AUTISM CONNECT DIRECTORY

Understanding Autism

Autism Spectrum Disorder (ASD) and autism are both common terms used for a group of complex neuro-developmental disorders Autism is a pervasive developmental disorder that involves abnormal development and function of the brain. Individuals with autism show decreased social communication skills and restricted or repetitive patterns of behaviors or interests.. Autism spectrum disorder impacts the nervous system and affects the overall cognitive, emotional, social and physical health of the affected individual. This section explains some of signs and symptoms of autism, deficits in their social, communication skills, the behavioural issues, associated problems with autism, related causes and the team involved in treating and diagnosing autism.

Autism Spectrum Disorder

What is Autism Spectrum Disorder or Autism?

Autism Spectrum Disorder (ASD) and Autism are both common terms used for a group of complex neuro-developmental disorders. ASD is primarily characterized by deficits in communication and social interactions and unusual behavior and interests (1). It impacts the nervous system and affects the overall cognitive, emotional, social and physical health of the affected individual. The signs and symptoms of autism are typically noticed in the first three years of life. Autism affects the way an individual relates to his or her environment and their interaction with other people. Subsequently, this grossly impacts development in the areas of daily functioning and social interaction. Mental capacities may be compromised due to atypical (sub normal) functioning of some areas of the brain. Hence, children with Autism have special needs that must be addressed differently.

Autism is usually diagnosed in early childhood and despite extensive studies, the exact cause of Autism remains elusive. However, with increased awareness, rapidly evolving technology and ever-growing research, it is now understood that an intricate interplay of genetics and environmental factors may be responsible for the onset of Autism. Research has established that early diagnosis and intervention, along with access to appropriate support lead to significantly improved outcomes. When Autism is detected and treated early, disruptive behaviors can be minimized and costs associated with treatment can be reduced significantly.

History of Autism

The root of the term “autism” is derived from the Greek word “autos” meaning “self”. Paul Eugen Bleuler, a Swiss psychiatrist, first coined the term in 1911 (2). He used it to describe a subset of schizophrenic patients who seemed to be self-absorbed and withdrawn. As time passed, our thinking and understanding of autism has evolved dramatically. An analysis of the description of behavior traits observed in several early documented cases suggests that these are in fact cases of what we now recognize as Autism. One famous and well documented example of this would be the story of Victor, the Wild Boy of Aveyron, who was found naked in a French forest (2). Victor did not understand language and would eat only half-burned or roasted potatoes, walnuts and raw chestnuts (3). Some even believed that he had been reared by wolves. The French physician Dr. Jean-Marc Gaspard Itard took Victor under his care and brought him to Paris. Dr. Itard spent several years trying to help Victor to integrate into human society and teaching him language. He was not completely successful as Victor only learned some French words, but never fully understood the language. However, there was an improvement in Victor’s fine motor skills and communication (3). He also developed friendship with his caregivers. It is now known that Victor may have been autistic and whoever he lived with was unable to understand him. Hence, although Autism seems to be a new condition, a look at its history suggests that it may have always existed.

Dr. Leo Kanner (pronounced “conner”) and Dr. Hans Asperger have played the most crucial roles in introducing Autism to the world. In 1943, Dr. Leo Kanner, an Austrian psychiatrist working at Johns Hopkins Hospital, published a paper describing 11 children who displayed a “strong desire of being alone”, had a “resistance to change” or a “need for sameness” (4). He introduced the term “early infantile autism” to describe his observations. A year later, Dr. Hans Asperger, also an Austrian psychiatrist, described similar characteristics in a group of children he was treating.

Dr. Leo Kanner and Dr. Hans Asperger

Image courtesy: elpsicoasesor

Prevalence of Autism

According to the World Health Organization (WHO), worldwide, 1 in 160 children has an ASD. This suggests that approximately 1% of the world population has ASD. Studies have also shown that boys are 5 times more likely to develop Autism than girls.

References:

1. Lord, C., Cook, E. H., Leventhal, B. L., &  Amaral, D. G. (2013). Autism spectrum disorders. Autism: The Science of Mental Health, 28(2), 217.

2. Feinstein, A. (2011). A history of autism: Conversations with the pioneers. John Wiley & Sons.

3. Starostina, N. (2016). Victor, the Wild Boy of Aveyron (c. 1788 – 1828), and the Rise of Special Education in Modern France,

4. Baron-Cohen, S. (2015). Leo Kanner, Hans Asperger, and the discovery of autism. The Lancet, 386(10001), 1329-1330.

Causes of Autism

Parents of children with autism usually have a few unanswered questions like “how did my child develop autism? My child was hale and healthy and had even started to speak a few words. Then, what happened suddenly?”So, is autism acquired? Could it have been prevented? Is it genetic? Can the other children also have autism? Yet, this is a question to which no definitive answers are given to them. Although the “why” may never be known. What is becoming clearer with ongoing research is, “what is the fundamental problem in the brains of the children with Autism”.

Associated problems with autism

Children who are diagnosed with Autism are known to have other co-existing problems. A thorough evaluation is needed to rule out whether the comorbidity is directly associated with ASD or is altogether a different condition in the child.

Some of the problems which may be associated with Autism are described below

Diagnosing Team

Autism is one of those common conditions which remain unidentified or undiagnosed until very late into the developmental or formative years of a child. The reasons behind this are limited awareness of parents as well as denial or hesitancy in accepting their child’s problems.

Signs and symptoms

ASD is a heterogeneous disorder i.e. no two individuals on the spectrum will have the same set of signs and symptoms. The severity and range of symptoms are highly variable. However, the symptoms or difficulties can be classified into core domains such as difficulty in social interactions, communication deficits, behavioral issues and unusual interests and certain physical attributes. An individual may present with any one, or a combination of or all of these difficulties/symptoms. Signs and symptoms usually become noticeable in the first three years of life. This section details the range of these signs and symptoms which are usually observed in individuals with autism.

Social Skills:

Individuals with ASD face difficulties in communicating and expressing their feelings. They also have trouble in understanding the feelings of the people around them. As they grow up, this social deficit is further affected due to feelings of anxiety and depression. This in turn intensifies the problem with social skills, making it hard for them to adjust or adapt to their surroundings.

Examples of Social Issues related to ASD:

  • Poor or fleeting eye contact
  • Delayed or lack of response to name
  • Isolated play (the child prefers to be aloof)
  • Inability to interpret gestures or non-verbal cues
  • Difficulty in expressing feelings
  • Lack of social awareness (difficulty in understanding personal space and boundaries)
  • Sensory issues (avoids touch or seeks more physical touch for example hugging, kissing, etc.)

Communication Skills:

Individuals with ASD may present with varying levels of communication skills. This ranges from being fluently verbal to nonverbal and the intensity of these challenges can be seen in their language processing abilities. About 25 to 30% of kids with Autism start developing vocabulary skills by 12 to 18 months, but may lose all progress by their second birthday.

Examples of Communication Difficulties are:

  • Delayed development of speech and language skills
  • Repetition of words, dialogues and sentences (echolalia)
  • Irrelevant speech i.e. giving unrelated answers to questions.
  • Lack of interest in pretend play (does not pretend to feed a doll)
  • Difficulty in interpreting or understanding jokes, riddles or questions

Behavioral Issues and Unusual Interests:

Individuals with autism often have unusual interests and behaviors like:

  • Unusual and inappropriate play with toys
  • Obsessed with objects like bottle caps, papers, wires, buttons, key rings, water pipes, straws, plastic, etc
  • Lining up objects or toys
  • Inability to adjust to or adapt to minor changes in the routine or environment
  • Repetitive behaviors like hand flapping, spinning objects.
  • Smelling or mouthing objects
  • Strong avoidance of certain food items, tastes, textures of clothing, etc.
  • Unusual fears or dislikes, e.g. cutting nails, flowers, etc.
  • Self-stimulatory behaviors like rocking, tapping hands/feet

Physical Features:

While social and behavioral issues are more obvious it these children, some characteristic physical features may also be noticed. These may also add to their difficulties in interacting with their environment.

Some physical features of Autism are:

  • Abnormal muscle tone (muscles may be too tight or too loose)
  • Bony prominences may visible e.g. winging of the Scapula (prominent shoulder blades due to weak muscles)
  • Flat Feet
  • Poor or lack of hand-eye coordination
  • Limb apraxia (difficulty in performing planned movements of the arms or legs)
  • Balance issues while sitting, standing or walking
  • Abnormal posture or lordotic back (excessive inward curvature of the spine or back bone)
  • Clumsiness
  • Unusual sweating
  • Abnormal reactions to sensory stimuli

Other Symptoms:

  • Hyperactivity.
  • Impulsive and uncontrolled behavior e.g. acting without thinking
  • Poor attention span (gets distracted very easily)
  • Self – injurious behavior like head banging, biting oneself, etc.
  • Aggressive behavior towards others like biting, scratching, hair pulling, throwing objects, etc.
  • Temper tantrums or erratic mood or inappropriate emotional reactions
  • Lack of fear (cannot sense danger)
  • Fear of irrelevant objects or situations e.g. fear of pressure cooker or a black plastic bag.
  • Hypersensitivity or hyposensitivity to touch, sound, taste, smell, look or feel.
  • Disrupted or disturbed sleep patterns
  • Odd eating or food habits e.g. may not eat food items which are white in color, etc.