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
General signs of the autistic spectrum include mild to severe impairments in social interactions and verbal and non-verbal communication, perceptual disorders, as well as limited 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
Symptoms of the autistic spectrum range from very mild to very severe
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 people are affected?
Autism is a condition with a broad spectrum. A steadily increasing percentage of the population is affected (1 in 59, according to estimates by the CDC’s autism and developmental disabilities monitoring (ADDM) network, Surveillance Summaries / April 27, 2018 / 67(6); 1–23). Boys are 4 times as likely as girls to be affected.
The exact number of children with autism is not known. A report by the US center for disease control and prevention shows that autism and related limitations are more common than previously thought. It is unclear whether this is due to the rising rate of autism or an increased ability to diagnose this condition.
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.
Communication
- Lack to draw the attention of others to objects (around the 14th month of life)
- Doesn’t focus on the things others look at
- Is unable to start or sustain a conversation
- Slow or no language development
- Repeating words or memorized phrases, for example from advertisements or movies
- Doesn’t refer to oneself correctly (for example, says “you want water” when meaning “I want water”)
- Deploys nonsensical rhymes
Communicates with gestures instead of vocal 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
Social Interaction
- Lack of compassion
- Difficulties to make friends
- Is non-communicative
- Prefers to be alone rather than with others
- May not respond to eye contact or smile
- Avoids eye contact
- Treats others as if they were items
Doesn’t play interactive games
Behavior
- Has a short attention span
- Shows repetitive body movements
- Shows a strong need for routines
- Has very violent outbursts
- Has very limited interests
- Perseveration on the same subject or thoughts
Is aggressive towards oneself or others
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 autistic tendencies
There are 5 areas of early childhood behaviors where there are variations in normal development in children with autism. I would like to explain this in more detail. This can help you to initiate a more detailed evaluation for autism as soon as possible.
Behaviors are shown In each of the 5 areas. If your child does not display any of these skills, or they can be observed only in a few areas, this is a warning signal. Please consider to clarify this with your doctors. Please note that the absence of neurotypical behavior is more difficult to determine than the presence of atypical behaviors.
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.
Look
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.
Hearing
Special features of hearing are of great importance, but difficult to classify. Many children are considered to have hearing difficulties in the beginning. Very few children are deaf. However, they don’t respond to their name and don’t seem to be swayed by noise-like changes around them. Children with autism even seem to ignore very loud noises that would make most other children shrug. This could have something to do with a generalized disinterest in the environment.
Because children with autism are very sensitive to certain sounds, this could be related to an unusual perception. For example, children with autism sometimes develop a fascination for certain sounds such as from a toy or react to the noise caused by removing the packaging of a chocolate bar at a greater distance. Other sounds, on the other hand, then appear to cause extreme discomfort, such as police sirens or the barking of a dog.
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
- Play
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.
Diagnosis
A child is diagnosed with autism when they show different forms of behavior in three deficit areas. These three areas are:
- Social interaction
- Communication
- Behavior/ interest.
Deficits of the autistic spectrum include:
- Lack of eye-contact
- Missing relationship building with peers
- Difficulty putting oneself in the position of others
- Lack of pretend play
When proper teaching is not given, many children are controlled by the effects of autism until they can no longer manage even simple human interactions.
The autism spectrum can usually be reliably diagnosed at age three. In the meantime, the latest research supports the diagnosis of autism even at the age of six months.
Act!
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 seemed different from birth. While other parents describe their child developing normally 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 wrong with the child 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 intervention starts, the better
If your child is diagnosed with autism, early intervention is essential to get the most benefit from existing therapies. Even if many parents have concerns about putting the label “autism” on the toddler, the earlier the diagnosis is made, the earlier the intervention can take place.
Science shows that early intensive intervention with ABA/VB (Applied Behavior Analysis and Verbal Behavior) for at least two years of preschool age can bring outstanding improvements for many children on the autistic spectrum.
Once autism is diagnosed, intensive intervention should begin. Effective ABA/VB programs focus on developing communication, as well as teaching social and cognitive skills.
Causes and risk factors
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 of autism are suspected but have not been proven. These include changes in the digestive tract, diet, mercury poisoning, response to vaccinations and insufficient utilization of vitamins and minerals in the body.
Autism affects boys four times as likely as girls.
Family income, parenting/education, lifestyle, race or religious affiliation do not appear to affect the risks of autism.