by Kirsta Grapentine

April is National Autism Awareness Month

In the 1998 movie Mercury Rising, a young autistic child cracks a governmental supercode by solving a seemingly unsolvable puzzle in a magazine. Similarly, the movie Rainman featured another autistic savant who could recite a myriad of baseball statistics, names and numbers from a telephone book and calculate at a moment's notice what day of the week any given date would fall on. Both movies introduced the American public to Autism, a complex disorder that covers a spectrum of behaviors.

Autism is part of a group of related neurological disabilities called Pervasive Developmental Disorders (PDD), which also includes Asperger Syndrome, Childhood Disintegrative Disorder and Rett's Syndrome. Autism is a severely incapacitating, lifelong developmental disability that typically appears during the first three years of life. It affects one in every 2,400 individuals -- although that statistic rises to 1 in 500 when the related PDD's are included. Autism is four times more common in males than females. It is found throughout the world in families of all racial, ethnic, and social backgrounds.

Autism is often referred to as a spectrum disorder because its symptoms cover a broad range of behaviors, combination of behaviors and range of severity. Two individuals with the diagnosis of Autism may exhibit entirely different behaviors and deficits. In general, Autism presents as markedly abnormal or delayed development of social interaction and communication, along with a very limited array of interests and activities. According to the DSM IV, to be labeled autistic, an individual must show:

A. A total of six or more behaviors, with at least two behaviors from area 1 and one each from areas 2 and 3:

1. Qualitative impairment in social interaction, as manifested by at least two of the following:
   a) marked impairments in use of multiple non-verbal behaviors (such as eye contact, facial expressions, body posture/gestures)
   b) failure to develop age appropriate peer relations
   c) lack of spontaneous sharing with others (i.e. lack of showing, bringing, sharing and pointing out objects to others)
   d) lack of social or emotional reciprocity
2. Qualitative impairments in communication as manifested by at least one of the following:
   a) delay in or total lack of development of spoken or equivalent (sign or gestures) language
   b) marked impairment in ability to initiate or sustain conversation
   c) stereotyped and repetitive use of language or idiosyncratic language
   d) lack of varied, spontaneous make-believe play or age appropriate imitative play
3. Restricted repetitive or stereotyped patterns of behavior, interests and activities as manifested by at least two of the following:
   a) encompassing preoccupation with one or more stereotyped and restrictive behaviors that is abnormal either in intensity or focus
   b) apparently inflexible adherence to specific, nonfunctional routines or rituals
   c) stereotyped and repetitive motor mannerisms (hand flapping, head banging, etc.)
   d) persistent preoccupation with parts of objects\

B. Delays or abnormal functioning in at least one of the following, with onset appearing prior to age three:

1. Social interaction
2. Language used in social communication
3. Symbolic or imaginative play

C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder (see article below).

Characteristics often associated with autistic children are avoidance of eye contact, extreme sensitivity to sound and tactile stimulation, diminished capacity to communicate, little interaction with others, hyperactivity or lethargy, mood swings, repetitive motion behaviors and lack of spontaneous play. Behaviors may change as children grow older, and seizure disorders and increased anxiety often mark the onset of puberty. Ten percent of autistic individuals display exceptional "savant" abilities (one who exhibits remarkable mental ability, while being severely mentally impaired), such as those shown by Raymond in the movie Rainman, compared with less than one percent in the rest of the population. Autistic behaviors show similarities to mental retardation, depression, Schizophrenia, Attention Deficit Disorder, Tourette Syndrome, Epilepsy, Obsessive Compulsive Disorder, Oppositional Defiant Disorder, deafness and speech disorders.

Although many children who are subsequently diagnosed as autistic initially develop normally, many resist physical and social contact with caregivers from an early age and/or appear as either very passive or overly agitated infants. An accurate diagnosis can only be given by a physician or specialist who may employ a checklist of behaviors at a child's 18 month check up to determine if there are any concerns. Key indicators of autism in toddlers are the absence or abnormality of play, and lack response to and development of communication.

Autism was first diagnosed only 54 years ago, and its exact cause is still a mystery. What is known is that it is biological, not psychological in nature, and is not caused by poor parenting or traumatic events, and is not a mental illness. Autism is a neurological condition that appears to effect the development of the limbic system, brain stem and cerebellum. Some theories indicate that Autism could be genetic in nature. Family members where one member has been diagnosed as autistic often show affective disorders, allergies and learning disorders similar to those seen with Autism. Identical twins are more likely to have Autism than fraternal twins. Other theories link Autism to prenatal exposure to viruses, vaccinations or indirect fetal contact with chemicals.

There is no known cure for Autism, however, the disorder is treatable. No one treatment works for every individual with Autism. Programs will vary depending on the age, behaviors and needs of the individual. Most autistic children do best with highly structured home and school routines. A well designed intervention will include some level of communication therapy, development of social skills, sensory impairment therapy and behavior modification. Other therapies may include the use of drugs (usually antidepressants), dietary modifications, and the use of symbolic (picture) language for those individuals who have severe language deficits. Because the needs of autistic children vary widely, schools or educational institutions should provide an individualized educational plan (IEP) that includes the family, student and helping professionals. Some children do best in specialized programs where they can received one-on-one attention; others can be mainstreamed into regular classrooms.

Most families benefit from working with a professional who is well trained in working with autistic individuals, and usually set up home routines and interventions that focus on identifying triggers for and the modification of a child's most challenging behaviors. A good program should be flexible, rely on positive reinforcement, be reevaluated on a regular basis, and support the transition of a child from school to home to the community. Additionally, families who have children who have been diagnosed with any of the Pervasive Development Disorders should create a supportive environment for themselves. Talking to other parents of autistic children, planned time away, self education and professional help are all productive methods of dealing with a sometimes overwhelming disorder.

Twenty years ago, most individuals with Autism were institutionalized. As more about Autism is discovered, early intervention and a focus on vocational and community living skills has made it so that even those individuals who have severe challenges can be taught skills that allow them to develop there fullest potential.

Resources:
Special thanks go to Craig Broome, an adoption specialist at Bethany Christian Service in Fremont for providing the groundwork for this article. Craig is the father of an autistic child and offers himself as a resource to parents and professionals who may have question about this disorder. His work phone number is (616) 924-3390.

Autism Society of Michigan: 1-800-223-6722.


When researching this article, I found use of the Internet indispensable. Type Autism in any search engine and you should get plenty of results. Sites for the Center for the Study of Autism, The Autism Society of America and One Mom's view for parents of children with autistic disorders were particularly useful.

Other Pervasive Development Disorders:

Asperger Syndrome is very similar to Autism, but differs primarily in the degree of impairment and cognitive ability (those with Asperger Syndrome have average to above-average ability; those with Autism may have some sort of mental retardation). The DSM IV diagnostic criteria for this syndrome is:

A) Qualitative impairment in social interaction as manifested by at least two of the following:

1. marked impairment in the use of multiple nonverbal behaviors (eye contact, gestures, body postures)
2. failure to develop age appropriate peer relations
3. lack of spontaneous seeking to share enjoyment with others (showing, bringing, pointing)
4. lack of social or emotional reciprocity.

B) Restrictive repetitive and stereotyped behaviors and limited interests as manifested by at least one of the following:

1. preoccupation with stereotyped and restrictive interests or activities that are either abnormal in focus or intensity
2. preoccupation with nonfunctional routines
3. stereotyped and repetitive motions (hand wringing, finger twisting, etc.)
4. preoccupation with parts of objects.

C) The disturbance causes clinically significant impairments in social functioning.
D) There is no clinically significant general delay in language (i.e. single words used by age 2, phrases used by age 3).
E) No clinically significant delay in cognitive abilities or age-appropriate self-help skills, and curiosity about the environment.
F) The disturbance is not better accounted for by another PDD or by Schizophrenia.

Childhood Disintegrative Disorder - The child exhibits normal development of communication, social interaction and play for at least first two years after birth. Subsequently, there is a clinically significant loss of previously acquired skills in at least two of the following areas: expressive or receptive language; social skills or adaptive behavior; bowel and bladder control; play; or motor skills. Also, there may be abnormalities in at least two of the following areas: qualitative impairment in social interaction; qualitative impairment in communication; or restrictive and repetitive patterns of behavior and interests. The disturbance also can not better accounted for by another PDD or by Schizophrenia.

Rett's Syndrome is a degenerative disorder which affects mostly (10:1) females. Individuals develop normally between 5 and 18 months, then show deceleration of head growth, loss of speech and social skills, development of repetitive motion behaviors and impaired motor skills. Severe mental retardation may also be present.

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