagnosis is given, it is a 

devastating blow. At such a time, it is hard to stay focused on asking 

questions. But while members of the evaluation team are together is 

the best opportunity the parents will have to ask questions and get 

recommendations on what further steps they should take for their child. 

Learning as much as possible at this meeting is very important, but it is 

helpful to leave this meeting with the name or names of professionals 

who can be contacted if the parents have further questions. 

Available Aids 

When your child has been evaluated and diagnosed with an autism 

spectrum disorder, you may feel inadequate to help your child develop to 

the fullest extent of his or her ability. As you begin to look at treatment 

options and at the types of aid available for a child with a disability, you 

will find out that there is help for you. It is going to be difficult to learn 

and remember everything you need to know about the resources that 

will be most helpful. Write down everything. If you keep a notebook, 

you will have a foolproof method of recalling information. Keep a record 

of the doctors’ reports and the evaluation your child has been given so 

that his or her eligibility for special programs will be documented. Learn 

16 
everything you can about special programs for your child; the more you 

know, the more effectively you can advocate. 

For every child eligible for special programs, each state guarantees 

special education and related services. The Individuals with Disabilities 

Education Act (IDEA) is a Federally mandated program that assures 

a free and appropriate public education for children with diagnosed 

learning deficits. Usually children are placed in public schools and the 

school district pays for all necessary services. These will include, as 

needed, services by a speech therapist, occupational therapist, school 

psychologist, social worker, school nurse, or aide. 

By law, the public schools must prepare and carry out a set of 

instruction goals, or specific skills, for every child in a special education 

program. The list of skills is known as the child’s Individualized 

Education Program (IEP). The IEP is an agreement between the school 

and the family on the child’s goals. When your child’s IEP is developed, 

you will be asked to attend the meeting. There will be several people at 

this meeting, including a special education teacher, a representative of the 

public schools who is knowledgeable about the program, other individuals 

invited by the school or by you (you may want to bring a relative, a child 

care provider, or a supportive close friend who knows your child well). 

Parents play an important part in creating the program, as they know 

their child and his or her needs best. Once your child’s IEP is developed, 

a meeting is scheduled once a year to review your child’s progress and to 

make any alterations to reflect his or her changing needs. 

If your child is under 3 years of age and has special needs, he or 

she should be eligible for an early intervention program; this program 

is available in every state. Each state decides which agency will be the 

lead agency in the early intervention program. The early intervention 

services are provided by workers qualified to care for toddlers with 

disabilities and are usually in the child’s home or a place familiar to the 

17 
child. The services provided are written into an Individualized Family 

Service Plan (IFSP) that is reviewed at least once every 6 months. The 

plan will describe services that will be provided to the child, but will also 

describe services for parents to help them in daily activities with their 

child and for siblings to help them adjust to having a brother or sister 

with ASD. 

There is a list of resources at the back of the brochure that will be 

helpful to you as you look for programs for your child. 

Treatment Options 

There is no single best treatment package for all children with ASD. 

One point that most professionals agree on is that early intervention is 

important; another is that most individuals with ASD respond well to 

highly structured, specialized programs. 

Before you make decisions on your child’s treatment, you will 

want to gather information about the various options available. Learn 

as much as you can, look at all the options, and make your decision on 

your child’s treatment based on your child’s needs. You may want to 

visit public schools in your area to see the type of program they offer to 

special needs children. 

Guidelines used by the Autism Society of America include the 

following questions parents can ask about potential treatments: 

■	 Will the treatment result in harm to my child? 

■ How will failure of the treatment affect my child and family? 

■	 Has the treatment been validated scientifi cally? 

■	 Are there assessment procedures specifi ed? 

■	 How will the treatment be integrated into my child’s current 

program? Do not become so infatuated with a given treatment that 

functional curriculum, vocational life and social skills are ignored. 

18 
The National Institute of Mental Health suggests a list of questions 

parents can ask when planning for their child: 

■	 How successful has the program been for other children? 

■	 How many children have gone on to placement in a regular school 

and how have they performed? 

■	 Do staff members have training and experience in working with 

children and adolescents with autism? 

■	 How are activities planned and organized? 

■	 Are there predictable daily schedules and routines? 

■	 How much individual attention will my child receive? 

■	 How is progress measured? Will my child’s behavior be closely 

observed and recorded? 

■	 Will my child be given tasks and rewards that are personally 

motivating? 

■	 Is the environment designed to minimize distractions? 

■	 Will the program prepare me to continue the therapy at home? 

■	 What is the cost, time commitment, and location of the program? 

Among the many methods available for treatment and education 

of people with autism, applied behavior analysis (ABA) has become 

widely accepted as an effective treatment. Mental Health: A Report 

of the Surgeon General states, “Thirty years of research demonstrated 

the efficacy of applied behavioral methods in reducing inappropriate 

behavior and in increasing communication, learning, and appropriate 

social behavior.”20 The basic research done by Ivar Lovaas and his 

colleagues at the University of California, Los Angeles, calling for an 

intensive, one-on-one child-teacher interaction for 40 hours a week, 

laid a foundation for other educators and researchers in the search for 

further effective early interventions to help those with ASD attain their 

potential. The goal of behavioral management is to reinforce desirable 

behaviors and reduce undesirable ones.21, 22 

19 
An effective treatment program will build on the child’s interests, 

offer a predictable schedule, teach tasks as a series of simple steps, 

actively engage the child’s attention in highly structured activities, 

and provide regular reinforcement of behavior. Parental involvement 

has emerged as a major factor in treatment success. Parents work with 

teachers and therapists to identify the behaviors to be changed and 

the skills to be taught. Recognizing that parents are the child’s earliest 

teachers, more programs are beginning to train parents to continue the 

therapy at home. 

As soon as a child’s disability has been identifi ed, instruction 

should begin. Effective programs will teach early communication 

and social interaction skills. In children younger than 3 years, 

appropriate interventions usually take place in the home or a child 

care center. These interventions target specifi c deficits in learning, 

language, imitation, attention, motivation, compliance, and initiative 

of interaction. Included are behavioral methods, communication, 

occupational and physical therapy along with social play interventions. 

Often the day will begin with a physical activity to help develop 

coordination and body awareness; children string beads, piece puzzles 

together, paint, and participate in other motor skills activities. At snack 

time the teacher encourages social interaction and models how to use 

language to ask for more juice. The children learn by doing. Working 

with the children are students, behavioral therapists, and parents who 

have received extensive training. In teaching the children, positive 

reinforcement is used.23 

Children older than 3 years usually have school-based, 

individualized, special education. The child may be in a segregated 

class with other autistic children or in an integrated class with children 

20 
without disabilities for at least part of the day. Different localities may 

use differing methods but all should provide a structure that will help 

the children learn social skills and, functional communication. In these 

programs, teachers often involve the parents, giving useful advice in 

how to help their child use the skills or behaviors learned at school 

when they are at home.24 

In elementary school, the child should receive help in any skill 

area that is delayed and, at the same time, be encouraged to grow in 

his or her areas of strength. Ideally, the curriculum should be adapted 

to the individual child’s needs. Many schools today have an inclusion 

program in which the child is in a regular classroom for most of the day, 

with special instruction for a part of the day. This instruction should 

include such skills as learning how to act in social situations and in 

making friends. Although higher-functioning children may be able to 

handle academic work, they too need help to organize tasks and avoid 

distractions. 

During middle and high school years, instruction will begin 

to address such practical matters as work, community living, and 

recreational activities. This should include work experience, using public 

transportation, and learning skills that will be important in community 

living.25 

All through your child’s school years, you will want to be an active 

participant in his or her education program. Collaboration between 

parents and educators is essential in evaluating your child’s progress. 

21 
The Adolescent Years 

Adolescence is a time of stress and confusion; and it is no less 

so for teenagers with autism. Like all children, they need help 

in dealing with their budding sexuality. While some behaviors 

improve during the teenage years, some get worse. Increased 

autistic or aggressive behavior may be one way some teens express 

their newfound tension and confusion. 

The teenage years are also a time when children become more 

socially sensitive. At the age that most teenagers are concerned 

with acne, popularity, grades, and dates, teens with autism 

may become painfully aware that they are different from their 

peers. They may notice that they lack friends. And unlike their 

schoolmates, they aren’t dating or planning for a career. For some, 

the sadness that comes with such realization motivates them to 

learn new behaviors and acquire better social skills. 

Dietary and Other Interventions 

In an effort to do everything possible to help their children, many 

parents continually seek new treatments. Some treatments are 

developed by reputable therapists or by parents of a child with ASD. 

Although an unproven treatment may help one child, it may not 

prove beneficial to another. To be accepted as a proven treatment, the 

treatment should undergo clinical trials, preferably randomized, doubleblind trials, that would allow for a comparison between treatment and 

no treatment. Following are some of the interventions that have been 

reported to have been helpful to some children but whose effi cacy or 

safety has not been proven. 

Dietary interventions are based on the idea that 1) food allergies 

cause symptoms of autism, and 2) an insufficiency of a specifi c vitamin 

or mineral may cause some autistic symptoms. If parents decide to try 

for a given period of time a special diet, they should be sure that the 

child’s nutritional status is measured carefully. 

A diet that some parents have found was helpful to their autistic 

child is a gluten-free, casein-free diet. Gluten is a casein-like substance 

22 
that is found in the seeds of various cereal plants—wheat, oat, rye, and 

barley. Casein is the principal protein in milk. Since gluten and milk are 

found in many of the foods we eat, following a gluten-free, casein-free 

diet is diffi cult. 

A supplement that some parents feel is beneficial for an autistic 

child is Vitamin B6, taken with magnesium (which makes the vitamin 

effective). The result of research studies is mixed; some children respond 

positively, some negatively, some not at all or very little.5 

In the search for treatment for autism, there has been discussion 

in the last few years about the use of secretin, a substance approved 

by the Food and Drug Administration (FDA) for a single dose normally 

given to aid in diagnosis of a gastrointestinal problem. Anecdotal 

reports have shown improvement in autism symptoms, including 

sleep patterns, eye contact, language skills, and alertness. Several 

clinical trials conducted in the last few years have found no signifi cant 

improvements in symptoms between patients who received secretin and 

those who received a placebo.26 

Medications Used in Treatment 

Medications are often used to treat behavioral problems, such as 

aggression, self-injurious behavior, and severe tantrums, that keep the 

person with ASD from functioning more effectively at home or school. 

The medications used are those that have been developed to treat similar 

symptoms in other disorders. Many of these medications are prescribed 

“off-label.” This means they have not been officially approved by the 

FDA for use in children, but the doctor prescribes the medications if he or 

she feels they are appropriate for your child. Further research needs to be 

done to ensure not only the efficacy but the safety of psychotropic agents 

used in the treatment of children and adolescents. 

23 
On October 6, 2006 the U.S. Food and Drug Administration 

(FDA) approved risperidone (generic name) or Risperdal (brand name) 

for the symptomatic treatment of irritability in autistic children and 

adolescents ages 5 to 16. The approval is the first for the use of a drug 

to treat behaviors associated with autism in children. These behaviors 

are included under the general heading of irritability, and include 

aggression, deliberate self-injury and temper tantrums. 

Olanzapine (Zyprexa) and other antipsychotic medications are used 

“off-label” for the treatment of aggression and other serious behavioral 

disturbances in children, including children with autism. Off-label means 

a doctor will prescribe a medication to treat a disorder or in an age group 

that is not included among those approved by the FDA. 

Other medications are used to address symptoms or other disorders 

in children with autism. Fluoxetine (Prozac) and sertraline (Zoloft) 

are approved by the FDA for children age 7 and older with obsessivecompulsive disorder. Fluoxetine is also approved for children age 8 and 

older for the treatment of depression. 

Fluoxetine and sertraline are antidepressants known as selective 

serotonin reuptake inhibitors (SSRIs). Despite the relative safety and 

popularity of SSRIs and other antidepressants, some studies have 

suggested that they may have unintentional effects on some people, 

especially adolescents and young adults. In 2004, after a thorough 

review of data, the Food and Drug Administration (FDA) adopted a 

“black box” warning label on all antidepressant medications to alert the 

public about the potential increased risk of suicidal thinking or attempts 

in children and adolescents taking antidepressants. In 2007, the agency 

extended the warning to include young adults up to age 25. A “black 

box” warning is the most serious type of warning on prescription drug 

labeling. The warning emphasizes that children, adolescents and young 

adults taking antidepressants should be closely monitored, especially 

24 
during the initial weeks of treatment, for any worsening depression, 

suicidal thinking or behavior, or any unusual changes in behavior such 

as sleeplessness, agitation, or withdrawal from normal social situations. 

A child with ASD may not respond in the same way to medications 

as typically developing children. It is important that parents work with a 

doctor who has experience with children with autism. A child should be 

monitored closely while taking a medication. The doctor will prescribe 

the lowest dose possible to be effective. Ask the doctor about any side 

effects the medication may have and keep a record of how your child 

responds to the medication. It will be helpful to read the “patient insert” 

that comes with your child’s medication. Some people keep the patient 

inserts in a small notebook to be used as a reference. This is most useful 

when several medications are prescribed. 

Anxiety and depression. The selective serotonin reuptake 

inhibitors (SSRI’s) are the medications most often prescribed for 

symptoms of anxiety, depression, and/or obsessive-compulsive disorder 

(OCD). Only one of the SSRI’s, fluoxetine, (Prozac®) has been approved 

by the FDA for both OCD and depression in children age 7 and older. 

Three that have been approved for OCD are fluvoxamine (Luvox®), age 

8 and older; sertraline (Zoloft®), age 6 and older; and clomipramine 

(Anafranil®), age 10 and older.5 Treatment with these medications can 

be associated with decreased frequency of repetitive, ritualistic behavior 

and improvements in eye contact and social contacts. The FDA is 

studying and analyzing data to better understand how to use the SSRI’s 

safely, effectively, and at the lowest dose possible. 

Behavioral problems. Antipsychotic medications have been 

used to treat severe behavioral problems. These medications work by 

reducing the activity in the brain of the neurotransmitter dopamine. 

Among the older, typical antipsychotics, such as haloperidol (Haldol®), 

thioridazine, fluphenazine, and chlorpromazine, haloperidol was found 

25 
in more than one study to be more effective than a placebo in treating 

serious behavioral problems.27 However, haloperidol, while helpful for 

reducing symptoms of aggression, can also have adverse side effects, 

such as sedation, muscle stiffness, and abnormal movements. 

Placebo-controlled studies of the newer “atypical” antipsychotics 

are being conducted on children with autism. The first such study, 

conducted by the NIMH-supported Research Units on Pediatric 

Psychopharmacology (RUPP) Autism Network, was on risperidone 

(Risperdal®).28 Results of the 8-week study were reported in 2002 

and showed that risperidone was effective and well tolerated for the 

treatment of severe behavioral problems in children with autism. 

The most common side effects were increased appetite, weight gain 

and sedation. Further long-term studies are needed to determine any 

long-term side effects. Other atypical antipsychotics that have been 

studied recently with encouraging results are olanzapine (Zyprexa®) 

and ziprasidone (Geodon®). Ziprasidone has not been associated with 

significant weight gain. 

Seizures. Seizures are found in one in four persons with ASD, 

most often in those who have low IQ or are mute. They are treated with 

one or more of the anticonvulsants. These include such medications 

as carbamazepine (Tegretol®), lamotrigine (Lamictal®), topiramate 

(Topamax®), and valproic acid (Depakote®). The level of the 

medication in the blood should be monitored carefully and adjusted 

so that the least amount possible is used to be effective. Although 

medication usually reduces the number of seizures, it cannot always 

eliminate them. 

Inattention and hyperactivity. Stimulant medications such as 

methylphenidate (Ritalin®), used safely and effectively in persons 

with attention deficit hyperactivity disorder, have also been prescribed 

for children with autism. These medications may decrease impulsivity 

26 
and hyperactivity in some children, especially those higher functioning 

children. 

Several other medications have been used to treat ASD symptoms; 

among them are other antidepressants, naltrexone, lithium, and some 

of the benzodiazepines such as diazepam (Valium®) and lorazepam 

(Ativan®). The safety and efficacy of these medications in children with 

autism has not been proven. Since people may respond differently to 

different medications, your child’s unique history and behavior will help 

your doctor decide which medication might be most benefi cial. 

Adults with an Autism 

Spectrum Disorder 

Some adults with ASD, especially those with high-functioning 

autism or with Asperger syndrome, are able to work successfully in 

mainstream jobs. Nevertheless, communication and social problems 

often cause difficulties in many areas of life. They will continue to need 

encouragement and moral support in their struggle for an independent life. 

Many others with ASD are capable of employment in sheltered 

workshops under the supervision of managers trained in working with 

persons with disabilities. A nurturing environment at home, at school, 

and later in job training and at work, helps persons with ASD continue 

to learn and to develop throughout their lives. 

The public schools’ responsibility for providing services ends when 

the person with ASD reaches the age of 22. The family is then faced 

with the challenge of finding living arrangements and employment to 

match the particular needs of their adult child, as well as the programs 

and facilities that can provide support services to achieve these goals. 

Long before your child finishes school, you will want to search for the 

27 
best programs and facilities for your young adult. If you know other 

parents of ASD adults, ask them about the services available in your 

community. If your community has little to offer, serve as an advocate 

for your child and work toward the goal of improved employment 

services. Research the resources listed in the back of this brochure to 

learn as much as possible about the help your child is eligible to receive 

as an adult. 

Living Arrangements for the Adult with an Autism Spectrum 

Disorder 

Independent living. Some adults with ASD are able to live entirely 

on their own. Others can live semi-independently in their own home or 

apartment if they have assistance with solving major problems, such as 

personal finances or dealing with the government agencies that provide 

services to persons with disabilities. This assistance can be provided by 

family, a professional agency, or another type of provider. 

Living at home. Government funds are available for families that 

choose to have their adult child with ASD live at home. These programs 

include Supplemental Security Income (SSI), Social Security Disability 

Insurance (SSDI), Medicaid waivers, and others. Information about 

these programs is available from the Social Security Administration 

(SSA). An appointment with a local SSA office is a good fi rst step 

to take in understanding the programs for which the young adult is 

eligible. 

Foster homes and skill-development homes. Some families 

open their homes to provide long-term care to unrelated adults with 

disabilities. If the home teaches self-care and housekeeping skills and 

arranges leisure activities, it is called a “skill-development” home. 

Supervised group living. Persons with disabilities frequently live 

in group homes or apartments staffed by professionals who help the 

28 
individuals with basic needs. These often include meal preparation, 

housekeeping, and personal care needs. Higher functioning persons 

may be able to live in a home or apartment where staff only visit a few 

times a week. These persons generally prepare their own meals, go to 

work, and conduct other daily activities on their own. 

Institutions. Although the trend in recent decades has been to 

avoid placing persons with disabilities into long-term-care institutions, 

this alternative is still available for persons with ASD who need 

intensive, constant supervision. Unlike many of the institutions years 

ago, today’s facilities view residents as individuals with human needs 

and offer opportunities for recreation and simple but meaningful work. 

Research into Causes and Treatment 

of Autism Spectrum Disorders 

Research into the causes, the diagnosis, and the treatment of autism 

spectrum disorders has advanced in tandem. With new well-researched 

standardized diagnostic tools, ASD can be diagnosed at an early age. And 

with early diagnosis, the treatments found to be beneficial in recent years 

can be used to help the child with ASD develop to his or her greatest 

potential. 

Disorders/Vaccinations 

The Institute of Medicine (IOM) conducted a thorough review on the 

issue of a link between thimerosal (a mercury based preservative that is 

no longer used in vaccinations) and autism. The final report from IOM, 

Immunization Safety Review: Vaccines and Autism, released in May 

2004, stated that the committee did not find a link. 

Until 1999, vaccines given to infants to protect them against 

diphtheria, tetanus, pertussis, Haemophilus infl uenzae type b (Hib), 

29 
and Hepatitis B contained thimerosal as a preservative. Today, with the 

exception of some flu vaccines, none of the vaccines used in the U.S. to 

protect preschool aged children against 12 infectious diseases contain 

thimerosal as a preservative. The MMR vaccine does not and never did 

contain thimerosal. Varicella (chickenpox), inactivated polio (IPV), and 

pneumococcal conjugate vaccines have also never contained thimerosal. 

A U.S. study looking at environmental factors including exposure 

to mercury, lead and other heavy metals is ongoing. 

Research on the Biologic Basis of ASD 

Because of its relative inaccessibility, scientists have only recently been 

able to study the brain systematically. But with the emergence of new 

brain imaging tools—computerized tomography (CT), positron emission 

tomography (PET), single photon emission computed tomography 

(SPECT), and magnetic resonance imaging (MRI), study of the structure 

and the functioning of the brain can be done. With the aid of modern 

technology and the new availability of both normal and autism tissue 

samples to do postmortem studies, researchers will be able to learn much 

through comparative studies. 

Postmortem and MRI studies have shown that many major brain 

structures are implicated in autism. This includes the cerebellum, 

cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain 

stem.29 Other research is focusing on the role of neurotransmitters such 

as serotonin, dopamine, and epinephrine. 

Research into the causes of autism spectrum disorders is being 

fueled by other recent developments. Evidence points to genetic factors 

playing a prominent role in the causes for ASD. Twin and family studies 

have suggested an underlying genetic vulnerability to ASD.30 To further 

research in this field, the Autism Genetic Resource Exchange, a project 

initiated by the Cure Autism Now Foundation, and aided by an NIMH 

30 
Major 


Brain 


Structures 

Implicated 

in Autism 

Cerebral cortex – 

a thin layer of gray 

matter on the surface 

of the cerebral 

hemispheres. 

Two-thirds of its 

area is deep in the 

fissures or folds. 

Responsible for 

the higher mental 

functions, general 

movement, 

perception, and 

behavorial reactions. 

Amygdala –

responsible

for emotional

responses,

including 

aggressive 

behavior. 

Hippocampus – 

makes it possible 

to remember new 

information and recent 

events.

Basal ganglia – 

gray masses

deep in the

cerebral

hemisphere

that serves as 

a connection

between the

cerebrum and 

cerebellum.

Helps to regulate

automatic 

movement. 

Brain stem – 

located in front of the 

cerebellum, it serves as a 

relay station, passing messages 

between various parts of the 

body and the cerebral cortex. 

Primitive functions essential to 

survival (breathing and heart rate 

control) are located here. 

Cerebellum – 

located at the back of the 

brain, it fine tunes our 

motor activity, regulates 

balance, body movements, 

coordination, and the 

muscles used in speaking. 

31 

Corpus callosum –

consists primarily 

of closely packed 

bundles of fibers that 

connect the right 

and left hemisphere 

and allows for 

communication 

between the 

hemispheres.
grant, is recruiting genetic samples from several hundred families. Each 

family with more than one member diagnosed with ASD is given a 

2-hour, in-home screening. With a large number of DNA samples, it 

is hoped that the most important genes will be found. This will enable 

scientists to learn what the culprit genes do and how they can go wrong. 

Another exciting development is the Autism Tissue Program 

(http://www.brainbank.org), supported by the Autism Society of 

America Foundation, the Medical Investigation of Neurodevelopmental 

Disorders (M.I.N.D.) Institute at the University of California, Davis, and 

the National Alliance for Autism Research. The program is aided by a 

grant to the Harvard Brain and Tissue Resource Center (http://www. 

brainbank.mclean.org), funded by the National Institute of Mental 

Health (NIMH) and the National Institute of Neurological Disorders and 

Stroke (NINDS). Studies of the postmortem brain with imaging methods 

will help us learn why some brains are large, how the limbic system 

develops, and how the brain changes as it ages. Tissue samples can 

be stained and will show which neurotransmitters are being made in 

the cells and how they are transported and released to other cells. By 

focusing on specific brain regions and neurotransmitters, it will become 

easier to identify susceptibility genes. 

Recent neuroimaging studies have shown that a contributing 

cause for autism may be abnormal brain development beginning in 

the infant’s first months. This “growth dysregulation hypothesis” 

holds that the anatomical abnormalities seen in autism are caused by 

genetic defects in brain growth factors. It is possible that sudden, rapid 

head growth in an infant may be an early warning signal that will 

lead to early diagnosis and effective biological intervention or possible 

prevention of autism.31 

32 
The Children’s Health Act 

of 2000—What It Means to 

Autism Research 

The Children’s Health Act of 2000 was responsible for the creation of 

the Interagency Autism Coordinating Committee (IACC), a committee 

that includes the directors of five NIH institutes—the National Institute 

of Mental Health, the National Institute of Neurological Disorders and 

Stroke, the National Institute on Deafness and Other Communication 

Disorders (NIDCD), the National Institute of Child Health and Human 

Development (NICHD), and the National Institute of Environmental 

Health Sciences (NIEHS)—as well as representatives from the Health 

Resource Services Administration, the National Center on Birth Defects 

and Developmental Disabilities (a part of the Centers for Disease Control), 

the Agency for Toxic Substances and Disease Registry, the Substance 

Abuse and Mental Health Services Administration, the Administration 

on Developmental Disabilities, the Centers for Medicare and Medicaid 

Services, the U.S. Food and Drug Administration, and the U.S. 

Department of Education. The Committee, instructed by the Congress 

to develop a 10-year agenda for autism research, introduced the plan, 

dubbed a “matrix” or a “roadmap,” at the first Autism Summit Conference 

in November 2003. The roadmap indicates priorities for research for years 

1 to 3, years 4 to 6, and years 7 to 10. 

The five NIH institutes of the IACC have established the Studies to 

Advance Autism Research and Treatment (STAART) Network, composed 

of eight network centers. They will conduct research in the fi elds of 

developmental neurobiology, genetics, and psychopharmacology. Each 

33 
center is pursuing its own particular mix of studies, but there also will 

be multi-site clinical trials within the STAART network. 

The STAART centers are located at the following sites: 

■ University of North Carolina, Chapel Hill 

■ Yale University, Connecticut 

■ University of Washington, Seattle 

■ University of California, Los Angeles 

■ Mount Sinai Medical School, New York 

■ Kennedy Krieger Institute, Maryland 

■ Boston University, Massachusetts 

■ University of Rochester, New York 

A data coordination center will analyze the data generated by both 

the STAART network and the Collaborative Programs of Excellence 

in Autism (CPEA). This latter program, funded by the NICHD and the 

NIDCD Network on the Neurobiology and Genetics of Autism, consists 

of 10 sites. The CPEA is at present studying the world’s largest group 

of well-diagnosed individuals with autism characterized by genetic and 

developmental profi les. 

The CPEA centers are located at: 

■ Boston University, Massachusetts 

■ University of California, Davis 

■ University of California, Irvine 

■ University of California, Los Angeles 

■ Yale University, Connecticut 

■ University of Washington, Seattle 

■ University of Rochester, New York 

■ University of Texas, Houston 

■ University of Pittsburgh, Pennsylvania 

■ University of Utah, Salt Lake City 

34 
The NIEHS has programs (http://www.niehs.nih.gov/translat/ 

children/ctr-desc.htm) at: 

■	 Center for Childhood Neurotoxicology and Assessment,University of 

Medicine & Dentistry, New Jersey 

■	 The Center for the Study of Environmental Factors in the Etiology 

of Autism, University of California, Davis 

35 
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39 
For more information on 

autism spectrum disorders 

Visit the National Library of Medicine’s MedlinePlus Web site at 

http://medlineplus.gov 

En Espanol, http://medlineplus.gov/spanish. 

For information on clinical trials: 

NIMH supported clinical trials 

http://www.nimh.nih.gov/health/trials/index.shtml 

National Library of Medicine Clinical Trials Database 

http://www.clinicaltrials.gov 

Clinical trials at NIMH in Bethesda, MD 

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40 
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

National Institutes of Health 

National Institute of Mental Health 

NIH Publication No. 08-5511 

Printed 2004 Reprinted 2008