Doctors have a comparatively small role in autism treatment, but they're integral for a diagnosis.

Until a doctor makes a diagnosis, parents grasp for reasons to explain a child's developmental delays and strange behaviors.

Autism is a range of disorders affecting a person's verbal, social and motor skills. How it affects each person varies as well as the amount of deficit in the different areas.

More children are being identified as having an autism spectrum disorder after the definition for autism changed and a study showed the prevalance rate for autism was closer to 1 in 166 children than 1 in 2,500 children, according to the Centers for Disease Control. Locally, parents, educators and doctors want more awareness about the disorder.

Verbal and nonverbal communication skills can include talking and an ability to read facial expression.

"They can't tell by looking at you what to do," Dr. Siriwan Kriengkrairut said. "They can't tell if you're mad."

Kriengkrairut is a child neurologist at St. Alexius Medical Center and treats patients with autism.

When a person cannot read nonverbal communication, they can come across awkward. Compounding that can be abnormal social skills.

Children with autism have trouble using imagination, do not play with other children and have poor eye contact.

On top of that, they can have strange mannerisms because of problems with central motor skills. This can include walking on toes, flapping arms or other repetitive motions.

"They're in their own world," Kriengkrairut said.

The overall deficits determine if a person has a highly-functioning form of autism, like Trisha Johnson's son, Rogan Isbell, or a low-functioning form of autism that prevents a person from talking, interacting with others and being able to perform motor skills like walking.

Most people with autism fall somewhere within this spectrum of functioning, Kriengkrairut said. Those on either end of the spectrum are less common, and those who are highly functioning could have Asperger's syndrome, she said.

Children are usually diagnosed with autism by 3 years, but can be diagnosed as early as 18 months. Early diagnosis is important to curtail the effects of the symptoms.

Red flags for parents should be if a child doesn't babble or point by one year, doesn't say any words by 15 to 16 months and cannot say any two-word combinations by two years. If a parent notices this, they should see their family doctor or pediatrician. The child can then be checked for hearing and other possible causes for the delays.

Autism does not get worse, unless there is an underlying disorder that gets worse over time, Kriengkrairut said.

On the highly-functioning end of autism, people will be able to care for themselves, be independent and lead seemingly normal lives. On the other end of the spectrum is the possibility of 24-hour care in an institution. In the middle is the possibility of group homes and lower-skilled jobs. A person's independence and future employment is dependent on his types of disabilities.

There is no cure for autism, and the medical community does not know the cause of the disorder. Research suggests it is a genetic disorder, Kriengkrairut said. Boys are more likely than girls to be diagnosed with autism.

Parents of the children she treats ask for different treatment options, but there isn't one treatment that seems to be better than another. Some treatments are not as well researched as others, and symptoms vary so much from patient to patient, results can vary, she said.

For parents who might be concerned about their child's developmental delays, the autism screening tool is quick to perform, Kriengkrairut said. A child must match six features on the screening tool to possibly receive an autism diagnosis.

The next person a child sees after the pediatrician is a pediatric neurologist. This person will double check that it is not another problem, like hearing, and check the child's development.

Once a diagnosis is made, Kriengkrairut refers the family to special education services and then any other specialists the child needs. For example, some families need a nutritionist because the child has problems with eating, she said. They also may need speech or occupational therapy.

"The main person to get involved is the school system special services," she said. "If you start early intervention, they do better."

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@;bismarcktribune.com.)