His mom, Michelle Berens, watches from a distance. She would like to sit on the floor with him, as she once did with her two older children, Adam, 14, and Amanda, 9. But Caden has a form of Autism Spectrum Disorder, which inhibits his ability to interact with others.
Having a child with ASD means "having to love someone unconditionally, when they are unable to establish an emotional bond with you in return," she said.
Autism is a misunderstood condition. First identified in 1943, autism was once blamed on poor parenting. Research has since shown that autism is a group of mild to severe social and developmental disorders. A child with this diagnosis is said to have Autism Spectrum Disorder.
A 1998 study in England suggested a link between ASD and immunizations, but a second study disproved the connection.
Two national surveys indicate that by 2004, 300,000 school-aged children were diagnosed with autism. Boys are four times more likely to be diagnosed with ASD than girls. The disorder is increasing at a rate of 10 to 17 percent a year, making it the fastest-growing developmental disability in the United States. (Bills have been introduced in the U.S. House and Senate to increase funding for research, screening, treatment and education; both are stalled in committees.)
ASD is a lifelong condition with no known cure; early aggressive education and therapy can help children develop interpersonal skills.
The U.S. Centers for Disease Control and Prevention recently started a $5.9 million study to find risk factors of autism. This study, one of several on autism the CDC funds, will follow some 2,700 children ages 2 to 5, and their parents.
"We hope this national study will help us learn more about the characteristics of children with ASDs, factors associated with developmental delays and how genes and the environment may affect child development," Dr. Jose F. Cordero, assistant surgeon general and director of CDC's National Center on Birth Defects and Developmental Disabilities, said in a CDC statement.
Researchers will collect information on infections, genetic factors and abnormal hormone function for each child and his or her parents and a host of other factors, using interviews, medical records, exams, cheek swabs, hair and blood sampling.
Berens knew Caden had a problem nearly a year ago and shared her concerns with Caden's pediatrician.
"I have two older kids," she says. "When Caden was not reaching his milestones - making eye contact, using his imagination - when he wasn't even talking at 2, that's when the red flags started going up."
Other signs included a need to repeatedly run between a door and wall, touching each. He had frequent temper tantrums, the kind that exasperated his mom and caused his older brother and sister to retreat to their rooms.
In February, Caden was diagnosed with ASD.
Now, his mom carries small cards for times when a quick trip to the store is interrupted by a tantrum. She hands the card to those glaring at her. It offers an apology for the disruption and a brief explanation about ASD. But Berens would rather talk about ASD before there's a tantrum.
"It's not mental retardation. It's not mental illness," Berens says. "Basically, my son is not physically handicapped."
She compares the way his brain processes sensations as a busy highway with periodic, severe traffic jams.
If he's overexposed to such things as light, noise, smells or visual patterns, "he gets very irritable and hard to please," she says, adding that some children with ASD might act out in violent ways, banging their heads or lashing out.
For Berens, daily life consists of putting together puzzle pieces of activity; educating herself, getting Caden to occupational and physical therapy and "anticipating his needs before he needs them," to minimize outbursts, she says, while finding ways to be a mom to her two older children.
She is hopeful researchers will learn what causes ASD so it can be prevented in others. She hopes to see more advanced therapy become affordable.
For now, she find pleasure in moments much simpler than a birthday party or visit to Santa Claus.
"This morning I started singing 'Hokey Pokey,' and he actually clapped his hands at the right part," Berens says. She stopped to praise him.
"By my getting more excited than I would have if one of my other kids had (done the same), that's an interaction. It's me and Caden singing a song and him clapping...we are playing together."
Symptoms of autism spectrum disorder
No two people with autism spectrum disorder (ASD) have the same symptoms, according to the National Center on Birth Defects and Developmental Disabilities. ASD is difficult to diagnose as a result.
Symptoms can include the inability to develop social skills from eye-to-eye contact and understand feelings. Nearly half (40 percent) of children with ASD do not talk at all or simply repeat what is said to them. Routine is very important to people with ASD; they may repeat certain movements. Children with ASD may develop motor skills on schedule but not speak. A child can learn to read a complex word, but be unable to pronounce an individual letter of the alphabet.
Any of these traits might be mild in one person and severe in another.
- National Center on Birth Defects and Developmental Disabilities