Pervasive Developmental Disorder: AUTISM

Autism is classified as a neurodevelopmental disorder that manifests in delays of "social interaction, language as used in social communication, or symbolic or imaginative play," with "onset prior to age 3 years," according to the Diagnostic and Statistical Manual of Mental Disorders.

The ICD-10 also requires symptoms to be "manifest before the age of three years." Autism is often not physiologically obvious, in that outward appearance may not indicate a disorder, and diagnosis typically comes from a complete physical and neurological evaluation. Some now speculate that autism is not a single condition but a group of several distinct conditions that manifest in similar ways

Causes of autism

Although the specific causes of autism are unknown, many researchers suspect that autism results from genetically mediated vulnerabilities to environmental triggers. While there is disagreement about the magnitude, nature, and mechanisms for such environmental factors, researchers have found seven genesdefine prevalent among individuals diagnosed as autistic. Further, observations such as autistic children having generally larger head circumferences are intriguing, but their roles in the disorder are unclear. However, researchers have found a link between autism, abnormal blood vessel function, and oxidative stress.

There is great variance in skills and behaviors of individuals with diagnosed autism, and physicians will often arrive at different conclusions about the appropriate diagnosis. Much of this is due to the sensory system of autistics, which is quite different from the sensory system of other people. Certain stimulations can affect an autistic differently than a non-autistic, and the degree to which the sensory system is affected varies wildly from one autistic to another.

Clinical Features

Physical Characteristics

Children with autistic disorder are often described as attractive and, on first glance; do not show any physical signs indicating autistic disorder. These children do have high rates of minor physical anomalies, such as ear malformation. Autistic children also have higher incidence of abnormal dermatoglyphics (e.g. finger prints)

Social development

Typically, developing infants are social beings—early in life they gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to faces and seem to have tremendous difficulty learning to engage in everyday human interaction. Even in the first few months of life, many autistic children seem indifferent to other people, because they avoid eye contact and do not interact with others as often as non-autistic children do. Some infants with autism may appear very calm; they may tend not to cry since they do not want parental attention.

Autistic children often seem to prefer being alone and may passively accept such things as hugs and cuddling without reciprocating, or resist attention altogether. Later, they seldom seek comfort from others or respond to parents' displays of anger or affection in a typical way.

Research has suggested that although autistic children are attached to their parents, their expression of this attachment may be unusual and difficult to interpret. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of expected attachment behavior.

Although not universal, it is common for autistics to be unable to regulate their behavior, with crying, verbal outbursts, or self-injurious behaviors that may seem out of proportion to the situation. Autistic individuals generally prefer consistent routines and environments; they may react negatively to changes in these environments. It is not uncommon for these individuals to exhibit aggression, increased levels of self-stimulatory behavior, self-injury, or extensive withdrawal in overwhelming situations.

Sensory system

Children will exhibit problems coping with normal sensory input. Indicators of autism include oversensitivity or under reactivity to touch, movement, sights, or sounds; physical clumsiness or carelessness; poor body awareness; a tendency to be easily distracted; impulsive physical or verbal behavior; an activity level that is unusually high or low; not unwinding or calming oneself; difficulty learning new movements; difficulty in making transitions from one situation to another; social and/or emotional problems; delays in speech, language or motor skills; specific learning difficulties/delays in academic achievement.

However, it is essential to remember that while most people with autism have some degree of sensory integration difficulty, not every person who has sensory problems is autistic.

Communication difficulties

Deficits in language development and difficulty using language to communicate ideas are among the principal criteria for diagnosing autistic disorder. Some remain mute throughout their lives with varying degrees of literacy; communication in other ways—images, visual clues, sign language, and typing may be far more natural to them. Dysfunctional verbal language, relying on rote learned stored phrases, songs, jingles and advertisements. Those with the autism spectrum condition of Semantic Pragmatic Disorder fall into this group.

Those who do speak sometimes use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat a mimicked phrase over and over. Some repeat what they hear, a condition called echolalia. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many people with autism have a strong tonal sense, and can often understand at least some spoken language whilst others can understand language fluently.

Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. The "give and take" of non-autistic conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to converse with other autistics, they comfortably do so in "parallel monologue"—taking turns expressing views and information.

Just as "neurotypical" (people without autism) have trouble understanding autistic body languages, vocal tones, or phraseology, people with autism similarly have trouble with such things in people without autism. In particular, autistic language abilities tend to be highly literal; people without autism often inappropriately attribute hidden meaning to what people with autism say or expect the person with autism to sense such unstated meaning in their own words.

Some people with high-functioning Autism can be extremely brilliant and have great vocabulary, but their social skills can be very low, even nonexistent at time.

Sometimes, the body language of people with autism can be difficult for other people to understand. Facial expressions, movements, and gestures may be easily understood by some other people with autism, but do not match those used by other people. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the auditory system of a person without autism often cannot sense the fluctuations. What seems to non-autistic people like odd prosody; things like a high-pitched, sing-song, or flat, robot-like voice may be common in autistic children and some will have combinations of these prosody issues. Some autistic children with relatively good language skills speak like little adults, rather than communicating at their current age level, which is one of the things that can lead to problems.

Since non-autistic people are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let other people know what they need. As anybody might do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for non-autistic people to learn to communicate with them, people with autism do whatever they can to get through to them.

Communication difficulties may contribute to autistic people becoming socially anxious or depressed or prone to self-injurious behaviors. Recently, with the awareness that those with autism can have more than one condition a significant percentage of people with autism are being diagnosed with co-morbid mood, anxiety and compulsive disorders which may also contribute to behavioral and functioning challenges.

Repetitive behaviors

Although people with autism usually appear physically normal and have good muscle control, unusual repetitive motions, known as self-stimulation or "stimming", may set them apart. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or wiggling their toes, others suddenly freeze in position.

As children, they might spend hours lining up their cars and trains in a certain way, not using them for the type of pretend play expected of a non-autistic child. If someone accidentally moves one of these toys, the child may be tremendously upset. Autistic children often need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, or going to school at a certain time and by the same route—can be extremely disturbing to them Repetitive behaviors can also extend into the spoken word as well. Perseveration of a single word or phrase, even for a specific number of times can also become a part of the child's daily routine.

Types of autism

Asperger's and Kanner's syndrome

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the most significant difference between Autistic Disorder (Kanner's) and Asperger's syndrome is that a diagnosis of the former includes the observation of "delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

• Social interaction,

• Language as used in social communication, or

• Symbolic or imaginative play",

While a diagnosis of Asperger's syndrome observes "no clinically significant delay" in the latter two of these areas. Asperger's syndrome tend to perform better than those with Kanner's autism.

Autism as a spectrum disorder

Another view of these disorders is that they are on a continuum known as autistic spectrum disorders. Autism spectrum disorder is an increasingly popular term that refers to a broad definition of autism including the classic form of the disorder as well as closely related conditions such as PDD-NOS and Asperger's syndrome. Although the classic form of autism can be easily distinguished from other forms of autism spectrum disorder, the terms are often used interchangeably.

Overall, autism is three to four times more common in boys than girls.