autism - i need it for child development
Autism
I. Introduction
Autism, disorder that severely impairs development of a person’s ability to communicate, interact with other people, and maintain normal contact with the outside world. The disorder was first described in 1943 by American psychiatrist Leo Kanner. One of the most common developmental disabilities, autism affects approximately 1 in 500 to 1 in 166 children and appears before the age of three. It is about four times more common in males than in females.
II. Characteristics
Autism is often referred to as a spectrum disorder-that is, a disorder in which symptoms can occur in any combination and with varying degrees of severity. Symptoms of autism usually begin during infancy. Autistic infants may stiffen or go limp when picked up by parents rather than clinging or cuddling up to them. Autistic infants often show little or no interest in other people and lack typical social behaviors. For example, they may not smile at their mother’s voice or make eye contact with caregivers. Autistic children fail to develop normal relationships with their parents, brothers or sisters, and other children. Often they seem unaware of the needs and feelings of other people, and may not respond if another person is hurt or in distress. They also fail to make friends.
Children with autism usually play alone. Often they engage in repetitious activities, such as arranging objects in meaningless patterns, flipping a light switch on and off, or staring at rotating objects. Some engage in repetitious body movements, such as spinning, flapping their arms, swaying, rocking, snapping their fingers, and clapping or flapping their hands. In some cases these movements may be harmful, involving repeated biting of their wrists or banging their head. Children with autism frequently become upset at minor changes in their surroundings and daily routines.
Autistic children also have difficulties with language. Some never learn to speak or develop very limited speech. An autistic child may say “you” when he means “I” and produce incorrectly formed sentences. For example, when the child wants a drink he may say, “You want a drink.” Autistic children may also demonstrate echolalia, mechanically repeating words or phrases that other people say.
About 75 percent of autistic children are classified as having mental retardation, meaning that they score well below average on a standard test of intelligence and that they have a significantly impaired ability to cope with common life demands. Many show great variability in their skill levels across different aspects of intelligence tests, characteristically scoring higher on tests of visual-spatial skills and rote memory than on tests of verbal skills and social understanding. Some experts argue that standard intelligence tests are inappropriate measures of an autistic person's intellectual abilities. These experts note that some symptoms of autism-such as speech and language problems, difficulty paying attention, and behavioral problems-may interfere with an autistic child's performance on standard intelligence tests.
Children and adults with autism who score in the average or high range on intelligence tests are considered to have high-functioning autism. About 10 percent of autistic individuals have extraordinary talents such as the ability to memorize long lists of information, the ability to make lightning-fast mathematical calculations, or precocious musical or artistic abilities. Experts call such individuals autistic savants. Savants may score above or below average on standard intelligence tests.
III. Causes
Scientists once regarded autism as a psychological disorder caused by traumatic experiences that forced a child to retreat into a world of fantasy. Some theorized that parents caused autism by unconsciously rejecting a child, or by failing to bond emotionally. These theories caused enormous guilt in parents and lacked any scientific validity. Scientists today still do not know what causes autism, but they have discredited and rejected theories about a parental cause.
Evidence indicates that autism results from biological abnormalities in brain structure and function. Studies have found that autistic people have abnormally low blood flow to certain parts of the brain and reduced numbers of certain brain cells. These studies suggest that mutations in genes are important in causing autism. Studies of families also support this possibility. For example, families with one autistic child are more likely to have a second autistic child. Other studies have linked some cases of autism with prenatal exposure to the rubella virus (see German Measles) and lack of oxygen during birth.
Another theory sees autism mainly as a problem of cognition. In this view, autism results from an inability to think in ways necessary for normal communication, sharing of experiences, and expression of emotions. Supporters argue that autistic people lack “a theory of the mind”-that is, they do not realize that other people have feelings, beliefs, needs, and an inner life. Without this conception of the minds of others, autistic people cannot predict or interpret the behavior of others and have severe problems in social interaction. Many experts criticize this theory, noting that autism appears at an early age when no children have a conception of the minds of others.
IV. Treatment
There is no cure for autism. But treatment may reduce symptoms and help people with autism function better. Experts disagree over the effectiveness of different treatments. Many treatments seemed promising when first introduced, but later proved disappointing. Because individuals respond in different ways, no single treatment works for everyone. Treatments include behavior modification, medication, facilitated communication, vitamin and mineral supplements, auditory training, and vision therapy.
Behavior modification involves analyzing the cause of an undesirable behavior, then using rewards and punishments or other approaches to replace the behavior with a more appropriate response. For instance, children who spin or flap their arms because of anxiety about a situation can be taught to say “stop” or point to a symbol for “stop.” Parents often collaborate with therapists in providing behavior therapy. Very intensive behavior programs, modeled on the teaching methods of American psychologist O. Ivar Lovaas, have yielded some of the best results. In such programs parents may provide therapy at home seven days a week for several years.
Physicians sometimes prescribe antipsychotic drugs, beta-blockers, anticonvulsants, and other medications to reduce self-abusive behavior, such as head banging and wrist biting. Some individuals with autism benefit from drugs that increase levels of serotonin, a brain chemical. These medications, which include fenfluramine (Pondimin), fluvoxamine (Luvox), and clomipramine (Anafranil), may reduce compulsive behavior and body movements. Other drugs that improve symptoms in some patients include naltrexone (ReVia), which blocks the action of natural opiate-like compounds in the brain, and haloperidol (Haldol), which interferes with the function of the neurotransmitter dopamine.
Facilitated communication is based on the idea that people with autism are unable to communicate because of impaired body coordination. In this technique, a trained professional, or facilitator, supports the person’s hand over an alphanumeric keyboard. The person with autism learns to type messages and responses to questions. Critics maintain that the facilitator, rather than the person with autism, is the true source of the messages.
Other treatments for autism include supplements of vitamin B6 and magnesium; auditory training for individuals who are hypersensitive to certain frequencies of sound; and vision training to correct eyesight problems.
V. Education
Federal law in the United States requires that states provide early intervention services for children aged one to three with autism and other disabilities. These services try to help children with autism develop academic and social skills in the hopes of lessening the disorder’s long-term effects. States also must provide an individual education plan when these children begin school. Children with autism may attend regular or special schools. See also Education of Students with Mental Retardation; Special Education.
VI. Work and Adult Life
Some individuals with autism get jobs and live independently or semi-independently as adults. They often succeed in jobs that emphasize specific skills, rather than those that require complex interactions with other people. Others with autism must depend on outside support. They may live with family members, in group homes, or in residential care facilities.
VII. Related Disorders
A number of other disorders may include characteristics of autism. In fragile X syndrome, which results from a defective X chromosome, people may show poor eye contact, limited speech, hand flapping, and hyperactivity. People with Asperger’s disorder may show some symptoms of autism such as difficulties in social interactions, poor eye contact, repetitive body movements, and an insistence on routines and rituals. However, they have normal language development and do not have mental retardation. Rett’s disorder involves repetitive hand movements, social withdrawal, and impaired language development. The disorder appears before the age of four and affects only girls. Some experts regard these disorders as mild forms of autism rather than as separate disorders.
What is autism?
Autism (sometimes called “classical autism”) is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Autism is characterized by impaired social interaction, problems with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests. Other ASDs include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Experts estimate that three to six children out of every 1,000 will have autism. Males are four times more likely to have autism than females.
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What are some common signs of autism?
There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling.
The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.
Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behavior. They lack empathy.
Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive 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.” Children with autism don’t know how to play interactively with other children. 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.
Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.
Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. For reasons that are still unclear, about 20 to 30 percent of children with autism 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.
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How is autism diagnosed?
Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism. These behaviors are:
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impaired ability to make friends with peers
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impaired ability to initiate or sustain a conversation with others
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absence or impairment of imaginative and social play
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stereotyped, repetitive, or unusual use of language
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restricted patterns of interest that are abnormal in intensity or focus
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preoccupation with certain objects or subjects
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inflexible adherence to specific routines or rituals
Doctors will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior. Some screening instruments rely solely on parent observations; others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of autism, doctors will ask for a more comprehensive evaluation.
Autism is a complex disorder. A comprehensive evaluation requires a multidisciplinary team including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for autism, children with delayed speech development should also have their hearing tested. After a thorough evaluation, the team usually meets with parents to explain the results of the evaluation and present the diagnosis.
Children with some symptoms of autism, but not enough to be diagnosed with classical autism, are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Children who develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors may be diagnosed with childhood disintegrative disorder. Girls with autistic symptoms may be suffering from Rett syndrome, a sex-linked genetic disorder characterized by social withdrawal, regressed language skills, and hand wringing.
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What causes autism?
Scientists aren’t certain what causes autism, but it’s likely 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 early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other. While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for autism has now been disproved.
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What role does inheritance play?
Recent studies strongly suggest that some people have a genetic predisposition to autism. 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.
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Do symptoms of autism change over time?
For many children, autism symptoms improve with treatment and with age. Some children with autism grow up to lead normal or near-normal lives. Children whose language skills regress early in life, usually before the age of 3, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems. Parents of these children should be ready to adjust treatment for their child as needed.
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How is autism treated?
There is no cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better.
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Educational/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.
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Medications: 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. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity.
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Other therapies: 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.
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What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) is one of the federal government’s leading supporters of biomedical research on brain and nervous system disorders. The NINDS conducts research in its laboratories at the National Institutes of Health in Bethesda, Maryland , and also awards grants to support research at universities and other facilities.
As part of the Children’s Health Act of 2000, the NINDS and three sister institutes have formed the NIH Autism Coordinating Committee to expand, intensify, and coordinate NIH’s autism research. Eight dedicated research centers across the country have been established as “Centers of Excellence in Autism Research” to bring together researchers and the resources they need. The Centers are conducting basic and clinical research, including investigations into causes, diagnosis, early detection, prevention, and treatment, such as the studies highlighted below:
* investigators are using animal models to study how the neurotransmitter serotonin establishes connections between neurons in hopes of discovering why these connections are impaired in autism
* researchers are testing a computer-assisted program that would help autistic children interpret facial expressions
* a brain imaging study is investigating areas of the brain that are active during obsessive/repetitive behaviors in adults and very young children with autism
* other imaging studies are searching for brain abnormalities that could cause impaired social communication in children with autism
* clinical studies are testing the effectiveness of a program that combines parent training and medication to reduce the disruptive behavior of children with autism and other ASDs
Prevalence
For many years, the most cited statistic is that autism occurs in 4.5 out of 10,000 live births. This was based on large-scale surveys conducted in the United States and England. More recently, estimates on the prevalence of autism have ranged been as high as 1/4% to 1/2% of the population. These estimates typically include those with autism, Asperger syndrome, and PDD.
Autism is three times more likely to affect males than females. This gender difference is not unique to autism since many developmental disabilities have a greater male to female ratio.
Major characteristics
Many autistic infants are different from birth. Two common characteristics they may exhibit include arching their back away from their caregiver to avoid physical contact and failing to anticipate being picked up (i.e., becoming limp). As infants, they are often described as either passive or overly agitated babies. A passive baby refers to one who is quiet most of the time making little, if any, demands on his/her parents. An overly agitated baby refers to an infant who cries a great deal, sometimes non-stop, during his/her waking hours. During infancy, many begin to rock and/or bang their head against the crib; but this is not always the case.
In the first few years of life, some autistic toddlers reach developmental milestones, such as talking, crawling, and walking, much earlier than the average child; whereas others are considerably delayed. Approximately one-half of autistic children develop normally until somewhere between 1 1/2 to 3 years of age; then autistic symptoms begin to emerge. These individuals are often referred to as having 'regressive' autism. Some people in the field believe that candida albicans, vaccinations, exposure to a virus, or the onset of seizures may be responsible for this regression. It is also thought that some children with 'regressive' autism may have Landau-Kleffner Syndrome (see next section).
During childhood, autistic children may fall behind their same-aged peers in the areas of communication, social skills, and cognition. In addition, dysfunctional behaviors may start to appear, such as self-stimulatory behaviors (i.e., repetitive, non-goal directed behavior, such as rocking, hand-flapping), self-injury (e.g., hand-biting, headbanging), sleeping and eating problems, poor eye contact, insensitivity to pain, hyper-/hypo-activity, and attention deficits.
One characteristic which is quite common in autism is the individual's ‘insistence on sameness’ or 'perseverative' behavior. Many children become overly insistent on routines; if one is changed, even slightly, the child may become upset and tantrum. Some common examples are: drinking and/or eating the same food items at every meal, wearing certain clothing or insisting that others wear the same clothes, and going to school using the same route. One possible reason for ‘insistence on sameness’ may be the person's inability to understand and cope with novel situations.
Autistic individuals sometimes have difficulty with the transition to puberty. Approximately 25% have seizures for the first time during puberty which may be due to hormonal changes. In addition, many behavior problems can become more frequent and more severe during this period. However, others experience puberty with relative ease.
In contrast to 20 years ago when many autistic individuals were institutionalized, there are now many flexible living arrangements. Usually, only the most severe individuals live in institutions. In adulthood, some people with autism live at home with their parents; some live in residential facilities; some live semi-independently (such as in a group home); and others live independently. There are autistic adults who graduate from college and receive graduate degrees; and some develop adult relationships and may marry. In the work environment, many autistic adults can be reliable and conscientious workers. Unfortunately, these individuals may have difficulty getting a job. Since many of them are socially awkward and may appear to be 'eccentric' or 'different,' they often have difficulty with the job interview.
Subgroups and Related Disorders
There is no adjective which can be used to describe every type of person with autism because there are many forms of this disorder. For example, some individuals are anti-social, some are asocial, and others are social. Some are aggressive toward themselves and/or aggressive toward others. Approximately half have little or no language, some repeat (or echo) words and/or phrases, and others may have normal language skills. Since there are no physiological tests at this time to determine whether a person has autism, the diagnosis of autism is given when an individual displays a number of characteristic behaviors.
In the last five years, research has shown that many people who engage in autistic behaviors have related but distinct disorders. These include: Asperger Syndrome, Fragile X Syndrome, Landau-Kleffner Syndrome, Rett Syndrome, and Williams Syndrome. Asperger Syndrome is characterized by concrete and literal thinking, obsession with certain topics, excellent memories, and being 'eccentric.' These individuals are considered high-functioning and are capable of holding a job and of living independently.
Fragile X Syndrome is a form of mental retardation in which the long arm on the X chromosome is constricted. Approximately 15% of people with Fragile X Syndrome exhibit autistic behaviors. These behaviors include: delay in speech/language, hyperactivity, poor eye contact, and hand-flapping. The majority of these individuals function at a mild to moderate level. As they grow older, their unique physical facial features may become more prominent (e.g., elongated face and ears), and they may develop heart problems.
People with Landau-Kleffner Syndrome also exhibit many autistic behaviors, such as social withdrawal, insistence on sameness, and language problems. These individuals are often thought of as having 'regressive' autism because they appear to be normal until sometime between ages 3 and 7. They often have good language skills in early childhood but gradually lose their ability to talk. They also have abnormal brain wave patterns which can be diagnosed by analyzing their EEG pattern during an extended sleep period.
Rett Syndrome is a degenerative disorder which affects mostly females and usually develops between 1/2 to 1 1/2 years of age. Some of their characteristic behaviors include: loss of speech, repetitive hand-wringing, body rocking, and social withdrawal. Those individuals suffering from this disorder may be severely to profoundly mentally retarded.
Williams Syndrome is characterized by several autistic behaviors including: developmental and language delays, sound sensitivity, attention deficits, and social problems. In contrast to many autistic individuals, those with Williams Syndrome are quite sociable and have heart problems.
Causes
Although there is no known unique cause of autism, there is growing evidence that autism can be caused by a variety of problems. There is some indication of a genetic influence in autism. For example, there is a greater likelihood that two monozygotic twins (i.e., identical twins) will have autism than two dizygotic twins (i.e., fraternal twins). In the case of monozygotic twins, there is a 100% overlap in genes; whereas in dizygotic twins, there is a 50% overlap in genes, the same overlap as in non-twin siblings. Currently, a great deal of research has focused on locating the 'autism gene;' however, many researchers speculate that three to five genes will likely be associated with autism. There is also evidence that the genetic link to autism may be a weakened or compromised immune system. Other research has shown that depression and/or dyslexia are quite common in one or both sides of the family when autism is present.
There is also evidence that a virus can cause autism. There is an increased risk in having an autistic child after exposure to rubella during the first trimester of the pregnancy. Cytolomegalo virus has also been associated with autism. Additionally, there is also a growing concern that viruses associated with vaccinations, such as the measles component of the MMR vaccine and the pertussis component of the DPT shot, may cause autism.
There is growing concern that toxins and pollution in the environment can also lead to autism. There is a high prevalence of autism in the small town of Leomenster, Massachusetts, where a factory manufacturing sunglasses was once located. Interestingly, the highest proportion of autism cases were found in the homes down-wind from the factory smokestacks. Recently, a large proportion of autistic children were identified in Brick Township, New Jersey. Several agencies are now attempting to uncover the reason(s) for the high proportion of autism in this community.
Physical abnormalities
Researchers have located several brain abnormalities in individuals with autism; however, the reasons for these abnormalities is not known nor is the influence they have on behavior. These abnormalities can be classified into two types--dysfunctions in the neural structure of the brain and abnormal biochemistry of the brain. It will be important for future researchers to examine the relationship between these two types of abnormalities.
With respect to brain structure, Drs. Bauman and Kemper examined post-mortem brains of several autistic individuals and have located two areas in the limbic system which are underdeveloped--the amygdala and the hippocampus. These two areas are responsible for emotions, aggression, sensory input, and learning. These researchers also found a deficiency of Purkinje cells in the cerebellum. Using Magnetic Resonance Imaging, Dr. Courchesne has found two areas in the cerebellum, vermal lobules VI and VII, which are significantly smaller than normal in autistic individuals. Interestingly, there are a some autistic individuals whose vermal lobules VI and VII are larger than normal. One or both of these areas of the cerebellum are believed to be responsible for attention.
With respect to biochemistry, many autistic individuals have elevated levels of serotonin in their blood and cerebral spinal fluid, whereas others have relatively low levels of serotonin. It should be mentioned that other disorders, such as Down Syndrome, attention deficit/hyperactivity disorder, and unipolar depression are also associated with abnormal levels of serotonin. There is also evidence that some autistic individuals have elevated levels of beta-endorphins, an endogenous opiate-like substance in the body. It is felt that those individuals who have an increased pain tolerance may likely be due to elevated levels of beta-endorphins.
A dysfunctional immune system has also been associated with autism. It is thought that a viral infection or an environmental toxin may be responsible for damaging the immune system. As mentioned above, there is also evidence of a genetic association to a compromised immune system. Researchers have found that many autistic individuals have a decreased number of helper t-cells which help the immune system fight infection.
There is growing evidence that the gut or intestinal tract of autism children is impaired. Researchers have documented yeast overgrowths (candida albicans), low levels of phenyl sulfur transferase, and measles virus in their intestinal tract.
Sensory impairments
Many autistic individuals seem to have an impairment in one or more of their senses. This impairment can involve the auditory, visual, tactile, taste, vestibular, olfactory (smell), and proprioceptive senses. These senses may be hypersensitive, hyposensitive, or may result in the person experiencing interference such as in the case of tinnitus, (a persistent ringing or buzzing in the ears). As a result, it may be difficult for individuals with autism to process incoming sensory information properly.
Sensory impairments may also make it difficult for the individual to withstand normal stimulation. For example, some autistic individuals are tactilely defensive and avoid all forms of body contact. Others, in contrast, have little or no tactile or pain sensitivity. Furthermore, some people with autism seem to 'crave' deep pressure. Another example of sensory abnormalities is hypersensitive hearing. Approximately 40% of autistic individuals experience discomfort when exposed to certain sounds or frequencies. These individuals often cover their ears and/or tantrum after hearing sounds such as a baby's cry or the sound of a motor. In contrast, some parents suspect their children of being deaf because they appear unresponsive to sounds.
Cognition
"Theory of mind" refers to one's inability to realize that other people have their own unique point of view about the world. Many autistic individuals do not realize that others may have different thoughts, plans, and perspectives than their own. For example, a child may be asked to show a photograph of an animal to another child. Rather than turning the picture around to face the other child, the autistic child may, instead, show the back of the photograph. In this example, the autistic child can view the picture but does not realize that the other child has a different perspective or point of view.
About 10% of autistic individuals have savant skills. This refers to an ability which is considered remarkable by most standards. These skills are often spatial in nature, such as special talents in music and art. Another common savant skill is mathematical ability in which some autistic individuals can multiply large numbers in their head within a short period of time; others can determine the day of the week when given a specific date in history or memorize complete airline schedules.
Many autistic individuals also have a narrow or focused attention span; this has been termed 'stimulus overselectivity.' Basically, their attention is focused on only one, often irrelevant, aspect of an object. For example, they may focus on the color of a utensil, and ignore other aspects such as the shape. In this case, it may be difficult for a child to discriminate between a fork and a spoon if he/she attends only to the color. Since attention is the first stage in processing information, failure to attend to the relevant aspects of an object or person may limit one's ability to learn about objects and people in one's environment.
Interventions
Over the years, families have tried various types of traditional and non-traditional treatments to reduce autistic behaviors and to increase appropriate behaviors. Although some individuals are given medications to improve general well-being, there is no primary drug which has been shown to be consistently effective in treating symptoms of autism. The most widely prescribed medication for autistic children is Ritalin, (a stimulant used to treat Attention Deficit/Hyperactivity Disorder). However, there are no double-blind controlled studies to demonstrate its effectiveness for those with autism.
The two treatments which have received the most empirical support are Applied Behavior Analysis (ABA; behavior modification) and the use of vitamin B6 with magnesium supplements. Behavior modification involves a variety of strategies, (e.g., positive reinforcement, time-out), to increase appropriate behaviors, such as communication and social behavior, and to decrease inappropriate behaviors, such as self-stimulatory and self-injurious behavior.
Vitamin B6 taken with magnesium has been shown to increase general well-being, awareness, and attention in approximately 45% of autistic children. There are also a number of recent reports about the benefits of another nutritional supplement, Di-methylglycine (DMG). DMG also seems to help the person's general well-being, and there are many anecdotal reports of it enhancing communication skills.
Some people with autism have excessive amounts of a type of yeast called 'candida albicans' in their intestinal tract. It is thought that high levels of candida albicans may be a contributing factor to many of their behavioral problems. One scenario is that when a child develops a middle ear infection, the antibiotics that help fight the infection may destroy microbes that regulate the amount of yeast in the intestinal tract. As a result, the yeast grows rapidly and releases toxins in the blood; and these toxins may influence the functioning of the brain. Excessive candida albicans can be treated with rather mild medications such as Nystatin.
Food intolerances and food sensitivities are beginning to receive much attention as possible contributors to autistic behaviors. Many families have observed rather dramatic changes after removing certain food items from their children's diet. Researchers have recently detected the presence of abnormal peptides in the urine of autistic individuals. It is thought that these peptides may be due to the body's inability to breakdown certain proteins into amino acids; these proteins are gluten (e.g., wheat, barley, oats) and casein (found in human and cow's milk). Many parents have removed these substances from their children's diets and have, in many cases, observed dramatic, positive changes in health and behavior.
As mentioned earlier, many autistic individuals have sensory impairments. Sensory integration techniques are often used to treat dysfunctional tactile, vestibular, and proprioceptive senses. Some of the techniques involve swinging a child on a swing in various ways to help normalize the vestibular sense and rubbing different textures on the skin to normalize the tactile sense. In addition, an autistic woman, Dr. Temple Grandin, developed a hug machine which provides the individuals with deep pressure which appears to have a calming effect on the person.
Many autistic individuals are also sensitive to sounds in their environment. They may hear sounds beyond the normal range and/or certain sounds may be perceived as painful. Auditory integration training, (listening to processed music for ten hours), is an intervention which is often used to reduce these sensitivities. Visual training is another sensory intervention designed to normalize one's vision. There are several different methods of visual training. One popular program, developed by Dr. Melvin Kaplan, involves wearing ambient (prism) lenses and performing movement exercises which appear to reorganize and normalize the visual system.
Conclusion
Autism is a very complex disorder; and the needs of these individuals vary greatly. After 50 years of research, traditional and contemporary approaches are enabling us to understand and treat these individuals. It is also important to mention that parents and professionals are beginning to realize that the symptoms of autism are treatable--there are many interventions that can make a significant difference.
The logo for the national parent support group, the Autism Society of America, is a picture of a child embedded in a puzzle. Most of the pieces of the puzzle are on the table, but we are still trying to figure out how they fit together. We must also keep in mind that these pieces may fit several different puzzles.