Autism is a complex pervasive developmental disorder that involves the functioning of the brain. It is a neurologicaldisorder and not simply a psychiatric disorder, even though typical characteristics include problems with social relationships and emotional communication, as well as stereotyped patterns of interests, activities and behaviors. It also involves problems with sensory integration. Typically, it appears during the first three years of life. It is estimated that it occurs in approximately 2 to 6 in 1,000 individuals, and is 4 times more prevalent in males than females (source: The Autism Society of America [1]). It is most prevalent in Caucasian males.
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).
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.
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.
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.
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.
**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.
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.
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]
Lovaas' Applied Behavioral Analysis (ABA) methods were the first scientifically validated therapy for autism. Early intervention, generally before school-age, is critical for children who would benefit from these programs.
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 .
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 Related categories
