WHAT IS AUTISM?

What are some common signs of autism?
How is autism diagnosed?
What causes autism?
What role does genetics play?
Do symptoms of autism change over time?
How can autism be treated?
Where can I get more information?

What is autism?
Autism is not a disease, but a developmental disorder of brain function.
People with classical autism show three types of symptoms:
impaired social interaction, problems with verbal and nonverbal communication
and imagination, and unusual or severely limited activities and interests.
Symptoms of autism usually appear during the first three years
of childhood and continue throughout life.
Although there is no cure, appropriate management may foster
relatively normal development and reduce undesirable behaviors.
People with autism have a normal life expectancy.
Autism affects an estimated two to 10 of every 10,000 people,
depending on the diagnostic criteria used. Most estimates that include people with
similar disorders are two to three times greater. Autism strikes males about
four times as often as females, and has been found throughout
the world in people of all racial and social backgrounds.
Autism varies a great deal in severity.
The most severe cases are marked by extremely repetitive, unusual,
self-injurious, and aggressive behavior. This behavior may persist over time
and prove very difficult to change, posing a tremendous challenge
to those who must live with, treat, and teach these individuals.
The mildest forms of autism resemble a personality disorder associated with a perceived learning disability.

What are some common signs of autism?
The hallmark feature of autism is impaired social interaction.
Children with autism may fail to respond to their names and often avoid looking at other people.
Such children often have difficulty interpreting tone of voice or
facial expressions and do not respond to others' emotions or watch other feelings toward them and of the negative impact of their behavior on other people.
Many children with autism engage in repetitive movements such as rocking and
hair twirling, or in self-injurious behavior such as biting or head-banging.
They also tend to start speaking later than other children and may refer to
themselves by name instead of "I" or "me." Some speak in a sing-song voice about a narrow
range of favorite topics, with little regard for the interests of the person to whom they are speaking.
People with autism often have abnormal responses to sounds,
touch, or other sensory stimulation.
Many show reduced sensitivity to pain.
They also may be extraordinarily sensitive to other sensations.
These unusual sensitivities may contribute to behavioral symptoms
such as resistance to being cuddled.

How is autism diagnosed?
Autism is classified as one of the pervasive developmental disorders.
Some doctors also use terms such as "emotionally disturbed" to describe people with autism.
Because it varies widely in its severity and symptoms, autism may go unrecognized,
especially in mildly affected individuals or in those with multiple handicaps.
Researchers and therapists have developed several sets of diagnostic criteria for autism.
Some frequently used criteria include:
Absence or impairment of imaginative and social play
Impaired ability to make friends with peers
Impaired ability to initiate or sustain a conversation with others
Stereotyped, repetitive, or unusual use of language
Restricted patterns of interests that are abnormal in intensity or focus
Apparently inflexible adherence to specific routines or rituals
Preoccupation with parts of objects
Children with some symptoms of autism,
but not enough to be diagnosed with the classical form of the disorder,
are often diagnosed with pervasive developmental disorder - not otherwise specified (PDD - NOS).
The term Asperger syndrome is sometimes used to describe people
with autistic behavior but well-developed language skills.
Children who appear normal in their first several years, then lose skills and begin showing autistic behavior,
may be diagnosed with childhood disintegrative disorder (CDD).
Girls with Rett's syndrome, a sex-linked genetic disorder characterized by
inadequate brain growth, seizures, and other neurological problems, also may show autistic behavior.
PDD - NOS, Asperger syndrome, CDD, and Rett's syndrome are sometimes referred to as autism spectrum disorders.
Since hearing problems can be confused with autism,
children with delayed speech development should always have their hearing checked.
Children sometimes have impaired hearing in addition to autism.
About half of people with autism score below 50 on IQ tests,
20 percent score between 50 and 70, and 30 percent score higher than 70.
However, estimating IQ in young children with autism is often difficult
because problems with language and behavior can interfere with testing.
A small percentage of people with autism are savants.
These people have limited but extraordinary skills in areas like music, mathematics, drawing, or visualization.

What causes autism?
Autism has no single cause. Researchers believe several genes,
as well as environmental factors such as viruses or chemicals, contribute to the disorder.
Studies of people with autism have found abnormalities in several regions of the brain,
including the cerebellum, amygdala, hippocampus, septum, and mamillary bodies.
Neurons in these regions appear smaller than normal and have stunted nerve fibers,
which may interfere with nerve signaling.
These abnormalities suggest that autism results from disruption of normal brain development
early in fetal development. Other studies suggest that people with autism
have abnormalities of serotonin or other signaling molecules in the brain.
While these findings are intriguing, they are preliminary and require further study.
The early belief that parental practices are responsible for autism has now been disproved.
In a minority of cases, disorders such as fragile X syndrome,
tuberous sclerosis, untreated phenylketonuria (PKU), and congenital rubella cause autistic behavior.
Other disorders, including Tourette syndrome, learning disabilities, and
attention deficit disorder, often occur with autism but do not cause it.
For reasons that are still unclear, about 20 to 30 percent of people with autism
also develop epilepsy by the time they reach adulthood.
While people with schizophrenia may show some autistic-like behavior,
their symptoms usually do not appear until the late teens or early adulthood.
Most people with schizophrenia also have hallucinations and
delusions, which are not found in autism.

What role does genetics play?
Recent studies strongly suggest that some people have a genetic
predisposition to autism. Scientists estimate that,
in families with one autistic child, the risk of having a second child
with the disorder is approximately five percent, or one in 20,
which is greater than the risk for the general population (see "What is autism?").
Researchers are looking for clues about which genes contribute to this increased susceptibility.
In some cases, parents and other relatives of an autistic person show mild social,
communicative, or repetitive behaviors that allow them to function normally but appear linked to autism.
Evidence also suggests that some affective, or emotional, disorders,
such as manic depression, occur more frequently than average in families of people with autism.

Do symptoms of autism change over time?
Symptoms in many children with autism improve with intervention
or as the children mature. Some people with autism eventually
lead normal or near-normal lives. However, reports from parents
of children with autism indicate that some children's language skills regress
early in life, usually before age three. This regression often seems linked
to epilepsy or seizure-like brain activity. Adolescence also worsens behavior
problems in some children with autism, who may become depressed or increasingly unmanageable.
Parents should be ready to adjust treatment for their child's changing needs.

How can autism be treated?
There is no cure for autism at present. Therapies, or interventions,
are designed to remedy specific symptoms in each individual.
The best-studied therapies include educational/behavioral and medical interventions.
Although these interventions do not cure autism, they often bring about substantial improvement.
Educational/behavioral interventions:
These strategies emphasize highly structured and often intensive
skill-oriented training that is tailored to the individual child.
Therapists work with children to help them develop social and language skills.
Because children learn most effectively and rapidly when very young,
this type of therapy should begin as early as possible.
Recent evidence suggests that early intervention has a good chance of favorably influencing brain development.
Medication:
Doctors may prescribe a variety of drugs to reduce self-injurious behavior or other
troublesome symptoms of autism, as well as associated conditions such as epilepsy and attention disorders.
Most of these drugs affect levels of serotonin or other signaling chemicals in the brain.
Many other interventions are available, but few, if any, scientific studies support their use.
These therapies remain controversial and may or may not reduce a specific person's symptoms.
Parents should use caution before subscribing to any particular treatment.
Counseling for the families of people with autism also may assist them in coping with the disorder.

DIAGNOSTIC CRITERIA FOR AUTISTIC DISORDER

Important: This is provided for information purposes only.
An accurate diagnosis is the important first step in
addressing any needs; such a diagnosis can only be performed
by a qualified professional who's familiar with the individual's history.
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 interaction,
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, facial expression,
body postures, and gestures, to regulate social interaction.
b. failure to develop peer relationships appropriate
to developmental level.
c. a lack of spontaneous seeking to share enjoyment,
interests or achievements with other people eg:
by a lack of showing, bringing or pointing out objects of interest.
d. lack of social or emotional reciprocity.
2. Qualitative impairments in communication as manifested
by at least one of the following:
a. delay in, or total lack of, the development of spoken
language not accompanied by an attempt to compensate through
alternative modes of communication such as gesture or mime.
b. in individuals with adequate speech, marked impairment
in the ability to initiate or sustain a conversation with others.
c. 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 is abnormal
either in intensity or focus.
b. apparently inflexible adherence to specific nonfunctional
routines or rituals.
c. stereotyped and repetitive motor mannerisms eg:
hand or finger flapping 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.
3. symbolic or imaginative play.
C. The disturbance is not better accounted for by
Rett's Disorder or Childhood Disintegrative Disorder.

Autism is the most prevalent of the PDDs .
It occurs in approximately fifteen of every 10,000 individuals.
Four out of five people with autism are male, but it is not limited
to a particular racial, ethnic or social group.
The specific causes of autism are not known, although they are related to brain function.
Autism is a spectrum disorder with skills and deficits varying greatly from person to person.
Behaviors characteristic of autism and mental disability also occur across a continuum
and may range from mild to severe. People with autism exhibit individualized
and distinctive combinations of strengths and needs.

characteristics
Speech develops slowly or not at all
uses words without attaching meaning to them
repeats certain words
Social Interaction
chooses to be alone
does not use cues, such as eye contact or smiles, to connect
Play
may be interested in only one specific object
may not participate in spontaneous or pretend game
Sensitivity to Pain and Sounds
may be very sensitive to touch and noise or may not react at all
Need for Sameness
may repeat the same motions
may expect the same routine in every detail of the day
Peak Skills
may show extraordinary talent in areas such as math, music, art or memory for specific facts strategies
Teach specific skills:
social, behavioral, academic and organizational.
Present information visually and verbally.
Structure the environment to be predictable with minimal distractions.
Develop schedules using visual cues of pictures and words.
Prepare for changes in routine.
Provide interaction with non-disabled peers as
role models for social, language and behavior skills.
Practice new skills in different environments.
Develop a behavior management system that provides structure and consistency.

Children with autism usually exhibit at least half of the traits listed below.
These symptoms can range from mild to severe and vary in intensity from symptom to symptom.
In addition, the behavior usually occurs across many different
situations and is consistently inappropriate for their age.

Problems in social relatedness and communication.
(Difficulty in mixing with other children;
prefers to be alone; aloof manner; difficulty in expressing needs;
uses gestures or pointing instead of words ).
Abnormal responses to one or a combination of senses; such as sight,
hearing, touch, balance, smell, taste, reaction to pain.
Sustained odd play.
Uneven gross/ fine motor skills.
Not responsive to verbal cues; acts as deaf.
Little or no eye contact.
Insistence on sameness; resist changes in routine.
Noticeable physical over activity or extreme under activity.
Tantrums; displays extreme distress for no apparent reason.
Speech and language absence or delays.
Inappropriate laughing and giggling.
Echolalia (repeating words or phrases in place of normal language).
Abnormal ways of relating to people,
objects and events. (Inappropriate attachment to objects; don't seek cuddling )
Spins objects.

An aspect of language that tends to be disturbed in autistic
people has to do with knowing how to use language appropriately and in context.
That includes knowing how to hold a conversation,
thinking about what the other person in a conversation understands and
believes, and tuning in to the meta-linguistic signals of the other person,
such as facial expression, tone of voice and body language.
It is important to remember that communication is as much
nonverbal as it is verbal, and autistic people have great difficulty
understanding nonverbal language.

Diagnosing and Evaluating Autism
Autism and related disabilities,
such as PDD-NOS (Pervasive Developmental Disorder - Not Otherwise Specified),
and Asperger's Syndrome are difficult to diagnose,
especially in young children where speech and reasoning skills are still developing.
It is essential that the process of diagnosing Autism
& related disabilities include the assessment and evaluation of a child's development,
communication, and social skills.
Evaluation and assessment are ongoing processes.
Once a diagnosis has been reached, this process should be repeated periodically.

Medical Tests
The following medical tests may help with diagnosis
and possibly suggest changes in the intervention or treatment strategy.

Hearing:
Various tests such as an Audiogram and Typanogram
can indicate whether a child has a hearing impairment.
Audiologists, or hearing specialists, have methods to test the hearing
of any individual by measuring responses such as turning their head, blinking,
or staring when a sound is presented.
Electroencephalogram (EEG):
An EEG measures brain waves that can show seizure disorders.
In addition, an EEG may indicate tumors or other brain abnormalities.
Additional tests will likely be needed to make an accurate diagnosis of these conditions.
Metabolic Screening:
Blood and urine lab tests measure how a child metabolizes food
and its impact on growth and development.
Some Autism spectrum disorders can be treated with special diets.
Magnetic Resonance Imaging (MRI):
An MRI involves using magnetic sensing equipment to create an
image of the brain in extremely fine detail.
Sometimes children are sedated in order to complete the MRI.
Computer Assisted Axial Tomography (CAT SCAN):
An X-Ray tube rotates around the child taking thousands
of exposures that are sent to a computer where the X-rayed section
of the body is reconstructed in great detail. CAT Scans are helpful
in diagnosing structural problems with the brain.
Genetic Testing:
Blood tests look for abnormalities in the genes
which could cause a developmental disability.

Therapy Evaluations
Many children with Autism and related disabilities
require some form of special therapy.
Evaluation can help determine the potential benefits of therapy.
Speech - Language Therapy:
Autistic children usually have delays in communication.
Some are nonverbal, and some who are verbal may also have deficiencies
or are unable to use language in a meaningful way.
A Speech Pathologist who specializes in the diagnosis
and treatment of language and speech disorders,
can help a child learn how to effectively communicate.
Occupational Therapy:
Commonly focuses on improving fine motor skills, such as brushing teeth,
feeding, and writing, or sensory motor skills that include balance (Vestibular System),
awareness of body position (Proprioceptive System), and touch (Tactile System).
After a therapist identifies a specific problem, therapy may
include sensory integration activities such as: massage, firm touch, ect..
Physical Therapy:
Specializes in developing strength, coordination and movement.
Therapists work on improving gross motor skills.
This therapy is concerned with improving function of the body's larger muscles
through physical activities including exercise.

Direct Observation
Direct observation, interaction, and interviews assessments:
Information about a child's emotional, social, communication,
and cognitive abilities is gathered through child-directed interactions,
observations in various situations, and interviews of parents and care givers.
Parents and family members should be actively involved throughout these assessments.
What actually occurs during a specific assessment depends
on what information parents and evaluators want to know.
Functional assessments:
Aim to discover why a challenging behavior (such as head banging) is occurring.
Based on the premise that challenging behaviors are a way of communicating,
functional assessment involves interviews, direct observations, and interactions
to determine what a child with autism or a related disability is trying
to communicate through their behavior.
Once the purpose of the challenging behavior is determined,
an alternative, more acceptable means for achieving that purpose can be developed.
This helps eliminate the challenging behavior.
Play based assessments:
Involve adult observation in structured and unstructured play situations that provide
information about a child's social, emotional, cognitive, and communication development.
By determining the child's learning style and interaction pattern
through play based assessments, an individualized treatment plan can be developed.

Standardized instruments
Standardized instruments are formal methods used to determine different levels of cognitive development.
Rating Scales & Developmental Inventories:
Vineland Adaptive Behavior Scales and Childhood Autism Rating Scale
are examples of standardized tests that measure a child's general developmental skills,
including socialization skills and coping skills.
Scores are based on parent interviews and evaluator observations.
Intelligence Tests (IQ):
Stanford-Binet Intelligence Scale and other intelligence tests attempt
to determine an individual's intelligence based on standardized criteria.
The results of educational tests are often provided in composite scores.
On the Wechsler Intelligence Scale for Children , (WISC-III),
three scores are usually provided:
Verbal IQ (VIQ), Performance IQ (PIQ), and a Full Scale IQ (FSIQ).
Each of these tests provides a composite score.
Both the Verbal and Performance IQ scores are composites of five different sub-tests.
Intelligence Tests (IQ) do not necessarily measure an autistic child
true abilities and unique potential to develop.

This Article has been submitted by the Jeremy's Prophecy Dot Com team for informational and educational purposes. Jeremy's Prophecy Dot Com is a website dedicated to telling the story of Jeremy Jacobs, a character in the novel, Jeremy's Prophecy Dot Com.