Autism has its origins in the first weeks or months of life. It is characterized by marked problems in social interaction (autism), as well as by delayed and deviant communication development (speech is absent in about 50 percent of cases) and various other behaviors which are usually subsumed in the term 'insistence on sameness.' Such behaviors include stereotyped motor behaviors (hand flapping, body rocking), insistence on sameness and resistance to change. Both categorical and dimensional approaches to diagnosis have been used, as for instance in the DSM-IV Worldwide Field Trial. Many individuals with autism exhibit mental retardation on the basis of their full-scale (or averaged) IQ score; however, unlike most people with primary mental retardation, those with autism often have marked scatter in their development, so that some aspects of the IQ, particularly nonverbal skills, may be within the normal range. Autism is sometimes observed along with other medical and psychiatric conditions such as Fragile X syndrome.
Most parents of autistic children suspect that something is wrong by the time the child is 18 months old and seek help by the time the child is 2. Children with autism typically have difficulties in verbal and nonverbal communication, social interactions, and pretend play. In some, aggression -- toward others or self -- may be present.
Some children with autism appear normal before age 1 or 2 and then suddenly "regress" and lose language or social skills they had previously gained. This is called the regressive type of autism.
People with autism may perform repeated body movements, show unusual attachments to objects or have unusual distress when routines are changed. Individuals may also experience sensitivities in the senses of sight, hearing, touch, smell, or taste. Such children, for example, will refuse to wear "itchy" clothes and become unduly distressed if forced because of the sensitivity of their skin. Some combination of the following areas may be affected in varying degrees.
Communication:
Is unable to start or sustain a social conversation
Develops language slowly or not at all
Repeats words or memorized passages, like commercials
Doesn't refer to self correctly (for example, says "you want water" when the child means "I want water")
Uses nonsense rhyming
Communicates with gestures instead of words
Social interaction:
Shows a lack of empathy
Does not make friends
Is withdrawn
Prefers to spend time alone, rather than with others
May not respond to eye contact or smiles
May actually avoid eye contact
May treat others as if they are objects
Does not play interactive games
Response to sensory information:
Has heightened or low senses of sight, hearing, touch, smell, or taste
Seems to have a heightened or low response to pain
May withdraw from physical contact because it is overstimulating or overwhelming
Does not startle at loud noises
May find normal noises painful and hold hands over ears
Rubs surfaces, mouths or licks objects
Play:
Shows little pretend or imaginative play
Doesn't imitate the actions of others
Prefers solitary or ritualistic play
Behaviors:
Has a short attention span
Uses repetitive body movements
Shows a strong need for sameness
"Acts up" with intense tantrums
Has very narrow interests
Demonstrates perseveration (gets stuck on a single topic or task)
Shows aggression to others or self
Is overactive or very passive
All children should have routine developmental exams by their pediatrician. Further testing may be needed if there is concern on the part of the clinician or the parents. This is particularly true whenever a child fails to meet any of the following language milestones:
Babbling by 12 months
Gesturing (pointing, waving bye-bye) by 12 months
Single words by 16 months
Two-word spontaneous phrases by 24 months (
Loss of any language or social skills at any age.
These children might receive a hearing evaluation, a blood lead test, and a screening test for autism (such as the Checklist for Autism in Toddlers (CHAT) or the Autism Screening Questionnaire).
A health care provider experienced in the diagnosis and treatment of autism is usually necessary for the actual diagnosis. Because there is no biological test for autism, the diagnosis will often be based on very specific criteria laid out in a book called the Diagnostic and Statistical Manual IV.
The other pervasive developmental disorders include:
Asperger syndrome (like autism, but with normal language development)
Rett syndrome (very different from autism, and only occurs in females)
Childhood disintegrative disorder (rare condition where a child acquires skills, then loses them by age 10)
Pervasive developmental disorder - not otherwise specified (PDD-NOS), also called atypical autism.
An evaluation of autism will often include a complete physical and neurologic examination. It may also include a specific diagnostic screening tool, such as:
Autism Diagnostic Interview - Revised (ADI-R)
Autism Diagnostic Observation Schedule (ADOS)
Childhood Autism rating Scale (CARS)
Gilliam Autism Rating Scale
Pervasive Developmental Disorders Screening Test-Stage 3
Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.
Autism encompasses a broad spectrum of symptoms. Therefore, a single, brief evaluation cannot predict a child's true abilities. Ideally, a team of different specialists will evaluate the child. They might evaluate speech, language, communication, thinking abilities, motor skills, success at school, and other factors.
Sometimes people are reluctant to have a child diagnosed because of concerns about labeling the child. However, failure to make a diagnosis can lead to failure to get the treatment and services the child needs.
Treatment
An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. Most programs will build on the interests of the child in a highly structured schedule of constructive activities. Visual aids are often helpful.
Treatment is most successful when geared toward the child's particular needs. An experienced specialist or team should design the individualized program. A variety of effective therapies are available, including applied behavior analysis (ABA), speech-language therapy, medications, occupational therapy, and physical therapy. Sensory integration and vision therapy are also common, but there is little research supporting their effectiveness. The best treatment plan may use a combination of techniques.
This program is for younger children with an autism spectrum disorder. It highly effective in many cases. ABA uses a one-on-one teaching approach that relies on reinforced practice of various skills. The goal is to get the child close to typical developmental functioning.
ABA programs are usually conducted within a child’s home, under the supervision of a behavioral psychologist. Unfortunately, these programs can be very expensive and have not been widely adopted by school systems. Parents often must seek funding and staffing from other sources, which can be hard to find in many communities.
Autism remains a challenging condition for individuals and their families, but the outlook today is much better than it was a generation ago. At that time, most people with autism were placed in institutions. Today, with appropriate therapy, many of the symptoms of autism can be improved, though most people will have some symptoms throughout their lives. Most people with autism are able to live with their families or in the community.
The outlook depends on the severity of the autism and the level of therapy the individual receives
2006-10-24 20:45:15
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answer #2
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answered by purple 6
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