Autism is a complex developmental disability that is present from birth or very early in development. It affects essential human behaviors such as social interaction, the ability to communicate ideas and feelings, imagination, self-regulation, and the ability to establish relationships with others. Although precise neurobiological mechanisms have not yet been established, it is clear that this disability reflects the operation of factors in the developing brain. Autism is estimated to occur in as many as 1 in 59 individuals (CDC). Autism is four times more prevalent in boys than in girls and knows no racial, ethnic, or social boundaries. Family income, life-style, and educational levels do not affect the chance of a child having autism. Autism is currently thought of as a “spectrum disorder.” This means that the severity of symptoms differs in people with ASD.
Language develops slowly or not at all, especially by 16 months; words may be used without attaching the usual meaning to them; gestures may be used instead of words; may have short attention spans; Immature rhythms of speech, limited understanding of ideas and the use of words without attaching the usual meanings to them; may have a loss of speech at any age.
Individual may spend time alone rather than with others; may show little interest in making friends; may be less responsive to social cues such as eye contact or smiles; No large smiles or other expressive, joyful facial expressions by six months; No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months; No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
May have abnormal responses to sensations. May be over-sensitive or under-responsive to pain, light, sound, smell, touch, or balance, the way a child holds his or her body; any one or a combination of these responses may be affected.
May demonstrate lack of spontaneous or imaginative play; may not imitate others’ actions; may not initiate pretend games; Abnormal ways of relating to people, objects and events; Lack of interest in peer relationships, may prefer to be alone
May be overactive or very passive; may throw frequent tantrums for no apparent reason; may become over-focused or absorbed with a single item, idea, or person; many demonstrate apparent lack of common sense; may display aggressive behavior or injure self; may have repetitive use of motor movements (e.g., hand-flapping, twirling objects); Persistent fixation on parts of objects.
Currently, the Autism Society estimates that the lifetime cost of caring for a child with autism ranges from $3.5 million to $5 million, and that the United States is facing almost $90 billion annually in costs for autism (this figure includes research, insurance costs and non-covered expenses, Medicaid waivers for autism, educational spending, housing, transportation, employment, in addition to related therapeutic services and caregiver costs).
Although these is no single specific cause of autism, current research links autism to biological and neurological differences in the brain, and Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) scans show abnormalities in the structure and function of the brain and frontal lobe. In some families, there appears to be a pattern of autism or related disabilities which suggests there may be a genetic basis to this disorder.
Several older theories about the cause of autism have now been proven false. Autism is not a mental illness, and individuals with autism do not choose to behave differently. Autism is not caused by bad parenting. Furthermore, no known psychological factors in the development of the individual have been shown to cause autism.
There are no medical tests for diagnosing autism. Many professionals utilize a medical diagnostic reference, the Diagnostic and Statistical Manual now in its fourth edition (DSMIV-TR) to diagnose the five Pervasive Developmental Disorders. Autism typically appears by age 3, though diagnosis and intervention can and should begin earlier. In order to be diagnosed accurately, an individual must be observed by professionals skilled in determining communication, behavioral, and developmental levels. Ideally, an individual should be evaluated by a multidisciplinary team which may include a neurologist, psychologist, developmental pediatrician, speech/language pathologist, occupational therapist, education consultant, or other professional knowledgeable about autism.
However, because many of the behaviors associated with autism are shared by other disorders, a doctor may complete various medical tests to rule out other possible causes. A brief observation in a single setting cannot present a true picture of an individual’s abilities and behavior patterns. At first glance, the person with autism may appear to have mental retardation, a learning disability, or problems with hearing. However, it is important to distinguish autism from other conditions, since an accurate diagnosis can provide the basis for building an appropriate and effective educational, vocational, and treatment program.
The understanding of autism has grown immensely since it was first described in 1943 by Leo Kanner. There is currently no known cure for autism; however, we are continuously finding better ways to understand the disorder and help families and individuals affected by Autism cope with the various symptoms of the disability. Some of these symptoms may lessen as the individual ages; others may disappear altogether. With appropriate intervention, many of the behaviors commonly associated with autism can be positively changed, even to the point that the child or adult may appear to the untrained person to no longer have autism. The majority of children and adults will, however, continue to exhibit some of the symptoms of autism to some degree throughout their lives.
Mental health professionals diagnose based on the Diagnostic and Statistical Manual of the American Psychiatric Association, fifth edition (DSM-I). DSM-I was published in 2013. It is the first edition to include all of the autism specturm as ASD or Autism Spectrum Disorder. In this version of the manual, it gives a Level 1, 2, or 3 in level of assistance the individual needs. Autism is listed in the category Pervasive Developmental Disorders.
Autism is characterized in the DSM-V by:
Diagnosis of autism requires a total of six (or more) items from the three areas, with at least two in the area of social interaction and at least one in the other two areas. Diagnosis of Asperger syndrome requires at least three items with at least one in the area of social interaction. If a clinician feels that there are concerns in all three areas but there are not enough specific items to diagnose autism or Asperger syndrome he/she might diagnose PDD-NOS.
Since the publication of the DSM-V our understanding of the autism spectrum has grown. Most clinicians recognize that difficulties with communication occur in all people on the spectrum.
Characteristics of autism change with age and learning. The qualitative differences look different in two-year-olds and twenty-year-olds so some clinicians may differently when they are not sure whether a behavior meets criteria.
Educational/behavioral therapies are often effective in children with autism, with Applied Behavioral Analysis (ABA) usually being the most effective. These methods can and should be used together with biomedical interventions, as together they offer the best chance for improvement. Parents, siblings, and friends may play an important role in assisting the development of children with autism. Typical preschool children learn primarily by play, and the importance of play in teaching language and social skills cannot be overemphasized. Ideally, many of the techniques used in ABA, sensory integration, and other therapies can be extended throughout the day by family and friends.
Applied Behavioral Analysis
Many different behavioral interventions have been developed for children with autism, and they mostly fall under the category of Applied Behavioral Analysis (ABA). This approach generally involves therapists who work intensely, one-on-one with a child for 20 to 40 hours/week. Children are taught skills in a simple step-by-step manner, such as teaching colors one at a time. The sessions usually begin with formal, structured drills, such as learning to point to a color when its name is given; and then, after some time, there is a shift towards generalizing skills to other situations and environments. A study published by Dr. Ivar Lovaas at UCLA in 1987 involved two years of intensive, 40-hour/week behavioral intervention by trained graduate students working with 19 young autistic children ranging from 35 to 41 months of age. Almost half of the children improved so much that they were indistinguishable from typical children, and these children went on to lead fairly normal lives. Of the other half, most had significant improvements, but a few did not improve much. ABA programs are most effective when started early, (before age 5 years), but they can also be helpful to older children. They are especially effective in teaching non-verbal children how to talk. Parents are encouraged to obtain training in ABA, so that they provide it themselves and possibly hire other people to assist. Qualified behavior consultants are often available, and there are often workshops on how to provide ABA therapy.
This may be beneficial to many autistic children, but often only 1-2 hours/week is available, so it probably has only modest benefit unless integrated with other home and school programs. Sign language and PECS may also be very helpful in developing speech.
This can be beneficial for the sensory needs of these children, who often have hypo and/or hyper sensitivities to sound, sight, smell, touch, and taste. Many autistic individuals have sensory problems, which can range from mild to severe. These problems involve either hypersensitivity or hyposensitivity to stimulation. Sensory integration focuses primarily on three senses — vestibular (i.e., motion, balance), tactile (i.e., touch), and proprioception (e.g., joints, ligaments). Many techniques are used to stimulate these senses in order to normalize them.
Often children with autism have limited gross and fine motor skills, so physical therapy can be helpful.
There are several types of auditory interventions. The only one with significant scientific backing is Berard Auditory Integration Training (called Berard AIT or AIT) which involves listening to processed music for a total of 10 hours (two half-hour sessions per day, over a period of 10 to 12 days). There are many studies supporting its effectiveness. Research has shown that AIT improves auditory processing, decreases or eliminates sound sensitivity, and reduces behavioral problems in some autistic children. Other auditory interventions include the Tomatis approach, the Listening Program, and the SAMONAS method. There is limited amount of empirical evidence to support their efficacy. Information about these programs can be obtained from the Society for Auditory Intervention Techniques’ website www.sait.org.
Relationship Development Intervention (RDI)
This is a new method for teaching children how to develop relationships, first with their parents and later with their peers. It directly addresses a core issue in autism, namely the development of social skills and friendships. Website: www.rdiconnect.com.al