A condition characterized by abnormal functioning in social interaction together with repetitive behaviour and poor communication, almost always commencing before three years of age. One in 2000 children suffer from the disorder, which is four times more common in males. It was first described by Leo Kanner (18941981), an Austrian-born US child psychiatrist, in 1943. Intelligence is very variable in autistic children, and outcome is crucially dependent on the facilities for teaching. In the best facilities, up to 80% of children are eventually able to look after themselves. The cause is unknown. A global research project aiming to determine the genetic causes of autism by studying 6000 DNA samples of affected families began in 2004.
ped/180Autism is classified as a neurodevelopmental disorder that manifests in delays of "social interaction, language as used in social communication, or symbolic or imaginative play," with "onset prior to age 3 years," according to the Diagnostic and Statistical Manual of Mental Disorders. Autism is often not physiologically obvious, in that outward appearance may not indicate a disorder, and diagnosis typically comes from a complete physical and neurological evaluation. Some now speculate that autism is not a single condition but a group of several distinct conditions that manifest in similar ways.
There have been large increases in the reported incidence of autism, for reasons that are heavily debated by researchers in psychology and related fields within the scientific community. The United States Centers for Disease Control (CDC) estimate the prevalence of autism spectrum disorders to be between 2 and 6 per 1000 births (i.e., between 1 in 500 and 1 in 166 births).
Although the specific causes of autism are unknown, many researchers suspect that autism results from genetically mediated vulnerabilities to environmental triggers. While there is disagreement about the magnitude, nature, and mechanisms for such environmental factors, researchers have found a genetic component related to autism. researchers at the University of Pennsylvania School of Medicine, for example, claim to have found a link between autism, abnormal blood vessel function, and oxidative stress (the result of higher levels of free radicals). This suggests that doors may be opened to new medical therapies if researchers can find more evidence linking decreased blood flow to the brain and oxidative stress with the pathology of autism.
With early interventions of intense therapy (most notably Applied Behavioral Analysis), practice, and schooling, some children diagnosed with autism may improve on their skills to the point of neurotypical children. Some autistic children and adults are opposed to attempts to "cure" autism, because they (and/or their guardians) see autism as part of who they are.
History
The word "autism" was first used in the English language by Swiss psychiatrist Eugene Bleuler in a 1912 issue of the American Journal of Insanity.
However, the classification of autism did not occur until 1943 when psychiatrist Dr. Leo Kanner of the Johns Hopkins Hospital in Baltimore reported on 11 child patients with striking behavioral similarities and introduced the label "early infantile autism." He suggested the term "autism" to describe the fact that the children seemed to lack interest in other people.
At the same time, an Austrian scientist named Dr. Hans Asperger made similar observations, although his name has since become attached to a different higher-functioning form of autism known as Asperger's syndrome.
Autism and Asperger's Syndrome are today listed in the DSM-IV-TR as two of the five pervasive developmental disorders (PDD), which are also referred to as autism spectrum disorders (ASD).
When referring to someone who is diagnosed with autism, the term "autistic" is often used. Alternatively, many prefer to use the person-first terminology "person with autism" or "person who experiences autism."
Characteristics
Individuals diagnosed with autism can vary greatly in skills and behaviors, and their sensory system is quite different from that of other people. Certain stimulations, such as sounds, lights, and touch, will often affect someone with autism differently than someone without, and the degree to which the sensory system is affected can vary greatly from one individual to another. On the surface, individuals who have autism are physically indistinguishable from those without. Sometimes autism co-occurs with other disorders, and in those cases outward differences may be apparent. Enlarged brain size appears to accompany autism, but the effects of this are still unknown
In assessing developmental delays, different physicians may not always arrive at the same conclusions. Much of this is due to the somewhat vague diagnostic criteria for autism, paired with an absence of objective diagnostic tests. Nevertheless, professionals within pediatrics, child psychology, behavior analysis, and child development are always looking for early indicators of autism in order to initiate treatment as early as possible for the greatest benefit.
Social development
Typically-developing infants are social beings—early in life they gaze at people, turn toward voices, grasp at fingers, and smile. Even in the first few months of life, many autistic children seem indifferent to other people, lacking the eye contact and interaction with others that non-autistic children are expected to exhibit. Some infants with autism may appear very calm — they may cry less often because they do not seek parental attention or ministration.
Autistic children often seem to prefer being alone and may passively accept such things as hugs and cuddling without reciprocating, or resist attention altogether.
According to Simon Baron-Cohen et al, many autistic children appear to lack a "theory of mind," which is the ability to see things from another person's perspective.
Children with autism often experience social alienation during their school-age years. Making friends in real life and maintaining those friendships often proves to be difficult for those with autism.
Although not universal, it is common for autistics to have difficulty regulating their behavior, resulting in crying, verbal outbursts, or self-injurious behaviors that seem inappropriate or without cause. Those who have autism generally prefer consistent routines and environments, and they may react negatively to changes in their surroundings.
Sensory system
Clinicians making a proper assessment for autism would look for symptoms much like those found in sensory integration dysfunction. Indicators of autism include oversensitivity or underreactivity to touch, movement, sights, or sounds; However, it is essential to remember that while most people with autism have some degree of sensory integration difficulty, not every person who has sensory problems is autistic.
One common example is autistic hearing. However, this is perhaps a part of autism that tends to vary widely from person to person, so these examples may not apply to every autistic person. Note that such auditory difficulties fall under auditory processing disorders, and like sensory integration dysfunction, are not necessarily experienced by all people with autism or indicative of a diagnosis of autism.
Communication difficulties
By age 3, typical children have passed predictable language learning milestones;
Speech development in people with autism takes different paths than the majority of neurotypical children. Contrary to the prevailing traditional stereotype of mute people with Kanner-type autism, around one third of people diagnosed with this type of autism will develop what is often viewed as dysfunctional verbal language, relying on rote learned stored phrases, songs, jingles and advertisements. Those with the autism spectrum condition of Semantic Pragmatic Disorder fall into this group.
Those who do speak sometimes use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Many people with autism have a strong tonal sense, and can often understand at least some spoken language whilst others can understand language fluently.
Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. Just as "neurotypicals" (people without autism) have trouble understanding autistic body languages, vocal tones, or phraseology, people with autism similarly have trouble with such things in people without autism. people without autism often inappropriately attribute hidden meaning to what people with autism say or expect the person with autism to sense such unstated meaning in their own words.
Some people with high-functioning Autism demonstrate advanced cognitive ability, but lack the skills or are not inclined to interact with others socially.
Some infants who later show signs of autism coo and babble during the first few months of life, but stop soon afterwards. Still, inability to speak does not mean that people with autism are unintelligent or unaware.
Sometimes, the body language of people with autism can be difficult for other people to understand. Facial expressions, movements, and gestures may be easily understood by some other people with autism, but do not match those used by other people. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the auditory system of a person without autism often cannot sense the fluctuations.
Since non-autistic people are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let other people know what they need. While waiting for non-autistic people to learn to communicate with them, people with autism do whatever they can to get through to them. Recently, with the awareness that those with autism can have more than one condition a significant percentage of people with autism are being diagnosed with co-morbid mood, anxiety and compulsive disorders which may also contribute to behavioural and functioning challenges.
Repetitive behaviors
Although people with autism usually appear physically normal and have good muscle control, unusual repetitive motions, known as self-stimulation or "stimming," may set them apart.
Effects in education
Children with autism are affected by their symptoms every day, which set them apart from unaffected students. Teachers need to be aware of a student's disorder, and ideally should have specific training in autism education, so that they are able to help the student get the best out of his or her classroom experiences.
Research has shown that working in pairs may be beneficial to autistic children. By facilitating peer interaction, teachers can help their students with autism make friends, which in turn can help them cope with problems.
Students with autism spectrum disorders sometimes have high levels of anxiety and stress, particularly in social environments like school.
DSM definition
Autism is defined in section 299.00 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:
A total of six (or more) items from (1), (2) and (3), with at least two from (1), and one each from (2) and (3): qualitative impairment in social interaction, as manifested by at least two of the following: marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction failure to develop peer relationships appropriate to developmental level a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) lack of social or emotional reciprocity qualitative impairments in communication as manifested by at least one of the following: delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others stereotyped and repetitive use of language or idiosyncratic language lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus apparently inflexible adherence to specific, nonfunctional routines or rituals stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) persistent preoccupation with parts of objects Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: social interaction language as used in social communication symbolic or imaginative play.Types of autism
Autism presents in a wide degree, from those who are nearly dysfunctional and apparently mentally disabled to those whose symptoms are mild or remedied enough to appear unexceptional ("normal") to others. Although not used or accepted by professionals or within the literature, 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).
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 so severe that no speech or writing is possible.
As a consequence, many "high-functioning" autistic persons, and autistic people with a relatively high IQ, are under diagnosed, thus making the claim that "autism implies retardation" self-fulfilling. Many also think that ASD's are being over diagnosed: (1) because the growth in the number and complexity of symptoms associated with autism has increased the chances professionals will erroneously diagnose autism and (2) because the growth in services and therapies for autism has increased the number who falsely qualify for those often free services and therapies.
Asperger's and Kanner's syndrome
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 syndrome is that a diagnosis of the former includes the observation of "delays 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", while a diagnosis of Asperger's syndrome observes "no clinically significant delay" in the latter two of these areas.
Whilst the DSM-IV does not include level of intellectual functioning in the diagnosis, the fact that those with Asperger's syndrome tend to perform better than those with Kanner's autism has produced a popular conception that Asperger's syndrome is synonymous with "higher-functioning autism", or that it is a lesser disorder than autism. The popular depiction of autism in the media has been of relatively severe cases, for example, as seen in the films Rain Man (autistic adult) and Mercury Rising (autistic child), and in turn many relatives of those who have been diagnosed in the autistic spectrum choose 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 known as autistic spectrum disorders. Autism spectrum disorder is an increasingly popular term that refers to a broad definition of autism including the classic form of the disorder as well as closely related conditions such as PDD-NOS and Asperger's syndrome. Although the classic form of autism can be easily distinguished from other forms of autism spectrum disorder, the terms are often used interchangeably. Autism, Asperger's syndrome, and Sensory Integration Dysfunction are all closely related and overlap.
Some people believe that there might be two manifestations of classical autism, regressive autism and early infantile autism. Early infantile autism is present at birth while regressive autism begins before the age of 3 and often around 18 months. Although this causes some controversy over when the neurological differences involved in autism truly begin, some speculate that an environmental influence or toxin triggers the disorder.
A paper published in 2006 concerning the behavioral, cognitive, and genetic bases of autism argues that autism should perhaps not be seen as a single disorder, but rather as a set of distinct symptoms (social difficulties, communicative difficulties and repetitive behaviors) that have their own distinct causes. An implication of this would be that a search for a "cure" for autism is unlikely to succeed if it is not examined as separate, albeit overlapping and commonly co-occurring, disorders.
Epidemiology of autism
Curing autism is a very highly controversial and politicized issue. Some seek a cure for autism - sometimes dubbed by pro-cure. Others do not desire a "cure", because they point out that autism is a way of life rather than a "disease", and as such resist it. Recently, with scientists learning more about autism and possibly coming closer to effective remedies, some members of the "anti-cure" movement sent a letter to the United Nations demanding to be treated as a minority group rather than a group with a mental disability or disease.
There are many resources available for autistic people. In addition, successful autistic adults in a local community will sometimes help children with autism, using their own experience in developing coping strategies and/or interacting with society.
The year 2002 was declared Autism Awareness Year in the United Kingdom—this idea was initiated by Ivan and Charika Corea, parents of an autistic child, Charin. Autism Awareness Year was led by the British Institute of Brain Injured Children, Disabilities Trust, National Autistic Society, Autism London and 800 organizations in the United Kingdom.
Culture
With the recent increases in autism recognition and new approaches to educating and socializing autistics, an autistic culture has begun to develop. Similar to deaf culture, autistic culture is based on a more accepting belief that autism is a unique way of being and not a disorder to be cured. There are some commonalities which are specific to autism in general as a culture, not just "autistic culture".
It is a common misperception that autistic people do not marry; Autistic people are often attracted to other autistic people due to shared interests or obsessions, but more often than not the attraction is due to simple compatibility with personality types, the same as for non-autistics.
It is also a common misperception that autistic people live away from other people, such as in a rural area rather than an urban area;
Parents and relatives of autistic adults strongly fear their loved ones would be unsuspected victims of crime and fraud, and autistic adults are said to end up a target for hate crimes.
In schools it is commonplace for autistics to be singled out by teachers and students as "unruly," though an autistic student may not understand why his or her actions are considered inappropriate, especially when the student has a logical explanation for his or her behavior.
The interests of autistic people and so-called "geeks" or "nerds" can often overlap as autistic people can sometimes become preoccupied with certain subjects, much like the variant normal behavior geeks experience. The connection of autism with so-called geek or nerd behavior has received attention in the popular press, but is still controversial within these groups.
Speculation arises over famous people and celebrities are now suspected, but unconfirmed, of having autism and Asperger's syndrome. They are rumored to have most symptoms of autism or autistic-spectrum disorder.
Autistic adults
Communication and social problems often cause difficulties in many areas of the autistic's life.
A small proportion of autistic adults, usually those with high-functioning autism or Asperger's syndrome, are able to work successfully in mainstream jobs, although frequently far below their actual level of skills and qualification.
It is often said that the Internet, since it is almost devoid of the non-verbal cues that autistics find so hard to interact with, has given some autistic individuals an environment in which they can, and do, communicate and form online communities.
Under the public law, in the United States, the public schools' responsibility for providing services ends when the autistic person is 21 years of age.
However autism can be a poverty trap for adult and young autistics, many of whom are engaged in unskilled jobs for which they are overqualified, or on welfare benefits. Furthermore, autistics who might qualify for financial assistance in one country are not eligible in another, as since some nations do not recognize autism as a disability.
Autism and blindness
The characteristics of a person with both an Autism Spectrum Disorder (ASD) and a severe visual impairment (VI) may vary from a person with just ASD or just VI, and there have been observations of relatively high co-occurrence of the two.
Developmental trajectories of children with ASD-VI are often very similar as those followed by children with typical autism, but the child with ASD-VI will have particularly unusual responses to sensory information.
Autistic savants
The autistic savant phenomenon is sometimes seen in autistic people. Although there is a common association between savants and autism (an association made especially popular by the 1988 film Rain Man), most autistic people are not savants and savantism is not unique to autistic people, though there does seem to be some relation.
Other pervasive developmental disorders
Autism and Asperger's syndrome are just two of the five pervasive developmental disorders (PDDs). Some of these are related to autism, while some of them are entirely separate conditions.
Rett syndrome
Rett syndrome is relatively rare, affecting almost exclusively females, one out of 10,000 to 15,000. Some of these early symptoms may be confused with autism.
Scientists sponsored by the National Institute of Child Health and Human Development have discovered that a mutation in the sequence of a single gene causes Rett syndrome, and can physically test for it with an 80% accuracy rate. Rett syndrome in the past was sometimes classified as an autistic spectrum disorder, however most scientists agree that Rett syndrome is a separate developmental disorder and not part of the autistic spectrum.
Childhood disintegrative disorder
Childhood disintegrative disorder (CDD, and sometimes abbreviated as CHDD also) is a very rare condition appearing in 3 or 4 year old children who have developed normally until age 2. This long period of normal development before regression helps differentiate CDD from Rett syndrome (and in fact it must be differentiated from autism in testing).
Pervasive developmental disorder not otherwise specified
Pervasive developmental disorder not otherwise specified, or PDD-NOS, is referred to as a subthreshold condition because it is a classification which is given to someone who suffers from impairments in social interaction, communication, and/or stereotyped behaviour but does not meet the criteria for one of the other four pervasive developmental disorders.
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