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What is Autism?

Autism is primarily characterized by impairment of social development from very early childhood (before 3 years of age). In other words, these children do not properly develop the natural ability of very young children to relate, interact and respond to people around them. They appear solitary, uninterested in people around them and more interested in objects.

Some of key milestones of social development in infancy are responding to mother’s call, responding to name call, development of eye-to eye contact to know the other persons intentions and feelings, social imitation (clap-clap, Namaste, ta-ta), pointing on request (to body parts, fan, light, moon), following the direction of another person’s gaze, following the direction of another person pointing, sharing an interest with another person (joint attention for example when you offer a toy, child looks at toy, then looks at you, then again at the toy before deciding to take it) ; doing something on request ( for example responding to the requests “how does a dog bark? , How does father read a newspaper? How does grandma conduct her pooja? Show me how an airplane flies). Children with Autism show marked delay in developing these social milestones (please see early signs section for more details). Similarly, when they grow up, they have major difficulties in developing social relationships with children of their own age.

In addition, children with Autism also have significant problems in communicating with others. This includes both verbal (understanding what others are saying and speaking) and non-verbal (understanding other people’s gestures, their body language and facial expressions as well as having difficulties in communicating through gestures and body language themselves). Sometimes, these children do learn to speak but may not know how to use language to communicate effectively with others. They may have an unusual way of using language such as repeating whatever they hear either immediately (immediate echolalia) or much later (delayed echolalia).

As they grow older, children with Autism often develop restricted, repetitive behaviours and stereotypies. Stereotypies is a term used for persistent, meaningless, repetition of some actions or activities such as rocking to and fro, waving hands in front of eyes, twirling and twisting of fingers, and jumping up and down without any obvious reason. Restricted behaviours include a very narrow range of interests – for example, being interested only in pens or thread, or papers and nothing else. Similarly, these children may have interest only in mobile phones, paper, turning the wheels, rotating objects etc. Their play behaviour tend to lack the imaginativeness of typical children.

Leo Kanner, an American psychiatrist from Johns Hopkins University, was the first to provide a detailed and meticulous description of Autism in 1943. He called this condition as “Autistic disturbances of affective contact”. He noted that, in these children “there is from the start an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out, anything that comes to the child from the outside.” He also described other core features of Autism viz., language abnormalities and insistence on sameness. Almost simultaneously Hans Asperger in Vienna observed autistic- like behaviour(s) and social communication difficulties in young boys who had normal language development and intelligence. This was termed as Asperger’s Disorder. Both these disorders are now considered as part of a spectrum and are increasingly termed as Autism Spectrum Disorders (referred to in this website as Autism).

Autism belongs to the class of neuro-developmental disorders. These are conditions with an onset in early childhood in which one or more areas of development are affected. These conditions due to an impairment in the smooth and systematic maturation and development of the brain. Some examples of neuro-developmental disorders, besides Autism, are Intellectual Disability, and Specific Language Impairment (commonly referred to as Expressive Speech Delay).

Autism may vary in terms of severity and extent of symptoms. Some children are more severely affected and show all symptoms whereas there are others may milder features of Autism. In other words, they fall into a spectrum of abnormalities and impairment, from very mild at one end to the very severe at the other end. The term ‘Autism Spectrum Disorders’ as an umbrella term which is now used to describe this variation.

Autism typically appears before three years of age. In some children, the features of Autism are clearly noticeable even earlier (see early signs).

In addition to core features mentioned above, persons with Autism may also have other problems. Their intelligence may be below normal, they may show excessive motor activity (hyperactivity), they may have poor attention span, engage in self-injurious behaviour (such as head-banging, biting hands and fingers, or hitting themselves on the side of their head), they may display aggressive behaviours, impulsivity (that is; suddenly doing something like throwing an object), have sudden unexpected changes in mood – crying /laughing, feeling scared and panicky, or anger / irritability which are not easy to explain, besides sleep disturbances.

Individuals with Autism may also have physical problems such as seizure disorder (epilepsy or convulsions), food intolerance, allergies, and “stomach upsets”.

People with Autism may commonly have unusual responses to ordinary sensory experiences, the so called sensory hyper-responsiveness or hypo-responsiveness. To explain further, they may become very upset and disturbed with ordinary sounds, touch, sights, and movement sensations. Sometimes to protect themselves, they may close their ears and eyes and avoid situations that they find too stimulating (such as crowded places, noisy places, certain kinds of cloths etc.). They may also seek certain kinds of sensations, such as mouthing objects, going round and round for vestibular stimulation. Sometimes these behaviours can also occur in children who do not have Autism. Feeding difficulties because of unusual responses to taste and texture of the food is another problem they may face.

No two individuals with Autism are the same. Each has their own pattern of impairments, assets, strengths and vulnerabilities. A detailed evaluation of these individual characteristics will help in planning individualized management for each person with Autism.

Some individuals with Autism may have special abilities and talents, for instance in music, mathematics, extraordinary memory for events and numbers, and dates, and in arts such as drawing.

Recognizing and encouraging these talents is one aspect of overall intervention in Autism, provided the special skill improves the functional abilities of the individual. Also, it is important to remember that such an encouragement does not hinder social, communicative and self-help skill development.

By its nature, Autism is a permanent disorder, which the person will have for the whole life-time. However with proper interventions a person with Autism can achieve competencies and skills with age.

Research has shown that some children with mild Autism with normal intelligence and language abilities respond very well to intensive intervention and grow up to be typically developed in many areas.

Autism is essentially identified (diagnosed) based on history and a detailed observation of the person’s behaviour. In other words it is a clinical diagnosis. To say an individual has Autism, there should be difficulties in the entire 3 core areas mentioned above, viz., impairment in reciprocal social interaction, impaired speech/language/communication, and restricted/ repetitive patterns of behaviour.

There is no specific physical test – blood test, urine test or brain scan - which can decide whether a given individual has Autism or not.

How common is Autism?

Autism is being identified much more often these days than before and this trend is seen all over the world including India. Recently, in the USA, it is reported that 1 in 88 children are affected with Autism. More global data suggests that of every 160 children 1 will have Autism.
  • The exact prevalence of Autism in India has not yet been properly studied. However, as noted earlier, it is being identified much more often these days than earlier. The reason for this increased occurrence of Autism is not clear. However, it is thought that it may be a combination of an increased awareness of the disorder, a clearer understanding of what “Autism” is; or a genuine increase in number.
  • Autism is known to be around 4 times more common in boys
  • Autism is known to occur in all countries, all ethnic groups, and in all social classes.

Ten things that every Child with Autism wants you to know:
http://www.communicationdeall.org/#!what-you-need-to-know-about-your-child/cueb

 
 
  Autism Spectrum Disorders or ASD is commonly called Autism Neuro- typical: A term used for people who do not have Autism or ASD  
 
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