What is Autism?
Adapted from the original by Professor Rendle-Short, Brisbane Children's Hospital, University of Queensland, Australia.
Autism is a developmental disability that typically appears during the first three years of life. Autism spectrum disorders (ASDs) are a broader category that includes autism in all its degrees of severity. Asperger’s disorder or syndrome is also in the ASD group. Altogether, research indicates that about one in 150 individuals has an autism spectrum disorder.
The “What is Autism” booklet generally concerns the disorder of autism, and it discusses the variation in symptoms and severity that are found in the disorder. Autism is three to five times more common in males and occurs in all social and ethnic groups. Family income, lifestyle and education do not affect the chance of occurrence.
Autism interferes with the development of the brain in reasoning, social interaction and communication skills. People with autism typically have deficiencies in verbal and non-verbal communication, social interactions and leisure or play activities. The disorder makes it hard for them to communicate and relate to others. They may resist changes in routine, exhibit repeated body movements (hand flapping, rocking, etc.) and have unusual responses to people or attachments to objects. Sometimes aggressive or self-injurious behavior occurs.
More than 1.5 million people in the U.S. (over 26,000 in South Carolina) have an autism spectrum disorders. Its prevalence rate now places it as one of the three most common developmental disabilities, much more common than Down syndrome. Yet the majority of the public, including some professionals in the medical, educational and vocational fields, are still unaware of how autism affects behavior. Progress is being made in developing more effective teaching methods and other interventions for individuals with autism.
Is there more than one type of autism?
Autism is considered to be a spectrum disorder, meaning that the symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. This is why the term autism spectrum disorders is sometimes used. Although autism is defined by a set of specific behaviors, children and adults can exhibit any combination of them with any degree of severity.
The disorder can be difficult to diagnose because no objective test has been developed so far to identify it. There is no blood test, for example. Accurate diagnosis depends instead on perceptive observations of the child, ideally across several settings (home, school, clinic, etc.), by professionals who have substantial knowledge about autism. Even then, a parent may hear more than one label applied to the child: for example, autistic-like, communication disorder with autistic tendencies or high functioning autism. Different labels may be the result of differences in the professionals’ training, vocabulary and experience with autism.
Some diagnostic criteria may confuse parents. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM, now in its fourth, TR 2000, edition) groups several disorders into the category of pervasive developmental disorders or PDDs. They include autistic disorder, Asperger’s disorder and pervasive developmental disorder-not otherwise specified (PDD-NOS). One professional may tell parents their child has PDD-NOS (or simply PDD) because the child does not appear to meet the criteria for autistic disorder. The parents feel relieved that their child does not have autism. However, a second professional may diagnose the child as having autism or explain PDD-NOS as a type of autism. Similar confusion may occur when the diagnosis is Asperger’s disorder, which generally includes symptoms related to social awkwardness more so than difficulties with communication.
For the most accurate diagnosis, parents are advised to seek out professionals with substantial knowledge about autism who will observe the child in different settings. Then, whatever the exact diagnosis turns out to be, parents need to remember that all children with autism spectrum disorderss are likely to benefit from similar approaches to education and treatment. In other words, the exact name may not make much difference when it comes to the types of intervention likely to help the individual child or adult.
What causes autism?
Medical researchers are exploring different explanations for the various forms of autism, including genetics and environmental factors early in prenatal development. Although no one specific cause of autism is known, current research links autism to biological or neurological differences in the brain. Brain scans indicate abnormalities in the structure of the brain, with significant differences in more than one area.
In some families there appears to be a pattern of autism, although the pattern of actual inheritance is not yet clear. Autistic-like traits may be seen in other family members, as well as problems such as learning disabilities. This further suggests there may be a genetic basis to the disorder, although no one gene has been directly linked to autism.
Several previous theories about the cause of autism have been proven false. Autism is not a mental illness. Children with autism are not unruly kids who choose not to behave. The disorder is not caused by bad parenting; in fact, no psychological factors have been shown to cause autism.
How is autism diagnosed?
There are no medical tests for diagnosing ASD. An accurate diagnosis must be based on observations of the child’s communication, behavior and developmental levels. However, because some of the behaviors associated with autism are shared by other disorders, a doctor may order a variety of medical tests to rule out other causes. For example, a doctor may recommend genetic testing.
Because the characteristics of ASD vary so much, diagnosis may be difficult for a practitioner who has limited training or experience with the disorder. Locating a medical
specialist or diagnostician who has experience with autism is strongly recommended. Ideally a child should be evaluated by a multidisciplinary team which may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant or other professionals who are knowledgeable about autism. Several screening tools have been developed to help professionals make an accurate diagnosis.
They include:
- ADI-R
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Autism Diagnostic Interview-Revised |
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SCQ |
Social Communication Questionnaire | |
ADOS |
Autism Diagnostic Observation Schedule | |
CARS |
Childhood Autism Rating Scale | |
CHAT |
Checklist for Autism in Toddlers
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A brief observation in a single setting cannot present a true picture of an individual’s abilities and behaviors. At first glance, the person with autism may appear to have mental retardation, a behavior disorder or even problems with hearing. It is important to distinguish autism from other conditions, since an accurate diagnosis can provide the basis for building an appropriate and effective educational and treatment program.
What are the symptoms of autism?
Children with autism often appear relatively normal in their development until the age of 18 to 24 months, when their parents notice delays in language, play or social interactions.
The following areas are among those most frequently affected by autism. Degrees of severity can vary significantly from one individual to the next.
- Communication Skills:
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Language develops slowly or not at all; words are used without attaching the usual meaning to them; communicates with gestures instead of words; has short attention span.
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Social Interaction: |
Spends time alone rather than with others; shows little interest in making friends; is less responsive than others to social cues such as eye contact or smiles.
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Sensory Impairment: |
Unusual reactions to physical sensations such as oversensitivity to touch or under-responsiveness to pain; responses to sights, sounds, touch, smells and tastes may be affected to lesser or greater degrees.
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Play: |
Lack of spontaneous or imaginative play; does not imitate the actions of others; doesn’t initiate pretend games.
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Behaviors: |
May be overactive or very passive; has tantrums for no apparent reason; may perseverate on a single item, idea, person, phrase or word; apparent lack of common sense; may display aggressive or violent behavior or injure self.
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There are great differences between individual people with autism. Some mildly affected individuals may exhibit only slight delays in language but have significant challenges with regard to social interactions. They may have average or above average verbal, memory or spatial skills but find it difficult to be imaginative or join in a game of softball with others. More severely affected individuals may need more assistance in handling day to day activities like crossing streets or making simple purchases.
Contrary to popular belief, many children and adults with autism make eye contact, show affection, smile, laugh and express a variety of other emotions, although in degrees that vary from person to person. Like other children, children with autism respond to their environment in positive and negative ways. Autism may affect their range of responses and make it more difficult for them to control how their bodies and minds react. People with autism live normal life spans. Some of the behaviors associated with autism may change or disappear over time, although this will vary from one individual to the next.
It can be difficult to predict which children will become more or less self-sufficient over time, but some adults with autism do live independently and find employment in their communities. Others will depend on the support of family and professionals. Adults with autism can benefit from vocational training, as well as training that will enable them to participate in social and recreational programs. They may live in a variety of residential settings, including living on their own, with family members, in group homes or supervised apartments and in structured residential care.
Individuals with ASD may have other disorders which affect the functioning of the brain, such as epilepsy, mental retardation, or genetic disorders such as Fragile X syndrome. Many individuals with autism have test scores that fall in the range of mental retardation; however, experts question the validity of tests that require communication skills and an understanding of the purpose of the testing that students with autism often lack. Approximately one third of individuals with autism have seizures at some point during their lifetime, with onset frequently occurring during adolescence.
Is there a cure for autism?
Our knowledge about autism has grown tremendously since it was first described in 1943. Some of the early searches for "cures" now seem unrealistic in terms of today’s understanding of brain-based disorders. To cure means "to restore to health, soundness or normality." In the medical sense, there is no cure, as of yet, for the differences in the brain that result in autism.
We are finding better ways to understand autism and help people live with its symptoms. Some symptoms may lessen as the child ages; others may disappear altogether. With appropriate intervention, many behaviors can be made less severe, sometimes to the point that to the untrained observer the individual may not appear to have autism. However, the majority of children and adults with autism will continue to exhibit some degree of symptoms throughout their lives.
What are the most effective approaches to treating autism?
Because of the spectrum nature of autism and the many combinations of behaviors that can occur, there is no single approach that will alleviate all symptoms in every case. Various types of therapies are available, including behavior training, speech/language therapy, sensory integration training, vision therapy, music therapy, auditory training, medications and dietary interventions.
Experience has shown that individuals with autism respond well to a highly structured, specialized education and behavior training program that is tailored to the individual needs of the person. A well designed intervention approach will include some level of communication therapy, social skill development, sensory impairment therapy and behavior training. It will be delivered by professionals who are trained in autism and in a consistent, comprehensive and coordinated manner. The particularly severe challenges of some children may be addressed most effectively by a structured education and behavior program that contains a 1:1 teacher to student ratio or a small group environment.
Students with autism should have training in vocational and community living skills at the earliest possible age. Learning to cross a street safely, make a simple purchase or ask for assistance are critical skills that may be difficult for even those with average intelligence to learn. Tasks that enhance independence, give more opportunity for personal choice or allow more freedom in the community are especially valuable.
To be effective, any approach should be flexible in nature, rely on positive reinforcement, be re-evaluated on a regular basis and provide a smooth transition from home to school to community environments.
A good program will also incorporate training and support systems for the caregivers. Rarely can a family, teacher, or other caregiver provide effective habilitation for a person with autism unless offered consultation or in-service training by a specialist knowledgeable about the disability.
Just a generation ago, the vast majority of people with autism lived at least a part of their lives in institutions. As a result of appropriate and individualized services and programs, today even severely disabled individuals can be taught skills to allow them to develop to their fullest potential.
Individuals with autism usually exhibit at least half of the traits that are listed on below. Symptoms can range from mild to severe, and they will be different from one person to the next. They usually occur across many different situations and are consistently inappropriate for the person’s age. Many traits can be addressed in carefully planned treatment plans.
The following traits are seen in autism. In most individuals, at least half of the traits are exhibited.
- Difficulty mixing with other children
- Insistence on sameness; resists changes in routine
- Inappropriate laughing and giggling
- No real fear of dangers
- Little or no eye contact
- Sustained odd play
- Apparent insensitivity to pain
- Echolalia (repeating words or phrases)
- Prefers to be alone; has an aloof manner
- May not want cuddling or act cuddly
- May spin objects inappropriately
- Not responsive to verbal cues; acts as if deaf
- Inappropriate attachment to objects
- Difficulty in expressing needs; uses gestures or pointing instead of words
- Noticeable physical over activity or extreme under activity
- Displays extreme distress or has tantrums for no apparent reason
- Unresponsive to normal teaching methods
- Uneven gross and fine motor skills (for example, may not want to kick ball but can stack blocks)
- Laughing, crying, showing distress for reasons not apparent to others
- Tantrums beyond what is age appropriate
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