What Are the Autism Spectrum Disorders?
The autism spectrum
disorders are more common in the pediatric population than are some
better known disorders such as diabetes, spinal bifida, or Down
syndrome.2 Prevalence studies have been done in several
states and also in the United Kingdom, Europe, and Asia. A recent study
of a U.S. metropolitan area estimated that 3.4 of every 1,000 children
3-10 years old had autism.3 This wide range of prevalence
points to a need for earlier and more accurate screening for the
symptoms of ASD. The earlier the disorder is diagnosed, the sooner the
child can be helped through treatment interventions. Pediatricians,
family physicians, daycare providers, teachers, and parents may
initially dismiss signs of ASD, optimistically thinking the child is
just a little slow and will “catch up.” Although early intervention has
a dramatic impact on reducing symptoms and increasing a child's ability
to grow and learn new skills, it is estimated that only 50 percent of children are diagnosed before kindergarten.
All
children with ASD demonstrate deficits in 1) social interaction, 2)
verbal and nonverbal communication, and 3) repetitive behaviors or
interests. In addition, they will often have unusual responses to
sensory experiences, such as certain sounds or the way objects look.
Each of these symptoms runs the gamut from mild to severe. They will
present in each individual child differently. For instance, a child may
have little trouble learning to read but exhibit extremely poor social
interaction. Each child will display communication, social, and
behavioral patterns that are individual but fit into the overall
diagnosis of ASD.
Children with ASD do not follow the typical
patterns of child development. In some children, hints of future
problems may be apparent from birth. In most cases, the problems in
communication and social skills become more noticeable as the child
lags further behind other children the same age. Some other children
start off well enough. Oftentimes between 12 and 36 months old, the
differences in the way they react to people and other unusual behaviors
become apparent. Some parents report the change as being sudden, and
that their children start to reject people, act strangely, and lose
language and social skills they had previously acquired. In other
cases, there is a plateau, or leveling, of progress so that the
difference between the child with autism and other children the same
age becomes more noticeable.
ASD is defined by a certain set of
behaviors that can range from the very mild to the severe. The
following possible indicators of ASD were identified on the Public
Health Training Network Webcast, Autism Among Us.4
Possible Indicators of Autism Spectrum Disorders
- Does not babble, point, or make meaningful gestures by 1 year of age
- Does not speak one word by 16 months
- Does not combine two words by 2 years
- Does not respond to name
- Loses language or social skills
Some Other Indicators
- Poor eye contact
- Doesn't seem to know how to play with toys
- Excessively lines up toys or other objects
- Is attached to one particular toy or object
- Doesn't smile
- At times seems to be hearing impaired
Social Symptoms
From
the start, typically developing infants are social beings. Early in
life, they gaze at people, turn toward voices, grasp a finger, and even
smile.
In contrast, most children with ASD seem to have
tremendous difficulty learning to engage in the give-and-take of
everyday human interaction. Even in the first few months of life, many
do not interact and they avoid eye contact. They seem indifferent to
other people, and often seem to prefer being alone. They may resist
attention or passively accept hugs and cuddling. Later, they seldom
seek comfort or respond to parents' displays of anger or affection in a
typical way. Research has suggested that although children with ASD are
attached to their parents, their expression of this attachment is
unusual and difficult to “read.” To parents, it may seem as if their
child is not attached at all. Parents who looked forward to the joys of
cuddling, teaching, and playing with their child may feel crushed by
this lack of the expected and typical attachment behavior.
Children
with ASD also are slower in learning to interpret what others are
thinking and feeling. Subtle social cues—whether a smile, a wink, or a
grimace—may have little meaning. To a child who misses these cues,
“Come here” always means the same thing, whether the speaker is smiling
and extending her arms for a hug or frowning and planting her fists on
her hips. Without the ability to interpret gestures and facial
expressions, the social world may seem bewildering. To compound the
problem, people with ASD have difficulty seeing things from another
person's perspective. Most 5-year-olds understand that other people
have different information, feelings, and goals than they have. A
person with ASD may lack such understanding. This inability leaves them
unable to predict or understand other people's actions.
Although
not universal, it is common for people with ASD also to have difficulty
regulating their emotions. This can take the form of “immature”
behavior such as crying in class or verbal outbursts that seem
inappropriate to those around them. The individual with ASD might also
be disruptive and physically aggressive at times, making social
relationships still more difficult. They have a tendency to “lose
control,” particularly when they're in a strange or overwhelming
environment, or when angry and frustrated. They may at times break
things, attack others, or hurt themselves. In their frustration, some
bang their heads, pull their hair, or bite their arms.
Communication Difficulties
By
age 3, most children have passed predictable milestones on the path to
learning language; one of the earliest is babbling. By the first
birthday, a typical toddler says words, turns when he hears his name,
points when he wants a toy, and when offered something distasteful,
makes it clear that the answer is “no.”
Some children diagnosed
with ASD remain mute throughout their lives. Some infants who later
show signs of ASD coo and babble during the first few months of life,
but they soon stop. Others may be delayed, developing language as late
as age 5 to 9. Some children may learn to use communication systems
such as pictures or sign language.
Those who do speak often use
language in unusual ways. They seem unable to combine words into
meaningful sentences. Some speak only single words, while others repeat
the same phrase over and over. Some ASD children parrot what they hear,
a condition called echolalia. Although many children with no
ASD go through a stage where they repeat what they hear, it normally
passes by the time they are 3.
Some children only mildly affected
may exhibit slight delays in language, or even seem to have precocious
language and unusually large vocabularies, but have great difficulty in
sustaining a conversation. The “give and take” of normal conversation
is hard for them, although they often carry on a monologue on a
favorite subject, giving no one else an opportunity to comment. Another
difficulty is often the inability to understand body language, tone of
voice, or “phrases of speech.” They might interpret a sarcastic
expression such as “Oh, that's just great” as meaning it really IS
great.
While it can be hard to understand what ASD children are
saying, their body language is also difficult to understand. Facial
expressions, movements, and gestures rarely match what they are saying.
Also, their tone of voice fails to reflect their feelings. A
high-pitched, sing-song, or flat, robot-like voice is common. Some
children with relatively good language skills speak like little adults,
failing to pick up on the “kid-speak” that is common in their peers.
Without
meaningful gestures or the language to ask for things, people with ASD
are at a loss to let others know what they need. As a result, they may
simply scream or grab what they want. Until they are taught better ways
to express their needs, ASD children do whatever they can to get
through to others. As people with ASD grow up, they can become
increasingly aware of their difficulties in understanding others and in
being understood. As a result they may become anxious or depressed.
Repetitive Behaviors
Although
children with ASD usually appear physically normal and have good muscle
control, odd repetitive motions may set them off from other children.
These behaviors might be extreme and highly apparent or more subtle.
Some children and older individuals spend a lot of time repeatedly
flapping their arms or walking on their toes. Some suddenly freeze in
position.
As children, they might spend hours lining up their
cars and trains in a certain way, rather than using them for pretend
play. If someone accidentally moves one of the toys, the child may be
tremendously upset. ASD children need, and demand, absolute consistency
in their environment. A slight change in any routine—in mealtimes,
dressing, taking a bath, going to school at a certain time and by the
same route—can be extremely disturbing. Perhaps order and sameness lend
some stability in a world of confusion.
Repetitive behavior
sometimes takes the form of a persistent, intense preoccupation. For
example, the child might be obsessed with learning all about vacuum
cleaners, train schedules, or lighthouses. Often there is great
interest in numbers, symbols, or science topics.
Problems That May Accompany ASD
Sensory problems.
When children's perceptions are accurate, they can learn from what they
see, feel, or hear. On the other hand, if sensory information is
faulty, the child's experiences of the world can be confusing. Many ASD
children are highly attuned or even painfully sensitive to certain
sounds, textures, tastes, and smells. Some children find the feel of
clothes touching their skin almost unbearable. Some sounds—a vacuum
cleaner, a ringing telephone, a sudden storm, even the sound of waves
lapping the shoreline—will cause these children to cover their ears and
scream.
In ASD, the brain seems unable to balance the senses
appropriately. Some ASD children are oblivious to extreme cold or pain.
An ASD child may fall and break an arm, yet never cry. Another may bash
his head against a wall and not wince, but a light touch may make the
child scream with alarm.
Mental retardation.
Many children with ASD have some degree of mental impairment. When
tested, some areas of ability may be normal, while others may be
especially weak. For example, a child with ASD may do well on the parts
of the test that measure visual skills but earn low scores on the
language subtests.
Seizures. One in four children with ASD develops seizures, often starting either in early childhood or adolescence. 5
Seizures, caused by abnormal electrical activity in the brain, can
produce a temporary loss of consciousness (a “blackout”), a body
convulsion, unusual movements, or staring spells. Sometimes a
contributing factor is a lack of sleep or a high fever. An EEG
(electroencephalogram—recording of the electric currents developed in
the brain by means of electrodes applied to the scalp) can help confirm
the seizure's presence.
In most cases, seizures can be controlled
by a number of medicines called “anticonvulsants.” The dosage of the
medication is adjusted carefully so that the least possible amount of
medication will be used to be effective.
Fragile X syndrome.
This disorder is the most common inherited form of mental retardation.
It was so named because one part of the X chromosome has a defective
piece that appears pinched and fragile when under a microscope. Fragile
X syndrome affects about two to five percent of people with ASD. It is
important to have a child with ASD checked for Fragile X, especially if
the parents are considering having another child. For an unknown
reason, if a child with ASD also has Fragile X, there is a one-in-two
chance that boys born to the same parents will have the syndrome. 6 Other members of the family who may be contemplating having a child may also wish to be checked for the syndrome.
Tuberous Sclerosis.
Tuberous sclerosis is a rare genetic disorder that causes benign tumors
to grow in the brain as well as in other vital organs. It has a
consistently strong association with ASD. One to 4 percent of people
with ASD also have tuberous sclerosis.7
Source: National Institute of Mental Health
Thirteen Great Books on Autism Spectrum Disorders:
-
Adolescents on the Autism Spectrum: A Parent's Guide to the Cognitive,
Social, Physical, and Transition Needs ofTeenagers with Autism Spectrum
Disorders by Chantal Sicile-Kira and Temple Grandin (Paperback - Feb
28, 2006)
-
1001
Great Ideas for Teaching and Raising Children with Autism Spectrum
Disorders by Veronica Zysk and Ellen Notbohm (Paperback - Dec 1, 2004)
-
Teaching Young Children With Autism Spectrum Disorder by Clarissa Willis (Paperback - Sep 1, 2006)
-
Helping Your Child With Autism Spectrum Disorder: A Step-By-Step
Workbook For Families by Stephanie B., Ph.D. Lockshin, Jennifer M.
Gillis, and Raymond G. Romanczyk (Paperback - Jun 2005)
-
Ten Things Every Child with Autism Wishes You Knew by Ellen Notbohm (Paperback - Jan 1, 2005)
-
Demystifying Autism Spectrum Disorders: A Guide to Diagnosis for
Parents and Professionals (Topics in Autism) by Carolyn Thorwarth Bruey
(Paperback - April 2004)
-
Autism Spectrum Disorders from A to Z: Assessment, Diagnosis... &
More! by Barbara T Doyle and Emily Doyle Iland (Paperback - Jan 1, 2004)
-
Autism Spectrum Disorders [Two Volumes]: A Handbook for Parents and
Professionals by Brenda Smith Myles, Terri Cooper Swanson, Jeanne
Holverstott, and Megan Moore Duncan (Hardcover - Sep 30, 2007)
-
Autism Spectrum Disorders: The Complete Guide to Understanding Autism,
Asperger's Syndrome, Pervasive Developmental Disorder, and Other ASDs
by Chantal Sicile-Kira and Temple Grandin (Paperback - Sep 7, 2004)
-
Autism Spectrum Disorders: The Complete Guide to Understanding Autism,
Asperger's Syndrome, Pervasive Developmental Disorder, and Other ASDs
by Chantal Sicile-Kira and Temple Grandin (Paperback - Sep 7, 2004)
-
My Son Fred- Living With Autism: How Could You Manage? I Couldn't, I Did It Anyway (Paperback) by Maud
-
Living With Autism (Overcoming Common Problems) (Paperback)by Fiona
-
Therese: Living With Autism (Paperback) by Therese M. Ronan
Nine Resource and Support Groups for Autism Spectrum Disorders:
- Autism Society of America
- Google Autism Support Groups
- Online Asperger Information and Support
- Daily Strength Autism Support Groups
- Parents Helping Parents
- Equip
- Children’s Disabilities Information
- Fathers of children with autism
- Aspie Hangout
Additional Resources:
- For related articles on
autism spectrum disorders on the Web, click on: “Sphere: Related Content”
located at the bottom of this blog post.
- For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Autism Spectrum Disorders” or type in the keyword “Autism Spectrum disorders” into “Google Search” located in the sidebar.
- For more books with related
content, click any hyperlinked keyword in the blog or type in the keyword,
“autism spectrum disorders” into “Amazon Search” on the Amazon banner
located in the side bar.
Sources: National Institute of Child Health and Human Development, See also blogposts in: Psychiatric Disorders: Autism Spectrum Disoders
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
