Autism

Autism is classified as a neurodevelopmental disorder that manifests itself in markedly abnormal social interaction, communication ability, patterns of interests, and patterns of behavior.

Although the specific etiology of autism is unknown, many researchers suspect that autism results from genetically mediated vulnerabilities to environmental triggers. And while there is disagreement about the magnitude, nature, and mechanisms for such environmental factors, researchers have found at least seven major genes prevalent among individuals diagnosed as autistic. Some estimate that autism occurs in as many as one United States child in 166, however the National Institute of Mental Health gives a more conservative estimate of one in 1000 [1]. For families that already have one autistic child, the odds of a second autistic child may be as high as one in twenty. Diagnosis is based on a list of psychiatric criteria, and a series of standardized clinical tests may also be used.

Autism may not be physiologically obvious. A complete physical and neurological evaluation will typically be part of diagnosing autism. Some now speculate that autism is not a single condition but a group of several distinct conditions that manifest in similar ways.

By definition, autism must manifest delays in "social interaction, language as used in social communication, or symbolic or imaginative play," with "onset prior to age 3 years", according to the Diagnostic and Statistical Manual of Mental Disorders. The ICD-10 also says that symptoms must "manifest before the age of three years." There have been large increases in the reported incidence of autism, for reasons that are heavily debated by researchers in psychology and related fields within the scientific community.

There are cases of children with autism who have improved their social and other skills to the point where they can fully participate in mainstream education and social events, but there are lingering concerns that an absolute cure from autism is impossible with current technology. However, many autistic children and adults who are able to communicate (at least in writing) are opposed to attempts to cure their conditions, and see such conditions as part of who they are.

Contents
1 History
2 Terminology
3 Characteristics
3.1 Social development
3.2 Sensory system
3.3 Communication difficulties
3.4 Repetitive behaviors
3.5 Effects in education 
 
History
 
Dr. Hans Asperger described a form of autism in the 1940s that later became known as Asperger's syndrome.The word autism was first used in the English language by Swiss psychiatrist Eugene Bleuler in a 1912 number of the American Journal of Insanity. It comes from the Greek word for "self".

However, the classification of autism did not occur until the middle of the twentieth century, when in 1943 psychiatrist Dr. Leo Kanner of the Johns Hopkins Hospital in Baltimore reported on 11 child patients with striking behavioral similarities, and introduced the label early infantile autism. He suggested "autism" from the Greek αυτος (autos), meaning "self", to describe the fact that the children seemed to lack interest in other people. Although Kanner's first paper on the subject was published in a (now defunct) journal, The Nervous Child, almost every characteristic he originally described is still regarded as typical of the autistic spectrum of disorders.

At the same time an Austrian scientist, Dr. Hans Asperger, described a different form of autism that became known as Asperger's syndrome—but the widespread recognition of Asperger's work was delayed by World War II in Germany, and by the fact that his seminal paper wasn't translated into English for almost 50 years. The majority of his work wasn't widely read until 1997.

Thus these two conditions were described and are today listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (fourth edition, text revision 1) as two of the five pervasive developmental disorders (PDD), more often referred to today as autism spectrum disorders (ASD). All of these conditions are characterized by varying degrees of difference in communication skills, social interactions, and restricted, repetitive and stereotyped patterns of behavior.

Few clinicians today solely use the DSM-IV criteria for determining a diagnosis of autism, which are based on the absence or delay of certain developmental milestones. Many clinicians instead use an alternate means (or a combination thereof) to more accurately determine a diagnosis.

Terminology
Look up autism and autistic in Wiktionary, the free dictionary.When referring to someone diagnosed with autism, the term autistic is often used. However, the term person with autism can be used instead. This is referred to as person-first terminology. The autistic community generally prefers the term autistic for reasons that are fairly controversial. This article uses the term autistic.

Recommended reading: The Essential Guide To Autism

Characteristics
 
Dr. Leo Kanner introduced the label early infantile autism in 1943.There is a great diversity in the skills and behaviors of individuals diagnosed as autistic, and physicians will often arrive at different conclusions about the appropriate diagnosis. Much of this is due to the sensory system of an autistic which is quite different from the sensory system of other people, since certain stimulations can affect an autistic differently than a non-autistic, and the degree to which the sensory system is affected varies wildly from one autistic person to another.

Nevertheless, professionals within pediatric care and development often look for early indicators of autism in order to initiate treatment as early as possible. However, some people do not believe in treatment for autism, either because they do not believe autism is a disorder or because they believe treatment can do more harm than good.

Social development
Typically, developing infants are social beings—early in life they do such things as gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to faces and 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 seem indifferent to other people because they avoid eye contact and do not interact with them as often as non-autistic children.

Children with autism often appear to prefer being alone to the company of others and may passively accept such things as hugs and cuddling without reciprocating, or resist attention altogether. Later, they seldom seek comfort from others or respond to parents' displays of anger or affection in a typical way. Research has suggested that although autistic children are attached to their parents, their expression of this attachment is unusual and difficult to interpret. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of expected attachment behavior.

Children with autism appear to lack "theory of mind", the ability to see things from another person's perspective, a behavior cited as exclusive to human beings above the age of five and, possibly, other higher primates such as adult gorillas, chimpanzees and bonobos. Typical 5-year-olds can develop insights into other people's different knowledge, feelings, and intentions, interpretations based upon social cues (e.g., gestures, facial expressions). An individual with autism seems to lack these interpretation skills, an inability that leaves them unable to predict or understand other people's actions. The social alienation of autistic and Asperger's people is so intense from childhood that many of them have imaginary friends as companionship. However, having an imaginary friend is not necessarily a sign of autism and also occurs in non-autistic children.

Although not universal, it is common for autistic people to not regulate their behavior. This can take the form of crying or verbal outbursts that may seem out of proportion to the situation. Individuals with autism generally prefer consistent routines and environments; they may react negatively to changes in them. It is not uncommon for individuals to exhibit aggression, increased levels of self-stimulatory behavior, self-injury or extensive withdrawal in overwhelming situations.

Sensory system
A key indicator to clinicians making a proper assessment for autism would include looking for symptoms much like those found in sensory integration dysfunction. Children will exhibit problems coping with the normal sensory input. Indicators of this disorder include oversensitivity or underreactivity to touch, movement, sights, or sounds; physical clumsiness or carelessness; poor body awareness; a tendency to be easily distracted; impulsive physical or verbal behaviour; an activity level that is unusually high or low; not unwinding or calming oneself; difficulty learning new movements; difficulty in making transitions from one situation to another; social and/or emotional problems; delays in speech, language or motor skills; specific learning difficulties/delays in academic achievement.

One common example is an individual with autism hearing. A person with Autism may have trouble hearing certain people while other people are louder than usual. Or the person with Autism may be unable to filter out sounds in certain situations, such as in a large crowd of people (see cocktail party effect). However, this is perhaps the part of the autism that tends to vary the most from person to person, so these examples may not apply to every autistic.

It should be noted that sensory difficulties, although reportedly common in autistics, are not part of the DSM-IV diagnostic criteria for autistic disorder.

Communication difficulties
By age 3, typical children have passed predictable language learning milestones; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he or she hears his or her name, points when he or she wants a toy, and when offered something distasteful, makes it clear that the answer is "no." Speech development in people with autism takes different paths. Some remain mute throughout their lives while being fully literate and able to communicate in other ways—images, sign language, and typing are far more natural to them. Some infants who later show signs of autism coo and babble during the first few months of life, but stop soon afterwards. Others may be delayed, developing language as late as the teenage years. Still, inability to speak does not mean that people with autism are unintelligent or unaware. Once given appropriate accommodations, many will happily converse for hours, and can often be found in online chat rooms, discussion boards or websites and even using communication devices at autism-community social events such as Autreat.

Those who do speak often use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat the same phrase over and over. Some repeat what they hear, a condition called echolalia. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many people with autism have a strong tonal sense, and can often understand spoken language. Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. The "give and take" of non-autistic conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to converse with other autistics, they comfortably do so in "parallel monologue"—taking turns expressing views and information. Just as "neurotypicals" (people without autism) have trouble understanding autistic body languages, vocal tones, or phraseology, people with autism similarly have trouble with such things in people without autism. In particular, autistic language abilities tend to be highly literal; people without autism often inappropriately attribute hidden meaning to what people with autism say or expect the person with autism to sense such unstated meaning in their own words.

The body language of people with autism can be difficult for other people to understand. Facial expressions, movements, and gestures may be easily understood by some other people with autism, but do not match those used by other people. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the auditory system of a person without autism often cannot sense the fluctuations. What seems to non-autistic people like a high-pitched, sing-song, or flat, robot-like voice is common in autistic children. Some autistic children with relatively good language skills speak like little adults, rather than communicating at their current age level, which is one of the things that can lead to problems.

Since non-autistic people are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let other people know what they need. As anybody might do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for non-autistic people to learn to communicate with them, people with autism do whatever they can to get through to them. Communication difficulties may contribute to autistic people becoming socially anxious or depressed.

Repetitive behaviors
Although people with autism usually appear physically normal and have good muscle control, unusual repetitive motions, known as self-stimulation or "stimming," may set them apart. 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 wiggling their toes, others suddenly freeze in position. As children, they might spend hours lining up their cars and trains in a certain way, not using them for pretend play. If someone accidentally moves one of these toys, the child may be tremendously upset. Autistic children often need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, or going to school at a certain time and by the same route—can be extremely disturbing. People with autism sometimes have a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules or lighthouses. Often they show great interest in different languages, numbers, symbols or science topics. Repetitive behaviors can also extend into the spoken word as well. Perseveration of a single word or phrase, even for a specific number of times can also become a part of the child's daily routine.

Effects in education
Children with autism are affected with these symptoms every day. These unusual characteristics set them apart from the everyday normal student. Because they have trouble understanding people’s thoughts and feelings, they have trouble understanding what their teacher may be telling them. They do not understand that facial expressions and vocal variations hold meanings and may misinterpret what emotion their instructor is displaying. This inability to fully decipher the world around them makes education stressful. Teachers need to be aware of a student's disorder so that they are able to help the student get the best out of the lessons being taught.

Some students learn better by visual aids. They are able to understand material that they see right in front of them. Because of this, many teachers create “visual schedules” for their autistic students. This allows the student to know what is going on through out the day. They know what to prepare for and what activity they will be doing next. Some autistic kids have trouble going from one activity to the next, so this visual schedule will cause less stress on such children.

Research has shown that working in partners is beneficial to autistic children. Autistic kids have problems in schools not only with language and communication, but with socialization as well. They feel self-conscious about themselves and feel that they will always be outcasts. By allowing them to work with peers they can make friends that can help them go through the problems that they deal with. By doing so they can become more integrated into the mainstream environment of the classroom.

A teacher's aide can also be useful to the student. The aide is be able to give more precise directions that the teacher doesn’t have time to explain to the autistic child. The aide can also facilitate the autistic child in such a way as to allow them to stay caught up with what the rest of the class is doing. This allows a more one-on-one lesson so that the child is still able to stay in a normal classroom but be given the extra help that they need.

There are many different techniques that teachers can use to assist their students. A teacher needs to become familiar with the child’s disorder to know what will work best with that particular child. Every child is going to be different and teachers have to be able to adjust with every one of them.

Students with Autism Spectrum Disorders typically have high levels of anxiety and stress particularly in social environments like school. If a student exhibits aggressive or explosive behavior, it is important for educational teams to recognize the impact of stress and anxiety. Preparing students for new situations by writing Social Stories can lower anxiety. Teaching social and emotional concepts using systematic teaching approaches such as The Incredible 5-Point Scale or other Cognitive Behavioral strategies can increase a student's ability to control excessive behavioral reactions.