Autism spectrum disorder (ASD)
Autism is a neurologic and developmental disorder that begins early in childhood and lasts throughout a person's life. It includes a wide range, “a spectrum,” of symptoms, skills, and levels of disability. Children with autism have social, communication and language problems. They also have restricted and repetitive patterns of behavior, interests, or activities, such as flipping objects, echolalia, or excessive smelling or touching of objects. Some are mildly impaired by their symptoms, while others are severely disabled.
Types of Autism
- Asperger's syndrome (AS). The mildest form of autism. Also called “high-functioning autism”, as children with AS frequently have normal to above average intelligence.
- Pervasive developmental disorder, not otherwise specified (PDD-NOS). Children whose autism is more severe than Asperger's syndrome, but not as severe as autistic disorder. They have better language skills than kids with autistic disorder but not as good as those with Asperger's syndrome, have fewer repetitive behaviors, and have a later age of onset.
- Autistic disorder. Children who meet more rigid criteria for a diagnosis of autism. They have more severe impairments involving social and language functioning, as well as repetitive behaviors. Often, they also have mental retardation and seizures.
· Rett Syndrome. Children often exhibit autistic-like behaviors. If someone with Rett syndrome displays autism symptoms, then they also have ASD. Between 6 and 18 months of age, the child stops responding socially, wrings hands habitually, and loses language skills. Coordination problems appear and can become severe. Head growth slows down significantly and by the age of two is far below normal.
· Childhood Disintegrative Disorder (CDD). The most severe and least common ASD. After a period of normal development, usually between ages 2 and 4, a child with CDD rapidly loses multiple areas of function. Social and language skills are lost, as well as intellectual abilities. Often, the child develops a seizure disorder. Children are severely impaired and don't recover their lost function.
- Difficulty in sharing a common focus with another person about the same object or event.
- Significant problems developing nonverbal communication skills, such as eye-to-eye gazing, facial expressions, and body posture.
- Failure to establish friendships with children the same age.
- Lack of interest in sharing enjoyment, interests, or achievements with other people.
- Lack of empathy. People with autism may have difficulty understanding another person's feelings, such as pain or sorrow.
Delay in, or lack of, learning to talk.
As many as 40% of people with autism never speak.
- Problems taking steps to start a conversation. Also, they have difficulties continuing a conversation after it has begun.
- Stereotyped and repetitive use of language (echolalia).
- Difficulty understanding their listener's perspective, such as the use of humor and implied meanings.
- An unusual focus on pieces (e.g. a child may focus on parts of toys, such as the wheels on a car, rather than playing with the entire toy).
- Preoccupation with certain topics (e.g. fascination with video games or trading cards).
- A need for sameness and routines (e.g. a child may always need to eat bread before salad and insist on driving the same route every day to school).
- Stereotyped behaviors (e.g. body rocking and hand flapping, spinning or staring).
- Genetic problems or syndromes.
- Severe infections that affect the brain (meningitis, celiac disease, encephalitis).
- Exposure to toxins or illness during pregnancy (rubella, chemicals).
Treatment and Management
- Behavioral training and management. This uses positive reinforcement, self-help, and social skills training to improve behavior and communication.
- Specialized therapies. These include speech, occupational, and physical therapy.
- Medicines. Medicines are most commonly used to treat related conditions and problem behaviors, including depression, anxiety, hyperactivity, and obsessive-compulsive behaviors.
- Community support and parent training. Talk to your doctor or contact an advocacy group for support and training.
Doctors to Consult
SLPs (speech-language pathologists [sometimes called speech therapists]), typically as part of a team, are involved in the evaluation process for autism. SLPs play a key role because problems with social skills and communication are often the first symptoms of autism. The team might include pediatricians, neurologists, occupational therapists, physical therapists, and developmental specialists, among others.