Tuesday, April 22, 2014

What is Autism?

Autism is a lifelong developmental disorder that affects the way people interact and communicate with those around them.  Each child and adult with an ASD is unique and has their own strengths, gifts and support needs. 

First identified in 1943 by Leo Kanner, Autism Spectrum Disorder (ASD) is one of the Pervasive Developmental Disorders (PDD) of childhood onset. The symptoms of autism may be present from birth, but they may not be noticed until a child is two or three, when language normally develops.  ASD is distinguished by severe impairments in communication and social interactions, a restricted range of interests and activities and stereotyped behaviours. These neurological characteristics are common to all ASD’s but symptoms can vary widely among individuals. The cause continues to elude us.

Prevalence of an Autism Spectrum Disorder Spectrum 
It was once thought that Autism occurs approximately in 10 to 12 people per 10,000 but studies have found the incidence to be much greater having increased tenfold over the past few decades. It is not known whether this is simply due to more thorough identification or diagnosis, or to other causes such as environmental influences. The incidence of an Autism Spectrum Disorder is now being documented at less than 1 in 100 of the population and is four times more common in boys than it is in girls. It occurs in all races, social and economic conditions globally. There are several theories, but no conclusive answer as to the cause(s). One thing that we do know is that autism is NOT caused by deficient parenting, which was put forth as a theory when first recognized as a distinct disability.

What are the Symptoms of an Autism Spectrum Disorder?
Each child and adult with an ASD is unique and has their own strengths, gifts and support needs.  Parents may report that their child was an unusually good and quiet baby who rarely cried, or a very difficult baby who cried all the time, spit up excessively and slept for only short periods. One of the most frustrating and confusing characteristics may be the inability to develop appropriate affectionate relationships. He/she may resist being held and cuddled, and may not seem to recognize familiar faces, or alternately may indiscriminately display affection towards unfamiliar people.  People with autism comprise a diverse group, differing in the number of characteristics they display as well as in the severity of their symptoms.  The nature of the symptoms may vary depending on the developmental level of the individual and may change over time. Features frequently seen include self-injurious behaviour, aggression, hyperactivity and short attention span. People often experience sensory processing difficulties and anxiety. They may have unusual responses to sensory stimulation, such as high tolerance for pain, over or under-reaction to sounds, oversensitivity to being touched, or a fascination of lights and shiny objects. Expressions or mood are frequently abnormal. There may be an unemotional or an inappropriate reaction to the surrounding circumstance. The Autism Spectrum includes Asperger Syndrome, Autistic Disorder, Childhood Disintegrative Disorder, Rett Syndrome, Pervasive Development Disorder Not Otherwise Specified (PDD/NOS).

Diagnosis 
Diagnosis often occurs between the ages of 18 to 30 months when parents notice an absence or a delay in speech development and a lack of normal interest in others or a regression of early speech and sociability.  Diagnosis is based on the child’s developmental history in areas such as speech, communication, social and play interaction provided by those who know the child well.  A multi-disciplinary team which may include the family doctor, psychologist, speech and language pathologist and an audiologist will provide further assessment. A diagnosis requires impairments in all of the following areas of development:

Communication:
The impairment includes both spoken language and non-verbal skills. People with autism may have no speech (approximately 50%), or may have difficulty with speech production and/or conversation skills. There may be a total lack of development of speech which is also not compensated by the development of non-verbal modes of communication (e.g., no use of gestures, facial expression, body posture). In individuals who have speech, there may be a repetitive and stereotypic use of language, abnormal prosody (i.e. pitch, intonation, rate, etc.), immature grammatical structures. There may be use of metaphorical language and/or neologisms (extended meaning of a word or phrase) which is understood only by those familiar with individual’s communication style.  There are also impairments in one’s ability to initiate or sustain conversation with others.

Social interaction:
People with autism often do not relate well with other people, have difficulty learning to play with others, may not imitate well, and have difficulty learning how to respond to social games. Manifestations of impaired social interaction include avoidance of eye contact, lack of interest in simple social activities, impaired awareness of the presence of others, minimal interest in establishing friendships or lack of understanding about rules of social interaction.

Restricted repertoire of activities and interests:
this includes some of the usual behaviours that are often associated with autism such as stereotyped and repetitive motor mannerisms or body movements, distress about changes in routines, preoccupations with parts of objects and a restricted range of interests.

Associated features:
Other features associated with the disorder may include difficulties in eating, sleeping or toileting, unusual fears, learning problems, repetitive behaviours, self injury and peculiar response to sensory input. Approximately 75% to 95% of people with autism have a cognitive impairment. Moreover, the profile of cognitive skills is usually uneven, regardless of the general level of intelligence (e.g. functioning is not at the same approximate developmental level for all areas).