Autism

Autism, which was first described in 1943 by Dr. Leo Kanner, is a neurological disorder that affects the functioning of the brain in the areas of social interaction and communication skills. It generally appears during the first three years of life and has been estimated to occur in 1 out of 68 individuals (as reported by the Center for Disease Control and Prevention). Autism is four times more prevalent in boys than girls (boys occurring at a rate of 1:54). Autism occurs in all socioeconomic groups and was once considered a rare disorder. Autism is now the second most common developmental disability in the U.S. It is estimated that over 1.5 million individuals have some form of autism in the United States.

Autism is a spectrum disorder in that it can present itself in a variety of combinations, from mild to severe. Children can exhibit any combination of behaviors in any degree of severity; two children with autism can act very differently from one another. It is also considered a pervasive developmental disorder because of its wide-ranging impact on the individual.

Medical researchers are looking into what causes autism and although there is no known unique cause, researchers have found that it is due to biological or neurological differences in the brain. MRI and PET scans have revealed structural abnormalities in the brain, with significant differences within the cerebellum. What has been confirmed, however, is that autism is not the result of bad parenting and is not caused by psychological factors in the development of the child.

In the recent past, a diagnosis of Asperger Syndrome (AS) was used to identify some individuals, however, changes to the DSM-V (the diagnostic manual) has eliminated this as a disability.  It is a neurobiological disorder characterized by a specific pattern of behaviors and deficiencies in social and communication skills. AS was first described in 1944 by a Viennese pediatrician, Hans Asperger, and was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) in 1994 but in 2013, the DSM-V placed this categorization under Autism Spectrum Disorder.

What to Expect

Some adults with autism live and work independently in the community, while others depend on the support of family members and professionals. They can live in a variety of settings such as independent apartments, group homes, supervised apartment settings, family members’ homes, or more structured residential care. There is no cure for autism, however, with appropriate intervention, many of the behaviors can be positively changed and in some cases, the individual can appear to no longer have autism. The majority of individuals, however, will continue to have symptoms of autism to some degree throughout their entire lives.

Since autism is a spectrum disorder, no single approach is effective in alleviating all symptoms in all cases. But, approaches should be flexible and should rely on positive reinforcement. Children may receive any of the following therapies: behavior modification, speech-language therapy, sensory integration therapy, vision therapy, music therapy, and auditory training.

Features and Characteristics of Autism
    • In infancy, arching of back to avoid physical contact and becoming limp when being picked up;
    • Usually described as either a passive baby (requires little attention from parents) or an overly agitated baby (non-stop crying during wake hours);
    • Difficulties in verbal and nonverbal communications – slow (or no) language development, use of words inappropriately, communication with gestures rather than words, short attention spans;
    • Difficulties in social interactions or play activities – spends time alone rather than with others, shows little interest in making friends, minimum eye contact with others;
    • Sensory impairment – oversensitive to touch or under-sensitive to pain;
    • Atypical play activities – lack of imaginative play, does not imitate others’ actions, does not initiate pretend games;
    • Unusual behaviors – Repeated body movements (hand flapping, rocking), aggressive and/or self injurious behavior, lack of common sense, frequent tantrums for no apparent reason, insistence on sameness (routines)
    • Brain abnormalities

 

Following is a list of characteristics commonly seen in individuals with Autism Spectrum Disorder:
    • Difficulty with social skills
    • Inability to develop peer relationships
    • Socially and emotionally inappropriate responses (they tend to misread social situations)
    • Unaware of others’ feelings
    • Difficulty with transitions or change
    • Obsessiveness with routines
    • Repetitive motor mannerisms
    • Areas of special interest, particularly in intellectual areas (math, science, reading) or parts of objects
    • Tendency to rock, fidget, or pace
    • Difficulty with nonverbal communication (limited use of gestures, clumsy body language, inappropriate facial expressions, stiff gaze)
    • Sensitivity to sights, tastes, sounds, or smells
    • Unusually accurate memory for details
    • Preoccupation with their own agenda (in their “own world”)
    • Normal to superior intellectual abilities
    • Difficulty understanding what they’ve heard or read
    • Formal manner of speaking
    • Talks at length about a subject or repeats a word or phrase many times
    • Unusually loud or monotonous voice
    • Physically awkward, clumsy and uncoordinated motor movements
    • Sleeping or eating problems

 

Diagnosis

There is no medical test available for autism. Instead, professionals use the Diagnostic and Statistical Manual of Mental Disorders to confirm or rule out the diagnosis. The diagnosis is made based on the observation of the child’s behavior, communication, and developmental levels. Professionals use several different types of diagnostic tools to make an accurate diagnosis of autism such as the Checklist for Autism in Toddlers (CHAT), Childhood Autism Rating Scale (CARS), Parent Interviews for Autism (PIA), Gilliam Autism Rating Scale (GARS), and the Behavior Rating Instrument for Autistic and other Atypical Children (BRIAC).

Children may be given a diagnosis of any of the following: autistic-like, learning disabled with autistic tendencies, high functioning autism, or low functioning autism. These different labels are merely the result of the professionals’ training, vocabulary, and exposure to autism.

The behaviors mentioned in the DSM IV must cause a significant interference in the individual’s social abilities or other areas of functioning. In addition, there must be no significant delay in cognitive abilities, self-help skills, interest in the environment, or overall language development. A diagnosis can typically be made between ages 3 and 5 years.

What to Expect

Individuals with AS can have symptoms ranging from mild to severe. Although the problems and symptoms seen in individuals with AS change over time, AS is not a disorder that can be “outgrown.” Problems are often first noted when the child enters preschool. There may be the tendency to avoid social interaction, problems with sustaining conversation, repetitiveness when conversing, odd verbal responses, preference for a routine, difficulty with social/emotional responses, hyperactivity, aggression, appearance of being in their own world, and the tendency to focus on objects.

When the child is ready for kindergarten, it is likely that he or she will be in a mainstreamed educational setting. The child may be thought of by others as odd or unusual. For the child with severe problems, a special education setting may be recommended. For most, academic progress is quite good in the elementary years. The child may begin to show an interest in developing relationships, however, their skills in making and keeping friends are typically weak.

As the child moves into middle school and high school, the problems continue to exist in socialization and behavioral adjustment. At this age, and because most children with AS are in mainstreamed educational settings, they are often misunderstood by teachers or other students. They may be mistreated, left out, and teased by their peers. Outbursts and lack of cooperation are often seen in the child with AS due to the desire, but inability, to fit in; depression is not uncommon. Academic performance usually continues to be strong. This can benefit the child, as in high school, they may be accepted and develop friendships with certain groups.

As the child enters adulthood, it is likely that he or she will function independently. It is common for adults to find a career that fits their special interest. Many individuals with AS do marry, however, the social and emotional aspects of the relationship can be particularly challenging. Adults with AS also sometimes experience depression and anxiety.