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Autism in Wikipedia

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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Autism". (Source - Retrieved 2006-09-07 14:10:01 from https://en.wikipedia.org/wiki/Autism)

Introduction

Autism is classified as a neurodevelopmental disorder that manifests itself in markedly abnormal social interaction, communication ability, patterns of interests, and patterns of behavior.

Although the specific etiology of autism is unknown, many researchers suspect that autism results from genetically mediated vulnerabilities to environmental triggers. While there is disagreement about the magnitude, nature, and mechanisms for such environmental factors, researchers have found seven genes prevalent among individuals diagnosed as autistic. Some estimate that autism occurs in as many as one child in 166 in the United States. However, the National Institute of Mental Health gives a more conservative estimate of one in 1000[1]. A study published in 2006 indicates that men over 40 are almost six times more likely to father a child with autism than younger men[2]. Although autism is about 3 to 4 times more common in boys, girls with the disorder tend to have more severe symptoms and greater cognitive impairment. Diagnosis is based on a list of psychiatric criteria, and a series of standardized clinical tests may also be used.

Autism may not be physiologically obvious. A complete physical and neurological evaluation will typically be part of diagnosing autism. Some now speculate that autism is not a single condition but a group of several distinct conditions that manifest in similar ways. Recently, researchers at the University of Pennsylvania School of Medicine have found a link between autism, abnormal blood vessel function and oxidative stress (the result of higher levels of free radicals). The study suggests that, if researchers can find more evidence linking decreased blood flow to the brain and oxidative stress with the pathology of autism, improvements in therapy could be found[3].

By definition, autism must manifest delays in "social interaction, language as used in social communication, or symbolic or imaginative play," with "onset prior to age 3 years", according to the Diagnostic and Statistical Manual of Mental Disorders. The ICD-10 also requires symptoms to be "manifest before the age of three years." There have been large increases in the reported incidence of autism, for reasons that are heavily debated by researchers in psychology and related fields within the scientific community.

With intense therapy and practice and schooling, some children diagnosed with autism can improve their social and other skills to the point where they can fully participate in mainstream education and social events, but there are no indications that a cure from autism is possible with current technology or advances in medicine. Some autistic children and adults who are able to communicate (at least in writing) are opposed to attempts to cure their autism, because they (and/or the guardians) see autism as part of who they are.

History

Dr. \$Hans Asperger\$ described a form of autism in the 1940s that later became known as \$Asperger's syndrome\$.

The word autism was first used in the English language by Swiss psychiatrist Eugene Bleuler in a 1912 issue of the American Journal of Insanity. It comes from the Greek word for "self". Bleuler used it to describe the schizophrenic's seeming difficulty in connecting with other people.

However, the classification of autism did not occur until the middle of the twentieth century, when in 1943 psychiatrist Dr. Leo Kanner of the Johns Hopkins Hospital in Baltimore reported on 11 child patients with striking behavioral similarities, and introduced the label early infantile autism. He suggested "autism" from the Greek αυτος (autos), meaning "self", to describe the fact that the children seemed to lack interest in other people. Although Kanner's first paper on the subject was published in a now defunct journal, The Nervous Child, almost every characteristic he originally described is still regarded as typical of the autistic spectrum of disorders.

At the same time an Austrian scientist, Dr. Hans Asperger, made similar observations, although his name has since become attached to a different, "higher-functioning", form of autism known as Asperger's syndrome. However, widespread recognition of Asperger's work was delayed by World War II in Germany, and by the fact that his seminal paper wasn't translated into English for almost 50 years. The majority of his work wasn't widely read until 1997.

These two conditions are today listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (fourth edition, text revision 1) as two of the five pervasive developmental disorders (PDD), more often referred to today as autism spectrum disorders (ASD). All of these conditions are characterized by varying degrees of difference in communication skills, social interactions, and restricted, repetitive and stereotyped patterns of behavior.

Few clinicians today use only the DSM-IV criteria, which are based on the absence or delay of certain developmental milestones, to diagnose autism.

Terminology

Look up autism, autistic in Wiktionary, the free dictionary.

When referring to someone diagnosed with autism, the term autistic is often used. However, the terms person with autism or person who experiences autism can be used instead. These are referred to as person-first terminology. The autistic community generally prefers the term autistic for reasons that are fairly controversial.[4] This article uses the term autistic.

Characteristics

There is a great diversity in the skills and behaviors of individuals diagnosed as autistic, and physicians will often arrive at different conclusions about the appropriate diagnosis. Much of this is due to the sensory system of autistics, which is quite different from the sensory system of other people, since certain stimulations can affect an autistic differently than a non-autistic, and the degree to which the sensory system is affected varies wildly from one autistic person to another.

Nevertheless, professionals within pediatrics, child psychology, behavior analysis, and child development often look for early indicators of autism in order to initiate treatment as early as possible for the greatest benefit. However, some people do not believe in treatment for autism, either because they do not believe autism is a disorder or because they believe treatment can do more harm than good.

The majority of autistics have slightly enlarged brain size, compared to normal people. Neurology Today (Volume 2,8: August 2002) stated that "Although it is accepted that autistic individuals have, on average, an enlarged brain size, the nature of this abnormality remains unknown.". (See also the paper "Brain Volume in Autism" PDF link).

Social development

Typically, developing infants are social beings—early in life they do such things as gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to faces and seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many seem indifferent to other people because they avoid eye contact and do not interact with them as often as non-autistic children.

Autistic children often appear to prefer being alone to the company of others and may passively accept such things as hugs and cuddling without reciprocating, or resist attention altogether. Later, they seldom seek comfort from others or respond to parents' displays of anger or affection in a typical way. Research has suggested that although autistic children are attached to their parents, their expression of this attachment may be unusual and difficult to interpret. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of expected attachment behavior.

According to Simon Baron-Cohen, autistic children often also appear to lack a "theory of mind", the ability to see things from another person's perspective, a behavior cited as exclusive to human beings above the age of five and, possibly, other higher primates such as adult gorillas, chimpanzees and bonobos. Typical 5-year-olds can develop insights into other people's different knowledge, feelings, and intentions, interpretations based upon social cues (e.g., gestures, facial expressions). An autistic individual may lack these interpretation skills, an inability that leaves them unable to predict or understand other people's actions.

The social alienation of autistics and people with Asperger's can be so intense from childhood that many of them report having imaginary friends or inventing imaginary worlds or scenarios. Making friends in real life, and maintaining those friendships, can be difficult.

Although not universal, it is common for auistics to be unable to regulate their behavior. This can take the form of crying or verbal outbursts or self-injurious behaviours that may seem out of proportion to the situation. Autistic individuals generally prefer consistent routines and environments; they may react negatively to changes in them. It is not uncommon for these individuals to exhibit aggression, increased levels of self-stimulatory behavior, self-injury or extensive withdrawal in overwhelming situations.

Sensory system

It has been suggested that Autism and blindness be merged into this article or section. (Discuss)

A key indicator to clinicians making a proper assessment for autism would include looking for symptoms much like those found in sensory integration dysfunction. Children will exhibit problems coping with the normal sensory input. Indicators of this disorder include oversensitivity or underreactivity to touch, movement, sights, or sounds; physical clumsiness or carelessness; poor body awareness; a tendency to be easily distracted; impulsive physical or verbal behavior; an activity level that is unusually high or low; not unwinding or calming oneself; difficulty learning new movements; difficulty in making transitions from one situation to another; social and/or emotional problems; delays in speech, language or motor skills; specific learning difficulties/delays in academic achievement.

One common example is autistic hearing. An autistic person may have trouble hearing certain people while other people are louder than usual. Or the autistic may be unable to filter out sounds in certain situations, such as in a large crowd of people (see cocktail party effect). However, this is perhaps a part of autism that tends to vary widely from person to person, so these examples may not apply to every autistic person.

Communication difficulties

By age 3, typical children have passed predictable language learning milestones; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he or she hears his or her name, points when he or she wants a toy, and when offered something distasteful, makes it clear that the answer is "no." It should be noted, however, that late language development does occur in a minority of neurotypical children.

Speech development in people with autism takes different paths to the majority of neurotypical children. Some remain mute throughout their lives with varying degrees of literacy; communication in other ways—images, visual clues, sign language, and typing may be far more natural to them. Contrary to the prevailing traditional stereotype of mute people with Kanner-type autism, around one third of people diagnosed with this type of autism will develop what is often viewed as dysfunctional verbal language, relying on rote learned stored phrases, songs, jingles and advertisements. Those with the autism spectrum condition of Semantic Pragmatic Disorder fall into this group.

Those who do speak sometimes use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat a mimicked phrase over and over. Some repeat what they hear, a condition called echolalia. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many people with autism have a strong tonal sense, and can often understand at least some spoken language whilst others can understand language fluently.

Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. The "give and take" of non-autistic conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to converse with other autistics, they comfortably do so in "parallel monologue"—taking turns expressing views and information. Just as "neurotypicals" (people without autism) have trouble understanding autistic body languages, vocal tones, or phraseology, people with autism similarly have trouble with such things in people without autism. In particular, autistic language abilities tend to be highly literal; people without autism often inappropriately attribute hidden meaning to what people with autism say or expect the person with autism to sense such unstated meaning in their own words.

Some people with high functioning Autism can be extremely brilliant and have great vocabulary, but their social skills can be very low, even nonexistent at times. Some infants who later show signs of autism coo and babble during the first few months of life, but stop soon afterwards. Others may be delayed, developing language as late as the teenage years. Still, inability to speak does not mean that people with autism are unintelligent or unaware. Once given appropriate accommodations, some will happily converse for hours, and can often be found in online chat rooms, discussion boards or websites and even using communication devices at autism-community social events such as Autreat.

Sometimes, the body language of people with autism can be difficult for other people to understand. Facial expressions, movements, and gestures may be easily understood by some other people with autism, but do not match those used by other people. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the auditory system of a person without autism often cannot sense the fluctuations. What seems to non-autistic people like odd prosody ; things like a high-pitched, sing-song, or flat, robot-like voice may be common in autistic children and some will have combinations of these prosody issues. Some autistic children with relatively good language skills speak like little adults, rather than communicating at their current age level, which is one of the things that can lead to problems.

Since non-autistic people are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let other people know what they need. As anybody might do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for non-autistic people to learn to communicate with them, people with autism do whatever they can to get through to them. Communication difficulties may contribute to autistic people becoming socially anxious or depressed or prone to self-injurious behaviours. Recently, with the awareness that those with autism can have more than one condition a significant percentage of people with autism are being diagnosed with co-morbid mood, anxiety and compulsive disorders which may also contribute to behavioural and functioning challenges.

Repetitive behaviors

Although people with autism usually appear physically normal and have good muscle control, unusual repetitive motions, known as self-stimulation or "stimming," may set them apart. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or wiggling their toes, others suddenly freeze in position. As children, they might spend hours lining up their cars and trains in a certain way, not using them for the type of pretend play expected of a non-autistic child. If someone accidentally moves one of these toys, the child may be tremendously upset. Autistic children often need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, or going to school at a certain time and by the same route—can be extremely disturbing to them. Autistics sometimes have persistent, intense preoccupations. For example, the child might be obsessed with learning all about computers, movie schedules or lighthouses. Often they show great interest in different languages, numbers, symbols or science topics. Repetitive behaviors can also extend into the spoken word as well. Preseveration of a single word or phrase, even for a specific number of times can also become a part of the child's daily routine.

Effects in education

Children with autism are affected with these symptoms every day. These unusual characteristics set them apart from typical students. Because they have trouble understanding people’s thoughts and feelings, they have trouble understanding what their teacher may be telling them. They do not understand that facial expressions and vocal variations hold meanings and may misinterpret what emotion their instructor is displaying. This inability to fully decipher the world around them makes education stressful. Teachers need to be aware of a student's disorder so that they are able to help the student get the best out of the lessons being taught.

Some students learn better with visual aids as they are better able to understand material presented this way. Because of this, many teachers create “visual schedules” for their autistic students. This allows the student to know what is going on throughout the day, so they know what to prepare for and what activity they will be doing next. Some autistic children have trouble going from one activity to the next, so this visual schedule can help to reduce stress.

Research has shown that working in pairs may be beneficial to autistic children. Autistic students have problems in schools not only with language and communication, but with socialization as well. They feel self-conscious about themselves and many feel that they will always be outcasts. By allowing them to work with peers they can make friends, which in turn can help them cope with the problems that arise. By doing so they can become more integrated into the mainstream environment of the classroom.

A teacher's aide can also be useful to the student. The aide is able to give more elaborate directions that the teacher may not have time to explain to the autistic child. The aide can also facilitate the autistic child in such a way as to allow them to stay at a similar level to the rest of the class. This allows a partially one-on-one lesson structure so that the child is still able to stay in a normal classroom but be given the extra help that they need. Although, many students with one-on-one aide help learn to become dependent on this adult and have trouble being independent, which should be the goal.

There are many different techniques that teachers can use to assist their students. A teacher needs to become familiar with the child’s disorder to know what will work best with that particular child. Every child is going to be different and teachers have to be able to adjust with every one of them.

Students with Autism Spectrum Disorders sometimes have high levels of anxiety and stress, particularly in social environments like school. If a student exhibits aggressive or explosive behavior, it is important for educational teams to recognize the impact of stress and anxiety. Preparing students for new situations by writing Social Stories can lower anxiety. Teaching social and emotional concepts using systematic teaching approaches such as The Incredible 5-Point Scale or other Cognitive Behavioral strategies can increase a student's ability to control excessive behavioral reactions.

DSM definition

Autism is defined in section 299.00 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as:

  1. A total of six (or more) items from (1), (2) and (3), with at least two from (1), and one each from (2) and (3):
    1. qualitative impairment in social interaction, as manifested by at least two of the following:
      1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
      2. failure to develop peer relationships appropriate to developmental level
      3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
      4. lack of social or emotional reciprocity
    2. qualitative impairments in communication as manifested by at least one of the following:
      1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
      2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
      3. stereotyped and repetitive use of language or idiosyncratic language
      4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
    3. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
      1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
      2. apparently inflexible adherence to specific, nonfunctional routines or rituals
      3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
      4. persistent preoccupation with parts of objects
  2. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
    1. social interaction
    2. language as used in social communication
    3. symbolic or imaginative play.
  3. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

These are rules of thumb and may not necessarily apply to all diagnosed autistics.

Types of autism

Autism presents in a wide degree, from those who are nearly dysfunctional and apparently mentally handicapped to those whose symptoms are mild or remedied enough to appear unexceptional ("normal") to others. Although not used or accepted by professionals or within the literature, autistic individuals are often divided into those with an IQ<80 referred to as having "low-functioning autism" (LFA), while those with IQ>80 are referred to as having "high-functioning autism" (HFA). Low and high functioning are more generally applied to how well an individual can accomplish activities of daily living, rather than to IQ. The terms low and high functioning are controversial and not all autistics accept these labels.

This discrepancy can lead to confusion among service providers who equate IQ with functioning and may refuse to serve high-IQ autistic people who are severely compromised in their ability to perform daily living tasks, or may fail to recognize the intellectual potential of many autistic people who are considered LFA. For example, some professionals refuse to recognize autistics who can speak or write as being autistic at all, because they still think of autism as a communication disorder so severe that no speech or writing is possible.

As a consequence, many "high-functioning" autistic persons, and autistic people with a relatively high IQ, are underdiagnosed, thus making the claim that "autism implies retardation" self-fulfilling. The number of people diagnosed with LFA is not rising quite as sharply as HFA, indicating that at least part of the explanation for the apparent rise is probably better diagnostics. Many also think that ASD's are being over diagnosed, due to the spectrum quality of the impairments and the desire to obtain services through schools and therapies.

Asperger's and Kanner's syndrome

Main article: Asperger syndrome

In the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the most significant difference between Autistic Disorder (Kanner's) and Asperger's syndrome is that a diagnosis of the former includes the observation of "delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play" [5], while a diagnosis of Asperger's syndrome observes "no clinically significant delay" in these areas. [6]

Whilst the DSM-IV does not include level of intellectual functioning in the diagnosis, the fact that those with Asperger's syndrome tend to perform better than those with Kanner's autism has produced a popular conception that Asperger's syndrome is synonymous with "higher-functioning autism," or that it is a lesser disorder than autism. Similarly, there is a popular conception that autistic individuals with a high level of intellectual functioning in fact have Asperger's syndrome, or that both types are merely 'geeks' with a medical label attached. The popular depiction of autism in the media has been of relatively severe cases, for example, as seen in the films Rain Man (autistic adult) and Mercury Rising (autistic child), and in turn many relatives of those who have been diagnosed in the autistic spectrum choose to speak of their loved ones as having Asperger's syndrome rather than autism.

Autism as a spectrum disorder

For more details on this topic, see Autistic spectrum.

Another view of these disorders is that they are on a continuum known as autistic spectrum disorders. A related continuum, Sensory Integration Dysfunction, involves how well humans integrate the information we receive from our senses. Autism, Asperger's syndrome, and Sensory Integration Dysfunction are all closely related and overlap.

Some people believe that there might be two manifestations of classical autism, regressive autism and early infantile autism. Early infantile autism is present at birth while regressive autism begins before the age of 3 and often around 18 months. Although this causes some controversy over when the neurological differences involved in autism truly begin, some speculate that an environmental influence or toxin triggers the disorder. This triggering could occur during gestation due to a toxin that enters the mother's body and is transferred to the fetus. The triggering could also occur after birth during the crucial early nervous system development of the child.

Increase in diagnoses of autism

Further information: Frequency of autism and Autism (incidence).
The number of reported cases of autism increased dramatically over a decade. Statistics in graph from the \$National Center for Health Statistics\$.

There was a worldwide increase in reported cases of autism over the decade to 2006, which may echo the pattern following the description of schizophrenia in the twentieth century. There are several theories about the apparent sudden increase.

Epidemiologists argue that the rise in diagnoses in the United States is partly or entirely attributable to changes in diagnostic criteria, reclassifications, public awareness, and the incentive to receive federally mandated services. A widely cited study from the M.I.N.D. Institute in California ($17 October$ 2002), claimed that the increase in autism is real, even after those complicating factors are accounted for.

Other researchers remain unconvinced (see references below), including Dr. Chris Johnson, a professor of pediatrics at the University of Texas Health Sciences Center at San Antonio and co-chair of the American Academy of Pediatrics Autism Expert Panel, who says, "There is a chance we're seeing a true rise, but right now I don't think anybody can answer that question for sure." (Newsweek reference below).

The answer to this question has significant ramifications on the direction of research, since a real increase would focus more attention (and research funding) on the search for environmental factors, while the alternative would focus more attention to genetics. On the other hand, it is conceivable that certain environmental factors (such as chemicals, infections, medicines, vaccines, diet and societal changes) may have a particular impact on people with a specific genetic constitution.

One of the more popular theories is that there is a connection between "geekdom" and autism. This is hinted, for instance, by a Wired Magazine article in 2001 entitled "The Geek Syndrome", which is a point argued by many in the autism rights movement[7]. This article, many professionals assert, is just one example of the media's application of mental disease labels to what is actually variant normal behavior—they argue that shyness, lack of athletic ability or social skills, and intellectual interests, even when they seem unusual to others, are not in themselves signs of autism or Asperger's syndrome. Others assert that it is actually the medical profession which is applying mental disease labels to children who in the past would have simply been accepted as a little different or even labeled 'gifted'. See clinomorphism for further discussion of this issue.

Due to the recent publicity surrounding autism and autistic spectrum disorders, an increasing number of adults are choosing to seek diagnoses of high-functioning autism or Asperger's syndrome in light of symptoms they currently experience or experienced during childhood. Since the cause of autism is thought to be at least partly genetic, a proportion of these adults seek their own diagnosis specifically as follow-up to their children's diagnoses. Because autism falls into the pervasive developmental disorder category, strictly speaking, symptoms must have been present in a given patient before age seven in order to make a differential diagnosis.

Therapies

Main article: Autism therapies

Causes

Main article: Causes of autism

Sociology

Due to the complexity of autism, there are many facets of sociology that need to be considered when discussing it, such as the culture which has evolved from autistic persons connecting and communicating with one another. In addition, there are several subgroups forming within the autistic community, sometimes in strong opposition to one another.

Community and politics

Further information: Autistic community and Autism rights movement.

Curing autism is a very highly controversial and politicized issue. What some call the "autistic community" has splintered into several strands. Some seek a cure for autism - sometimes dubbed by pro-cure. Others do not desire a "cure", and as such resist it. They are sometimes dubbed anti-cure. Many more may have views between these two. Recently, with scientists learning more about autism and possibly coming closer to effective remedies, some members of the "anti-cure" movement sent a letter to the United Nations demanding to be treated as a minority group rather than a group with a mental disability or disease. Web sites such as autistics.org[8] present the view of the anti-cure group.

There are many resources available for autistic people. Because many autistics find it easier to communicate online than in person, a large number of these resources are online. In addition, successful autistic adults in a local community will sometimes help children with autism, using their own experience in developing coping stategies and/or interacting with society.

The year 2002 was declared Autism Awareness Year in the United Kingdom—this idea was initiated by Ivan and Charika Corea, parents of an autistic child, Charin. Autism Awareness Year was led by the British Institute of Brain Injured Children, Disabilities Trust, National Autistic Society, Autism London and 800 organizations in the United Kingdom. It had the personal backing of British Prime Minister Tony Blair and parliamentarians of all parties in the Palace of Westminster.

Culture

For more details on this topic, see Autistic culture.

With the recent increases in autism recognition and new approaches to educating and socializing autistics, an autistic culture has begun to develop. Similar to deaf culture, autistic culture is based in a belief that autism is a unique way of being and not a disorder to be cured. There are some commonalities which are specific to autism in general as a culture, not just "autistic culture".

It is a common misperception that autistic people do not marry; many do seek out close relationships and marry. Often, they marry another autistic, although this is not always the case. Autistic people are often attracted to other autistic people due to shared interests or obsessions, but more often than not the attraction is due to simple compatibility with personality types, the same as is true for non-autistics. Autistics who communicate have explained that companionship is as important to autistics as it is to anyone else. Multigenerational autistic families have also recently become a bit more noticeable.

It is also a common misperception that autistic people live away from other people, such as living in a rural area rather than an urban area; there are many autistics who happily live in a suburb or large city. However if an autistic lives in a metro area he/she might be more subjected to poverty and bullying. It is unknown why, but it has been proven that the more an autistic is closer to a metropolitan area the more likely he/she will have more difficulty .

The interests of autistic people and so-called "geeks" or "nerds" can often overlap as autistic people can sometimes become preoccupied with certain subjects, much like the variant normal behavior geeks experience. However, in practice many autistic people have difficulty with working in groups, which impairs them even in the most "technical" of situations. The connection of autism with so-called geek or nerd behavior has received attention in the popular press, but is still controversial within these groups.

Autistic adults

Communication and social problems often cause difficulties in many areas of the autistic's life. Far fewer adult autistics marry or have children than the general population. Even when they do marry it is more likely to end in divorce than the norm.[9]. Furthermore, far fewer autistic adults live in metropolitan areas than the general population, and even if they live near metro areas they are more likely going to experience bullying and poverty than the norm. Nevertheless, as more social groups form, progressively more diagnosed adults are forming relationships with others on the spectrum.

A small proportion of autistic adults, usually those with high-functioning autism or Asperger's syndrome, are able to work successfully in mainstream jobs, although frequently far below their actual level of skills and qualification. Some have managed self-employment; many of those are listed on self-employment sites such as Auties.org.

Others are employed in sheltered workshops under the supervision of managers trained in working with persons with disabilities. A nurturing environment at home, at school, and later in job training and at work, helps autistic people continue to learn and to develop throughout their lives.

It is often said that the Internet, since it is almost devoid of the non-verbal cues that autistics find so hard to interact with, has given some autistic individuals an environment in which they can, and do, communicate and form online communities. The internet has also provided the option of occupations such as, teleworking and independent consulting, which, in general, do not require much human interaction offline.

In the United States, the public schools' responsibility for providing services ends when the autistic person is in their 20s, depending on each state. The autistic person and their family are then faced with the challenge of finding living arrangements and employment to match their particular needs, as well as the programs and facilities that can provide support services to achieve these goals.

However autism can be a poverty trap for adult and young autistics,[10] many of whom are engaged in unskilled jobs for which they are overqualified, or on welfare benefits. Many parents of autistic children also face financial difficulties as they must often pay for essential support and therapeutic services. Plus, autistics who might qualify for financial assistance in one country are not eligible in another, since some nations do not recognize autism as a disability, making the link between poverty and autism more severe.[11][12].

Autistic savants

Main article: autistic savant

The autistic savant phenomenon is sometimes seen in autistic people. Estimates of the prevalence of this phenomenon range between 1% and 10% [13]. The term is used to describe a person who is autistic and has extreme talent in a certain area of study. Although there is a common association between savants and autism (an association created by the 1988 film Rain Man), most autistic people are not savants, and savantism is not unique to autistic people (though there does seem to be some relation [14]). Mental calculators and fast computer programming skills are the most common form. A well known example is Daniel Tammet, the subject of the documentary film The Brain Man [15] (Kim Peek, one of the inspirations for Dustin Hoffman's character in the film Rain Man, is not autistic). "Bright Splinters of the Mind" is a book that explores this issue further.

Other pervasive developmental disorders

Autism and Asperger's syndrome are just two of the five pervasive developmental disorders (PDDs). The three other pervasive developmental disorders are Rett syndrome, Childhood disintegrative disorder, and Pervasive developmental disorder not otherwise specified. Some of these are related to autism, while some of them are entirely separate conditions.

Rett syndrome

Rett syndrome is relatively rare, affecting almost exclusively females, one out of 10,000 to 15,000. After a period of normal development, sometime between 6 and 18 months, autism-like symptoms begin to appear. The little girl's mental and social development regresses; she no longer responds to her parents and pulls away from any social contact. If she has been talking, she stops; she cannot control her feet; she wrings her hands. Some of these early symptoms may be confused with autism. Some of the problems associated with Rett syndrome can be treated. Physical, occupational, and speech therapy can help with problems of coordination, movement, and speech.

Scientists sponsored by the National Institute of Child Health and Human Development have discovered that a mutation in the sequence of a single gene causes Rett syndrome, and can physically test for it with an 80% accuracy rate [16]. Rett syndrome in the past was sometimes classified as an autistic spectrum disorder, however most scientists agree that Rett syndrome is a separate developmental disorder and not part of the autistic spectrum [17].

Childhood disintegrative disorder

Childhood disintegrative disorder (CDD, and sometimes abbreviated as CHDD also) is a very rare condition appearing in 3 or 4 year old children who have developed normally until age 2. Over several months, the child will deteriorate in intellectual, social, and language functioning from previously normal behaviour. This long period of normal development before regression helps differentiate CDD from Rett syndrome (and in fact it must be differentiated from autism in testing). The cause for CDD is unknown (thus it may be a spectrum disorder) but current evidence suggests it has something to do with the central nervous system [18] [19].

Pervasive developmental disorder not otherwise specified

Pervasive developmental disorder not otherwise specified, or PDD-NOS, is referred to as a subthreshold condition because it is a classification which is given to someone who suffers from impairments in social interaction, communication, and/or stereotyped behaviour but does not meet the criteria for one of the other four pervasive developmental disorders. Unlike the other four pervasive developmental disorders, PDD-NOS has no specific guidelines for diagnosis, so the person may have a lot of characteristics of an autistic person, or few to none at all. Note that pervasive developmental disorder is not a diagnosis, just a term to refer to the five mentioned conditions, while PDD-NOS is an official diagnosis [20].

See also

  • General
  • Groups
  • Aspies For Freedom
  • National Alliance for Autism Research
  • Cure Autism Now
  • Athletes Against Autism
  • Controversy
  • Controversies about functioning labels in the autism spectrum
  • Controversies in autism
  • Ethical challenges to autism treatment
  • Lists
  • List of autism-related topics
  • List of fictional characters on the autistic spectrum
  • List of autistic people

References

Footnotes

  1. ^ NIH Autism Overview 2005. Retrieved on February 5, 2006.
  2. ^ Reichenberg, Abraham, et al. (September 2006). "Advancing Paternal Age and Autism" (PDF). Archives of General Psychiatry 63 (9): 1026-1032.
  3. ^ Penn Researchers Find Link Between Autism and Abnormal Blood-Vessel Function and Oxidative Stress. Retrieved on August 15, 2006.
  4. ^ The Diary, July-August 2005, publication of the Autism Society of Washington, accessed 24 August 2006
  5. ^ BehaveNet autism description. Retrieved on July 30, 2005.
  6. ^ BehaveNet aspergers description. Retrieved on July 30, 2005.
  7. ^ Silberman, Steve, "The Geek Syndrome", Wired, December 2001.
  8. ^ autistics.org: The REAL Voice of Autism (See above). Retrieved on December 11, 2005.
  9. ^ Asperger syndrome and adults, Dr Isabelle Henault. Retrieved on June 12, 2006.
  10. ^ https://www.parl.gc.ca/39/1/parlbus/chambus/house/debates/008_2006-04-24/han008_1310-E.htm
  11. ^ https://www.daylon.com/autism/
  12. ^ https://www.nas.org.uk/content/1/c4/28/61/ignored.pdf
  13. ^ Savant prevalence. Retrieved on June 23, 2006.
  14. ^ Heaton, P. & Wallace, G.L. (2004). Annotation: The savant syndrome. Journal of Child Psychology and Psychiatry, 45(5), 899-911.
  15. ^ Guardian "Brain Man" article. Retrieved on July 30, 2005.
  16. ^ NIH Rett description. Retrieved on July 30, 2005.
  17. ^ Bright Tots Rett description. Retrieved on July 30, 2005.
  18. ^ Yale CDD description. Retrieved on July 30, 2005.
  19. ^ NIH CDD description. Retrieved on July 30, 2005.
  20. ^ PDD-NOS at Yale. Retrieved on August 22, 2005.

Internal links

  • Bruno Bettelheim
  • Simon Baron-Cohen
  • Wrong Planet Autism Community
  • EQ SQ Theory
 

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