- Characteristics of autism
- Diagnoses: the autistic spectrum
- Associated problems
Autism is a pervasive developmental disorder, appearing prior
to the age of three years. It is characterized by impairment in
communication, social interaction, and behavior. Autistic symptoms,
and the severity of impairment caused by autism, vary from individual
to individual. Individuals with autism range from non-verbal and
severely mentally retarded to more independent, although still
affected by difficulty with social skills. The latter group is
1. Characteristics of Autism
Individuals with an autistic disorder tend to three share common
factors: impairment in social interaction, language delays and
impairments, and a restricted repertoire of activities and interests.
There are also a number of less common factors.
a. Impairment in social interaction
Infants with autism often refuse to cuddle or engage in eye-to-eye
gaze, and as children, rarely engage in spontaneous play (Koegel,
Valdez-Menchaca, & Koegel, 1994). Children also may avoid
others of their own age; as adolescents and adults, they may want
to make friends, but have a great deal of difficulty doing so
due to lack of social skills (Howlin, 1997). They are also impaired
in both the recognition and production of emotional expression,
making it very difficult for them to read others reactions
accurately (Loveland, Tunali-Kotoski, Pearson, Brelsford et al.,
b. Language delays and impairments
The second common factor is language delays and impairments, possibly
as a result of impaired social functioning (Koegel et al., 1994).
Even those who do develop language still have difficulty communicating
in a way that would be considered "normal" by others;
for example, children with Aspergers Disorder (a variant
of autism or a similar disorder as discussed below) have unimpaired
verbal skills but often engage in long monologues without spaces
for others to communicate or respond.
c. Restricted repertoire of activities and interests
The third common factor is a restricted repertoire of activities
and interests. Individuals with autism often engage in self-stimulatory
behavior, "repetitive behavior that appears to serve no observable
social function" (Koegel et al., 1994), such as lining up
small objects, flicking their fingers in front of their face,
and rocking back and forth. These behaviors are also known as
stereotypies. In milder form, they may manifest as particular
hobbies, such as an intense interest in train schedules, constellations,
math, music, and so forth.
d. Other common features
Some other common features of autism include extreme difficulty
in dealing with change (Cohen, 1998) and difficulty in regulating
sensory input (Ornitz, 1992). At the same time, children with
autism often have good visuospatial skills and good rote memory
(Prior & Ozonoff, 1998), and a small subgroup of children
with autism display splinter skills, impressive but isolated skills
such as the ability to name what day of the week any day in history
falls on or the ability to play a piece of music perfectly the
first time it is heard.
is autism? from NIMH
A summary of features of autism including a picture of a child
with autism from the Asperger's Association of New England.
of children with autism from the Asperger's Association of
Spectrum Quotient (test developed by Simon Baron-Cohen and
his colleagues at Cambridge's Autism Research)
of personal thoughts from the brother of a child with autism
from the Can Foundation (Go to the bottom-right of the page).
Life on the Spectrum
2. Diagnoses: the autistic spectrum
Autism, termed Autistic Disorder under the DSM-IV, is considered
to be one of the Pervasive Developmental Disorders (PDDs). The
other PDDs are Aspergers Disorder, Pervasive Developmental
Disorder Not Otherwise Specified (PDD-NOS), Childhood Disintegrative
Disorder (CDD), and Retts Disorder (DSM-IV).
The diagnosis of Aspergers Disorder is given to children
who display autistic symptoms but have no language delay. The
diagnosis of PDD-NOS is given to those who display some autistic
symptoms but not enough for a diagnosis of Autistic Disorder,
Aspergers Disorder, or CDD (Cohen, 1998). The diagnosis
of CDD is given to those who have a period of documented normal
development prior to the emergence of autistic symptoms (DSM-IV).
Some diagnosticians believe these three disorders to be points
along an autistic spectrum ranging from severely impaired (Autistic
Disorder, CDD) to less impaired (PDD-NOS, Aspergers Disorder),
but some believe them to be separate disorders. Retts Disorder,
which is rare and occurs only in girls, is not generally considered
part of such a spectrum.
In this chapter, unless otherwise specified, "autism"
is used to refer to these disorders collectively, with the most
emphasis on Autistic Disorder followed by Aspergers Disorder.
is Autism Diagnosed? From NIMH
and Statistical Manual (summarized by Meredyth Goldberg Edelson,
Department of Psychology, Willamette University)
Developmental Disorder test (including autism) by Rami Grossmann,
M.D., a neurologist in New York.
of the video: "The Different Shades of Autism" from
The Veronica Bird Charitable Foundation.
3. Associated problems
Individuals with autism often have other medical problems as
well. Seventy percent are mentally retarded; twenty-five percent
suffer from epilepsy; and smaller numbers suffer from attentional
deficits, and aggressive and impulsive disorders (Teeter &
Semrud-Clikeman, 1997), as well as fragile-X syndrome and an increased
rate of minor physical anomalies (Koegel, Valdez-Menchaca, &
Autism occurs in 5 of every 10,000 people (Fombonne, 1998);
estimates of Aspergers Disorder are similar (Volkmar &
Klin, 2000). Autism is highly genetic: rates are very high for
identical twins with estimates as high as 98% (Szatmari &
Jones, 2000). The rates for fraternal twins and non-twin siblings
of affected individuals are considerably higher than in the general
population, although lower than that for identical twins (Volkmar
& Klin, 2000). One estimate of the genetics of autism, based
on statistical modeling of the prevalence of autism among families,
suggests that there are two to five genes which predispose the
bearer to develop autism (Cook, 2000).
Although there is no cure for autism, behavioral and pharmacological
treatments are effective in reducing some of the symptoms. Behavioral
treatment focuses on teaching new skills, particularly social
skills, and attempts to decrease maladaptive behavior (Harris,
1998). Early intervention with behavioral therapy can be helpful.
Drugs can reduce symptoms of autism such as anxiety, aggression,
and compulsive behavior.
In addition, unproven and frequently ineffective treatments
for autism abound. Many of these are supported with at best poorly
done research studies and at worst only anecdotal information.
Parents are often attracted to these because they want the best
for their child, and conventional treatments seem to offer little
in comparison with impressive claims of healing. Unfortunately,
these treatments are often expensive and result in little in the
way of improvement. Unproven treatments, and other controversial
issues related to autism, are more fully discussed in the links.
Practices for Designing and Delivering Effective Programs for
Individuals with Autistic Spectrum Disorders by the Families
for Early Autism Treatment, Inc.
assessment of some of the unorthodox forms of
biomedical intervention currently being applied to autism.
By Paul Shattock, University of Sunderland, UK.
for the treatment of autism. From NIMH
Most individuals with autism need complete supervision all their
lives, some achieve independence, and many are somewhere in between
(Howlin & Goode, 1998); they may hold a job, but still live
at home. Those who do achieve some degree of independence often
remain socially isolated; many have difficulty with achieving
close friendships and some do not desire to do so. Individuals
with better outcomes tend to be those with higher verbal ability,
intelligence, and education; success depends on both the severity
of autism as well as environmental factors. Girls tend to be more
severely affected by autism and do less well in adult life than