What is Autism?

Autism is a developmental disability that typically appears during the first three years of life. The symptoms of autism may manifest in early infancy, with the infant shying away from a parent's touch and affection, not responding to a parent who returns after an absence, and inappropriate gazing behavior. The child may fail to meet early language and other developmental milestones. This is the time when most parents begin to become aware that there is something "different" about their child. Quite often, there is up to a 3-year delay between the report of symptoms to physicians and diagnosis of autism, which is usually made at around age five. This is a few years later than most children are diagnosed with cerebral palsy (which is typically diagnosed around 2 or 3 years of age).

Autism and its associated behaviors have been estimated to occur in as many as 1 in 500 individuals. Autism is 4 times as likely to occur in males, although when females are afflicted, they usually experience a more severe form. Autism knows no racial, social, or ethnic boundaries. Family income, lifestyle and education do not seem to affect the chance of autism. Autism was first identified in 1943, but appears to have existed throughout recorded history. It occurs in all ethnic and social groups. Knowledge of autism has improved greatly over the years, although as with cerebral palsy, there is no known cure.

As opposed to cerebral palsy, which effects the motor skills of an individual, autism impacts the normal development of the brain in the areas of social interaction and communication skills. Children and adults with autism typically have difficulties in communication (verbal and non-verbal), social interactions and leisure or play activities. The disorder makes it hard for them to communicate and relate to the outside world. They may exhibit repeated body movements, unusual responses to people or attachments to objects and strongly resist any changes in their routines. In some cases, aggressive and/or self-injurious behavior may manifest.

Over 500,000 people in the U.S. today have some form of autism. Its prevalence rate now places it as the third most common developmental disability - more common than Down's syndrome. Yet most of the public, including many professionals in the medical, vocational, and educational fields are still unaware of how autism affects people and how to work effectively with individuals who have autism.

Usually, autism is referred to as a spectrum disorder, meaning that the symptoms and characteristics of autism can present themselves in a wide variety of combinations. These characteristics can be mild to severe in nature. Although autism is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Two different children, both with a diagnosis of autism, can act very extremely different from each another.

What are Possible Causes of Autism?

Currently, researchers are exploring different explanations for the various forms of autism. Although one specific cause of autism is not yet known (perhaps there is no single cause), current research does link autism to biological or neurological differences in the brain. MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography) scans show abnormalities in brain structure, with significant differences within the cerebellum, including the size and number of Purkinje cells. In some families there appears to be a pattern of autism or related disabilities, which suggests there may be a genetic basis.

Still another possible cause is exposure to too much mercury. Most compounds which contain mercury are poisonous. Methylmercury is an organic form of mercury that is sometimes used as a preservative. It can also be produced from metallic mercury or mercury compounds in bodies of water by the action of bacteria. This is why in January of 2001 the FDA issued a warning to pregnant women, nursing mothers, and small infants to avoid fish that may contain unsafe levels of methylmercury. This would include the larger, longer living fish, since methylmercury accumulates through time.

The fetus and young babies are very sensitive to the effects of methylmercury's. It is known to cause central nervous system damage and the severity of the damage largely depends on the extent of the exposure. It is also known that overexposure to methylmercury causes some forms of cerebral palsy. There are studies underway right now attempting to find out if the small amounts of methylmercury present in vaccines (used as a preservative) is a cause for the rise of autism and cerebral palsy over the past 15 years.

How is Autism Diagnosed?

There are no medical tests for diagnosing autism. An accurate diagnosis must be based on observations of the child's communication, behavior and developmental levels. 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.

Diagnosis is difficult for a practitioner with limited training or exposure to autism, since the characteristics of the disorder vary so much. Locating a medical specialist or a diagnostician who has experience with autism is most important. A child should be evaluated by a multidisciplinary team which may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant or other professionals knowledgeable about autism.

What are Some Symptoms of Autism?

Children who have autism usually appear mostly normal in their development until the age of 24-30 months, when parents may notice delays in language, play or social interaction. The following areas are among those which may be affected by autism:

Social Interaction: spends time alone rather than with others; shows little interest in making friends; less responsible to social cues such as eye contact or smiles.

Communication: language develops slowly or not at all; use of words without attaching the usual meaning to them; communicates with gestures instead of words; short attention spans.

Sensory Impairment: unusual reactions to physical sensations such as being overly sensitive to touch or under-responsive to pain; sight, hearing, touch, pain, smell, taste may be affected to a lesser or greater degree.

Play: lack of spontaneous or imaginative play; does not imitate others actions; doesn't initiate pretend games.

Behaviors: may be overactive or very passive; throw frequent tantrums for no apparent reason; may perseverate on a single item, idea or person; apparent lack of common sense; may show aggressive or violent behavior or injure self.

Some individuals mildly affected with autism may exhibit only slight delays in language and greater challenges with social interactions. They may have average or above average verbal, memory or spatial skills but find it difficult to be imaginative or join in a game of softball with their friends. Others more severely affected may need greater assistance in handling day to day activities like crossing the street or making a purchase.

Contrary to popular understanding, many children and adults with autism make eye contact, show affection, smile and laugh, and show a variety of other emotions, but in varying degrees. Like other children, they respond to their environment in positive and negative ways. The autism may affect their range of responses and make it more difficult to control how their body and mind react. They live normal life spans and the behaviors associated with may change or disappear over time.

Is a Cure in Sight?

Our understanding of autism has grown tremendously since it was first described in 1943. Some of the earlier searches for "cures" now seem unrealistic in terms of today's understanding of brain-based disorders. To cure means:
"to restore to health, soundness, or normality." In the medical sense, there is no cure for the differences in the brain which result in autism.

We are finding better ways to understand the disorder and help people cope with the various symptoms of the disability. Some of these symptoms may lessen as the child ages while some may disappear altogether. With appropriate intervention, many of the autism behaviors 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 symptoms of autism to some degree throughout their entire lives.

What are Some Effective Approaches towards Autism?

Because of the spectrum nature of autism and the many behavior combinations which can occur, no one approach is effective in alleviating symptoms of autism in all cases. Various types of therapies are available, including behavior modification, speech/language therapy, sensory integration, vision therapy, music therapy, auditory training, medications and dietary interventions, among others.

Experience has shown that individuals with autism respond well to a highly structured, specialized education and behavior modification program, tailored to the individual needs of the person. A well designed intervention approach will include some level of communication therapy, social skill development, sensory impairment therapy and behavior modification at a minimum, delivered by autism trained professionals in a consistent, comprehensive and coordinated manner. The more severe challenges of some children with autism may be best addressed by a structured education and behavior program which contains a 1:1 teacher to student ratio or small group environment.

Students with autism should have training in vocational skills and community living skills at the earliest possible age. Learning to cross a street safely, to make a simple purchase or to ask assistance when needed are critical skills, and may be difficult, even for those with average intelligence levels. Tasks that enhance the person's independence, give more opportunity for personal choice or allow more freedom in the community are important.

To be effective, any approach should be flexible in nature, rely on positive reinforcement, be re-evaluated on a regular basis and provide a smooth transition from home to school to community environments. A good program will also incorporate training and support systems for the caregivers as well. Rarely can a family, classroom teacher or other caregiver provide effective habilitation for a person with autism unless offered consultation or in-service training by a specialist knowledgeable about the disability.

30 years ago, the vast majority of the people with autism were eventually placed in institutions. Today, as a result of appropriate and individualized services and programs, even the more severely disabled can be taught skills to allow them to develop to their fullest potential.