Autism

A severe psychological disorder that first appears in early childhood and is characterized by impaired social interaction and language development, and other behavioral problems.

First described by Dr. Leo Kanner in 1943, autism is a severe psychological disorder that affects an estimated four children in 10,000. Autism manifests itself in early childhood. The autistic child is impaired socially, in language development, and exhibits other behavioral problems. This disorder is also known as infantile or childhood autism and Kanner's autism.

The occurrence of autism is four times higher in boys than girls. It is now believed that some of the "wild" or "feral" children found living outdoors on their own may have been autistic children abandoned by their parents. The most famous of these was Victor, the "wild boy of Aveyron," discovered in 1799 at the age of approximately 11. Although he remained almost totally unable to speak, Victor showed great improvements in socialization and cognitive ability after working for several years with Jean-Marc-Gaspard Itard, a physician and teacher of the deaf.

Contrary to earlier beliefs, autism is not thought to have psychological origins, such as inadequate parenting. Several possible causes of autism have been proposed, including phenylketonuria (an inherited metabolic disease), exposure to rubella or certain chemicals in utero, and hereditary predisposition. There is no accurate test for autism, although CT scans of autistic children sometimes reveal abnormalities in the ventricles of the brain. Autism is usually diagnosed in children between the ages of two and three years based on clinical observation and parental reports. Until this point, manifestations of the disorder are difficult to detect, and in some cases an autistic child will develop normally for the first year or two of life. However, a break usually occurs before the age of two and a half, when speech development (if it has begun) stops and social responses fail to develop.

Children and adults with autism demonstrate a marked impairment in social interaction. Generally, it first appears in children as an inability to form a close attachment to their parents. As infants, they may refuse to cuddle and may react to physical contact by stiffening their bodies and attempting to slide away. Often, autistic children do not develop other feelings that commonly accompany emotional attachments, such as grief, sadness, guilt, or shame, and when older, they are generally impervious to being left with strangers. There is also a lack of interest in or a failure to form peer relationships, and the ordinary desire to share experiences and interests with others tends to be lacking. Autistic children lack interest and skill in games and other typical kinds of reciprocal child's play, including imitative play. Standard nonverbal behaviors that support social interactions— eye contact, facial expressions, and body language—are generally not used appropriately.

Language difficulties are the single symptom that most often leads parents to seek diagnosis and help for autistic children. The development of spoken language is either delayed or totally absent in children with autism. Those who can speak still have trouble listening to others and initiating or carrying on a conversation. The speech of autistic persons often lacks normal grammatical structures and is also nonstandard in terms of such characteristics as pitch, speed, rhythm, or stress on syllables. Echolalia (echoing other people's voices or voices heard on television) is also common.

Besides social and language impairments, the other major symptom of autism is the presence of repetitive, ritualized patterns of behavior. These may be repeated physical movements, such as rocking, swaying, flapping one's arms, or clapping. Autistic behavior may also take such forms as arranging objects in specific patterns or quantities, mimicking a particular action, or performing a routine activity exactly the same way every day. Other behavioral characteristics associated with autism are a preoccupation with a single interest (often one for which a large number of facts may be collected); resistance to trivial changes in routine; fascination with a moving object (such as revolving doors) or a particular part of an object; and a strong attachment to an inanimate object. Persons with autism may exhibit oversensitivity to certain stimuli (such as light or touch), unusual pickiness in eating, inappropriate fear and/or fearlessness, and self-injuring behavior, such as head banging. As many as 25 percent of autistic children develop epileptic seizures later in life, often in adolescence, although this particular symptom appears only in those who are mentally retarded.

Three-fourths of autistic children are mentally retarded, and 60 percent have IQ scores below 50. However, many demonstrate skill in music, mathematics, long-term memorization of trivial data, and specialized tasks such as assembling jigsaw puzzles. Autistic children with IQ scores of 70 and above have the best prognosis for living and working independently as adults, although only one in six children with autism becomes a well-adjusted adult, with another one out of six achieving a fair degree of adjustment. Even those autistic adults who function relatively well will still experience difficulty with social interaction and communication, and highly restricted interests and activities. Besides IQ, other predictors of future adjustment for autistic children are their degree of language development, the overall severity of their symptoms, and the types of treatment they receive. While psychotherapy has not been of value in treating persons with autism, behavior modification, medication, and dietary recommendations have been proven effective in controlling specific symptoms. Special education programs are able to improve the social interaction of autistic children and enhance their academic skills. Developmental work that includes parents has been found to be especially helpful.