Autism

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Autism

Autism is a profound mental disorder marked by an inability to communicate and interact with others. The condition’s characteristics include language abnormalities, restricted and repetitive interests, and the appearance of these characteristics in early childhood. The disorder begins in infancy, but typically is not diagnosed until the ages two to five years. Although individuals with autism are more likely to be mentally retarded than other individuals some people with the disorder have a high intelligence level. The cause of autism is unknown although it is probably biological in origin.

According to the U.S. Centers for Disease Control and Prevention (CDC), a little over 15, 500 cases of autism were reported in the United States in 1992 for people six years to 22 years old. In just over ten years, the number of reported cases steadily climbed over the years, reaching over 141,000 in 2003. As of 2006, the National Institutes of Health, CDC, U.S. Department of Education, and the Autism Society of America reports that autism could afflict (unreported and reported) as many as 1.0 to 1.5 million people in the United States. These organizations consider autism to be the fastest growing developmental disability in the country. In addition, autism is found four times more often in boys (usually the first-born) and it occurs around the world in people of all races and social backgrounds. Autism usually is evident in the first three years of life, although sometimes the condition is not diagnosed until a child enters school.

A singular world view

Children with autism were described as early as 1908 by Theodor Heller (1869–1938), a Viennese educator. Autism was not named and identified as a distinct condition until 1943. That year American psychiatrist Leo Kanner wrote about what he called infantile autism. Kanner derived the term autism from the Latin word aut, meaning self. Kanner described a group of children who looked normal but showed limited communication skills and were drawn to repetitive behavior. Researchers have since discovered that the disorder is not common, occurring in two to five of every 10, 000 births; although some researchers now contend that autism occurs much more frequently: one in 250 births in the United States. The disorder is more common in males than in females.

As many as two-thirds of children with autistic symptoms are mentally deficient. But individuals with autism can be highly intelligent. Some achieve great levels of success at school and at work. The term autism is more a description of a range of behavioral traits than a term to describe a single type of person with a single level of potential.

Autistic individuals generally share a defect in ‘the theory of mind.’ This term is used to describe the way normal individuals develop a sense of what others are thinking and feeling. This sense is usually developed by about age four years. Autistic individuals typically are limited in their ability to communicate nonverbally and verbally. About half of all autistic people never learn to speak. They are likely to fail in developing social relationships with peers, have limited ability to initiate conversation if they do learn how to talk, and show a need for routines and rituals.

The range of ability and intelligence among autistic individuals is great. Some individuals are profoundly withdrawn. These aloof individuals generally do not greet parents when they enter the house or seek comfort when in pain. Others can conduct a conversation but may be obsessed with strange or unusual behaviors, such as a fascination with calendars or timetables. Still others use their ability to focus on particular bodies of fact to master a job or a profession. For instance, Temple Grandin has attained an educational level of Ph.D. (doctor of philosophy) and is a successful animal behavior expert who is autistic and an international expert in her field.

Certain autistic people have areas of expertise in which they are superior to normal individuals. These skills are called savant abilities and have been well documented in music, drawing, and areas where calculation is involved. The vibrant drawings of buildings by autistic British artist Stephen Wiltshire have been published to great acclaim.

Abundance of theories

The precise cause of autism is not known and many theories have emerged concerning its origin. Initially autism was believed to be caused by destructive parents. Kanner observed in 1943 that there are few “really warmhearted fathers and mothers” among parents of autistic children (Groden 1988). Other experts suggested that parents of autistic children are more likely to be cold and unsupportive of their children than parents of normal children. In the 1950s and 1960s it was still generally believed that this parental behavior caused autism. Children were therefore advised to have psychotherapy for autism. This therapy was generally unsuccessful. Some experts suggested that autistic children be removed from their parents.

In the mid-1960s experts began to challenge the assumption that parents cause autism. Evidence emerged that while autistic children look normal they have particular physical abnormalities. These include a higher-than-normal likelihood of epilepsy—it occurs in as many as 30% of children with autism. Researchers also looked at the way parents interacted with autistic children. Their findings showed that parents of autistic children are equally as skilled as parents of normal children on average.

The general belief today is that autism is a biological disorder and has nothing to do with parenting skill. Clues to what causes autism include a wealth of abnormalities documented to occur in higher percentages among autistic people than normal people. These include certain genetic conditions, epilepsy, mental disabilities, and some birth defects.

Genetics appears to play a role in autism but its role is not completely understood. Brothers or sisters of individuals with autism are slightly more likely than others to be autistic. Approximately 2 to 3% of siblings of autistic people have the disorder. The twin of an autistic individual is also more likely to have autism.

The occurrence of fragile X syndrome, a genetic disorder, in about 10% of autistic people has presented researchers with a documented cause of the disorder. Fragile X victims have a gap on their X chromosome. The condition is generally linked to mental disabilities and a characteristic facial appearance (a high forehead and long ears) among other traits. Brothers or sisters of individuals with fragile X syndrome are nearly 50% more likely to be autistic than are brothers and sisters of normal children. It is not clear what causes the syndrome.

Another genetic trait more common among autistic individuals than others is neurofibromatosis, a genetic condition which affects the skin and the nerves and sometimes causes brain damage. Researchers also have noted that mothers of autistic children are more likely to receive medication during pregnancy. They have also found that autistic children are more likely to have been born with meconium (the first stool of the infant) in the amniotic fluid during labor. However these events also commonly occur among normal children. Other possible causes of autism include rubella infection in early pregnancy, herpes encephalitis (which can cause inflammation of the brain), and cytomegalovirus infection.

Whatever the cause of the damage, various abnormalities in the autistic brain have been documented. These include variations in the frontal lobes of the brain which focus on control and planning, and in the limbic system. The limbic system is a group of structures in the brain which are linked to emotion, behavior, smell, and other functions. Autistic individuals may suffer from a limited development of the limbic system. This would explain some of the difficulties faced by autistic individuals in processing information.

Studies using MRI (magnetic resonance imaging) scanners have found abnormalities in the cerebellum. Some researchers suggest that the section where abnormalities have been documented is the part of the brain concerned with attention. Other tests using electroencephalograms have found that autistic

KEY TERMS

Limbic system —A group of structures in the brain including the hippocampus and dentate gyrus. These structures are associated with smell, emotion, behavior, and other brain activity.

Psychotherapy —A broad term that usually refers to interpersonal verbal treatment of disease or disorder that addresses psychological and social factors.

children show abnormalities in the way the brain processes sound.

Teaching and learning

As theories about the cause of autism have changed so have approaches to teaching autistic individuals. Individuals with autism were once considered unteachable and were often institutionalized. Experts currently recommend early education for autistic individuals using approaches geared specifically for them. Those who cannot speak may learn sign language. Often some form of behavioral modification is suggested including offering positive reinforcement for good behavior.

Given the need for organization and repetitive behavior among autistic people, many experts suggest a structured environment with a clearly defined schedule. Some experts advocate special schools for autistic children while others recommend including them in a general school program with appropriate help.

Controversy exists concerning the best way to teach and communicate with autistic children who do not speak. In the 1980s some parents and educators claimed great success using so-called facilitated communication. This technique involves the use of a keyboard or letter board and a facilitator to help the autistic individual use the device. Some have said the device allows autistic individuals to break through the barriers of communication. Others have criticized facilitated communication as a contrived and false method of communication. The technique remains controversial.

Earlier generations placed autistic children in institutions. Today, even severely disabled children can be helped in a less restrictive environment to develop to their highest potential. Many become more responsive to others as they learn to understand the world around them, and some can lead nearly normal lives.

With no cure and no prenatal test for autism, there is no prospect of eliminating this condition in the near future. Continued educational research concerning the best way to teach autistic children and continued scientific research concerning possible treatments for autism are the greatest hope for dealing with the effects of this profound developmental problem.

Resources

BOOKS

Autism and Genes. Rockville, MD: National Institute of Child Health and Human Development, 2005.

Breakey, Christine. The Autism Spectrum and Further Education: A Guide to Good Practice. London, UK: Jessica Kingsley Publishers, 2006.

Hart, Charles A. A Parent’s Guide to Autism. New York: Pocket Books, 2001.

Hesmondhalgh, Matthew. Autism, Access and Inclusion on the Front Line: Confessions of an Autism Anorak. London, UK: Jessica Kingsley Publishers, 2006.

Tuchman, Roberto, and Isabelle Rapin, eds. Autism: A Neurological Disorder of Early Brain Development. London, UK: MacKeith Press for the International Child Neurology Association, 2006.

Volkmar, Fred R., ed. Handbook of Autism and Pervasive Developmental Disorders. Hoboken, NJ: John Wiley, 2005.

Zager, Dianne, ed. Autism Spectrum Disorders: Identification, Education, and Treatment. Mahwah, NJ: Lawrence Erlbaum Associates, 2005.