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Autism or PPD (pervasive developmental disorder) is defined by the Columbia encyclopedia as a rare neurodevelopmental disorder characterized by the inability to relate to and perceive the environment in a realistic manner. The onset of the disorder is in infancy or early childhood, generally before the age of thirty months, and males are affected four times as often as females. Symptoms include impairment in social interaction, fixation on inanimate objects, inability to communicate normally, and resistance to changes in daily routine (Anthes, 1997).
Characteristics of Autism
Diagnosing Autism is based on four characteristics: difficulty with language, abnormal responses to sensory stimuli, resistance to change and difficulty with social interaction. ?Other characteristics of autism may include: making the same repetitive motion for hours, repeating a sound or phrase, inability to hold a conversation, practicing unusual play patterns, and extreme sensitivity to sound and touch? (Riccio, 1999). Autistics can exhibit any combination of these characteristics in any degree. That is why autism is referred to as a ?spectrum? disorder, because at one end of the disorder a child may be inflicted with some symptoms, while at the opposite end a child may be inflicted with multiple symptoms with many areas in between. Children who display few symptoms may be characterized as ?mildly autistic?.
Early signs of Autism may appear in the first months of life. Autistic infants tend to stray away from other people, avoiding touch and become limp or stiff when picked up or help. Autistic children don?t reach maturation as fast as normal children. A normal child will point to objects or smile when seeing their mother before the end of their first year, but children with autism develop this behavior much later. These symptoms may go on unnoticed by parents or doctors in infancy, but by the age of two to three it is clear that something is wrong.
History of Autism
In 1943, a man by the name of Leo Kanner formally identified autism; he labeled the disorder ?autistic disturbance of affective contact? (?Autism Web? n.d.). Autism was first described in America, officially, in 1980 with the publication of DSMIII (Tanguay, Robertson, Derrick, 1980). There was much confusion, both before and after Kanner's description, regarding the continuity of autism with schizophrenia and other then-recognized forms of psychosis (Lippcott/Williams & Wilkins, 1999). Kanner noticed that autistic infants had a reverse pattern typically observed in normal infants.
Infants are normally interested in social, as opposed to nonsocial environments.
Source of Autism
The cause for autism remains unclear, although most neurological studies seem to indicate a dysfunction in the brain as a possible reason. Autism has been found in children with brain abnormalities such as congenital rubella syndrome, neurofibromatosis, and tuberous sclerosis. Autism can also be present in genetic syndromes such as fragile X syndrome and phenylketonuria. Some research has shown that there may be an autism gene, or two genes working together. These genes are thought to be on the seventh and thirteenth chromosome. The disorder is, in some instances, may be hereditary as shown by twin studies that cite there is a ?substantially higher rate in identical twins?so much so that heritablity is over 90%?, says Joseph Piven (cited in ?Applied Genetics News?, 1999). In a Harvard Mental Health letter (1997) statistics found that the rate of autism and mild retardation in brothers, sisters and fraternal twins of autistics is 50-100 times higher than average and in identical twins the rate is 65% to 90%. In 1980 it was found that among 11 families with a father diagnosed with autism more than half of their children were autistic. The apparently normal parents of autistic children had undiagnosed mild symptoms of autism when tested.
The Center for Disease Control and Prevention states that one in 500 children in America suffer from autism. Autistic children are unable to recognize themselves or remember things that they have just done. For example, if an autistic child were to show someone a toy of theirs, they would forget they had just shown it and show the toy repeatedly as if they have never presented it before. They may examine a simple little toy or electronic device for hours without losing interest, or rock back and forth in a particular spot for an entire afternoon. The repetitions of little things seem to be a grand achievement for these children.
In diagnosing, or assessing autism the child?s history is taken into consideration. For instance whether or not the family has autism in any other branches of its tree can help to determine whether a child may or may not have autism. The Journal of the American Academy of Child and Adolescent Psychiatry (1999) states: Aspects of the assessment will vary depending on the child's age, history, and previous evaluations. The history would include the history of the pregnancy and development of the child, marking such milestones as communication and motor skills (i.e. child?s first words or steps), and when thought to be unusual. Doctors will often discuss their medical history, such as possibility of seizures, hearing and visual impairments along with other conditions or syndromes such as fragile X syndrome. Doctors will do this because there is not a specific laboratory test for autism at this point in time. These studies and discussions help in the search for a diagnosis. A test for fragile X syndrome may be given because of its association with autism. Autistic children are often characterized by repetitive motions such as clapping, handflapping and rocking back and forth. Some are extremely sensitive to minor noises, scents and pain, and may even throw tantrums for no apparent reason at any given time.
Experts say early intervention is critical. Some treatments include special diets and vitamin supplements, and focus on drawing a child with autism away from their agenda (rocking). If an autistic child is geared away from what they want they tend to become aggressive. Autistic children tend to stray away from conversation or tasks in an irregular manner unable to focus on what others may want. Some signs of the disorder include a decrease in language skills and interaction in activity and attention with others. People with autism don?t understand social norms or rules like normal people. Autistics are unable to learn from observation. They need to be taught the significance and meaning of a frown as a pose to a smile, or how to focus on the person that is talking to them.
Misconceptions Associated With Autism
Autism is easily confused with low intelligence, but many children with autism are in fact very smart. ?While 70 percent of the children diagnosed with autism score below average on IQ tests, many are of normal intelligence, and a few are considered quite bright? (Riccio, 1999). Autistics can learn and improve their education and behavior, and this allows some of them to function as close to normal if not equal in society although most still need assistance with living and job skills throughout adulthood.
Although most autistic people are severely mentally retarded about 10 percent are autistic ?savants?. A savant is a person who incredibly excels in a particular area, such as music or math. ?A person who has autism yet can play a Beethoven sonata after hearing it just once, or can do complex mathematical equations, or tell you whether December 3, 1956, fell on a Tuesday or Wednesday? (Riccio, 1999). Savants may be mentally retarded but they have what Dr. Pratt says is ?a very strong, specific talent? (Riccio, 1999). Savants may also have the ability to focus solely on one specific task, or talent while tuning out their immediate surroundings. The part of their brain that their talent is derived from may be intensified, and used almost to full capacity. Gary Anthes, a reporter for Computer World states, ?autistic individuals are excellent candidates for computer programming and graphics positions? (1997). Because autistics can often exhibit strong talents and are able to focus so well these types of jobs would be greatly beneficial to themselves and their employers. Because of their lack of social skills they are able to focus solely on their work, and the fact that autistic people need a clear-cut plan or goal, like the plans and goals programming offers, helps them overcome the obstacles of life with autism. The Americans with Disabilities Act of 1990 helped produce user-friendly work environments for those with physical impairments (Anthes, 1997). This act has helped both the disabled and the employer realize the specific needs of each other and work together to suit the interests of both the employer and the disabled associate.
Every autistic child is unique. Not all therapies are universal. Each one has to be tailored for the specific patient. People with autism like a very structured environment. They like consistency in their surroundings. Even a slight change in their home setting (the movement of a table) can be very unsettling and make the child agitated.
Treatments for Autism
There are several methods of educating young children with autism. The most well known strategies are "Applied Behavior Analysis" (also known as Discrete Trial Instruction) and TEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children). Some school districts will offer just one strategy, however, it is good to be familiar with all of them, as some children may respond better to one than another.
Applied Behavior Analysis generally assumes that appropriate behavior, including speech, academic skills and life skills, can be taught using scientific principles. It also assumes that children are more likely to repeat behaviors or responses that are rewarded, and they are less likely to continue behaviors that are not reinforced. Eventually, the "reinforcers" are reduced so that the child can learn without them. The most well known form of Applied Behavior Analysis is called discrete trial instruction. Discrete trials are used to teach a variety of skills, such as eye contact, imitation, fine motor skills, academic skills and language. Students start with learning small skills and gradually learn more complicated skills as each smaller one is mastered.
If a therapist is trying to teach imitation, for example, they may give a command, such as "Do this", while tapping the table. The child is then expected to tap the table. If the child succeeds they receive positive reinforcement, such as a snack, toy or praise. If the child fails, then the therapist may say, "No." The therapist then pauses before repeating the next trial ensuring that each trial is separate or discrete. If the child continues to respond incorrectly the therapist may also use a prompt such as helping the child tap the table.
One drawback of Applied Behavior Analysis is that children in intensive home therapy programs may not have time to socialize with children their age. Also, some school districts do not pay for Applied Behavior Analysis, and it can be expensive for parents to fund.
TEACCH is often less intensive than ABA in the preschool years. A TEACCH classroom is usually very structured with separate, defined areas for each task, such as individual work, group activities, and play. It relies heavily on visual learning, which is a strength for many children with autism and PDD. The children use schedules made up of pictures and/or words to order their day and to help them move smoothly between activities, since children with autism often find it difficult to make transitions between activities and places.
Children may sit at a workstation and be required to complete certain activities such as matching pictures. The finished assignments are then placed in a container. Children may use picture communication symbols (small laminated squares that contain a symbol and a word) to answer questions and request items from their teacher. The symbols help relieve frustration for nonverbal children while helping those who are starting to speak to recall and say the words they want.
One drawback of TEACCH is that social interaction and verbal communication may not be heavily stressed. Also, more research is needed into the effectiveness of TEACCH, especially in comparison to Applied Behavior Analysis. TEACCH has not published comprehensive, long-term studies of its effectiveness in treating and educating children (Autism Web, 2001).
New Discoveries In Autism
Some new information about the diet of autistics is headlining the battle for autism. New research has shown substantial evidence that diet can play a role in the source of autism. Two proteins - Gluten and Casein seem to be the underlying ?drug? in the behavior of children with autism (Autism Web, 2001).
Gluten is a protein found in many grains, including wheat, oats, rye, barley and spelt. It is also found in food starches, some vinegars, soy sauce, flavorings and hydrolyzed vegetable proteins (ingredients that may be found in commercially prepared foods, sauces and condiments). Casein is a protein found in milk and products containing milk, such as cheese, butter, yogurt, ice cream and even some brands of margarine. It also may be added to non-milk products such as soy cheese. ?Some parents and researchers say that children have shown mild to dramatic improvements after these substances were removed from their diet (Autism Web).
The theory is that some people with autistic spectrum disorders cannot properly digest gluten and casein, which break down into substances that act like opiates in their bodies. This "drug" substance alters the person's behavior, perceptions, and responses to their environment. This theory has not been scientifically proven yet, and has not gained widespread acceptance in the U.S. medical community. However, there are anecdotal reports of improvement in people with autism.
Statistics Of Autism: Incidence, Cost And Ratio
Autism is more common than previously believed. It occurs in 1 out of every 500 births (?Centers for Disease Controls and Prevention?, 1997). It is the third most common developmental disorder (Mental Retardation being most common and Cerebral Palsy being second). Autism affects over 400,000 Americans and costs the nation well over $13 billion a year. It is four times more common in males than females. Every day there are 53 babies born in the United States who will later be diagnosed with Autism Spectrum Disorder, which equals over 19,000 individuals each year. An estimated 51.7 million children were enrolled in the nation's public and private elementary and secondary schools in the fall of 1996. According to the National Center for Education Statistics, enrollment in school will be 55.9 million by 2005, and 280,000 of those students will have autism spectrum disorder. At least 800,000 educational personnel are needed to serve these students.
In conclusion, autism is a very complex disorder and because of the different extents of the disorder it is very hard to find a cure. With the technology of today improving at a rapid rate, autism is now better understood and treated than fifty years ago when autism was first ?announced?. People are starting to realize and understand that people with autism have something to offer, and just aren?t mentally retarded. Although this disorder is not very pleasant, its condition has improved over the time it was first introduced as a pervasive development disorder, and hopefully within the next fifty years a possible cause or cure will be developed for autism.
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