The Autism Corner

Autism is still one of the lesser understood disorders. The Autism Corner of the Disability India Network seeks to provide in-depth information and answer specific questions that arise in the minds of our readers.

Autism Information

1.1 Overview

Autism is a complex developmental disability that typically appears during the first three years of life and causes substantial impairments in social interaction and communication and the presence of unusual behaviors and interests. Many people with ASDs also have unusual ways of learning, paying attention, and reacting to different sensations. The thinking and learning abilities of people with ASDs can vary—from gifted to severely challenged. Autism is defined by a certain set of behaviors and is a "spectrum disorder" that affects individuals differently and to varying degrees. An ASD begins before the age of 3 and lasts throughout a person's life. There is no known cause for autism.

All children with ASD demonstrate deficits in 3 main areas-

  1. social interaction
  2. verbal and nonverbal communication, and
  3. repetitive behaviors or interests

As the name "autism spectrum disorders" suggests, ASD’s cover a wide range of behaviors and abilities. No two people with ASDs will have the same symptoms. They will present in each individual child differently. Each child will display communication, social, and behavioral patterns that are individual but fit into the overall diagnosis of ASD.

These could be possible indicators of autism spectrum disorders-

  • Does not babble, point, or make meaningful gestures by 1 year of age
  • Does not speak one word by 16 months
  • Does not combine two words by 2 years
  • Does not respond to name
  • Loses language or social skills

People with autism process and respond to information in unique ways. In some cases, aggressive and/or self-injurious behavior may be present. Persons with autism may also exhibit some of the following traits:

  • Poor eye contact
  • Insistence on sameness; resistance to change
  • Difficulty in expressing needs; using gestures or pointing instead of words
  • Repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language (echolalia)
  • Laughing (and/or crying) for no apparent reason; showing distress for reasons not apparent to others
  • Preference to being alone; aloof manner
  • Difficulty in mixing with others
  • Not wanting to cuddle or be cuddled
  • Tantrums
  • Unresponsive to normal teaching methods
  • Sustained odd play
  • Does not play "pretend" games (pretend to "feed" a doll, “drive” a car)
  • Doesn't seem to know how to play with toys
  • Excessively lines up toys or spins objects
  • Obsessive attachment to objects
  • Apparent over-sensitivity or under-sensitivity to pain
  • No real fears of danger
  • Noticeable physical over-activity or extreme under-activity
  • Non-responsive to verbal cues; acts as if deaf, although hearing tests are in normal range

* Note: Contact your child’s doctor or specialist if your child experiences a dramatic loss of skills at any age.


Autism is one of a group of disorders known as autism spectrum disorders (ASDs). ASDs include Autistic Disorder, Pervasive Developmental Disability (Not Otherwise Specified)  and Asperger syndrome. These conditions all have some of the same symptoms, but they differ in terms of when the symptoms start, how severe they are, and the exact nature of the symptoms. The three conditions, along with Rett Syndrome and Childhood Disintegrative Disorder, make up the broad diagnosis category of Pervasive Developmental Disorders.

ASDs can often be detected as early as 18 months. While all children should be watched to make sure they are reaching developmental milestones on time, children in high-risk groups—such as children who have a parent or brother or sister with an ASD—should be watched extra closely.

ASDs occur in all racial, ethnic, and socioeconomic groups and are four times more likely to occur in boys than in girls. CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network released data in 2007 that found about 1 in 150 8-year-old children in multiple areas of the United States had an ASD.

Autism may seem like a modern disorder, but it’s not. People have probably lived with what we know today as autism spectrum disorders throughout history. Autism was first identified as a specific disorder in 1943 by child psychiatrist Dr. Leo Kanner 1. At about the same time, German scientist Dr. Hans Asperger, based on his study of 400 children, described another form of autism that became known as Asperger syndrome2. The criteria used to diagnose ASDs have changed many times since Kanner’s original description.

1.2 PREVALENCE

The overall incidence of autism is consistent around the globe. Autism knows no racial, ethnic, or social boundaries; family income levels; lifestyle choices; or educational levels, and can affect any family and any child. Autism is the most common of the Pervasive Developmental Disorders and it is four times more prevalent in boys than in girls.

In February 2007, the Centers for Disease Control and Prevention 3 issued their ADDM 4 autism prevalence report, which looked at a sample of 8 year olds in 2000 and 2002. The report concluded that the prevalence of autism had risen to 1 in every 150 American children, and was almost 1 in 94 boys.

1.3 CAUSES

We have learned a lot about the symptoms of ASDs and have improved efforts to track the disorders, but we still don’t know a lot about the causes of ASDs. Currently, there is no known single cause for autism.   Scientists think that both genes and the environment play a role, and there might be many causes that lead to ASDs.  Researchers are investigating the possibility that under certain conditions, a cluster of unstable genes may interfere with brain development, resulting in autism.

Genetic Vulnerability

While no one gene has been identified as causing autism, researchers are searching for irregular segments of genetic code that children with autism may have inherited. It also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single "trigger" that causes autism to develop.

Family studies have been most helpful in understanding how genes contribute to autism. Studies have shown that among identical twins, if one child has autism, then the other will be affected about 75% of the time. In non-identical twins, if one child has autism, then the other has it about 3% of the time. Also, parents who have a child with an ASD have a 2%–8% chance of having a second child who is also affected 5.

ASDs tend to occur more often than expected among people who have certain other medical conditions, including Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, and untreated phenylketonuria (PKU). Some harmful drugs taken during pregnancy also have been linked with a higher risk of autism.

Environmental Factors

Researchers are investigating the possibility that under certain conditions, a cluster of unstable genes may interfere with brain development, resulting in autism. Still other researchers are investigating problems during pregnancy or delivery as well as environmental factors, such as viral infections, metabolic imbalances, and exposure to environmental chemicals.

Research also  indicates that other factors besides the genetic component are contributing to the rise in increasing occurrences of ASD, such as environmental toxins (e.g., heavy metals such as mercury), which are more prevalent in our current environment than in the past.

1.4 DIAGNOSIS

Whether you or your child's pediatrician is the first to suspect autism, your child will need to be referred to someone who specializes in diagnosing autism spectrum disorders. This may be a developmental pediatrician, a psychiatrist or psychologist, and other professionals that are better able to observe and test your child in specific areas.

ASDs can often be detected as early as 18 months. While all children should be watched to make sure they are reaching developmental milestones on time, children in high-risk groups—such as children who have a parent or brother or sister with an ASD—should be watched extra closely.

A brief observation in a single setting cannot present a true picture of an individual's abilities and behaviors. Parental (and other caregivers' and/or teachers’) input and developmental history are important components of making an accurate diagnosis. Doctors usually make use of the DSM-IV-R (Diagnostic and Statistical Manual of Mental Disorders IV- Revised) to make their diagnosis. For DSM IV criteria for Autism, click here.

There are no medical tests for diagnosing autism. An accurate diagnosis must be based on observation of the individual's communication, behavior and developmental levels. However, because many of the behaviors associated with autism are shared by other disorders, various medical tests may be ordered to rule out or identify other possible causes of the symptoms being exhibited. At first glance, some persons with autism may appear to have mental retardation, a behavior disorder, problems with hearing, or even odd and eccentric behavior. To complicate matters further, these conditions can co-occur with autism. However, it is important to distinguish autism from other conditions, since an accurate diagnosis and early identification can provide the basis for building an appropriate and effective educational and treatment program.

1.5 EARLY IDENTIFICATION AND INTERVENTION

Research indicates that early identification is associated with dramatically better outcomes for individuals with autism 6. The earlier a child is diagnosed, the earlier the child can begin benefiting from one of the many specialized intervention approaches to treatment and education.

It is important that parents and professionals work together for the child's benefit. While professionals will use their experience and training to make recommendations about your child's treatment options, you have unique knowledge about his/her needs and abilities that should be taken into account for a more individualized course of action.

Once a treatment program is in place, communication between parents and professionals is essential in monitoring the child's progress. Here are some guidelines for working with professionals:

  • Be informed. Learn as much as you can about your child's disability so you can be an active participant in determining care. If you don't understand terms used by professionals, ask for clarification.
  • Be prepared. Be prepared for meetings with doctors, therapists, and school personnel. Write down your questions and concerns, and then note the answers.
  • Be organized. Many parents find it useful to keep a notebook detailing their child's diagnosis and treatment, as well as meetings with professionals.
  • Communicate. It's important to ensure open communication - both good and bad. If you don't agree with a professional's recommendation, speak up and say specifically why you don't.

1.6 PROGNOSIS

Though there is no single known cause or cure, autism is treatable. Children do not “outgrow” autism, but studies show that early diagnosis and intervention can lead to significantly improved outcomes. With the right services and supports, people with autism can live full, healthy and meaningful lives.

1.7 LIFE WITH AUTISM

Though there is no single known cause or cure, autism is treatable. Children do not “outgrow” autism, but studies show that early diagnosis and intervention can lead to significantly improved outcomes. With the right services and supports, people with autism can live full, healthy and meaningful lives.

1.8 REFERENCES

National Research Council. Educating Children with Autism.  Washington, DC: National Academy Press, 2001.

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

Medline Plus
http://www.nlm.nih.gov/medlineplus/autism.html

Center for Disease Control and Prevention
http://www.cdc.gov/ncbddd/autism/overview.htm

Autism Society of America
http://www.autism-society.org/site/PageServer?pagename=about_home

National Institute of Mental Health
http://www.nimh.nih.gov/health/publications/autism/complete-publication.shtml

  1. Kanner, L.  Autistic disturbances of affective contact. Nervous Child 1943; 2:217-250.
  2. Asperger, H. Die “Autistichen Psychopathen” Kindesalter. Arch Psychiatr Nervenkr 1944; 117:76-136.
  3. Centers for Disease Control and Prevention:  http://www.cdc.gov/ncbddd/autism/
  4. ADDM: http://www.cdc.gov/ncbddd/autism/addm.htm                               
  5. Boyle C, Van Naarden Braun K, Yeargin-Allsopp M. The Prevalence and the Genetic Epidemiology of Developmental Disabilities.  In: Genetics of Developmental Disabilities. Merlin Butler and John Meany eds. 2004 (Table 3, p. 716-717)

    Muhle R, Trentacoste V, Rapin I. The Genetics of Autism. Pediatrics 2004;113;472-486
  6. Handleman, J.S., Harris, S., eds. Preschool Education Programs for Children with Autism (2nd ed). Austin, TX: Pro-Ed. 2000.