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AUTISM
Definition:
Autism is a complex, life-long neurological disorder that affects a person’s ability to communicate, understand and use language, play, and socially interact with others.
Autism is currently understood as existing on a spectrum that ranges in severity and is referred to as “autism spectrum disorder.” Autism spectrum disorders include several diagnosis including Pervasive Developmental Disorder, Asperger’s Syndrome, and Autistic Disorder. All of these disabilities fall under the “autism spectrum disorder” umbrella as they all share similar features. To describe each of them separately would be beyond the scope of this handout. Here, we will only provide details about Autistic Disorder. However, much of what is described below is relevant to all autism spectrum disorders.
Autism can be reliably diagnosed at or before the age of three years. Parents and expert clinicians can often detect symptoms during infancy, although a formal diagnosis is generally not made until the child fails to develop functional language by age two. Approximately 20 percent of children with autism reportedly experience a “regression”; that is, they have apparently normal development followed by a pronounced loss of communication and social skills.
Although there is currently no known cure for autism, autism is treatable. Persons with autism can make progress if they receive appropriate intervention. Children who receive intensive, individualized, behavioral interventions show remarkable progress, especially when these interventions are started before or during the preschool years. Pharmacological treatments are sometimes effective in treating specific characteristics of autism, such as perseverant or self-injurious behaviors.
Incidence:
Although the exact prevalence of autism is not yet known, estimates range from one-in 88, to one-in-150 births. While the overall chance that a child will have autism is less than 1 percent, that chance increases to 5-10 percent when a child has a sibling with autism. Current statistics show that autism occurs three to four times more often in boys than in girls. In addition, approximately 70 percent of people with autism also have some degree of mental retardation. Further research indicates that the incidence of autism is increasing.
Causes:
Nobody knows what causes autism. However, recent studies suggest a genetic element, possibly serving as a predisposition, is involved in causing autism very early in a child’s in utero growth. Speculated triggers or other causes include infectious, neurological, metabolic, and environmental factors.
Although the research community does not know what causes autism, it is clear that the quality of parenting is not a cause or a contributing factor to autism.
Characteristics:
The symptoms of autism can be measurable by 18 months of age, although parents and experts of autism can often detect symptoms before this time. Parents who have a child that is later diagnosed with autism first express concern that their child has a suspected speech delay and/or a problem with social development. The following is a list of concerns that are signs of autism:
- Is very independent
- Is in his/her “own world”
- Unaware of surroundings and tunes people out
- Does not respond to his/her name
- Cannot tell what he/she wants
- Has language delays
- Does not follow directions
- Appears deaf at times, but not at others
- Doesn’t point or wave good-bye
- Used a few words, now does not
- Has tantrums
- Exhibits self-stimulatory behavior
- Appears to be a perfectionist
- May exhibit echolalia
- May be a selective eater
- Has ritualistic movement patterns
- Is hyperactive, uncooperative, or oppositional
- Does not know how to play with toys
- Gets stuck on things over and over
- Does not smile socially
- Prefers to play alone
- Exhibits very high or low tolerance for pain
- Desires sameness
- Transitions to unfamiliar situations are difficult
- Has poor eye-contact
- Is not interested in interacting with others
- Has unusual attachments to toys or other unusual objects
General symptoms for autistic disorder include the following:
A total of six (or more) items from a list of qualitative impairments in the following categories: (1) Social interactions (at least two from this group) (2) Communication (at least one from this group) (3) Restrictive repetitive and stereotyped patterns of behavior, interests, and activities (at least one from this group).
Delays or abnormal functioning in (1) social interactions, (2) language used in social communication, or (3) symbolic or imaginative play, with onset before age three.
Symptoms that cannot be described as Rett’s syndrome or Childhood Disintregrative Disorder.
A Formal diagnosis is typically not made until a child shows delays in language development. Autism is a spectrum disorder, and some people on the higher functioning end, are not diagnosed until well into the elementary school years or later. Symptoms of autism vary in both occurrence and severity, which can make diagnosis difficult.
Once a Person is Diagnosed with Autism:
According to Public Law 105-17: Individuals with Disabilities Act-IDEA (1997), a child’s primary care provider is required to give the family a referral to an early intervention service. The family with a child under the age of three should be referred to the community zero-to-three service system. After that, the local school district must provide free and appropriate services for a family with a child three years to twenty-one years. Most people with autism spectrum disorders are also eligible for lifelong services throughout their adult life through Disability Service Providers.
Treatment:
To date, there is no cure for autism and children do not outgrow the symptoms. However, there are a number of treatments available that help people with autism learn new skills and become more independent. Some of these treatments include:
Individualized Education Programs (IEP’s) can provide children with autism the supports necessary to receive a free and appropriate public education in the least restrictive setting possible. The IEP team, which by law must include the child’s parents or guardian and ideally will include any professional who works with the child in an educational capacity, design an education plan by identifying goals for the child and creating strategies to help the child achieve those goals. Children with autism can respond very well when IEP’s are properly designed and systematically implemented.
Comprehensive Treatment Programs encompass a number of different theories about treating autism. These programs range from specific method of learning, to applied behavioral analysis, to reaching certain developmental goals. In general, children who participate in this type of program for 15-40 hours per week, for two years or more, experience great benefits and changes in behavior.
Related Services are services that a person needs to meet their educational goals. Such services may include therapies such as speech therapy, occupational therapy, or social skills training. Related services may also include parent trainings and specific behavioral supports such as Applied Behavioral Analysis (ABA) or Positive Behavioral Interventions and Supports (PBS). When related services are part a person’s IEP, it is the responsibility of the local school district or RegionalCenter to provide such services at no cost to the family.
Pharmacological Treatments can also be effective in improving the behavior or abilities of a person with autism. In general, these medications are called “psychoactive” because the drugs affect the brain of a person with autism. Medication is often used to address a specific symptom, such as self-injurious behavior or aggression, which may allow the person with autism to focus on other things, like learning.
When considering treatment options it is important that people with autism be evaluated for co-morbid, potentially treatable conditions, such as seizures, allergies, gastrointestinal problems, or sleep disorders. Treatment of co-morbid features can lead to improvements in quality-of-life for them and their families.