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Autism Spectrum Disorders: Autism

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Psychology 221

The syndrome of autism is a "complex and puzzling disorder" (Prizant, 1982) first described by Dr. Leo Kanner of the John Hopkins School of Medicine in 1943. "In identifying ‘infantile autism,’ Kanner was attempting to indicate ‘a major differentiation within the overall group of children with so-called childhood schizophrenia’" (Prizant, 1982). While describing the behavioral patterns of 11 children who were characterized by "extreme autistic aloneness," Kanner noted that early onset was a major determining factor that differentiated autism from childhood schizophrenia. He described this group of children as having "autistic disturbances of affective contact" (Ornitz, E.M. MD & Ritvo, E.R. MD). After this, he was able to adopt the term "early infantile autism". Since that time, a broad range of labels have been applied to this syndrome, including childhood psychosis, symbiotic psychosis, childhood schizophrenia, and mental retardation with autistic features. As a result of these labels, confusion has persisted regarding both the diagnosis of, and the range of, appropriate therapies.

Autism is a severely to mildly "incapacitating, lifelong developmental disability that usually appears during the first 3 years of life. It occurs in approximately 5 out of every 10,000 births. Autism is four times more common in males than in females, and has been found throughout the world in families of all racial, ethnic, and social backgrounds" (Fact Sheet: Autism, 1980).

The population of autistic children represents an extremely varied group. As a consequence, definitions of autism often don’t correspond.

Authorities throughout the world now support the following concepts:

  1. Autism is a neurodevelopmental syndrome and a spectrum disorder whose expression ranges from severely involved to more mildly disabling. Autism is the most common condition in a group of developmental disorders known as the autism spectrum disorders which also include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (generally referred to as PDD-NOS).
  2. Autism is a developmental diagnosis, and its expression will vary with age and developmental level. Though symptoms may vary or diminish, the disorder is lifelong.
  3. The diagnosis must be made retrospectively on the basis of specific developmental criteria.
  4. Autism can coexist with, and is separate from, other diagnostic categories, including mental retardation, attention deficit disorder, and depressive disorders.

Although definitions may vary, when people refer to autism they are typically describing children who display a majority of the following symptoms. Some such symptoms include lack of appropriate speech and social behavior and apparent but unconfirmed sensory deficit. Other symptoms may include lack of appropriate play, inappropriate and out of context emotional behavior and repetitive behaviors. Another symptom includes "isolated areas of high level functioning in the context of otherwise low level intellectual functioning" (Dunlap, Koegel & Egel, 1979).

"Although Autism is probably present at birth the first symptoms may not be recognized or recalled by parents. Two courses of the illness have been reported. In the first, deviant behavior is noted shortly after birth even though mothers are not always able to specify the subtle nature of their infants’ ‘strange behavior.’ The infants may cry infrequently, not respond to companionship, and apparently not need stimulation. They become limp or rigid when held and are often described as ‘very good babies’ who never fuss. On the other hand, they may be intensely irritable and overreact to any form of stimulation and may have flaccid muscle tone. In the second course of development, the parents report relatively normal development up to 18 to 24 months, at which time they first note symptoms. The obvious appearance of symptoms invariably occurs before 30 months of age. In our experience, the subsequent clinical course is the same regardless of the age at which symptoms are first reported. A recent report of better prognosis when the apparent onset of symptoms is delayed suggests that symptoms are not recognized at birth in milder forms of the illness" (Ornitz & Ritvo, 1976).

The core symptoms of autism are impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Slow development or lack of physical, social, and learning skills is very common in these children. Children with autism are extremely sensitive to, and have abnormal responses to, sensations such as "sight, hearing, touch, pain, balance, smell, taste, the way a child holds his body (any one or a combination of these responses may be affected)" (Fact Sheet: Autism, 1980). These children are often withdrawn, may have a difficult time reading emotional states, and are often intensely preoccupied with a single activity or subject.

"The most outstanding difficulty for autistic young people is communication" (Everard, 1976). They have an abnormal way of relating to people, objects and events. They may display immature rhythms of speech and a limited understanding of ideas. Speech and language development may be totally delayed (muteness) or fixations may occur along the normal course of development. "Approximately 35-50% of autistic children are mute" (Prizant, 1982). Echolalia is a common feature and is usually accompanied by the misuse or reversal of pronouns and use of words without attaching the usual meaning to them. The echoing of feelings as well as words occurs. "When functional speech develops, it is usually atonal and arrhythmic, lacking inflection and failing to convey subtle emotion. The atonal and poor affective qualities of speech in young autistic children usually persist into adulthood even in those few children who develop communicative language" (Ornitz & Ritvo, 1976).

"Another frequently cited characteristic is their normal physical appearance. As children they present no associated physical deformities (although years of untreated autistic responding may eventually lead to physical degeneration), and, indeed, they are usually portrayed as cute and physically attractive: that is, their deviance is behavioral" (Dunlap, Koegel, Egel & 1979). The strange and bizarre appearance of some autistic children is due to their peculiar mannerisms and patterns of motility. These may be complex and repeated continuously, and they do not appear to be involuntary movements typical of seizure patterns. Disturbances of motility may appear intermittently in some autistic children while they may be continuously present in others. "Disturbances of perception are most likely due to an underlying neuropathophysiological process that is common to all autistic patients. It results in faulty modulation of external sensory input, distortion of the normal hierarchy of receptor preferences, and an impaired ability to use internal sensory input to make discriminations in the absence of feedback from motor responses" (Ornitz & Ritvo, 1976).

Behaviors that indicate disturbances of relating are due to developmental delays in personality formation. Behaviors characteristic of such ego pathology include poor or deviant eye contact and a delayed or absent social smile. They also include delayed or absent anticipatory response to being picked up. There is an apparent dislike to physical contact; a tendency to respond to only a part of another person; disinterest in playing games with others; and delayed, absent, or over-reactive anxiety to strangers. "Disturbances in relating may be subtle and intermittent" (Ornitz & Ritvo, 1976). "Severe autism may cause extreme forms of self-injurious, repetitive, highly unusual, and aggressive behavior. The behavior may persist and be very difficult to change, posing a tremendous challenge to those who must manage, treat, and teach autistic people. In it’s milder form, autism most resembles a learning disability such as childhood aphasia. Usually, however, people with autism are substantially handicapped" (Fact Sheet: Autism, 1980).

In autistic children, there are usually "isolated areas of high level functioning in the context of otherwise low level intellectual functioning" (Dunlap, Koegel & Egel, 1979). In IQ testing (Fact Sheet: Autism, 1980), approximately 60% of autistic patients have scores below 50, 20% between 50 and 70, and 20% greater than 70. Most patients show wide variations in performance on different tests at different times. Many autistic children have special skills in music, mathematics, or in using spatial concepts (for example, working on jigsaw puzzles), but are severely retarded in other areas.

"People with autism live through a normal life span. Since symptoms change, sometimes disappearing with age, patients should be reevaluated periodically to adjust their treatment to changing needs" (Fact Sheet: Autism, 1980).

Originally, parents were unjustly thought to be at fault for their children’s behavioral abnormalities. Although recent studies strongly suggest that some people have a genetically greater risk to autism, research has shown no connection between parental practices and their child’s autism and that theory has now been disproved. Scientists aren’t certain as to what causes autism but it’s possible that both genetics and environment play a role.

Researchers have identified a number of genes associated with the disorder. Studies of people with autism have found irregularities in several regions of the brain. Other studies suggest that people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of normal brain development in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other" (NINDS, 2004).

Drs. William Walsh and Anjum Usman in Chicago have done a study (ABCs of Autism, 2003) on patients in the autistic spectrum, showing that 99 percent of these 503 autistic patients displayed evidence of a metal-metabolism disorder. These findings suggest that genetic error of metal metabolism may be a central cause of autism and autistic spectrum disorders.

"In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism" (NINDS, 2004).

There is much controversy on the issue of whether environmental factors – such as such as mercury (found in vaccinations and/or dental work), lead, copper, and other heavy metals and chemicals, additives and preservatives, and even certain foods – acts as catalysts that can trigger these disorders. What doctors have found is that neurodevelopmentally-challenged children are missing an enzyme (called metallothionein) that breaks down heavy metals. Without this enzyme, heavy metals accumulate in the body, resulting in an increased vulnerability to these toxins and in an impaired immune system. Scientists are presently engaged in an experimental investigation of metal-metabolism genetics in an attempt to find the "autism gene(s)" (ABCs of Autism, 2003).

Because there are presently no medical tests for autism, the diagnosis must be based on observations of the child’s behavior. "Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism" (NINDS, 2004). These behaviors include an impaired ability to make friends with peers and to initiate or sustain a conversation. These behaviors may also include a lack of imaginative and social play and use of stereotyped, repetitive, or unusual speech patterns. Other behaviors may include restricted patterns of interest that are abnormal in intensity or focus, a preoccupation with certain objects or subjects and inflexible adherence to specific routines or rituals. Although some screening instruments rely on a combination of parent and doctor observations, some rely solely on those of the parent. Doctors will often interview the parents about the child’s early years to gather information about the child’s development and behavior in order to avoid misdiagnosis. If any of these screening instruments indicate the possibility of autism, doctors will ask for a more extensive evaluation. Autism varies widely in its severity and symptoms and, therefore, may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps.

Various methods of treatment have been tried but no single treatment is completely effective in every case. "There is no ‘cure’ in a medical sense" (Fact Sheet: Autism, 1980). Although there is no cure for autism "therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement" (NINDS, 2004). The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism. Most professionals agree that the earlier the intervention, the better.

"Highly structured, skill-oriented training, tailored to the individual, has proven most helpful. Social and language skills should be developed as much as possible" (Fact Sheet: Autism, 1980). For educational and behavioral interventions "therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child" (NINDS, 2004).

"In the types of autism where metabolic abnormalities can be identified, diet and medication can sometimes help. Also, medicine to decrease specific symptoms can help some autistic people live more satisfactory lives" (Fact Sheet: Autism, 1980). "Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems." (NINDS, 2004). "Supplements that are often recommended for autistic spectrum disorder patients include extra calcium, extra magnesium, vitamin C, vitamin E, vitamin B6, zinc, fish oil, DMG, digestive enzymes, probiotics, antifungals, colostrum, and glyconutrients" (ABCs of Autism, 2003).

Lifestyle changes and precautions that can be taken would include reducing the amount of toxins in the body. This means eliminating preservatives, additives, food colorings, artificial sweeteners, MSG and artificial flavorings. It also means reducing exposure to airborne chemicals such as perfumes and tobacco smoke, household chemicals, and pesticides and insecticides. This also means drinking only pure filtered water and preparing/storing foods in inert containers (not plastics). Many autistic patients have malabsorption problems related to leaky gut syndrome, and improve when gluten and casein are eliminated from the diet. (ABCs of Autism, 2003)

"There are a number of controversial therapies or interventions available for autistic children, but few, if any, are supported by scientific studies. Parents should use caution before adopting any of these treatments" (NINDS, 2004).

Although every situation is different, the following is one story of a parent with an autistic child.

We were very excited to have our first child I had a perfect pregnancy. When we went in to have her it was on my due date. The labor was long and the delivery difficult but in the end we had a beautiful 9lb 3oz, baby girl. I was anxious to keep her close but when I got tired they took her to be with the other babies. I was a little puzzled when they brought her back a few hours later and asked if I minded her staying in my room, it seemed that her "screaming" was keeping the other babies awake. Then when we were getting ready to take her home my nurses very quietly sat me down and talked to me about remaining calm and if there was any problem with her to call a friend for help and not to get upset or abuse her. After a long cry on the way home I convinced myself that I must be overreacting and they probably gave that talk to all new mothers.

We had the smartest daughter, she had great fine motor skills, learned quickly and I never had to move items so she wouldn’t touch; she seemed to be content in doing whatever she happened to be doing. The only thing was the screaming, I was told it was just colic but after a year and a half I began to wonder. I also noticed that she never cried, no tears, ever.

We were anxious to show off our little girl to some friends who were having a get together. I was truly concerned, as each child showed up and joined in the play area, she withdrew farther and farther away until she was observing them from behind a tree.

We then decided that even though she wasn’t quite three that preschool and other children were probably the best remedy for a shy child. "Shy" was the last word that came to mind when I thought of her, to me it seemed more "selective". When I walked her to and from school we talked about everything she did and learned in school, so I was quite surprised when two teachers who had observed us having an animated conversation said they had never seen or heard her speak.

About this time she had a new baby brother and she was very kind and loving. I’m not sure what developed over the next few years but slowly my angel was slipping away, it was very subtle and everyone else seemed to have "reasonable" answers for why her behavior was changing. There was no emotion or compassion.

My bright child who had learned to read at such a young age was now reading in a whisper and would not speak at all if someone else was in the room. Short-term memory was almost gone, obsessive behavior was normal and tantrums when she could not finish a started project became violent. We searched for help. I took her to counseling, but one-on-one she was almost normal. We looked for a diagnosis but anxiety was the only one they would give us. A friend suggested I look up information on autism and although very high functioning this diagnosis explained everything.

I cannot go into detail about the every day trauma we went through. Her not being able to put on clothes for lack of decision making and then not being able to wear them because everything felt funny. Loving school and teachers but not being able enter the car, then the school, and then the classroom without a nudge or even a firm push. I remember curling up in a ball and crying in the gym before composing myself enough to drive home. But my poor daughter, she spent a lot of time curled up in a fetal position under any chair or table she could find, anytime things were difficult for her mind to handle. Still, no new diagnosis.

Each year, to each new counselor or teacher, we had to re-explain that there was no abuse just an EI diagnosis because nothing else seemed to fit.

In the second grade we got a saint of a teacher who insisted they test her. This teacher found ways to get her to finish projects and even leave the classroom after school so I didn’t have to wait a half an hour for her to finish whatever she was doing. I also met a mother at church who had an autistic child, she explained that a diagnosis for children like ours were very difficult and if the first psychiatrist didn’t label autistic it was very unlikely any others would overrule, even if they suspected it. She also explained how important diet was, and within a week of eliminating all dairy, the glaze over her eyes diminished and her short-term memory started to return. She was out of the cloud, we had our child back and there was hope.

Diet became a big part: no food coloring, preservatives or dairy. Herbs helped with the anxiety and her sheer determination to never let anything stop her from her goal was the rainbow we needed. In fourth grade she started speaking to people, slowly at first, barely audible, but it was a start. In fifth grade a clinical hospital testing center diagnosed her with Asperger’s (a high functioning Autism). There was no question in their mind and said it was quite obvious. Apparently, Autism and it’s testing had come a long way.

Katie as she likes to be called now rides the scariest roller coasters, takes the most challenging classes and is even taking college classes in her senior year of high school, including a speech class. Her hope is to work with children who need love and a few breaks in their life. I know, even though these emotions did not come natural to her she has found a way.

References

ABCs of Autism. (2003). Evenbetternow, LLC. Tucson, AZ. Retrieved April 10, 2006 from http://www.clayforautism.com

Bal, D., MHS, OTR/L. (1995). Integrated Service Model in the 1990s. The American Occupational Therapy Association, Inc.

Dunlap, G., Koegel, R.L., & Egel, A.L. (1979). Autistic Children in School. The Counsel for Exceptional Children.

Everard, M.P. (1976). Mildly Autistic Young People and Their Problems.

FAQs. (2003). Evenbetternow, LLC. Tucson, AZ. Retrieved April 10, 2006 from http://www.clayforautism.com

Grandin, T. (1988). Focus on Autistic Behavior (Vol. 3, No. 1): Teaching Tips from a Recovered Autistic.

Greene, S., MA, OTR. (1995). Social Skills in Context: Group Intervention for Children with Autism. The American Occupational Therapy Association, Inc.

Kaler, S., PhD, RN. (1995). The Syndrome of Autism: A Social Communications Approach to Intervention. The American Occupational Therapy Association, Inc.

Kirby, B.L. (2005). What is Asperger Syndrome? Retrieved April 10, 2006 from http://www.udel.edu/bkirby/asperger/aswhatisit.html

Lovaas, O.I. (1979). Journal of Autism and Developmental Disorders (Vol. 9, No. 4): Contrasting Illnesses and Behavioral Models for the Treatment of Autistic Children: A Historical Perspective.

Magee, K. MA. (2003). Encyclopedia provided by HealthWise: Asperger’s Syndrome. Retrieved April 10, 2006 from http://health.yahoo.com/ency/healthwise

NINDS. (2004). Autism Fact Sheet. Published Dec. 2004. No. 05-1877. Retrieved April 10, 2006 from http://www.ninds.gov/disorders/autism/detail_autism.htm. Last updated March 23, 2006.

Office of Scientific and Health Reports National Institute of Neurological and Communicative Disorders and Strokes. (1980). Fact Sheet: Autism. Bethesda, Maryland.

Ornitz, E.M. MD, & Ritvo, E.R. MD. (1976). The Syndrome of Autism: A Critical Review. The American Journal of Psychiatry.

Prizant, B.M. (1982). Speech-language pathologists and autistic children: What is our role? American Speech-Language-Hearing Association.