Autism

As of 2004, autism is treatable, but not curable. Early diagnosis and intervention are vital to the future development of the child. It is widely considered that cure is impossible, because autism involves aspects of brain structure that are determined very early in development. However, there are persistent claims that some individuals after diagnosis have been helped to recover. (See references to Karyn Seroussi, and Cheri Florance).

Table of contents

1 History 2 Symptoms 2.1 Social symptoms 2.2 Communication difficulties 2.3 Repetitive behaviors 3 Severity of symptoms 4 "Low" and "High-functioning" 5 Asperger's and Kanner's syndrome 6 Autism as a spectrum disorder 7 Rare autism spectrum disorders 7.4 Rett Syndrome 7.5 Childhood Disintegrative Disorder 8 Increase in diagnoses of autism 9 Remediation of autistic behaviors 10 Aspects of autism 11 Problems that may accompany autism spectrum disorders 11.6 Sensory problems 11.7 Mental retardation 11.8 Seizures 11.9 Fragile X syndrome 11.10 Tuberous Sclerosis 12 Controversies in autism 13 Adults with an autism spectrum disorder 14 See also 15 External links 16 References

History

Not until the middle of the twentieth century was there a name for a disorder that now appears to affect an estimated one of every five hundred children, a disorder that causes disruption in families and unfulfilled lives for many children.

In 1943 Dr. Leo Kanner of the Johns Hopkins Hospital studied a group of 11 children and introduced the label early infantile autism into the English language. At the same time a German scientist, Dr. Hans Asperger, described a milder (or at least different) form of autism that became known as Asperger syndrome.

Thus these two disorders were described and are today listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (fourth edition, text revision 1) as two of the five pervasive developmental disorders (PDD), more often referred to today as autism spectrum disorders (ASD). All these disorders are characterized by varying degrees of difference in communication skills, social interactions, and restricted, repetitive and stereotyped patterns of behavior.

Symptoms

Communication difficulties

By age 3, neurotypical children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is "no."

Speech development in Autism takes a different path developmentally than in neurotypical children. Some autistics remain mute throughout their lives, while being fully literate and able to communicate in other ways -- images, sign language, and typing are far more natural to them. Some infants who later show signs of ASD coo and babble during the first few months of life, but they soon stop. Others may be delayed, developing language as late as the teen years. Still, inability to speak no more means that autistics are unintelligent or unaware than it does in a neurotypical with his or her mouth taped shut. Once given appropriate accommodations, many will happily "talk" for hours, and can often be found in spectrum chat rooms, discussion boards, websites, or even using communication devices at the annual Autreat.

Those who do speak often use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat the same phrase over and over; some repeat what they hear, a condition called echolalia. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many autistics have a strong tonal sense, and can often understand spoken language better if it is sung to them.

Some children may exhibit slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining a conversation neurotypical-style. The "give and take" of NT conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to interact with other autistics, they comfortably do so in "parallel monologue" -- taking turns expressing views and information. Just as neurotypicals are not designed to understand autistic body languages, vocal tones, or phraseology, autistics similarly have trouble with such things in NTs. In particular, autistic language abilities tend to be highly literal; neurotypicals often inappropriately attribute hidden "meaning" to what autistics say or expect the autistic to sense such unstated meaning in their own words.

The body language of autistics is uniquely designed for other autistics, and therefore can be difficult for NTs to understand. Facial expressions, movements, and gestures are appropriate for and easily understood by other autistics, but do not match those used by neurotypicals. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the neurotypical auditory system often cannot sense the fluctuations. What seems to NTs like a high-pitched, sing-song, or flat, robot-like voice is common. Some children with relatively good language skills speak like little adults, rather than falling into the immature "kid-speak" that is common in their neurotypical peers.

With neurotypicals often refusing to learn the autistic body language, and their natural language not tending towards speech, people with ASD often are forced to struggle to let others know what they need. As a result, as anybody would do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for neurotypicals to learn to communicate with them, autistics do whatever they can to get through to them. As people with autism grow up, the accumulation of mistreatment, constant rejection from NTs assuming that differences are something to "cure", and constantly being misunderstood by NTs refusing to help bridge the neurological gap logically causes them to become anxious or depressed.

Repetitive behaviors

Although children with ASD usually appear physically normal and have good muscle control, unusual repetitive motions may set them off from other children. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or walking on their toes. Some suddenly freeze in position.

As children, they might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of the toys, the child may be tremendously upset. ASD children often need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, going to school at a certain time and by the same route—can be extremely disturbing. Perhaps order and sameness lend some stability in a world of confusion.

Repetitive behavior sometimes takes the form of a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Often there is great interest in numbers, symbols, or science topics.

Severity of symptoms

Autism presents in a wide degree, from those who are nearly dysfunctional and apparently mentally retarded to those whose symptoms are mild or remedied enough to appear unexceptional (normal) to the general public - who often refers to the most functional autistics as 'nerds'.

"Low" and "High-functioning"

In terms of both classification and therapy, autistic individuals are often divided into those with an IQ<80 referred to as having "low-functioning autism" (LFA), while those with IQ>80 are referred to as having "high functioning autism" (HFA). Low and high functioning are more generally applied to how well an individual can accomplish activities of daily living, rather than to IQ.

This discrepancy can lead to confusion among service providers who equate IQ with functioning and may refuse to serve high-IQ autistic people who are severely compromised in their ability to perform daily living tasks, or may fail to recognize the intellectual potential of many autistic people who are considered LFA. For example, some professionals refuse to recognize autistics who can speak or write as being autistic at all, because they still think of autism as a communication disorder.

Asperger's and Kanner's syndrome

Of the most common presentations of autism, Kanner's syndrome is often described as classical autism, implying low-functioning, while Asperger's syndrome is described as a high-functioning form of autism, but this is not necessarily the case.

In the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) the most significant difference between Autistic Disorder (Kanner's) and Asperger's Disorder is that a diagnosis of the former includes the observation of "[d]elays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play[,]" [1] while in these areas a diagnosis of Asperger's observes "no clinically significant delay." [1]

The DSM makes no mention of level of intellectual functioning, but the fact that Asperger's autistics as a group tend to perform better than those with Autistic Disorder has fed the popular conception that Asperger's Syndrome is synonymous with HFA, or that it is a lesser disorder than autism. There is also a popular but untrue conception that all autistic individuals with a high level of intellectual functioning have Asperger's autism; or that both types are merely geeks with a medical label attached.

Autism has evolved in the public understanding, but the popular identification of autism with relatively severe cases as accurately presented in Rain Man is an encouragement for relatives of family members diagnosed in the autistic spectrum to speak of their loved ones as having Asperger's syndrome rather than autism.

Autism as a spectrum disorder

Another view of these disorders is that they are on a continuum, so can be known as autistic spectrum disorders. Another related continuum is Sensory Integration Dysfunction which is about how well we integrate the information we receive from our senses. Autism, Asperger's Syndrome, and Sensory Integration Dysfunction are all closely related and overlap.

Some high-achieving individuals are thought to have had some form of autism. However, this may be favoured diagnosis due to the high current visibility of autism in the popular press. In the 1980s, such individuals were often characterised as dyslexic or dysmetric; other popular diagnoses for famous achievers have included bipolar disorder (manic depressive), schizophrenia or in one lamentable case, Tourette syndrome (Mozart was supposed to have it because of his reported fondness for scatological humor). However, it is true that autistic people may have other learning disabilities such as dyslexia.

There are two main types of autism, regressive autism and early infantile autism. Early infantile autism is present at birth while regressive autism begins at approximately 18 months. There are also cases of children developing abnormally from birth but regressing around the age of 18 months, causing some degree of controversy as to when the neurological difference involved in autism truly began.

Rare autism spectrum disorders

Childhood Disintegrative Disorder

Very few children who have an autism spectrum disorder (ASD) diagnosis meet the criteria for childhood disintegrative disorder (CDD). An estimate based on four surveys of ASD found fewer than two children per 100,000 with ASD could be classified as having CDD. This suggests that CDD is a very rare form of ASD. It has a strong male preponderance.** Symptoms may appear by age 2, but the average age of onset is between 3 and 4 years. Until this time, the child has age-appropriate skills in communication and social relationships. The long period of normal development before regression helps differentiate CDD from Rett syndrome.

\n*Rett syndrome. NIH Publication No. 01-4960. Rockville, MD: National Institute of Child Health and Human Development, 2001. Available at [1]

**Frombonne E. Prevalence of childhood disintegrative disorder. Autism, 2002; 6(2): 149-157.

***Volkmar RM and Rutter M. Childhood disintegrative disorder: Results of the DSM-IV autism field trial. Journal of the American Academy of Child and Adolescent Psychiatry, 1995; 34: 1092-1095.

Increase in diagnoses of autism

There has been an explosion worldwide in reported cases of autism over the last ten years. There has been considerable speculation as to why this might be, with no conclusive proof emerging around any theory. However, studies have ruled out the speculation that the rise is [entirely] attributable to an improvement in diagnostic methods.

In the last decade, the population of the United States has increased by 13%. There has been an increase in non-autism-related disabilities of 16%. The increase in autism is 173%.

In 2001, Wired Magazine published an interesting speculative article The Geek Syndrome exploring the surge in apparent autism in Silicon Valley. This is only one example of the media's application of mental disease labels to what is actually variant normal behavior. Shyness, lack of athletic ability or social skills, and intellectual interests, even when they seem unusual to others, are not in themselves signs of autism or Asperger's syndrome.

Remediation of autistic behaviors

Remediation of debilitating aspects of autism was long hindered not only by widespread disagreement over its nature and causes, but by lack of a recognized and effective course of therapy.

Dr. Bruno Bettelheim believed that autism was linked to trauma in early childhood, and his work was highly influential for decades. Parents, and especially mothers, of autistics were blamed for having caused their child's condition through the withholding of affection. Leo Kanner, who first described autism (Autistic disturbances of affective contact, 1943) originated the concept of "refrigerator mothers" in regard to autism, although he eventually renounced the concept and apologized publicly. Bettelheim took the theory further. These theories did nothing to address the fact that having more than one autistic child in a family is exceptional, not the rule. Treatments based on these theories failed to help autistic children.

A major breakthrough in the remediation of autistic behaviors came through work spearheaded by Ole Ivar Lovaas, who believed that success could be obtained by behavioral approaches.

Lovaas' approaches—often referred to as Discrete Trial, Intensive Behavior Intervention, and Applied Behavior Analysis—are some of the best known and most widely used in the field and focus on the development of attention, imitation, receptive or expressive language, and pre-academic and self-help skills. Using a one-to-one therapist-child ratio and the “antecedent-behavior-consequence” (ABC) model, interventions based on this work involve trials or tasks. Each consists of (a) an antecedent, which is a directive or request for the child to perform an action; (b) a behavior, or response from the child, which may be categorized as successful performance, noncompliance, or no response; and (c) a consequence, defined as the reaction from the therapist, which ranges from strong positive reinforcement to a strong negative response, “No!”(Autism Society of America, 2001).[1]

The scientific validity of Lovaas's methods is questioned by their proponents. Nevertheless, some believe that ethical reasons exist for applying Lovaas's techniques.

ABA may not be appropriate for every autistic or developmentally delayed child. ABA has come into widespread use only in the last decade and the demand is outstripping the supply of committed and experienced service providers. As a result, parents of children need to be extra vigilant in choosing appropriate treatments for their children and especially in choosing providers, who may be inexperienced, use questionable methods or even deceive parents that they are competent to run an ABA or any other program. Such problems have led to horror stories from some parents. [1] [1]. See also .

Aspects of autism

Some things to mention here:

• the autistic savant phenomenon occasionally seen in people with autism

• Simon Baron-Cohen's team at the Autism Research Centre in Cambridge, UK, measured testosterone levels in the amniotic fluid of mothers while pregnant. This is presumed to reflect levels in the babies themselves. The team found that the babies with higher fetal testosterone levels had a smaller vocabulary and made eye contact less often when they were a year old.
  • His group has looked at the original 58 children again, at age four. The researchers found that the children with higher testosterone in the womb are less developed socially, and the interests of boys are more restricted than girls. The results will be published in the Journal of Child Psychology and Psychiatry (2004).
  • Baron-Cohen theorizes that high fetal testosterone levels push brain development towards an improved ability to see patterns and analyse systems. Males supposedly tend to be better at these tasks than females. But the high levels are thought to inhibit the development of communication and empathy, which are allegedly typical female skills.(New Scientist, 24 May 2003). There is still no demonstrable evidence that testosterone levels affect brain development at all, let alone autism. Gender or bio-determinism is a fashionable explanation for many human behaviours, but has been challenged by other professionals.

• there was some research by Andrew Wakefield in the UK, published in The Lancet in February 1998, suggesting a possible link between autism and the MMR vaccine. This was very controversial. Subsequent studies failed to confirm the link, and some in fact showed a lack of such a link. The original research has come under criticism, largely due to a conflict of interest on Wakefield's part. In February 2004 The Lancet described the research as "entirely flawed" and said that it should never have been published. Controversy continues, with Wakefield defending his integrity.

• research in the US suggesting a similar link between autism and DPT vaccine.

• the analysis of autism as "mind blindness"—the inability to create models of other people's thoughts. the typical example of this is "where does X look for the object they stored, but which was moved by Y"—see theory of mind

• Dr. Bernard Rimland's influential research and his book Infantile Autism (1967) which argued that autism was not caused by childhood trauma or abuse, but by damage to certain areas of the brain, particularly the reticular formation which associates present sensory input with memories of past experiences. Dr. Rimland is a foremost advocate of the theory that autism may be precipitated by mercury/heavy metal toxicity.[1] He also is prominent in increasingly common claims of successful treatment of autism in children with the Source | Copyright

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