THE MYSTERIES OF AUTISM WHILE CAUSES AND CURES ELUDE EXPERTS, PARENTS CAN GET HELP IN DEALING WITH THE DISORDER THAT AFFECTS A RISING NUMBER OF CHILDREN.

Byline: Mariko Thompson Staff Writer

When Jared Elkin arrived at the Help Group's preschool program in Sherman Oaks in April, he brought a rocky academic record. Diagnosed with autism at age 2 1/2, Jared had been kicked out of two preschools and an autism program because of his disruptive and aggressive behavior. His mother, Jennifer, was desperate for help.

After one month at the Young Learner Therapeutic preschool at the Village Glen campus, one of six schools run by the Help Group for children with special needs, Elkin saw a marked difference in her son. He no longer needed Prozac. He didn't kick and bite. When another boy asked him to play, Jared not only said yes, he played.

``The difference is stunning,'' says Elkin, 31, of Sherman Oaks. ``I have a new child.''

A changed child, but not a cured child. Researchers are still pursuing the causes and searching for treatments for autism, a neurological disorder that has soared among California children since 1987.

Experts stress the importance of early intervention in addressing the impaired language skills, difficulty in social interaction and odd repetitive behaviors associated with autism. As the number of cases increases, so does the need for intensive therapeutic programs before the child turns 5.

Autism, called a spectrum disorder, is not a cookie-cutter disease. Children can fall anywhere on the spectrum, from mild forms - with which most go on to lead normal, productive lives - to severe forms requiring long-term care.

In California alone, the number of reported cases of autism rose 273 percent from 1987 to 1998. A recent study by the MIND Institute at UC Davis, commissioned by the state legislature, found that the staggering jump in autism cases could not be attributed to artificial causes, such as a change in diagnostic criteria or greater awareness of the disease.

The study, which looked at 684 children born in the early to mid-1980s and 1990s, confirmed what many in the field have reported for years. Over the last decade, the number of autistic children in the Los Angeles Unified School District has doubled to about 4,000 students out of an estimated 749,000.

``I've been in the field for 30 years, and we've seen this dramatic increase in the last eight to 10 years,'' says Debbie Moss, an autism specialist for the district. ``We've got to find out what's creating this.''

The increase in numbers has left parents and the agencies charged with serving autistic children scrambling for resources. In California, public schools have long faced a shortage of special education teachers. And the cost to provide appropriate services to a school-age autistic child runs more than $30,000 a year, according to the National Alliance for Autism Research.

California has kept comprehensive data over the last 20 years that made the MIND Institute study possible. But the trend is believed to be national. Dr. Robert Byrd, a pediatrician at UC Davis Children's Hospital and lead author, hopes the California study will prompt efforts at the national level.

``Everybody who's looking and doing population studies is seeing larger numbers than in the past,'' Byrd says.

Difficult diagnosis

Getting a child diagnosed at a young enough age to receive early intervention can be a challenge, says Laurie Stephens, director of the autistic spectrum disorders program for the Help Group.

Elkin, like many parents of autistic children, suspected a problem early. As a baby, Jared jerked in her arms to avoid eye contact with other people. As a toddler, one of his favorite pastimes was setting remote controls in a straight line on the couch. Tantrums would last until he passed out from screaming. Even more disconcerting was the fact that by age 2 he still didn't talk.

``Jared is an only child, our first child,'' Elkin says. ``You don't realize what is or is not normal behavior.''

Elkin worried that she was a bad mother. Her own mother, who loved to baby-sit the other grandchildren in the family, said she didn't feel comfortable being left alone with Jared.

Finally, another parent Elkin met through work suggested Jared might be autistic. The Elkins had Jared evaluated. When the diagnosis came back, she experienced a moment of relief.

``At least I know I can do something,'' she says. ``I don't have a horrible child. I'm not a horrible parent.''

Elkin's experience is common, says Stephens. Often the diagnosis isn't made until the child goes to preschool, where the signs become more evident. Knowledge about autism is increasing, she says, but it's only a start.

``There still needs to be a much larger push, but without scaring people,'' Stephens says. ``Just because your child isn't talking by age 2 doesn't mean they're autistic.''

Subtle adjustments

The preschool Jared attends looks like any other preschool. The eight children have circle time, nap time and play time. But rather than do work around a common table, each child has his or her own work station inside a cubicle. The program also uses a rewards system. If Jared gets three lines of stickers by the end of the day, he receives a prize.

``This is the most important time, these years between zero and 5,'' Elkin says. ``If you don't start with a program like this, you won't see the results.''

After determining that Jared posed a danger to himself and to others, the Los Angeles Unified School District approved placement for Jared in a nonpublic school, Elkin says. She was lucky to find an opening at Village Glen. Other programs she contacted had yearlong waiting lists, she says.

The preschool program is the most recent addition to the Village Glen campus in Sherman Oaks, gated and nearly hidden from the street by tall trees. At Village Glen, 300 children with high-functioning autism and Asperger's disorder (also a high-functioning syndrome) attend classes through high school.

Children diagnosed with autism can receive therapy from the state's 21 regional centers until age 3. Then they become the responsibility of the local school district, which can mean switching sites for preschool and kindergarten - less than ideal for children with a disorder that demands routine and repetition.

``Now the school districts and programs like ours are looking to provide more continuity so there's not as much change,'' Stephens says.

The Los Angeles Unified School District also has integrated services at seven school sites for children starting at age 3. More than 80 children receive 30 hours a week of early intervention therapies.

``We're looking at a variety of ways to address the tidal wave,'' Moss says.

While schools grapple with the rising numbers, researchers work to uncover the pieces to the autism puzzle, investigating genetics, brain development and environmental factors. Experts say there are likely multiple causes of autism.

The number of families with multiple autistic children suggests one of the causes is hereditary. In Sari Pill-Kahan's family, the discovery started with their youngest son, Danny. For Danny, now 12, it took five long years to get a diagnosis. As Pill-Kahan learned more about autism, she looked more closely at her oldest son, 16-year-old Natan. He was diagnosed with a learning disability similar to autism. More recently, her husband was diagnosed with high-functioning autism.

``There has to be at least a genetic component, because it wouldn't be my husband and the two boys,'' says Valley Glen resident Pill-Kahan, who also has a 13-year-old daughter named Lili. ``But then you meet all the kids here and you see that there's no one reason.''

A theory that the measles-mumps-rubella (MMR) vaccine causes autism persists despite research to the contrary. A Danish study released this month looked at a half-million children and found no link.

``It is an important study since it is so large,'' Stephens says. ``Clearly, this study indicates that it's not true.''

The Centers for Disease Control and Prevention in Atlanta also notes that the number of autism cases in California showed an upward trend, while the number of children vaccinated for MMR remained relatively stable - an unlikely scenario if the two were linked.

'A new life'

Elkin doesn't have any theories on why Jared is autistic. It might be genetic. Her husband, Jason, was adopted, so that part of the family history is unknown. While she's heard speculation about the MMR vaccine, about birth trauma and more, she doesn't spend much time pondering the cause.

``It's not that I don't care where it came from,'' she says. ``I'm just really (concerned) about dealing with the problem.''

She's thrilled that her mother, who didn't feel comfortable having Jared in her charge, now offers to take care of him. Jared's language skills have improved to the point where he serenades his parents with songs that he finds on a karaoke Web site. There are still times when the old behaviors surface. No child is perfect.

``We have a new life,'' she says. ``To think of all that's changed is amazing.''

Fit the treatment to the child

When Laurie Stephens explains the term autism spectrum disorders, she describes not a straight line but a three-dimensional prism.

The sides of the prism are social interaction, language skills and behavior. A child with autism could exhibit any combination of symptoms and fall anywhere on the prism, from the low-functioning end to the high, says Stephens, a director at the Help Group, which runs day schools and clinical programs for children with special needs in Los Angeles.

The individualized nature of autism - a neurological disorder that has increased dramatically in California in the last 15 years - means that no one treatment works for every child. Experts say behavior therapies can improve the child's outcome, especially when started as early as possible.

``There are all different levels of intervention, depending on the specific needs of a child,'' Stephens says.

A child with Asperger's disorder on the high-functioning end of the spectrum might need only one day a week of social skills training vs. five days a week for a child with a more severe case of autism.

While there is consensus on the benefit of early intervention, finding the right medication - assuming one is needed - requires trial and error, says Dr. Sarah Spence of the UCLA Autism Evaluation Clinic. Spence is the lead investigator at UCLA for a national clinical trial for the drug secretin, which has shown promise for a certain subgroup of autistic patients.

``There are a lot of medications used to target specific symptoms,'' Spence says. ``One of the things we're having a hard time with is finding medicine to work on the core symptoms of autism.''

Anti-depressants might be used for obsessive-compulsive behaviors. Stimulants might be used to address inattentiveness. And anti-convulsants might be used as mood stabilizers.

``The way I describe it to parents, we do know the behavior therapies improve outcome,'' Spence says. ``If your child has behaviors that are so disruptive that they can't participate in those therapies, that's the time to consider medication.''

- M.T.

THE SYMPTOMS

According to the Autism Society of America, traits associated with the disorder include insistence on sameness, repetition of words or phrases in place of normal responsive language, aloofness, tantrums, little or no eye contact, no fear of danger and sustained odd play.

CAPTION(S):

6 photos, 2 boxes

Photo:

(1 -- cover -- color) UNLOCKING AUTISM

Early intervention holds promise in treating childhood neurological disorder

Jennifer Elkin and son Jared, 5.

(2 -- 4 -- color) Clockwise from top left: Jennifer Elkin shares a playful moment with son Jared. The 5-year-old, snuggling with the family's pet dachshund and playing on the stairs of his home, attends the Young Learners Therapeutic Preschool in Sherman Oaks, where he receives speech therapy from Kyle Meyerowitz, plus other therapy to help him function more successfully in everyday life.

(5 -- 6) Above, Jason Elkin gives son Jared a kiss after scolding him for unacceptable behavior. His parents say he has made significant strides in his school program, below.

Charlotte Schmid-Maybach/Staff PhotographerBox:

(1) Fit the treatment to the child (see text)

(2) THE SYMPTOMS (see text)