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the child’s second birthday because parents may not notice any developmental impairment until then. To make a diagnosis of autism, doctors usually rely on interviews with the child and parents, careful observation of the child for the characteristic symptoms of the disorder, and a review of the results of the child’s previous physical and neurological examinations. There are no medical tests for diagnosing autism, although doctors may order tests to rule out other disorders. The child may have tests that evaluate his or her brain, such as an electroencephalogram (EEG; see page 687), a CT scan (see page 112), or an MRI (see page 113). Genetic tests are also sometimes done to rule out other disorders.

Treatment

There is no cure for autism and no single treatment is effective for all autistic children, but a combination of early intervention programs, special education, family support, and medication can improve the behavior and functioning of affected children and adults. Educational programs for the affected child stress the development of communication and social skills. To help an autistic child reach his or her full potential, parents and siblings are taught behavior training, how to maintain structure in the home, and how to cope with the stresses and challenges of having an autistic child.

Doctors may prescribe some medications for specific symptoms. For example, drugs used to treat anxiety, depression, and psychosis sometimes have a calming effect on a child with autism. Stimulant drugs used to treat hyperactivity may help reduce the frenzied activity sometimes displayed by autistic children.

Addictions and Abuses

Substance abuse poses a threat to both the user and to society. Drug abuse decreases productivity in school and on the job and impairs judgment, increasing the risk of injury. Substance abuse also raises the risk of illness and death from overdose or from serious medical conditions, such as liver damage and some cancers.

This section covers the abuse of and dependence on alcohol and other drugs—both prescription and illegal. It also discusses the abuse of such substances as common household products used as inhalants, often by grade-school children. Although the nicotine found in tobacco products is also highly addictive, it is discussed in another section (see page 27). While not a true addiction, compulsive gambling is a serious and growing problem in the United States and, for this reason, is included in this section.

Alcohol Abuse and Alcohol Dependence

Alcohol abuse is the most serious and most common form of substance abuse in the United States. Regular social drinking can quickly turn into problem drinking and, even if the drinking causes no difficulties at home or at work, it can seriously harm a person’s health. Alcoholism, also called alcohol dependence, is a chronic (long-term) disease characterized by a strong craving for and physical dependence on alcohol.

Alcohol dependence is not the only type of alcohol problem. Alcohol abuse can be just as damaging. A person who abuses alcohol may not be dependent on it, but may still drink enough to adversely affect his or her health. Binge drinking—defined as having more than five drinks in a row (for males) or four drinks in a row (for females)—engaged in by many college students, is an example of alcohol abuse that can occur with or without dependence.

The risk of developing alcoholism is inherited, but lifestyle factors also play a role. Peer pressure, the ready availability of alcohol, whether your spouse or partner drinks, and your stress level all contribute to your risk for alcoholism. However, having an inherited tendency to become dependent on alcohol doesn’t necessarily mean you will develop a drinking problem. Conversely, not having a family history of alcoholism does not guarantee that you will not develop a problem.

Alcohol abuse and dependence occur in people of every race, gender, and nationality. About 1 in 13 adults—nearly 14 million people nationwide—either abuses alcohol or is dependent on alcohol. Alcohol problems