What is autism?
Autism is a complex developmental disorder with a wide spectrum that occurs in the first three years of life. Often, however, it is not diagnosed until much later, on average at 5 1/2 years of age. Autism has an impact on the brain in terms of social and communicative skills.
Signs of autism
According to the ICD-10 classification system (International Classification of Diseases, WHO, 1992), signs of the autistic spectrum include mild to severe impairments in social interactions and in verbal and non-verbal communication, but also perceptual disorders, as well as restricted and repetitive behavioral patterns.
- Changed sensory perception
- Development of rituals and stereotypes
- Disruption of all communication
- Disruption in social behavior and understanding
- Disruption in play skills and directed attention
The manifestations of the autistic spectrum vary widely. Some individuals experience autistic symptoms as less limiting and others as more limiting, which in turn may result in a higher need for support.
The diagnosis of autism has been around since …
In 1943, autism was first recognized by Dr. Leo Kanner of John Hopkins Hospital. At the same time, the German scientist Dr. Hans Asperger has described a milder form of the autistic state, now known as asperger syndrome. The diagnosis of “autistic spectrum” includes:
- Symptoms of the autistic spectrum range from very mild to very severe
- Infantile autism, asperger syndrome
- Rett Syndrome
- PDD NOS (pervasive developmental disorder, without further specification)
In the recent diagnostic there is a summary term: autism spectrum disorder (ASD) which includes all former diagnoses of autism
How many autistic people are there?
Every autistic person is different and so is the appearance of “their” autism. An ever-increasing percentage of the population is affected (1 in 59, according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network, Surveillance Summaries / April 27, 2018 / 67(6); 1–23).
The exact number of children with autism is unknown. A report from the U.S. Centers for Disease Control and Prevention indicates that autism and related disabilities are more common than previously suspected. It is unclear whether this is due to an increasing rate of autism or an increased ability to diagnose autism.
Autism is difficult to diagnose
Unlike other limitations and conditions, the symptoms of autism are usually not apparent at birth. The autistic signs usually become apparent in the first three years of life. There is currently no blood or DNA test to diagnose autism.
Autism is a series of symptoms. After these, the doctor usually don’t look until certain developmental delays and limitations cannot be explained in any other way.
Symptoms of autism
Children with autism usually have difficulties in verbal and non-verbal communication, social interaction and imaginary play. Some also show aggression towards other people or themselves.
Individuals with autism can display repetitive body movements, unusual preferences to items and conspicuous difficulty changing routines. Some individuals with autism are sensitive in the sensory perception (vision, hearing, touch/feeling, smell and taste). For example, some children refuse to wear “scratchy” clothes and become very stressed when forced to do so, as their skin is so sensitive.
Some combinations of the following characteristics can occur in different proportions in people with autism.
- Fails to point to draw others’ attention to objects (around 14 months of age)
- Does not direct gaze to things others are looking at
- Is unable to initiate or sustain a conversation
- Slow or no language development
- Repeats words or memorized phrases, for example, from advertisements or movies
- Does not talk about self in the first person (for example, says “You want water” when it means “I want water”)
- Uses rhymes that are incomprehensible to others or out of context
- Communicates with gestures instead of verbal language.
Reaction to sensory information
- Has an increased or low perception in sight, hearing, touching, feeling, smell or taste
- Seems to have increased or low pain sensation
- May withdraw physical contact because it is perceived as over-stimulating or overwhelming
- Doesn’t wince to loud noises
- Could find everyday sounds painful and cover own ears with their hands
- Rubs surfaces, takes objects in their mouth or licks them
- Shows little or no imaginary play
- Does not imitate the activities and movements of other people
Prefers to play alone or ritualized
- There seems to be a lack of empathy
- Making friends is absent or seems to be more difficult
- Seems withdrawn
- Withdraws and seems to prefer being alone
- May not respond to eye contact or smiles
- Avoids eye contact
- Treats others as if they were objects
- Does not play interactive games
- Has very strong emotional reactions and states
Signs and tests
All children should have a pediatric consultation for routine developmental evaluations. Further investigation may be necessary if there are concerns on the part of the parents or the doctor. This is especially important if the child has not reached any of the following milestones in language development:
Making sounds at 12 months
Gestures (pointing, waving) at 12 months
Single words at 16 months
Spontaneous two-word sentences at 24 months (not just repeating)
Loss of language or social ability at any age level
Children may then be given a hearing test, blood test (lead poisoning), and a test to rule out autism.
The actual diagnosis should be made by a doctor who has experience in diagnosing and treating autism. Because there is no biological test for autism, the diagnosis is often based on very specific criteria (set out in ICD 10).
Autism involves a wide range of symptoms. Therefore, a single, short assessment cannot foresee the true abilities of the child. ideally, a team of different specialists should evaluate the child. Language, communication, thinking ability, motor skills, success in school or preschool and other factors should be looked at.
Some are reluctant to diagnose a child with autism because of concerns about labeling the child. However, failure to diagnose means that, unfortunately, the child does not receive the necessary instruction and support.
Questions to clarify whether diagnostic clarification might be useful.
There are 5 domains of early childhood behaviors in which deviations from the development of non-autistic children are noted in children with autism.
Behaviors are listed in each of the 5 areas. If these behaviors are not observed in your child, or are only observed in very small ways, this is a reason to seek diagnostic clarification. Then consider clarification with physicians and child and youth psychiatrist.
1. Does the child respond to own name when called by his caregiver(s)?
By contrast, toddlers who are later diagnosed with autism mostly don’t respond to their name. They also often react only to a limited extent. It also happens that they completely ignore some sounds, but react to others very directly. For example, they may not show a reaction when they are called by their name by their parents. But they hear immediately, when the TV is turned on. It is not uncommon for parents to suspect that their child is hard of hearing or deaf.
2. Does the toddler have joint attention?
This behavior has a certain quality of communicating. For example, the toddler might point to a plane flying over his head, looking at his mother or father as if to say, “Look there!”
In contrast, toddlers with autism have great difficulty sharing attention with others. They rarely turn their gaze to showing others. They don’t often switch their gaze from items to people. And they don’t really seem to be present when the caregiver watches things, people or activities and talks about them. They rarely turn their gaze to show something to others.
3. Does the child imitate others?
Typically developing toddlers are imitators. Even babies can mimic facial movements (for example sticking out tongue or opening their mouths). Already at the age of 8 to 10 months, the mother and toddler mimic each other’s sounds and movements. Imitation also plays a very big role in well-known finger games, such as “pat-a-cake” or “how big?” (“how big is …? This big!” while the child stretches her arms up).
Toddlers with autism mimic other people less often. They demonstrate fewer imitations with the body or face (waving, making faces, playing toddler games) and also mimic less with objects.
4. Does the child respond emotionally to others?
Typically developing children react socially to others. They smile when they are smiled, they also initiate smiles and laugh when playing with toys or others. When typically developing children watch other children cry, they may start to cry themselves or look distressed. Slightly older toddlers then perhaps crawl close to the crying person, caressing or trying to offer comfort in other ways. These somewhat later behaviors indicate compassion and can be observed especially in children in the second year of life.
In contrast, children with autism seem not to perceive the feelings of others. They don’t notice the smiles of others and therefore they don’t look. They might not smile back in response to each other’s smiles, either. They may ignore the sadness of other people.
Several scientists have shown that children with autism are more likely to be distressed than compassionate when another injures themselves. For example, if an adult pretends to get their knee injured, young children with autism look less at the adult or show concern in the facial expression.
5. Does the child play imaginary games?
Someone once said, “playing is the child’s work.” Toddlers love role play in which they pretend to be a mother, a father, a baby, a firefighter or a horse. Although the children play with toys at about 6 months old, it does not come to the pretend play until the end of the first year of life. This way of playing, for example, could start by feeding the mother or a doll. Or the child combs the doll or puts the bear to bed. Around the second birthday, children play imaginary games. Dolls then take on human qualities such as speaking or household routines are re-enacted. The children may then imagine that a sponge is something to eat, a building block a hat or a plastic bowl a swimming pool with water.
In contrast, the play of children with autism highlights many deficits. The toddler may not be interested in objects at all, or the interest is more focused on the movement of her own hand or on a piece of string. If they are interested in toys, it is often only very specific toys that elicit interest. These are used in a repetitive way, which doesn’t align with the way most other kids would play with the toy. One may be more interested in flipping a toy car and spinning the wheels instead of pushing the car back and forth. Summing up, the qualities of pretend play are completely absent from children with autism under the age of two.
Avoiding eye-contact Is often referred to as a characteristic for children with autism. Here, however, it is above all the quality of the eye-contact that matters. Many children don’t seem to see people at all and therefore don’t look them in the eye. In an infant with autism, the viewing takes place briefly and out of the corner of the eye.
Specifics of hearing are of great importance, but difficult to classify. Many children with autism are initially presumed to be deaf. Only a few have deafness. But they do not respond to their name and seem unaffected by noisy changes in the environment. Children with autism even seem to ignore very loud noises that would make most other children flinch. The reception and processing of auditory stimuli may be different in autistic individuals. These differences can cause them to appear deaf or even disinterested to others. This need not be the case, however, and the reason for lack of response should rather be seen in perceptual and processing differences.
Social development and play
In infants, play and social interaction are so directly linked that it is precisely at this stage of development that the behavior of the child is conspicuous. Infants with autism often show no interest in the games that require social interaction with parents.
The absence of this joint activity seems to be very significant. The study by Frith and Soares shows that statements by parents with children with autism show an absence of common interests and activities within the first year of life. The children do not point to things that interest them, do not take an active part of finger games and do not want to carry out activities together.
Transfer (referral) to specialist:
Early concerns of parents about progress in the infant’s development should be taken into account. When a mother expresses fears about the social and emotional responses, as well as the skills in perception, professionals should be on alert regarding autism.
Adequate referrals to specialists for children with and without developmental disabilities could mean that the diagnosis can be made faster than in the past. While infants can show autistic traits, only a comprehensive diagnostic approach can reveal whether they have autism or have behavioral characteristics of other difficulties.
A professional assessment is necessary
This is best clarified in a child development unit. Several experts are needed for this, because good team collaboration yields better results for an accurate diagnosis. The assessment includes an overview of family history, pregnancy, child behavior and progress in development. A physical examination is necessary to detect hidden medical conditions that contribute to deviations or delays in expected development.
The development investigation includes:
- Fine and gross motor skills
- Language (language comprehension, expressive language and sound production)
- Sensory perception
- Social and emotional development
The quality of development is an important factor in the assessment. It’s a big difference, for example, whether skills are only present, or whether they are also used for social behavior. A child with autism may have the ability to repeat words, but not yet an understanding of their meaning. Or a toddler with autism can point to things, but doesn’t use that ability to draw another person’s attention to it.
Ideally, children should be observed in their everyday environment, for example at home or in daycare.
Diagnosis of autism is unlikely to occur within just one examination date, especially if the child is still very small.
Close monitoring of development and regular assessments are necessary to get a full overview. But regardless of a definitive diagnosis of autism or autistic spectrum, help can be offered to the children and their parents. Infants suspected of a developmental disorder (autism autistic spectrum) may receive services tailored to each needs. Parents can be instructed on how to support their child in the respective stages of development.
A child is diagnosed with autism when he or she exhibits various behaviors in three areas of deficit. These three areas are:
- Social interaction
Autism spectrum deficits include the following:
- lack of eye contact
- lack of relationship building with peers
- difficulty putting oneself in the shoes of others
- lack of imaginative play
Autistic Spectrum can usually be reliably diagnosed by age 3. Meanwhile, recent research supports the diagnosis of autism as early as 6 months of age.
Parents are the first to notice their child’s extraordinary behavior and, compared to other children, see that their child is not reaching the usual stages of development. Some parents describe that their child’s behavior seemed different from birth. While other parents describe their child developing age appropriately but then losing skills.
Pediatricians often overlook the first signs of autism and advise parents to wait and see, with the explanation that the child is a late bloomer. New research shows that parents’ first assumptions that something is discernible with the child’s behavior are often confirmed. If you have concerns about the development of your child (or a child you work with), don’t hesitate. Talk to a doctor (or parents) to clarify autism. That’s the best thing you can do for the child.
The earlier support begins, the better.…
Diagnosis (early) can help provide an explanation for developmental differences, an understanding of the resulting needs, and a claim for appropriate support.
Studies suggest that early ABA/VB (applied behavior analysis and verbal behavior) support for at least 2 years in kindergarten age, can bring outstanding improvements in a wide range of skills for many children on the autistic spectrum.
After the diagnosis is completed, appropriate support can be started. ABA/VB programs can have a variety of objectives. Common areas of support include communication, self-care, cognitive skills, and social interaction skills.
Autism is a physical condition associated with a change in brain biology and chemistry. The exact causes of these changes are still unknown, but research is very active in this area. Presumably, there is a combination of factors that lead to autism.
Genetic predisposition seems to play an important role in autism. Identical twins seem to be more likely to have autism than fraternal twins or other siblings. Language problems are also more common among relatives of children with autism. Changes in chromosomes and other neurological problems are also more common in families with autism.
A whole number of possible causes for autism are suspected but not proven. Genetic as well as neurophysiological causes are considered likely. Interactions between environmental factors and genes also seem to play a role.
Many sources state that with an autism ratio of 4:1, significantly more males are affected. These figures should be judged cautiously. Females with Asperger syndrome, for example, are diagnosed less often. Possible reasons for this may be that diagnosis tends to be more boy- or male-specific. Other sources suggest that girls/women are better able to adapt and compensate for their environment and are therefore less likely to stand out.
Family income, parenting/education, lifestyle, race or religious affiliation do not appear to affect the development of autism.