Autism
What is autism?

Autism (sometimes called “classical autism”) is the most common condition in a group of develop-mental disorders
known as the autism spectrum disorders (ASDs).   Autism is characterized by impaired social interaction, problems
with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests.  

Other ASDs include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive
developmental disorder not otherwise specified (usually referred to as PDD-NOS).  

Experts estimate that three to six children out of every 1,000 will have autism.  Males are four times more likely to
have autism than females.

Autism is a developmental disability of the brain, much like dyslexia, mental retardation, or attention deficit
disorder. Autism is not a form of mental retardation, and though many autistic people appear to function as
retarded, they are frequently quite intelligent. According to the Autism Society of America, "autism...occur[s] in
approximately 15 of every 10,000 individuals...[and]...nearly 400,000 people in the U.S. today have some form of
autism."

Some Things Autism is Not

1. Autism is not mental retardation. Some autistic people may be very intelligent — there is a lot of evidence that
Albert Einstein may have been autistic.

2. Autism is not "savant" syndrome. Some autistic people are "savants," (e.g., instant calculator, etc.) but most are
not. Other autistic people are "gifted," however, and have high "general" intelligence. Many autistic people have
normal intelligence, and some may be retarded.

3. Autism is not an emotional problem. Autism is a neurological condition which people are usually born with.
Psychological trauma doesn't cause it.

4. Autism is not a psychosis or lack of reality contact.

5. People do not choose to be autistic.

6. Autism is not "a fate worse than death." Autistic people have some disadvantages, but some live very happy
and rewarding lives. Many autistic people wouldn't want to be "cured," as this would be like erasing them and
replacing them with different people.

What are some common signs of autism?

There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social
interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive
interests.  These behaviors can range in impact from mild to disabling.

The hallmark feature of autism is impaired social interaction.  Parents are usually the first to notice symptoms of
autism in their child.  As early as infancy, a baby with autism 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.  

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.  

Many children with 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.  

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.   

Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X
syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic
seizures, Tourette syndrome, learning disabilities, and attention deficit disorder.  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.

How is autism diagnosed?

Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children
or when it is masked by more debilitating handicaps.  Doctors rely on a core group of behaviors to alert them to
the possibility of a diagnosis of autism.  These behaviors are:  

  • impaired ability to make friends with peers
  • impaired ability to initiate or sustain a conversation with others
  • absence or impairment of imaginative and social play
  • stereotyped, repetitive, or unusual use of language
  • restricted patterns of interest that are abnormal in intensity or focus
  • preoccupation with certain objects or subjects
  • inflexible adherence to specific routines or rituals

Doctors will often use a questionnaire or other screening instrument to gather information about a child’s
development and behavior.  Some screening instruments rely solely on parent observations; others rely on a
combination of parent and doctor observations.  If screening instruments indicate the possibility of autism, doctors
will ask for a more comprehensive evaluation.

Autism is a complex disorder.  A comprehensive evaluation requires a multidisciplinary team including a
psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with
ASDs.  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.  

Children with some symptoms of autism, but not enough to be diagnosed with classical autism, are often
diagnosed with PDD-NOS.  Children with autistic behaviors but well-developed language skills are often
diagnosed with Asperger syndrome.  Children who develop normally and then suddenly deteriorate between the
ages of 3 to 10 years and show marked autistic behaviors may be diagnosed with childhood disintegrative
disorder.  Girls with autistic symptoms may be suffering from Rett syndrome, a sex-linked genetic disorder
characterized by social withdrawal, regressed language skills, and hand wringing.

What causes autism?

Scientists aren’t certain what causes autism, but it’s likely that both genetics and environment play a role.   
Researchers have identified a number of genes associated with the disorder.  Studies of people with autism have
found irregularities in several regions of the brain.  Other studies suggest that people with autism have abnormal
levels of serotonin or other neuro-transmitters 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.  The theory that parental practices are responsible for
autism has now been disproved.

The largest study of the genetics of autism ever conducted, involving DNA from almost 1,200 affected families
worldwide, has already yielded two important clues to the poorly understood disorder, scientists say.  Discoveries
in two areas of the genome -- a region on chromosome 11 suspected of having links to autism, and aberrations in
a brain-development gene called neurexin 1 -- could spur more targeted research, the experts noted.

What role does inheritance play?

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 this 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.

Do symptoms of autism change over time?

For many children, autism symptoms improve with treatment and with age.  Some children with autism grow up to
lead normal or near-normal lives.  Children whose language skills regress early in life, usually before the age of 3,
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.

How is autism treated?

There is no cure for autism.  Therapies and behavioral interventions are designed to remedy specific symptoms
and can bring about substantial improvement.  The ideal treatment plan coordinates therapies and interventions
that target the core symptoms of autism:  impaired social interaction, problems with verbal and non-verbal
communication, and obsessive or repetitive routines and interests.  Most professionals agree that the earlier the
intervention, the better.

·        Educational/behavioral interventions:  Therapists use highly structured and intensive skill-oriented training
sessions to help children develop social and language skills.  Family counseling for the parents and siblings of
children with autism often helps families cope with the particular challenges of living with an autistic child.  

·        Medications:  Doctors often prescribe an antidepressant medication to handle symptoms of anxiety,
depression, or obsessive-compulsive disorder.  Anti-psychotic medications are used to treat severe behavioral
problems.  Seizures can be treated with one or more of the anticonvulsant drugs.  Stimulant drugs, such as those
used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity
and hyperactivity.

·        Other therapies:  There are a number of controversial therapies or interventions available for autistic
children, but few, if any, are supported by scientific studies. Parents should use caution before adopting any of
these treatments.

Treatment approaches are evolving as more is learned about autism. There are many therapeutic programs, both
conventional and complementary, that focus on replacing dysfunctional behaviors and developing specific skills.

As a parent, it's natural to want to do something immediately. However, it is important not to rush in with changes.
Your child may have already learned to cope with his or her current environment and changes could be stressful.
You should investigate various treatment approaches and gather information concerning various options before
proceeding with your child's treatment.

You will encounter numerous accounts from parents about successes and failures with many of the treatment
approaches mentioned. You will also discover that professionals differ in their theories of what they feel is the
most successful treatment for autism. It can be frustrating! But you will learn to sift through them and make
rational, educated decisions on what is appropriate for your child. You live with your child every day and you know
his/her needs. And in time, you will come to know his/her autism. Trust your instincts as you explore various
options.

Again, please keep in mind that the descriptions of treatment approaches provided here are for informational
purposes only. They are meant to give you an overview of an approach. The Autism Society of America does not
endorse any specific treatment or therapy.

During your research, you will hear about many different treatments approaches, such as auditory training,
discrete trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music therapy, occupational
therapy, physical therapy, and sensory integration. These approaches can generally be broken down into three
categories:

  • Learning Approaches
  • Biomedical & Dietary Approaches
  • Complementary Approaches

Some of these treatment approaches have research studies that support their efficacy; others may not. Some
parents will only want to try treatment methods that have undergone research and testing and are generally
accepted by the professional community. But keep in mind that scientific studies are often difficult to do since
each individual with autism is different.

For others, formal testing might not be a pre-requisite for them to try a treatment with their child. Even for those
with "scientific" proof, we recommend that the family or caregiver investigate all options available to determine the
appropriateness to their child.

Experts agree though, that early intervention is important in addressing the symptoms associated with autism. The
earlier treatment is started, the better the chance the child will reach normal functioning levels. Many of the
approaches described can be used on children as young as age 2 or 3. They may also continue to be used in
conjunction with special education programs or traditional elementary school for children who are mainstreamed.

What About School?

Early diagnosis and appropriate educational programs are very important to children with autism or PDD. The
Individuals with Disabilities Education Act (IDEA) includes autism as a disability category. Children with autism and
PDD are eligible for an educational program appropriate to their individual needs. Educational programs for
students with autism or PDD focus on improving communication, social, academic, behavioral, and daily living
skills.

Behavior and communication problems that interfere with learning sometimes require the assistance of a
professional who is particularly knowledgeable in the autism field, who develops and helps to implement a plan
which can be carried out at home and school.

The classroom environment should be structured so that the program is consistent and predictable. Students with
autism or PDD learn better and are less confused when information is presented visually as well as verbally.
Interaction with non-disabled peers is also important, for these students provide models of appropriate language,
social, and behavioral skills. To overcome frequent problems in generalizing skills learned at school, it is very
important to develop programs with parents, so that learning activities, experiences, and approaches can be
carried over into the home and community.

With educational programs designed to meet a student’s individual needs and specialized adult support services
in employment and living arrangements, many children and adults with autism
or PDD grow up to live and work successfully in the community.

Tips for Parents

  • Learn about autism/PDD. The more you know, the more you can help yourself and your child.
  • Be mindful to interact with and teach your child in ways that are most likely to get a positive response.
    Learn what is likely to trigger melt-downs for your child, so you can try to minimize them. Remember, the
    earliest years are the toughest, but it does get better!
  • Learn from professionals and other parents how to meet your child’s special needs, but try not to turn your
    lives into one round of therapy after another.
  • If you weren’t born loving highly structured, consistent schedules and routines, ask for help from other
    parents and professionals on how to make it second nature for you. Behavior, communication, and social
    skills can all be areas of concern for a child with autism and experience tells us that maintaining a solid,
    loving, and structured approach in caring for your child, can help greatly.
  • Learn about assistive technology that can help your child. This may include a simple picture communication
    board to help your child express needs and desires, or may be as sophisticated as an augmentative
    communication device.
  • Work with professionals in early intervention or in your school to develop an IFSP or an IEP that reflects
    your child’s needs and abilities. Be sure to include assistive technology, related services, and
    supplementary aids and supports, if your child needs these. Don’t forget about a positive behavior plan, if
    needed.