(Parenting) Autism - Symptoms, Parenting
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AUTISM
SYMPTOMS, CAUSES, ASSESSMENT, AND TREATMENT
What is Autism?
Definition
Autism or Autistic Disorder is a pervasive developmental disorder that affects all of mental
development. It looks very different at different ages and certain features do not become
apparent until later. Autism is probably present at birth but is often not identified until the child
fails to develop communicative language at about 2 years of age. 70% of children with Autism
have IQ's below 70; and 11% have IQ's above 85. Those individuals who are most
developmentally delayed are usually also most autistic. As with normally developing children
no two children with Autism are alike and the differential diagnosis of such disorders as
Autism, Asperger's Syndrome, Nonverbal Learning Disability (NLD), Pervasive
Developmental Disorder (PDD), and severe communication disorder can be difficult. It is
believed by many researchers that the fundamental deficit that is seen in autistic children
is a "mind blindness" or a lack of a theory of mind or the capacity to understand that
other people think and feel the same way as they do. This deficit is believed to
contribute to the difficulty that autistic children have in imitating another person's
reactions, particularly their body movements, and particularly if the content of the
actions is affective. Several studies have also found specific deficits in autistic children's
perception and understanding of emotions.
“Autism or Autistic
Disorder is a pervasive
developmental disorder
that affects all of mental
development.”
Children with Autism have three primary distinguishing features:
·
Impairments in social interaction
(are not interested in peer interactions and
may show little eye-to-eye contact and lack of sharing with others).
·
Impairments in communication
(delays in or lack of spoken language).
·
Repetitive and stereotypic behaviours, interests and activities
(may show
behaviours such as hand flapping, spinning objects, and rituals).
Incidence
10 - 15 per 10,000 children are autistic and an additional 12 - 20 per 10,000 have autistic-like
features. Three boys to one girl have the disorder.
Diagnosis
The DSM-IV-TR (2000) has identified Autistic Disorder as one disorder under the wider category of Pervasive
Developmental Disorders. Under the broader category there are other disorders included such as Asperger's
Syndrome, Rett's Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder (Not
Otherwise Specified). DSM-IV-TR has identified the following diagnostic criteria for the Autistic Disorder.
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AUTISM
Diagnostic Criteria
A.
A total of six or more items from (1), (2), and (3) with at least two from (1), and one each from (2)
and (3).
(1)
qualitative impairment in social interactions, as manifested by at least two of
the following:
(a)
marked impairment in the use of multiple nonverbal behaviours
such as eye-to-eye gaze, facialexpression, body postures, and
gestures to regulate social interaction
(b)
failure to develop peer relationships appropriate to develop
mental level
(c)
a lack of spontaneous seeking to share enjoyment, interests,
or achievements with other people (e.g. by lack of showing,
bringing, or pointing out objects of interest)
(d)
lack of social or emotional reciprocity
(2)
qualitative impairment in communication as manifested by at least
one of the following:
“10 - 15 per 10,000
children are autistic...”
(a)
delay in, or total lack of, the development of spoken lan
guage (not accompanied by an attempt to compensate
through alter native modes of communication such as
gestures and mime)
(b)
in individuals with adequate speech, marked impairment in
the ability to initiate or sustain a conversation with others
(c)
stereotyped and repetitive use of language or idiosyncratic
language
(d)
lack of varied, spontaneous make-believe play or social
imitative play appropriate to developmental level
(3)
restricted repetitive and stereotyped patterns of behaviour, interests, and
activities as manifested by at least one of the following:
(a)
encompassing preoccupation with one or more stereotyped and
restricted patterns of interest that isabnormal either in intensity or
focus
(b)
apparently inflexible adherence to specific, nonfunctional routines or
rituals
(c)
stereotyped and repetitive motor mannerisms (e.g. hand or finger flap
ping or twisting, or complex whole-body movements)
(d)
persistent preoccupation with parts of objects
B.
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3
years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or
imaginative play
C.
The disturbance is not better accounted for by Rett's Disorder or Childhood Distintegrative
Disorder.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, Text Revision (DSM-IV-TR) (p. 79).Washington, D.C.: American Psychiatric
Association.
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AUTISM
Diagnostic Criteria
It is still not clear what precise deficits underlie Autistic Disorders but researchers have got much closer
to understanding them in the last five years. This has mainly occurred because the latest research has
compared autistic children to other children with the same IQ and chronological age. Deficits appear to
be very selective and are not the same in all children with Autism.
Other Symptoms That may Be Present For Some Children
·
Gross and sustained impairment of emotional relationships with people, aloofness
and/or empty symbiotic clinging.
·
Apparent unawareness of their own personal identity (e.g. posturing, self-mutilation,
and failure to use "I").
·
Obsessive use of and preoccupation with objects without regard to their functions.
“It is still not clear
what precise deficits
underlie Autistic
Disorders but
researchers have got
much closer to
understanding them in
the last five years.”
·
Resistance to change in the environment and a striving to maintain sameness.
·
Excessive, diminished, or unpredictable responses to sensory stimuli.
·
Acute, excessive, and illogical anxiety especially precipitated by change.
·
Speech may have been lost or never acquired.
·
May use echolalia and certain idiosyncratic words.
·
Distortion in mobility patterns such as bizarre postures or ritualistic manner
isms, strange gestures and toe walking.
·
Serious retardation with possible islets of normal or near normal intelligence
and sometimes exceptional functioning in very isolated areas.
·
Poor concentration, short attention span and distractibility.
·
Minimal social and self help behaviours.
·
May place him/herself in danger by, for example, not watching while crossing
the road.
·
Does not show mutual sharing of interests, activities, and emotions with others,
particularly other children.
·
Does not understand the perspective of others.
·
May be aggressive if frustrated or if a child comes too close to their space.
·
May line up toys and not be interested in their function.
·
May seem unaware of what is going on around them.
·
May wander off in shopping malls and in parking lots seemingly without a sense that
they are alone.
·
Mainly engages in interaction in order to get what they want.
·
May "use" a person's arm in order to get what they want or to do something they cannot
do. This has been called "hand leading" and is used instead of pointing.
·
Does not use the emotions of others or "social referencing" in order to decide how to act.
·
Does not follow through on the requests of others because they are really not understood and
the child is doing what he wants to do.
·
May enjoy physical contact with parents and other caregivers if it is when they want it.
·
May not seek out comfort when upset or hurt.
·
Show little desire to imitate or copy another person's behaviour.
·
May show self-injurious behaviour.
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AUTISM
Causes
Causes
Exactly what causes Autism is unknown although it is believed to be a neurological condition. Medical
conditions that could be causal are found in only about 5-10% of cases.
Genetic Component
It seems likely that a predisposition to Autism is inherited. The evidence of the heritability of
Autism comes from twin and family studies. In twin studies, unusually high rates of Autism are
found in identical twins, and very low rates in fraternal or non-identical twins. Studies of
families have indicated that 2-6% of the siblings of autistic children are also autistic, and that
8% of the extended families will include another member who is autistic. Family studies also
reveal an increased prevalence of mental retardation and cognitive difficulties in the
siblings of autistic children especially those who are mentally retarded themselves. This
suggests that what may be inherited is not an "Autism gene" but rather a nonspecific
factor which increases the likelihood of various cognitive problems including Autism.
“It seems likely that a
predisposition to Autism
is inherited.”
Neurobiological Difficulties
It is believed that Autism may be related to damage to the prefrontal cortex and limbic
region of the brain and to the connections between the two regions. The most
consistent findings are of brain stem and cerebellum abnormalities. P.E.T. scans with
Autistic children show the location of problems to be in these areas of the brain. Adults
with this kind of brain damage, as a result of accident or stroke, display similar
difficulties as autistic individuals. There is some indication that the brains of children with
Autism may have increased cell density suggesting that the cells did not get pruned back
as they do in normal development. Other researchers have found that this is
particularly true within the dopamine system suggesting that there may be an excess of
dopamine which could contribute to an overactive system. Studies of glucose metabolism
and blood flow have failed to reveal consistent global or regional abnormalities, although
correlational studies do show some promise.
Developmental History
The developmental history of autistic children seldom reveals medical conditions that can be linked
to the disorder. However, certain other illnesses place children at risk for developing Autism. These
are neurofibromatosis, tuberous sclerosis, and fragile X syndrome. Many children with Autism
(approximately one fifth to one third) develop seizures. Most of these occur in lower functioning
individuals and usually develop in later childhood or adolescence. Many studies have shown that the
number of perinatal problems experienced by autistic children are exceptionally high including: difficult
delivery, infantile seizures, delayed breathing and neonatal convulsions. Some children appear to have
normal development earlier and only show the symptoms of Autism in the second year of life. There have
been two explanations given for this: (1) the child did show problems earlier but they only became obvious
when speech failed to develop and the pressure for socialization was greater, or (2) the child was born with a
vulnerability to acquiring the syndrome and it was triggered by a virus or other insult.
Environmental Factors
As mentioned previously in a very few cases of Autism a viral infection in a young child preceded the onset of
the symptoms of Autism, before which there was a period of apparently normal development. There are also
some cases where infections occurred in the mother at an early stage of pregnancy. No other links to
environmental conditions have been found.
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AUTISM
Development
Development
Infancy
In general, unless there is mental retardation, the signs of Autism may not be obvious until the second year of life when language
does not develop normally and the child does not show any interest in playing with other children. Stereotypic behaviours may also
develop at this time. However, even in early infancy some signs of difficulties may be observable. See the following chart for a list of
these signs
Signs in Infancy (first year)
MOTOR
PERCEPTUAL
SOCIAL-EMOTIONAL
LANGUAGE
MENTAL
REPRESENTATIONAL
Inactive:
· Flaccid muscle tone
· Rarely cries
Unusually sensitive to
sensory stimuli
Unresponsive:
Delayed or absent coo or
expressive socialization
Decreased visual pursuit
of objects and people
· No social smile
· Avoidance of eye
contact when held
· Fleeting eye contact at a
distance
· Lack of anticipatory
response to being
picked up
· Seems not to like being
held or hugged
· Seems content left alone
· Does not visually follow
the coming and going
of primary caregiver
· Does not play peek-a-
boo or patty-cake or
wave bye-bye
· Fails to show normal 8-
month stranger anxiety
· Does not respond to
social bids from
caregiver
Or
Auditory:
· Appears deaf to voice
but jolts or panics at
environmental sounds
Failure to imitate sounds,
words, or gestures
Object permanence
develops slowly or stops
at age 2 or 3 years so
child does not develop
capacity for retaining a
memory of object or per-
son or for searching for
them
Irritable:
· Inconsolable
· Only soothed when
in constant motion
· Limp
Little communication or
use of gestures
Tactile:
· Refuses food with rough
texture
· Adverse reaction to
wool fabrics and labels,
etc.
· Prefers smooth surfaces
Speech delayed or shows
precocious advances
followed by failure to use
previously learned words
Or
Motorically
disorganized:
· May be very active
· Have poor motor
planning in reaching
for objects
Use eye contact when
interacting
Visual:
· Sensitive to light
· May panic at change in
illumination
· Preoccupied in
observing own hand
and finger movements
Does not point to object
or hold up an object to
show it to caregiver
Fails to form strong
personal attachments
Early Childhood
It is usually in the second year of life that signs of Autism become most obvious and assessment is requested in order to determine
the reason or cause of the symptoms. Some of the signs that become obvious at this time are outlined below.
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