What Is Autism?

Autism is a Physical disorder of the brain that causes a lifelong developmental disability. The many different symptoms of autism can occur by themselves or in combination with other conditions such as mental retardation, blindness, deafness, and epilepsy. Because children with autism--like all children--vary widely in their abilities and behavior, each symptom may appear differently in each child. For example, children with autism often exhibit some form of bizarre, repetitive behavior called stereotypedbehavior. Some, like Robbie, may incessantly spin plates or other objects. Others may lick their fingers immediately after touching a doorknob. The following section introduces the six major symptoms of autism.

The Symptoms of Autism:

Failure to Develop Normal Socialization

The inability of children with autism to develop normal social skills is probably the most noticeable characteristic of autism. Children with autism don't interact with others the way most other children do or simply don't interact at all. Like Robbie, they seem to prefer to be alone most of the time. They appear to live a life of extreme isolation. They have great difficulty understanding and expressing emotion, and show few, if any, signs of attachment, the emotional bonding that occurs between people who care for each other. This behavior is very different from the social behavior of most infants and young children.

The child with autism may appear to be very uninterested in other people. She may avoid eye-contact or appear to "look through" people. She may seem extremely apathetic and unresponsive; showing no desire to initiate contact or to be held or cuddled. Indeed, when she is held she may stiffen or arch her back as if being held is somehow distressing. The social cues of others--a smile, a wave, a frown--may be meaningless to her. She may not develop a social smile until quite late. In addition, she may not play with others. She may use people mechanically as a "means to an end." For example, your child may approach you and take you by the hand to something she wants--like to the refrigerator for juice--without a word or a glance. You are treated just like any other tool.

Most children with autism have extremely limited social skills and seem to live in a world of their own, separate from and unfathomable to outsiders. This inability to relate to the world of people is often the strongest clue to autism.

Disturbances in Speech,
Language, and Communication

Autism's second major symptom is speech, language, and communication problems. Approximately 40 percent of children with autism do not speak at all. Others have what is called echolalia, a parrotlike repeating of what has been said to them. Sometimes echolalia is immediate, as when your child says, "Do you want a cookie?" after you have just asked her, "Do you want a cookie?" Sometimes echolalia is delayed, and may involve the recitation of TV commercials, advertising jingles, or single words heard several minutes, days, weeks, or even months ago. Your child may have little or no understanding of abstract concepts such as danger, or of symbolic gestures such as waving "bye-bye." She may not understand the proper use of pronouns, particularly "you" and "I," and may reverse them. She may not use speech for communication, and what speech she does use may be repetitive and filled with illogical words or phrases.

Your child's voice may sound flat or monotonous and she may have no apparent control over her pitch or volume. For example, she may speak in a loud, high-pitched voice in response to your questions. In addition, she may rely excessively on jargon or use words or phrases out of context. For example, one child said, "Time to be heading home," with great agitation whenever asked to do something she did not want to do.

Abnormal Relationships to Objects and Events

Children with autism are usually unable to relate normally to objects and events. For example, remember the way Robbie would constantly spin objects. Your child may also interact with things or events in this nonfunctional way.

A great many children with autism have what is called a "need for sameness," and may become very upset if objects in their environment or schedules are changed from their familiar placement or pattern. For example, if you ask your child to brush her teeth before her bath instead of afterwards, she may resist the change mightily. This inflexibility can force families into a very difficult and rigid existence as they attempt to follow their child's "rules."

The way children with autism "play" may be very unusual; sometimes children with autism do not play at all. Your child may have no "pretend" play and may start few, if any, play activities on her own. When she does use toys or play materials, she may use them in unusual ways. For example, she may repeatedly drop Legos onto a hard surface, or always arrange her blocks in the same pattern based on size, shape, or color.

These unusual responses to people, objects, and events can and do change. Over time, and with appropriate treatment, children with autism can learn to enjoy using various objects appropriately and can learn to tolerate some change in their world.

Abnormal Responses to Sensory Stimulation

Sensory stimuli are the things in the environment that we touch, smell, feel, see, and hear. While we respond to much of what goes on around us, our brains filter out certain unimportant stimuli, allowing our attention to be focused on the most important information in the environment at that moment, For example, many large department stores use a tone signal to alert store employees. For shoppers, these signals are extraneous noises in the environment. Because they do not communicate a meaningful message to shoppers, most people just filter them out, Children with autism have difficulty with this "filtering out" process. They may greatly overreact to sensory stimuli, or have almost no reaction whatsoever. For instance, some children with autism find the tone signals in department stores very distressing. They may cover their ears and throw a tantrum until their parent takes them out of the store. Other children may appear enthralled with sounds they make themselves or with "background" sounds such as distant police sirens. Yet, except for a strong reaction to only these sounds, they may appear to have no reaction to any other sounds whatever, and indeed may appear deaf at other times. We do not know exactly why sounds affect children with autism in this way, but it appears to be part of the overall tendency of children with autism to overreact to some stimuli and underreact to others.

As part of her sensory problems, a child with autism may be fascinated with lights, color patterns, logos, shapes, or the configuration of letters and words. She may be preoccupied with scratching or rubbing certain surfaces. She may also furiously avoid certain food textures for example, "rough" textures like toast. In addition, your child may respond to motion in abnormal ways. Some children with autism enjoy being thrown into the air or spinning themselves around and around, never apparently becoming dizzy. Others have an intense fear of "roughhousing" or the movement of elevators.

Generally speaking, children with autism, especially younger children, appear to use their senses of taste and smell more than their senses of hearing and vision to learn and explore. Their reaction to cold or pain may vary from indifference, to oversensitivity, to unpredictable vacillation between thc two.

Developmental Delays and Differences

The fifth symptom of autism is the significantly different way a child with autism develops. Children without special needs develop at a relatively even pace across all of the many areas of development. A child's skills at a given age may be slightly ahead of or behind most other children's and still be well within normal limits. For example, a child may learn to walk sooner than most children, but learn to talk a bit later. For children with autism, however, this development process is not at all even. Their rate of development is quite different, particularly in communication, social, and cognitive skills. In contrast, motor development--the ability to walk, hop, climb stairs, and manipulate small objects with the fingers--may be relatively normal or only slightly delayed.

Thc sequence of development within any one of these areas of development can also bc unusual. For example, your child may be able to read complex words and phrases like "Exxon" or "Masters of thc Universe" and yet have no understanding of thc sounds of particular vowels and consonants.

Sometimes skills will appear in children with autism at thc expected time and then disappear. Like Robbie, a child may appear to develop spoken language at thc normal time, and then at about age two abruptly stop talking. While a child's abilities in areas such as working puzzles or counting may be normal or even precocious, her language skills may remain far below her age level.

Development is discussed more fully later in this book. Chapter 6 provides an overview of typical child development and explains how you can judge your child's individual development compared to that of most children.

Begins during Infancy or Childhood

The sixth symptom of autism is that it begins during infancy or childhood. Autism is a lifelong disability that one is born with. Generally, parents get a diagnosis before their child is thirty-six months old, but later diagnosis sometimes occurs. Furthermore, for a variety of reasons, some children may not be correctly diagnosed until several years later. In fact, some parents of children diagnosed with mental retardation do not learn until their child's adolescence or adulthood that she actually has autism. Do not rule out autism in your child just because all of the symptoms of autism are not actually observed until after thirty-six months.

Regardless of their age at diagnosis, children with autism almost always exhibit the five other symptoms to some degree throughout their lives. In some children, symptoms become less severe around ages five or six. This change can occur even earlier for some children where highly specialized early intervention programs are available, although the evidence is inconclusive as to exactly which children benefit most from these programs.

Adolescence typically heralds additional changes--some positive, others not--for the child with autism, and the severity of his or her symptoms may increase. Remember that your child's disorder and diagnosis are features of her personality that signify her need for carefully planned, well thought-out services throughout her life.

Types of Autism

Some children with autism are more disabled by their disorder than others. Autism in children can run the gamut from mild to severe, with the majority of children clustering toward the mid-point. However, it is important to remember that with any given child, each symptom can also be present in varying degrees of mildness or severity. In other words, some of a child's autistic symptoms may be milder than others. For example, a child with seriously impaired social skills may have normal or near normal cognitive skills--he may be quite aloof socially, but have no trouble learning to read or solve arithmetic problems.

We sometimes say that children most severely disabled in social interactive skills, language, and communication have "classic autism " (sometimes called "Kanner's autism"). These cases are rare, however; most children have a variable assortment of symptoms and severity. Instead of hearing that their child has classic autism, parents are more likely to hear labels like "Pervasive Developmental Disorder," "Atypical Pervasive Developmental Disorder," "Autistic-like," or "Pervasive Developmental Disorder Not Otherwise Specified." It is important to remember that, regardless of their label the education and treatment of these children is the same.

The examples below illustrate the possible range of severity for two of autism's primary symptoms — problems with social interactions and problems with communication. Also listed are behavioral symptoms. The mildest symptoms--those closest to "normal" behavior — come first, followed by the more severe symptoms.

Social Interactions

Communication

Behavioral Symptoms

How Many People Have Autism?

In the United States, there are at least 360,000 people with autism,^* one-third of whom are children. Autism is the fourth most common developmental disability; only mental retardation, epilepsy, and cerebral palsy occur more frequently. Autism occurs in about four to five of every ten thousand births. Children with the most severe form of this disorder probably make up only about 2-3 percent of children with autism. Some researchers maintain that autism occurs in fifteen out of ten thousand births, but they include children who have some, but not all, of the symptoms of autism. Again, you must remember that regardless of the number or severity of symptoms, the treatment for all of these children is basically the same.

Do More Boys Than Girls Have Autism?

For reasons we do not yet understand, autism occurs about four times more frequently in boys than in girls. There is some indication that autism is more common in first-born males, but there have been no conclusive studies to date and there is just not enough research available to know for sure. Girls, when affected, are more likely to be more seriously disabled and to have lower IQs.