What is Autism?

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Autism occurs in approximately 5 out of every 10,000 births, with males 4 times as likely to have the disorder, although when females are afflicted, they usually experience a more severe form. The symptoms of autism may manifest in early infancy, with the infant shying away from the parent’s touch, not responding to a parent who returns after an absence, and inappropriate gaze behavior. The child may fail to meet early language and other developmental milestones. This is the time when most parents begin to become aware that there is something “different”. There is often up to a 3-year delay between the report of symptoms to physicians and diagnosis of autism, which is usually made at around age five. The age of the child makes a marked difference in the perceived severity of the disorder.

It should be noted that when evaluating the behavior of an Autistic person, their age must be kept in mind. It tends to be worse from ages 2 through 5, and then improve from 6 through 10 years of age. It often worsens again in adolescents and young adults, then finally calming back down as they grow older.

The majority of those with autism, as they get older, take on the negative symptoms of schizophrenia, such as withdrawal, flattened affect, and poverty of thought.

In regards to social aspects, it is suggested that the child with autism will present with self-absorption, and rather than forming attachments to persons, may form an obsessive attachment to an inanimate object. Additionally, even the highest functioning autistic persons have difficulty making and maintaining friendships, showing empathy, and understanding what is expected in social situations . When in a room with other people, the person with autism will, instead of engaging in social contact, involve themselves in solitary activities, generally with an inanimate object. When they are forced into a group, they have difficulty making eye contact with others, or directly communicating with others. This carries over into their play. The play of the autistic child tends to be solitary. They do not wish to engage with others in play, their play is less mature, less creative, and they use fewer toys than non-handicapped children. Additionally, when they do play with toys, their play is much more likely to be inappropriate, either aggressive or self-stimulatory. They are also unable to stop their play at the request of others.

Autistic children focus strongly on their task at hand. To attempt to change their focus of play, for instance, before they are ready to, can create an emotional crisis. These same crises can occur with nearly any change, from something as simple as adding new furniture to the house to changing their daily routine. On the other hand, they are highly distractible, and have difficulty paying attention for periods of time. Both the crisis and distractibility have a wide variety of behavioral effects. Behaviorally, children with autism may display self-injurious behavior, non-compliance, and aggression, over- and under- reaction to stimuli and self-stimulation (often in the form of repetitive movements). They may engage in activities ranging from hand-flapping to repetitive sounds to complex repetitive body maneuvers to biting, hitting or scratching themselves. Much of this may be attributed to their lack of ability to communicate their needs and desires, as well as attempts at relieving possible sensory issues.

When looking at verbal skills, it should be noted that fully one-half of autistic children are nonverbal. Other’s speech may simply consist of echolalia. Age 5 is generally considered the milestone for the development of usable speech in autistic children. When speech is present, turn taking seems to be a foreign concept, and speech patterns and intonations are odd . This speech deficit is beyond what would be expected from their cognitive level.

Cognitively, the majority of persons, about 75%, with autism fall into the category of Mental Retardation. There are additionally about 10% of those persons with autism that fall into the category known as Savant . These persons have a single ability that is extraordinary, such as mathematical calculations or musical ability or artistic ability. The common perception of a Savant is Dustin Hoffman’s apt portrayal in the movie Rainman. However, It has been questioned if this number of persons represented as mentally retarded is abnormally high, due to interfering effects of the other symptoms of autism on the testing process. Testing may also be impaired by other medical or comorbid psychiatric disorders.

Autism Presents comorbidly with a number of other psychiatric disorders, further compounding diagnosis, such as tourettes syndrome, obsessive-compulsive disorder, and bipolar disorder. There is the following Information regarding a review of literature of comorbidity of specific symptoms in persons with autism: 64% had poor attention or concentration; 36% to 48% were hyperactive; 43% to 88% showed morbid or unusual preoccupation; 37% exhibited obsessive phenomena; 16% to 6% showed compulsions or rituals; 50% to 89% demonstrated stereotyped utterances; 68% to 74% exhibited stereotyped mannerisms; 17% to 74% had anxiety or fears; 9% to 44% showed depressive mood, irritability agitation and inappropriate affect; 11% had sleep problems; 24% to 43% had a history of self-injury; and 8% presented with tics.

The following are medical conditions that can lead to autism: Tuberous sclerosis, chromosomal abnormalities including fragile X, cerebral palsy, congenital rubella, sensory impairments, and Downs syndrome. Additionally, approximately 25% of those with autism also have Epilepsy. It is more common in the more severely impaired sensorily, with blindness and deafness being found at a higher rate in the autistic population and the possibility of hypo- and hyper-sensitivities to sight, hearing, touch, smell and taste.

Unless a person has a very clear picture of autism, there is controversy regarding the diagnosis at the less severe stages. The boundaries of autism as diagnosis are so vague that its presence may be a matter of degree. Many children (and adults) have the symptoms of only milder forms, some of which may be accommodated by the APAs diagnosis of pervasive developmental disorder not otherwise specified. In some cases, mild autism may be difficult to distinguish from personality disorders such as schizoid or obsessional personality or even from certain kinds of personal eccentricity and social awkwardness.

There are a wide range of treatment approaches, from medication to various types of therapy, to vitamin supplementation, each with its own supporters. No one type will work for every person.

Derek Wood is a Nationally Board Certified Psychiatric/Mental Health Nurse, and holds a Master's degree in Psychology. His experience in the online arena of mental health can be traced back to 1997, when he was a host for Online Psych on AOL. He joined Get Mental Help, Inc. as Clinical Content Director for Mental Health Matters. Derek, with his wife Lisa, developed the original version of psychTracker (then called A Mood Journal), after his diagnosis with Schizo-Affective Bipolar, when they could not find a system available that was robust enough to help him effectively manage his symptoms and accurately interpret his charting. Derek has worked in the field of mental health since 2001, as a Unit Manager of an adult long-term treatment facility, a charge nurse in an adolescent short-term inpatient facility and long-term residential facility, and as a School Psychologist. He has also written several articles which are being used as CEU for nurses and educators.

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