Dr.Ayman
10-04-2002, 11:35 PM
Definition
Autism is a complex developmental disorder that appears in the first 3 years of life (though it may be diagnosed much later). It affects the brain's normal development of social and communication skills. Autism is a spectrum that encompasses a wide continuum of behavior. Core features include impaired social interactions, impaired verbal and nonverbal communication, and restricted and repetitive patterns of behavior. The symptoms may vary from quite mild to quite severe.
Alternative names
Autistic disorder/autism spectrum; Infantile autism; Autistic-like/autistic tendencies; High-functioning autism; Low-functioning autism; Pervasive developmental delay
Causes, incidence, and risk factors
In the past, autism was thought to be a mental illness caused by bad parenting. This destructive idea has been disproved. We now know autism to be a physical condition linked to abnormal biology and neurochemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research.
Genetic factors are involved. Language and cognitive abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other neurological problems are also more common in families with autism.
In the general population, autism affects up to 0.2% of children, but the risk of having a second autistic child increases more than 50 times -- to 10-20%. An identical twin is far more likely to also have autism than would be a fraternal twin or another sibling.
Autism affects boys 3 to 4 times more often than girls. Family income, education, and lifestyle do not affect the risk of autism.
Prevention
Nothing has been proven to prevent autism.
Symptoms
Most parents with 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 (though the diagnosis is usually not made until long after that). Those with autism typically have difficulties in verbal and non-verbal communication, social interactions, and pretend play. In some, aggression toward others or oneself may be present. People with autism may perform repeated body movements, show unusual attachments to objects, or have unusual distress to changes in routines. Individuals may also experience sensitivities in the senses of sight, hearing, touch, smell, or taste. Some combination of the following areas may be affected in varying degrees:
Communication: Inability to start or sustain a conversation; language develops slowly or not at all; repeating words; reversing pronouns; nonsense rhyming; communicating with gestures instead of words; short attention span.
Social Interaction: Lack of empathy; difficulty making friends; withdrawn; prefers to spend time alone rather than with others; less responsive to social cues such as eye contact or smiles.
Sensory Impairment: Heightened or decreased sensitivities to sight, hearing, touch, smell, or taste; mouthing of objects; rubbing of surfaces; diminished response to pain; lack of startle to loud noises.
Play: Decreased pretend or imaginative play; decreased imitation of others' actions; prefering solitary or ritualistic play.
Behaviors: Repetitive body movements; strong need for sameness; intense tantrums; very narrow interests; perseveration (an obsessive interest in a single item, idea, activity or person); apparent lack of common sense; may show aggression to others or self; may be overactive or very passive.
Signs and tests
Routine developmental screening should be performed for all children at all well-child visits. Further evaluation is warranted 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 (e.g., pointing, waving bye-bye) by 12 months; single words by 16 months; two-word spontaneous phrases by 24 months (not just echoing); or the loss of any language or social skills at any age.
These children might receive an audiologic 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 clinician experienced in the diagnosis and treatment of autism is usually necessary for the actual diagnosis of autism. Because there is no biological test for autism, the diagnosis will often be based on specific criteria laid out in the Diagnostic and Statistical Manual IV as follows:
Diagnostic Criteria for Autistic Disorder
A total of six or more items from (1), (2), and (3):
Qualitative impairment in social interaction, manifest by at least two of the following: Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures, to regulate social interaction; Failure to develop peer relationships appropriate to developmental level; Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest); Lack of social or emotional reciprocity.
Qualitative impairment in communication, as manifest by at least one of the following: Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime); In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others; Stereotyped and repetitive use of language, or idiosyncratic language; Lack of varied, spontaneous make-believe, or social imitative play appropriate to developmental level
Restrictive repetitive and stereotypic patterns of behavior, interests, and activities, as manifested by at least one of the following: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus; Apparently inflexible adherence to specific nonfunctional routines or rituals; Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements); Persistent preoccupation with parts of objects.
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
Social interaction
Language as used in social communication
Symbolic or imaginative play
The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.
The other pervasive developmental disorders include Asperger's disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder--not otherwise specified (PDD-NOS), or atypical autism.
EVALUATION:
The diagnostic evaluation of autism will often include a complete physical and neurologic examination, as well as the use of a specific diagnostic instrument such as the Gilliam Autism Rating Scale, the Pervasive Developmental Disorders Screening Test-Stage 3, the Childhood Autism Rating Scale (CARS) or the Autism Diagnostic Observation Schedule-Generic. Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.
Because autism encompasses such a broad spectrum, a brief observation in a single setting cannot predict an individual's true abilities. Ideally, a multidisciplinary team would evaluate a child. This might include a comprehensive speech-language-communication evaluation, a cognitive and adaptive behavior evaluation, a sensorimotor and occupational therapy evaluation, and neuropsychological, behavioral, and academic assessments.
Sometimes people are reluctant to make the diagnosis of autism because of concerns about ‘labeling' the child. While ‘pigeon-holing' is inappropriate with the autism spectrum of conditions, failure to make a diagnosis can lead to failure of getting the treatment and services the child needs.
:)
Autism is a complex developmental disorder that appears in the first 3 years of life (though it may be diagnosed much later). It affects the brain's normal development of social and communication skills. Autism is a spectrum that encompasses a wide continuum of behavior. Core features include impaired social interactions, impaired verbal and nonverbal communication, and restricted and repetitive patterns of behavior. The symptoms may vary from quite mild to quite severe.
Alternative names
Autistic disorder/autism spectrum; Infantile autism; Autistic-like/autistic tendencies; High-functioning autism; Low-functioning autism; Pervasive developmental delay
Causes, incidence, and risk factors
In the past, autism was thought to be a mental illness caused by bad parenting. This destructive idea has been disproved. We now know autism to be a physical condition linked to abnormal biology and neurochemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research.
Genetic factors are involved. Language and cognitive abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other neurological problems are also more common in families with autism.
In the general population, autism affects up to 0.2% of children, but the risk of having a second autistic child increases more than 50 times -- to 10-20%. An identical twin is far more likely to also have autism than would be a fraternal twin or another sibling.
Autism affects boys 3 to 4 times more often than girls. Family income, education, and lifestyle do not affect the risk of autism.
Prevention
Nothing has been proven to prevent autism.
Symptoms
Most parents with 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 (though the diagnosis is usually not made until long after that). Those with autism typically have difficulties in verbal and non-verbal communication, social interactions, and pretend play. In some, aggression toward others or oneself may be present. People with autism may perform repeated body movements, show unusual attachments to objects, or have unusual distress to changes in routines. Individuals may also experience sensitivities in the senses of sight, hearing, touch, smell, or taste. Some combination of the following areas may be affected in varying degrees:
Communication: Inability to start or sustain a conversation; language develops slowly or not at all; repeating words; reversing pronouns; nonsense rhyming; communicating with gestures instead of words; short attention span.
Social Interaction: Lack of empathy; difficulty making friends; withdrawn; prefers to spend time alone rather than with others; less responsive to social cues such as eye contact or smiles.
Sensory Impairment: Heightened or decreased sensitivities to sight, hearing, touch, smell, or taste; mouthing of objects; rubbing of surfaces; diminished response to pain; lack of startle to loud noises.
Play: Decreased pretend or imaginative play; decreased imitation of others' actions; prefering solitary or ritualistic play.
Behaviors: Repetitive body movements; strong need for sameness; intense tantrums; very narrow interests; perseveration (an obsessive interest in a single item, idea, activity or person); apparent lack of common sense; may show aggression to others or self; may be overactive or very passive.
Signs and tests
Routine developmental screening should be performed for all children at all well-child visits. Further evaluation is warranted 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 (e.g., pointing, waving bye-bye) by 12 months; single words by 16 months; two-word spontaneous phrases by 24 months (not just echoing); or the loss of any language or social skills at any age.
These children might receive an audiologic 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 clinician experienced in the diagnosis and treatment of autism is usually necessary for the actual diagnosis of autism. Because there is no biological test for autism, the diagnosis will often be based on specific criteria laid out in the Diagnostic and Statistical Manual IV as follows:
Diagnostic Criteria for Autistic Disorder
A total of six or more items from (1), (2), and (3):
Qualitative impairment in social interaction, manifest by at least two of the following: Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures, to regulate social interaction; Failure to develop peer relationships appropriate to developmental level; Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interest); Lack of social or emotional reciprocity.
Qualitative impairment in communication, as manifest by at least one of the following: Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime); In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others; Stereotyped and repetitive use of language, or idiosyncratic language; Lack of varied, spontaneous make-believe, or social imitative play appropriate to developmental level
Restrictive repetitive and stereotypic patterns of behavior, interests, and activities, as manifested by at least one of the following: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus; Apparently inflexible adherence to specific nonfunctional routines or rituals; Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements); Persistent preoccupation with parts of objects.
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
Social interaction
Language as used in social communication
Symbolic or imaginative play
The disturbance is not better accounted for by Rett's disorder or childhood disintegrative disorder.
The other pervasive developmental disorders include Asperger's disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder--not otherwise specified (PDD-NOS), or atypical autism.
EVALUATION:
The diagnostic evaluation of autism will often include a complete physical and neurologic examination, as well as the use of a specific diagnostic instrument such as the Gilliam Autism Rating Scale, the Pervasive Developmental Disorders Screening Test-Stage 3, the Childhood Autism Rating Scale (CARS) or the Autism Diagnostic Observation Schedule-Generic. Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and perhaps metabolic testing.
Because autism encompasses such a broad spectrum, a brief observation in a single setting cannot predict an individual's true abilities. Ideally, a multidisciplinary team would evaluate a child. This might include a comprehensive speech-language-communication evaluation, a cognitive and adaptive behavior evaluation, a sensorimotor and occupational therapy evaluation, and neuropsychological, behavioral, and academic assessments.
Sometimes people are reluctant to make the diagnosis of autism because of concerns about ‘labeling' the child. While ‘pigeon-holing' is inappropriate with the autism spectrum of conditions, failure to make a diagnosis can lead to failure of getting the treatment and services the child needs.
:)