Autism

Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. According to the Centers for Disease Control, autism affects an estimated 1 in 36 children in the United States today.

What are some symptoms of autism that parents and caregivers can look for?

Children diagnosed with autism tend to process and respond to information in the environment in unique ways. In some cases, parents are frightened because they exhibit aggressive and/or self-injurious behaviors which are difficult to manage.

• Insistence on sameness in routines (O)
• Difficulty in expressing needs verbally, using gestures or pointing instead of words (C)
• Repeating words or phrases in place of normal, responsive language (C)
• Laughing (and/or crying) for no apparent reason; showing distress for reasons not apparent to others (S)
• Prefers to be alone; aloof manner evident to strangers and family members (S)
• Tantrums and low frustration tolerance (S)
• Difficulty in initiating social contact with others (S)
• Uncomfortable with physical contact even when given with affection such as a hug (S)
• Little or no eye contact even when spoken to directly (S)
• Unresponsive to normal teaching methods (S)
• Plays with toys as objects (example bangs a toy car as a block rather than as a moving vehicle) (S)
• Focus on spinning objects such as a fan or the propeller of a toy helicopter (O)
• Obsessive attachment to particular objects (O)
• Apparent over-sensitivity or under-sensitivity to pain (S)
• No real fears of danger despite obvious risks of harm. (S)
• Noticeable physical over-activity or extreme under-activity (S)
• Impaired fine motor and gross motor skills (S)
• Non-responsive to verbal instructions; often appears as if child is deaf although hearing tests in normal range (C)

Legend: Communication (C), Obsessive-Compulsive Behavior (O), Social (S)

What is the difference between autism and Asperger’s disorder?

Unlike children with autism, individuals with Asperger’s disorder do not present with delays in language acquisition or with marked unusual behaviors and environmental responsiveness during the first years of life. Consequently, parents often have no concerns about their child’s early development. A child with Asperger’s may be diagnosed later than 3 years old because they are achieving their developmental milestones at a normal rate and are only referred for evaluation because parents observe that they are behaving differently from same aged peers. They may appear socially awkward, lack awareness of conventional social rules, or show limited empathy to others. Social interaction is affected because of diminished eye contact, disengagement in conversations, and inability to pick up social cues or understand the meaning of gestures

Speech patterns may be unusual and lack inflection or may be formal, but excessively loud or high pitched. Children with Asperger’s may not understand the subtleties of language, such as irony and humor. Frequently, they may not recognize the give-and-take nature of a conversation, and this translates into difficulty initiating and/or maintaining conversations. Their communication is sometimes described as “one way” so they appear to be “talking at” others instead of to them.

For example, a child diagnosed with Asperger’s disorder had social problems due to his restricted and circumscribed interests. In his conversations with peers, he delivered monologues on his favorite subject of planets in a slow methodical way. He was so involved in talking about the planets that he did not notice the frustration of his peers. Attempts to interject comments to initiate conversation were missed and the child continued to “lecture”. Consequently, the other children eventually walked away feeling unfulfilled by the lack of connection and bored by the persistence of the same topic.

Another distinction between Asperger’s syndrome and autism concerns cognitive ability. While some individuals with autism experience intellectual disability, by definition a person with Asperger’s cannot possess a “clinically significant” cognitive delay, and most possess average intelligence. The outcome in Asperger’s disorder generally appears to be better than that for autism, although this may, in part, relate to better cognitive and/or verbal abilities.

Are there treatments available for autism?

There are no specific treatments to “cure” autism. Each child with an autism spectrum disorder has a unique constellation of developmental delays, speech deficits, social and cognitive impairments. Therefore, comprehensive treatment plans need to be developed to target each child’s unique profile of strengths and functional impairments.

Are there medication treatments for autism?

There are no medication treatments that treat the core symptoms of autism. However, often children with autism exhibit disturbing repetitive, stereotypical, or self-injurious behaviors that can be distressing to both the child and the parent. In cases when a child may be hitting himself repetitively, has mood instability or is aggressive to other children or family members, medication intervention may be warranted. The FDA has approved use of the medication risperidone to target aberrant behaviors of autism such as severe mood instability and aggression. There are other medications that are currently being studied to help reduce problem behaviors in autism but there are no other FDA approved treatments. Pharmacological interventions may increase the ability of persons with ASD to profit from educational and other interventions, and to remain in less restrictive environments through the management of severe and challenging accompanying behaviors. Frequent targets for medication include features such as aggression, self-injurious behavior, hyperactivity, inattention, anxiety, compulsive-like behaviors, other repetitive or stereotypic behaviors, and sleep disturbances. Sometimes SSRIs are used to address symptoms of mood or anxiety in children and adolescents with autism.

Why do children with autism have difficulty learning in a regular classroom setting?

There are many reasons that a child diagnosed with autism spectrum disorders is not able to learn in a regular classroom setting. These include but are not limited to the following reasons:

• coexisting learning disabilities.
• coexisting intellectual disability.
• speech and communication delays.
• aggression to self or others.
• affective Instability.
• require individual supervision to participate in the classroom.
• social reciprocity problems.

Therefore, special efforts need to be made by parents and caregivers to explore options so that the child’s abilities are maximized. Availability of resources differs by community, so it is important to contact a child and adolescent psychiatrist or pediatrician to discuss the options available in your community.