If you watched this year's Emmy Awards show, you might have noticed the blue puzzle piece that host Conan O'Brien was wearing as a lapel pin.

He wore it to raise awareness of autism, which is a rapidly growing concern across the United States as well as on the North Shore ­ where local service providers have been out front in offering treatment.

According to the Autism Society of America, "Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills."

Parents of children diagnosed with autism often struggle to feel like a real family and may hesitate to pursue outside activities.

For instance, Doug Flutie Jr., son of football star Doug Flutie and his wife, Laurie, was diagnosed with autism at age three.

Lisa Borgess, now executive director of the Doug Flutie Jr. Foundation for Autism, recounts how the Fluties began to discover what was possible for their son from AccesSportAmerica, a national nonprofit based in Acton, Mass., dedicated to higher function and fitness for disabled children and adults through high-challenge sports.

"They were unsure if he could participate. In a matter of minutes Dougie was on a windsurfer! I'll never forget the smile that was on Dougie's face. That opened their eyes to the possibilities. Now they can do things as a family."

Dougie's world continued to expand with therapeutic riding of horses at Andover's Ironstone Farm. Now he's 15, and his parents are making plans for him to experience skiing.

Speculation rages about the potential causes of autism and the seemingly rapid climb in diagnosed cases. According to a 2004 study by the National Institutes of

Health, 1 in 166 American children is diagnosed with autism. The U.S Department of Education's report to Congress on people with disabilities (1999) illustrated that during the 1990s, the number of people reported diagnosed with a recognizable disability increased by 16 percent, while autism diagnoses increased by a staggering 172 percent. Most believe better diagnostic criteria, increased reporting by physicians,and heightened awareness by parents and schools have contributed significantly to the increase.

Peter Raffalli, M.D., F.A.P., an attending physician in child neurology at Children's Hospital, Boston, and an instructor at Harvard Medical School, explains that the single term "autism" is being replaced by several new descriptive terms reflecting more specific clinical observations. This new terminology helps both parents and practitioners to understand the condition and obtain the best care.

"Now the emphasis has been to pick up on it earlier," says Dr. Raffalli. Even though it's difficult to diagnose autism in children less than a year old, "we still begin to look at eye contact in infants," he says. "I examine peer interaction, receptive language, unusual habits, motor mannerisms, or unusual preoccupations that may exclude other interests."

Dr. Raffalli believes that applied behavioral analysis (ABA) is a crucial part of any treatment plan. He also recommends parents try therapeutic horseback riding, which offers many of the benefits of traditional occupational and physical therapies and sensory integration training with the fun of riding.

ABA is the cornerstone of the programs that Melmark New England, a private, not-for-profit organization, will be offering starting this month at its new River Road facility in Andover.

Rita Gardner, executive director at Melmark, explains, "So far the North Shore's rise in children diagnosed with autism is consistent with the national average.... Working with the public school districts demonstrated an overwhelming need for these services."

As awareness about autism grows and the number of diagnosed cases continues to climb, families, school systems, and communities are reaching out for help.

One place they've been turning to is the therapeutic riding program at Ironstone Farm, at 450 Lowell Street in Andover, which began in 1983 and serves 450 individuals weekly with 32 professional staff, 33 horses and over 150 volunteers. "Therapeutic riding helps the children focus and allows them to follow directions," says Deedee O'Brien, executive director at Ironstone. "The riders are calmed by the movement of the horse; it helps them function in an orderly manner."


Here are some useful resources for additional information on autism:

Autism Society of America www.autism-society.org
Center for the Study of Autism www.autism.org
Melmark New England www.melmarkne.org
Ironstone Farm www.challengeunlimited.org
Doug Flutie Jr. Foundation www.dougflutiejrfoundation.org
Autism Speaks www.autismspeaks.org
AccesSportAmerica www.accessportamerica.org