What is Autism?
Autism is a neurodevelopmental disorder that manifests in children as a spectrum of related conditions including low functioning autism, Asperger's Syndrome / high functioning autism, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder - Not Otherwise Specific (PDD-NOS). The triad of symptoms that most professionals associated with autism involve:
- Communication abnormalities and problems, such as lost language or echolalia
- Problems with social interaction, such as eye contact avoidance or parallel play
- Behavioral abnormalities such as rigid insistence on routines and patterns
However, the range of symptoms that parents and caregivers of autistic children deal with on a daily basis are much greater than those listed in normal scientific venues. A broader list of symptoms for classic autism is contained in the Syptoms of Atuism sub-page. Also, the symptoms of the autism spectrum vary from condition to condition and person to person. A discussion of the diagnoses on the autism spectrum is on The Autism Spectrum sub-page.
Gender and Autism
In classic low functioning autism, boys are diagnosed about three to four times more frequently than girls. A much greater percentage of girls are diagnosed with mental retardation, indicating to me that a higher percentage of femaile cases result from chromosomal abnormalities such as Rett Syndrome (boys with Rett Syndrome die prenatally) and Down Syndrome (this is to be expected because there are a much smaller number of total female cases). On the high functioning side of autism, reports indicate that boys are diagnosed at up to 10 times the rate of girls.
Autism Onset
Age of onset in autism varies. Some children come out of the womb arching their backs in reponse to touch, never able to really settle down. and quickly progress to diagnosis. Other children appear to develop normally for 12 to 24 months and then begin to regress into autism - loss of language previously learned is a classic sign of regressive autism. It is this regression that causes the coincidential association between autism and vaccines - my views on this matter are discussed on my Vaccines and Autism page. However, studies using home movies of children with regressive autism has shown that signs of autism, that professionals can identify, predated the regression. Autistic behaviors that develop after 3 years result in diagnoses that are not considered classic autism.
Progression of Condition Over Time
Autistic symptoms vary over time, with and without treatment. In early childhood, hyperactivity, stereotyped behaviors, irritability, and temper tantrum may be prominent, whereas ticlike behaviors, aggressiveness, and self-injurious behaviors may characterize the child later. In adolescence and adulthood, particularly in higher functioning individuals, depression or obsessive compulsive phenomena may develop and interfere with functioning.
One fact that we know is that intensive, early treatment can alter the course of autism. As autistic children mature, particularly those who have received intensive intervention, some children with autism become more engaged with others and show less marked disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have great difficulty with language or social skills, and the adolescent years can mean a worsening of behavior problems.
However, even for those who seem to be cured, autism never really goes away entirely. For those who are no longer diagnosable because they are not adequately disorderd to receive a diagnosis, they will still continue to experience symptoms of autism, such as sensory defensivenss, or a tendency to use withdrawal as a coping strategy, or a limited ability to engage in aye contact. They will also likely retain some of the strengths seen in autism, such as facility with solving problems or building mathematical models. Autism is not a disease to be cured. It is a way the nervous system is wired. You can reduce symptoms, but it is always there.
Co-Morbid Conditions
Autism is not a discrete, isolated condition. It shares many characteristics with other psychological conditions, and is co-morbid with a number of disorders, meaning autistic individuals also are frequently diagnosed with other psychological conditions. In addition to the core autistic symptoms, other behavioral and/or psychological symptoms in person with autism include: problems with attention and concentration, hyperactivity, morbid or unusual preoccupation, OCD, compulsions and rituals, anxiety or fears, depressive mood, irritability, agitation and inappropriate affect, sleep problems, a history of self injury, and tics. Other autistic symptoms include seizures, arousal dysregulation, attachment disorders, face recognition deficits, gaze aversion, gastrointestinal disorders, and altered heart rate variability.
Learning Disorders / Retardation in Autism
A sizable number of autistic children are either mentally retarded or have a learning disorder; for instance, children with two of the most common forms of mental retardation, Down Syndrome and Fragile X Syndrome, tend to develop autism as well. However, the number of autistic children who are affected by cognitive problems is, in my view, seriously overstated. We know that many high functioning autistics have significantly higher than normal IQs. Research has emerged in the last year that much of the difference in IQs in low functioning autistics from normals has to do with testing techniques. The researchers showed that the current standard testing vehicle has 11 sections - most of which are delivered verbally - which is a huge problem for autistic children since verbal communication is one of their core deficits. When the test was revised to be taken fully on paper, autistic performance rose to normal, or even heightened levels. My ultimate concern related to this matter is that due to testing prejudice, the bar is being set way too low for autistic children from a standpoint of academic performance.
Personally, I believe that it is crucial to distinguish between autism and mental retardation. Autism can exist without mental retardation and vice versa. Sometimes both conditions exist in the same individual, but this only occurs in some persons. Mental retardation involves cognitive capacity. Autism involves a way of interacting with the world. Mental retardation can exacerbate autistic symptoms. And, autism can negatively impact perceived intelligence. However, these are distinct conditions, and should be treated as such.