Can You Explain What Autism is?

Q: My cousin was just diagnosed with Autism. Can you explain what that is?

A: Autism is a group of developmental brain disorders, collectively called Autism Spectrum Disorder (ASD). Autism, being a spectrum disorder, means that the symptoms and characteristics of autism can present themselves in a wide variety (spectrum) of combinations, from mild to severe. Although autism is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Two children, both with the same diagnosis, can act very differently from one another and have varying skills.

Autism typically appears during the first three years of life and is the result of a neurological disorder that affects the functioning of the brain. Autism Spectrum Disorder is one of the most common developmental disabilities. It is estimated that approximately 1 in 100 children have ASD and that boys have a four to five times higher risk of developing it than girls.

There is no typical or standard type of person with autism. Parents may hear different terms used to describe children within this spectrum such as, autistic tendencies, autism spectrum, high-functioning or low-functioning autism, more able or less-able. Whatever the diagnosis, children can learn and function productively and show gains from appropriate education and treatment.

People with autism typically have difficulties communicating with others and relating to the outside world in daily activities. In some cases, aggressive behavior or self injury may be present. Persons with autism may exhibit repeated body movements like hand flapping or body rocking, unusual responses to people, attachments to objects and resistance to changes in routines. Individuals may also experience sensitivities in sight, hearing, touch, smell, and taste and may respond unusually when others show anger, distress, or affection.

Children with ASD appear to be drawn to repetitive movements linked to a sound, such as hand-clapping. Children with ASD may misread or not notice subtle social cues like a smile, a wink, or a frown that could help them understand what a person is thinking and responding to an interaction. Questions like "Can you hold on a minute” are taken literally.

Facial expressions, movements, and gestures children with ASD are often vague or do not match what they are saying. Their tone of voice may not reflect their actual feelings either and may talk monotone like a robot. They may also have trouble understanding another person's point of view or feelings and may not understand or predict another person's actions. Due to the difficulty understanding and reacting to social cues, children will often talk or long periods about a favorite subject and not allow others a chance to talk.

Autism Spectrum Disorder Includes Five Disorders

(sometimes called Pervasive Developmental Disorders -PDDs) It is diagnosed according to guidelines listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed. (DSM-IV-TR). The five disorders are:

1.       Autistic Disorder: refers to impairments in social interaction, communication, imaginative play prior to age 3 and repetitive type behaviors, interests and activities. Autistic Disorder occurs four times more frequently in boys than girls and is characterized in some children by withdrawn behavior. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities. Autism is one of five Pervasive Developmental Disorders (PDD) characterized by “severe and pervasive impairment in several areas of development."

2.       Asperger's Disorder: People with Asperger syndrome have autism-like problems in areas of social interaction and communication, but have normal intelligence and verbal skills.  Asperger syndrome is usually thought to be the mildest of the autism spectrum disorders. Many experts view Asperger's Disorder as high-functioning autism.   Impairments in social interactions and the presence of restricted interests and activities but with no clinically significant delay in language, curiosity about their environment or cognitive development and tend to have average to above average intelligence. People with this syndrome have difficulty interacting socially, repeat behaviors, and often are clumsy. People with Asperger do not withdraw from the world in the way that people with autism do. They will often approach other people, however, their problems with speech and language in a social setting often lead to isolation.

3.       Pervasive Development Disorder- Not Otherwise Specified (PDD-NOS) is commonly referred to as atypical autism and is diagnosed when a child does not meet the criteria for a specific diagnosis, but there is a severe impairment in specified behaviors.

4.       Rett's Disorder is a progressive disorder which, so far, occurs almost exclusively in girls and may be misdiagnosed as autism or cerebral palsy. They tend to have a period of normal development until between 5-18 months and then there is loss of previously acquired skills, loss of purposeful use of the hands replaced with repetitive hand movements.

Studies have linked many Rett syndrome cases to a defect in a gene on the X chromosome. Females have two X chromosomes, so even when one has this significant defect, the other X chromosome is normal enough for the child to survive. Males born with this defective gene do not have a second X chromosome to make up for the problem and therefore males affected with this usually do not survive birth.

5.       Childhood Disintegrative Disorder (CDD) is characterized by normal development for at least the first 2 years, followed by significant loss of previously acquired skills.

Rett Syndrome and Childhood Disintegrative Disorder (CDD) are two very rare forms of ASD that include a regression in development. Only 1 of every 10,000 to 22,000 girls has Rett syndrome.  Even rarer, only 1 or 2 out of 100,000 children with Autism Spectrum Disorder have Childhood Disintegrative Disorder.

What causes Autism Spectrum Disorder ASD?

Scientists don't know the exact causes of Autism Spectrum Disorder (ASD), but research suggests that both genes and environment play important roles. Most people who develop ASD have no reported family history of autism, suggesting that random, rare, and possibly several gene mutations are likely to affect a person's risk.

Symptoms of Autism Spectrum Disorder (ASD) varies from one child to the next, but in general, they fall into these areas:

·         Social interaction impairment: spends time alone rather than with others; shows little interest in making friends; less responsive to social cues such as eye contact or smiles;

o   Does not make friends

o   Does not play interactive games

o   Is withdrawn and Prefers solitary or ritualistic play

o   May not respond to eye contact or smiles, or may avoid eye contact

o   May treat others as if they are objects

o   Prefers to spend time alone, rather than with others

o   Display a lack of empathy

o   Display little pretend or imaginative play

·         Communication difficulties: Language develops slowly or not at all; uses words without attaching the usual meaning to them; communicates with gestures instead of words; has short attention span

o   Cannot start or maintain a social conversation

o   Communicates with gestures instead of words

o   Develops language slowly or not at all

o   Does not adjust gaze to look at objects that others are looking at

o   Does not refer to self correctly (for example, says "you want water" when the child means "I want water")

o   Repeats words or memorized passages, such as commercials

o   Uses nonsense rhyming

·         Repetitive “Stereotyped” behaviors. Children with Autism Spectrum Disorder often have repetitive motions or unusual behaviors which can be extreme and very noticeable, or they can be mild and subtle.

o   Some children may repeatedly flap their arms or walk in specific patterns, or may subtly move their fingers by their eyes in what looks to be a gesture.

o   Children with Autism Spectrum Disorder often do best with routines for their daily activities but a slight change in a specific routine can be extremely upsetting.

Other Common Symptoms:
Sensory Impairments:  May either overreact or under react to certain sights, sounds, smells, textures, and tastes.

·         Do not startle at loud noises

·         May find normal noises painful and hold hands over ears

·         May withdraw from physical contact because it is overstimulating or overwhelming

·         Dislikes or shows discomfort from a light touch or the feel of clothes on their skin

·         Rubs surfaces, mouths or licks objects

·         Seems to have a heightened or low response to pain

·         Use peripheral vision rather than looking directly at someone

·         Closeness of others may be painful resulting in withdrawal even from family members

·         Anxiety, fear and confusion may result from being unable to make sense of the world

Behaviors:

·         May be overactive or very passive

·         Throw tantrums for no apparent reason

·         Show an obsessive interest in a single item, idea, activity or person

·         May show aggression to others or self

·         Often have difficulty with changes in routine.

·         Tend to have overly focused interests on moving objects or spend hours lining up toys but not actually play with them and then become very upset if someone accidentally moves one. Repetitive behavior can also take the form of a persistent, intense preoccupation with learning all about things such as train schedules or particular objects like red cars. Children with ASD often have great interest in numbers, symbols, or science topics

·         Have unusual distress when routines are changed

·         Gets stuck on a single topic or task (perseveration)

·         Has a short attention span

·         Has very narrow interests

·         Shows a strong need for sameness

Sleep problems

Children with Autism Spectrum Disorder tend to have problems falling asleep or staying asleep, or have other sleep problems. These problems make it harder for them to pay attention, reduce their ability to function, and lead to poor behavior. In addition, parents of children with Autism Spectrum Disorder and sleep problems tend to report greater family stress and poorer overall health among themselves.

Intellectual disability

Many children with Autism Spectrum Disorder have some degree of intellectual disability. When tested, some areas of ability may be normal, while others, especially cognitive (thinking) and language abilities may be relatively weak. Children with a form of Autism Spectrum Disorder like Asperger syndrome often have average or above-average language skills and do not show delays in cognitive ability or speech.

Seizures

One in four children with Autism Spectrum Disorder has seizures, often starting either in early childhood or during the teen years. Seizures are caused by abnormal electrical activity in the brain and can result in a short loss of consciousness or a blackout or convulsions with uncontrollable shaking of the whole body, or unusual movements and some children experience periods of staring.

Strengths Exhibited by Individuals with Autism

Although some areas of development in a child with autism are delayed, children with Autism Spectrum Disorder (ASD) often exhibit skills beyond their years in other areas. These intellectual strengths may overshadow the developmental problems experienced by your child. These strengths may include one or more of the following:

·         Non-verbal reasoning skills

·         Reading skills

·         Perceptual motor skills

·         Drawing skills

·         Computer interest and skills

·         Exceptional memory

·         Visual Spatial abilities

·         Music skills

Understanding Teens with Autism Spectrum Disorder

The teen years can be a time of stress and confusion for any growing child, including teenagers with autism spectrum disorder (ASD).

During the teenage years, adolescents become more aware of other people and their relationships with them. While most teenagers are concerned with acne, popularity, grades, and dates, teens with ASD may become painfully aware that they are different from their peers. For some, this awareness may encourage them to learn new behaviors and try to improve their social skills. For others, hurt feelings and problems connecting with others may lead to depression, anxiety, or other mental disorders. One way that some teens with ASD may express the tension and confusion that can occur during adolescence is through increased autistic or aggressive behavior. Teens with ASD will also need support to help them understand the physical changes and sexual maturation they experience during adolescence.

How is Autism diagnosed?
There are no medical tests for diagnosing autism. An accurate diagnosis must be based on observation of the individual's communication, behavior, and developmental levels. Because many of the behaviors associated with Autism are shared by other disorders, various medical tests may be ordered to rule out or identify other possible causes of the symptoms.

How is Autism Spectrum Disorder treated?

While there's no proven cure yet for autism spectrum disorder (ASD), treating ASD early, using school-based programs, and getting proper medical care can greatly reduce ASD symptoms and increase your child's ability to grow and learn new skills. The disorder is treated by working to change the symptoms of Autism to help to improve the person's ability to communicate and cope with the symptoms and deal with the repetitive behaviors

Early intervention

Whether your child has been diagnosed with PDD-NOS or Autism, the treatment strategies are the same. Early intervention is the key to success, no matter what the diagnosis. Research has shown that intensive behavioral therapy during the toddler or preschool years can significantly improve cognitive and language skills in young children with ASD

Treatment

Treatment is most successful when it is geared toward the child's particular needs. An experienced specialist or team should design the program for the individual child. A variety of therapies are available, including:

·         Applied behavior analysis (ABA) to shape and reinforce new behaviors as well as reduce undesirable ones.

·         Medications

·         Occupational therapy

·         Physical therapy

·         Speech-language therapy

·         Social skills training to improve skills of social interactions and avoiding negative responses.