Autism

Autism is a brain disorder that affects a person's ability to communicate, form relationships with others, and respond appropriately to the external world. People with the condition often exhibit repetitive behavior or narrow, obsessive interests. Other characteristics of autism include problems with verbal and nonverbal communication and social interaction. Scientists aren't certain what causes the disorder, but it's likely that both genetics and environment play a role.

Autism varies widely in its severity and symptoms. Because of this, early signs may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicap

Autism Symptoms

Distinctive autism signs and symptoms include difficulties with social interaction, problems with communication, and repetitive behaviors. A baby with symptoms may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. Symptoms may include engaging in repetitive movements, such as rocking and twirling, or in self-abusive behavior, such as biting or head-banging.

There are three distinctive symptoms of autism:

• Difficulties with social interaction
• Problems with verbal and nonverbal communication
• Repetitive behaviors or narrow, obsessive interests.

Autistic children can also develop symptoms that include reduced sensitivity to pain but increased sensitivity to sound, touch, or other sensory stimulation. Symptoms can range from mild to disabling.

Symptoms of Autism: Social Interaction

The hallmark symptom of autism is impaired social interaction. Parents are usually the first to notice possibly symptoms in their child.

As early as infancy, a baby with autism symptoms may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time.

A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.

Autism Symptoms: Verbal and Nonverbal Communication

The second most common symptom of autism is problems with verbal and nonverbal communication.

Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can't understand social cues, such as tone of voice or facial expressions, and don't watch other people's faces for clues about appropriate behavior. They lack empathy.

Autism Symptoms: Repetitive Behaviors or Narrow, Obsessive Interests

Many children with symptoms of autism engage in repetitive movements, such as rocking and twirling, or in self-abusive behavior, such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of "I" or "me."

Children with autism don't know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Autism Symptoms: Sensitivity

Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms, such as a resistance to being cuddled or hugged.

Symptoms of Autism and Other Medical Conditions

Children with autism symptoms appear to have a higher-than-normal risk for certain coexisting conditions, including:

• Fragile X syndrome (which causes mental retardation)
• Tuberous sclerosis (in which tumors grow on the brain)
• Epileptic seizures
• Tourette syndrome
• Learning disabilities
• Attention deficit disorder (ADD).

For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood.

While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.

Progression of Autism Symptoms

For many children, symptoms of autism improve with treatment and with age. Some children with the condition grow up to lead normal or near-normal lives. Children whose language skills regress early in life, usually before the age of three, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems. Parents of these children should be ready to adjust treatment for their child as needed.

Some people with the condition can function at a relatively high level, with speech and intelligence intact. Others have serious cognitive impairments and language delays, and some never speak.

In addition, individuals with autism may seem closed off and shut down, or locked into repetitive behaviors and rigid patterns of thinking. An infant may avoid eye contact, seem deaf, and abruptly stop developing language. The child may act as if unaware of the coming and going of others, or physically attack and injure others without provocation. Infants with autism often remain fixated on a single item or activity, rock or flap their hands, seem insensitive to burns and bruises, and may even mutilate themselves.

A Team Approach to Making a Diagnosis

Autism is a complex disorder. A comprehensive evaluation requires a multidisciplinary team including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals experienced in diagnosing autism. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing.

Because hearing problems can cause behaviors that could be mistaken for autism, children with delayed speech development should also have their hearing tested. After a thorough evaluation, the team usually meets with parents to explain the results of the evaluation and present the diagnosis.

What Causes It?

Scientists aren't certain what causes autism, but it's likely that both genetics and environment play a role.

Family Factors

Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population.

Researchers are looking for clues about which genes contribute to increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.

The theory that parental practices are responsible for autism has now been disproved.

Neurotransmitters

Some studies suggest that people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other. While these findings are intriguing, they are preliminary and require further study.

Treatment for Autism

There is no single best treatment for autism. One point that most professionals agree on is that early treatment is important; another is that most individuals with autism respond well to highly structured, specialized programs.

Before you make decisions on your child's autism treatment, you will want to gather information about the various treatments that are available. Learn as much as you can, look at all the options, and make your decision on your child's treatment based on your child's needs. You may want to visit public schools in your area to see the type of program they offer to special needs children.

Autism Treatment: Questions to Ask

Guidelines used by the Autism Society of America include the following questions parents can ask about potential treatment for autism:

• Are there assessment procedures specified?
• Has the treatment been validated scientifically?
• Will the treatment result in harm to my child?
• How will failure of the treatment affect my child and family?
• How will the treatment be integrated into my child's current program?

Do not become so infatuated with a given treatment that functional curriculum, vocational life, and social skills are ignored.

The National Institute of Mental Health suggests a list of questions parents can ask when planning for their child, including the following:

• How successful has the program been for other children?
• How are activities planned and organized?
• Are there predictable daily schedules and routines?
• How much individual attention will my child receive?
• How is progress measured?
• Will my child's behavior be closely observed and recorded?
• Will my child be given tasks and rewards that are personally motivating?
• Is the environment designed to minimize distractions?
• Will the program prepare me to continue the therapy at home?
• What is the cost, time commitment, and location of the program?
• How many children have gone on to placement in a regular school and how have they performed?
• Do staff members have training and experience in working with children and adolescents with autism?
  
  

  Applied Behavior Analysis

  Among the many methods available for treating autism and education of people with autism, applied behavior analysis (ABA) has become widely accepted as an effective treatment. Applied behavioral methods have been shown to reduce inappropriate behavior and increase communication, learning, and appropriate social behavior.

  The basic research done by Ivar Lovaas and his colleagues at the University of California, Los Angeles, calling for an intensive, one-on-one child-teacher interaction for 40 hours a week, laid a foundation for other educators and researchers in the search for further effective early interventions to help those with ASD attain their potential.

  The goal of behavioral management is to reinforce desirable behaviors and reduce undesirable ones.

  
  

  Goals of Autism Treatment

  An effective treatment program will:

  • Offer a predictable schedule
  • Build on the child's interests
  • Teach tasks as a series of simple steps
  • Actively engage the child's attention in highly structured activities
  • Provide regular reinforcement of behavior.

  Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Recognizing that parents are the child's earliest teachers, more programs are beginning to train parents to continue the therapy at home.

  Instruction Based on Age

  As soon as a child's disability has been identified, instruction should begin. Effective programs will teach early communication and social interaction skills.

  
  

  Younger Than Three

  In children younger than 3 years, appropriate interventions usually take place in the home or a child care center. These interventions target specific deficits in learning, language, imitation, attention, motivation, compliance, and initiative of interaction. Included are behavioral methods, communication, occupational and physical therapy along with social play interventions.

  Often the day will begin with a physical activity to help develop coordination and body awareness; children string beads, piece puzzles together, paint, and participate in other motor skills activities. At snack time the teacher encourages social interaction and models how to use language to ask for more juice. The children learn by doing. In teaching the children, positive reinforcement is used.

  Older Than Three

  Children older than 3 years usually have school-based, individualized, special education. The child may be in a segregated class with other autistic children or in an integrated class with children without disabilities for at least part of the day. These programs should provide a structure that will help the children learn social skills and functional communication. In these programs, teachers often involve the parents, giving useful advice in how to help their child use the skills or behaviors learned at school when they are at home.

  Elementary School

  In elementary school, the child should receive help in any skill area that is delayed and be encouraged to grow in his or her areas of strength. Ideally, the curriculum should be adapted to the individual child's needs. Many schools have an inclusion program in which the child is in a regular classroom for most of the day, with special instruction for a part of the day. This instruction should include such skills as learning how to act in social situations and in making friends.

  
  

  Middle and High School

  During middle and high school years, instruction will begin to address such practical matters as work, community living, and recreational activities. This should include work experience, using public transportation, and learning skills that will be important in community living. Collaboration between parents and educators is essential in evaluating your child's progress.

  Adolescence is a time of stress and confusion; and it is no less so for teenagers with autism. Like all children, they need help in dealing with their budding sexuality. While some behaviors improve during the teenage years, some get worse. Increased autistic or aggressive behavior may be one way some teens express their newfound tension and confusion.

  The teenage years are also a time when children become more socially sensitive. At the age that most teenagers are concerned with acne, popularity, grades, and dates, teens with autism may become painfully aware that they are different from their peers. They may notice that they lack friends. And unlike their schoolmates, they aren't dating or planning for a career. For some, the sadness that comes with such realization motivates them to learn new behaviors and acquire better social skills.