What is
Autism?
The Autism
Society of America defines autism as "a severely incapacitating lifelong
developmental disability that typically appears during the first three years of
life. The result of neurological
disorder that affects functioning of the brain. Autism and its behavioral symptoms appear in approximately
fifteen out of every 10,000 births.
Autism is four times more common in boys than girls. It has been found throughout the world in
families of all racial, ethnic, and social backgrounds. No known factors in the psychological
environment of a child have been shown to cause autism".
Medical
researchers are exploring different explanations for the various forms of
autism. Although one specific cause of
autism is not known, current research links autism to biological or
neurological differences in the brain.
MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography)
scans show abnormalities in the structure of the brain, with significant
differences within the cerebellum, including the size and number of Purkinje
cells. In some families there appears
to be a pattern of autism or related disabilities, which suggests there may be
a genetic basis to the disorder, although at this time no one gene has been
directly linked to autism.
Several
older theories about the cause of autism have been now proven false. Autism is not a mental illness. Children with autism are not unruly kids,
who choose not to behave. Autism is not
caused by bad parenting. Furthermore, no
known psychological factors in the development of the child have been shown to
cause autism.
Autism
affects everyone who knows someone with the disorder. It is four times more prevalent in boys than girls and knows no
racial, ethnic, or social boundaries.
Family income, lifestyle, and educational levels do not affect the
chance of autism's occurrence.
Autism
currently affects over 400,000 individuals in the U.S. and 1 in every 500
children born today. The 3rd most
common developmental disorder, autism is more prevalent than Down syndrome,
childhood cancer or cystic fibrosis - at an annual cost to our nation of over
13 billion. Yet it receives less than
5% of the funding of other less common diseases.
Over one
half million people in the U.S. today have some form of autism. Its prevalence rate now places it as the
third most common developmental disability - more common than Down's
syndrome. Yet the majority of the
public, including many professionals in the medical, educational, and
vocational fields are still unaware of how autism affects people and how to
work effectively with individuals with autism.
What
Are the Characteristics of Autism?
Children
with autism often appear relatively normal in their development until the age
of 24-30 months, when parents may notice delays in language, play, or social
interaction.
There is no
"medical" test, such as a blood test or X-ray, which can show who has
autism and who does not. Autism is
diagnosed when professionals familiar with the disorder spend time with a
person to look at the way the person communicates with others, understands and
responds to social interactions, and reacts to other things in the
environment. People with autism often
have:
1. Delayed or unusual language patterns.
2.
Difficulty interacting socially with their peers.
3. Unusual
and/or restricted interests and sensory responses.
The
disorder makes it hard for them to communicate with others and relate to the
outside world. They may exhibit
repeated body movements (hand flapping, rocking), unusual responses to people
or attachments to objects and resist any changes in routines. In some cases, aggressive and/or
self-injurious behavior may be present.
Autism
impacts the normal development of the brain in the areas of social interaction
and communication skills. Children and
adults with autism typically have difficulties in verbal and nonverbal
communication, social interactions, and leisure or play activities.
There are
no medical tests for diagnosing autism.
An accurate diagnosis must be based on observations of the child's
communication, behavior, and developmental levels. However, because many of the behaviors associated with autism are
shared by other disorders, a doctor may complete various medical tests to rule
out other possible causes.
Diagnosis
is difficult for a practitioner with limited training or exposure to autism,
since the characteristics of the disorder vary so much. Locating a medical specialist or a
diagnostician who has experience with autism is most important. Ideally a child should be evaluated by a
multidisciplinary team which may include a neurologist, psychologist, and
developmental pediatrician, speech/language therapist, learning consultant or
other professionals knowledgeable about autism. Several diagnostic tools have been developed over the past few
years to help professionals make an accurate autism diagnosis:
CHAT
Checklist for Autism in Toddlers
CARS
Childhood Autism Rating Scale
PIA Parent
Interviews for Autism
GARS
Gilliam Autism Rating Scale
BRIAC
Behavior Rating Instrument for Autistic and other Atypical Children
A brief
observation in a single setting cannot present a true picture of an
individual's abilities and behaviors.
At first glance, the person with autism may appear to have mental
retardation, a behavior disorder, or even problems with hearing. However, it is important also to distinguish
autism from other conditions, since an accurate diagnosis can provide the basis
for building an appropriate and effective educational and treatment program.
While no
one can predict the future, we do know that some adults with autism live and
work independently in the community, while others depend on the support of
family and professionals. Adults with
autism can benefit from vocational training to provide them with the skills
needed for obtaining jobs, in addition to social and recreational
programs. Adults with autism may live
in a variety of residential settings, ranging from independent home or apartments
to group homes, supervised apartment settings, living with other family members
to more structured residential care.
Is There More
Than One Type of Autism?
Autism is
often referred to as a spectrum disorder, meaning that the symptoms and characteristics
of autism can present themselves in a wide variety of combinations, from mild
to severe. Although autism is defined
by a certain set of behaviors, children and adults can exhibit any combination
of the behaviors in any degree of severity.
Two children, both with a diagnosis of autism, can act very differently
from one another.
Professionals
utilize a diagnostic handbook, the Diagnostic and Statistical Manual now in its
fourth edition (DSM-IV). Several
autism-related disorders are grouped under the broad heading "Pervasive
Developmental Disorder" or PDD: Autism, PDD-NOS (pervasive developmental
disorder, not otherwise specified), Asperger's syndrome and Rett's syndrome. These four diagnoses are used differently by
professionals to describe individuals who manifest some, but not all, of the
autism characteristics.
The
diagnosis of autism is made when a specified number of characteristics listed
in the DSM-IV are present, in ranges inappropriate for the child's age. In contrast, a diagnosis of PDD-NOS may be
made when a child exhibits fewer symptoms than in autism, although those
symptoms may be exactly the same as a child with an autism diagnosis. Asperger's and Rett's syndrome display the
most marked differences from autism.
Therefore,
most professional will agree that there is no standard "type" or
"typical" person with autism.
Parents may hear more than one label applied to the same child:
autistic-like, learning disabled with autistic tendencies, high functioning or
low functioning autism. These labels
don't describe differences between the children as much as they indicate
differences between the professionals' training, vocabulary, and exposure to
autism.
The
differences in children's behaviors are often very subtle. Each diagnosis relies on observation of the
child and the whether or not the professional is well educated on autism will
certainly affect which label is used. Many
professionals believe that the distinction between autism and PDD-NOS is not
significant. Some believe they are
"sparing" the parents by giving a diagnosis of PDD-NOS rather than
autism. Many professionals still argue
whether or not Asperger's is really a form of autism. What is most important to understand is that whatever the autism
diagnosis, children are likely to benefit from similar approaches to education
and treatment.
Is There a Cure for Autism?
Our
understanding of autism has grown tremendously since it was first described in
1943. Some of the earlier searches for
"cures" now seem unrealistic in terms of today's understanding of
brain-based disorders. To cure means
"to restore to health, soundness, or normality.” In the medical sense, there is no cure for the differences in the
brain which result in autism.
However,
we're finding better ways to understand the disorder and help people cope with
the various symptoms of the disability.
Some of these symptoms may lessen as the child ages; others may
disappear altogether. With appropriate
intervention, many of the autism behaviors can be positively changed, even to
the point that the child or adult may appear to the untrained person to no
longer have autism. The majority of
children and adults will, however, continue to exhibit some symptoms of autism
to some degree throughout their entire lives.
What are the Most Effective Approaches for Treating Autism?
Because of
the spectrum nature of autism and the many behavior combinations which can
occur, no one approach is effective in alleviating symptoms of autism in all
cases. Various types of therapies are
available, including behavior modification, speech/language therapy, sensory
integration, vision therapy, music therapy, auditory training, medications, and
dietary interventions, among others.
Experience
has shown that individuals with autism respond well to a highly structured,
specialized education and behavior modification program, tailored to the
individual needs of the person. A well
designed intervention approach will include some level of communication
therapy, social skill development, sensory impairment therapy and behavior
modification at a minimum, delivered by autism trained professionals in a
consistent, comprehensive, and coordinated manner. The more severe challenges of some children with autism may be
best addressed by a structured education and behavior program which contains a
1:1 teacher to student ratio or small group environment.
Students
with autism should have training in vocational skills and community living
skills at the earliest possible age. Learning
to cross a street safely, to make a simple purchase or to ask assistance when
needed are critical skills, and may be difficult, even for those with average
intelligence levels. Tasks that enhance
the person's independence, give more opportunity for personal choice, or allow more
freedom in the community are important.
To be
effective, any approach should be flexible in nature, rely on positive
reinforcement, be reevaluated on a regular basis, and provide a smooth
transition from home to school to community environments. A good program will also incorporate
training and support systems for the caregivers as well. Rarely can a family, classroom teacher or
other caregiver provide effective habilitation for a person with autism unless
offered consultation or in-service training by a specialist knowledgeable about
the disability.
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