CHARACTERISTICS OF AUTISM

Autism is distinguished by a pattern of symptoms rather than one single symptom. The main characteristics are impairments in social interaction, impairments in communication, restricted interests and repetitive behaviors. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.[22] Individual symptoms of autism occur in the general population and appear not to associate highly, without a sharp line separating pathological severity from common traits.[23]

effects Social development from autism

People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic Temple Grandin described her inability to understand the social communication of neurotypicals as leaving her feeling "like an anthropologist on Mars".[24]

Social impairments become apparent early in childhood and continue through adulthood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers have more striking social deviance; for example, they have less eye contact and anticipatory postures and are less likely to use another person's hand or body as a tool.[21] Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers.[25] They display moderately less attachment security than usual, although this feature disappears in children with higher mental development or less severe Autism Spectrum Disorder.[26] Older children and adults with Autism Spectrum Disorder perform worse on tests of face and emotion recognition.[27]

Contrary to common belief, autistic children do not prefer to be alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they are.[28]

There are many anecdotal reports, but few systematic studies, of aggression and violence in individuals with Autism Spectrum Disorder. The limited data suggest that in children with intellectual disability, autism is associated with aggression, destruction of property, and tantrums. Dominick et al. interviewed the parents of 67 children with Autism Spectrum Disorder and reported that about two-thirds of the children had periods of severe tantrums and about one-third had a history of aggression, with tantrums significantly more common than in children with a history of language impairment.[29]

effects on communication from autism

About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs.[30] Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and the desynchronization of vocal patterns with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words (echolalia)[20][31] or reverse pronouns.[32] Autistic children may have difficulty with imaginative play and with developing symbols into language.[20][31] They are more likely to have problems understanding pointing; for example, they may look at a pointing hand instead of the pointed-at object.[21][31]

In a pair of studies, high-functioning autistic children aged 8–15 performed equally well, and adults better than individually matched controls at basic language tasks involving vocabulary and spelling. Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends.[33]

Repetitive behavior

Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R)[34] categorizes as follows.

* Stereotypy is apparently purposeless movement, such as hand flapping, head rolling, or body rocking.
* Compulsive behavior is intended and appears to follow rules, such as arranging objects in a certain way.
* Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
* Ritualistic behavior involves the performance of daily activities the same way each time, such as an unvarying menu or dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.[35]
* Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program.
* Self-injury includes movements that injure or can injure the person, such as biting oneself. Dominick et al. reported that self-injury at some point affected about 30% of children with Autism Spectrum Disorder.[29]

No single repetitive behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.[34]

Other symptoms of autism

Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family.[22] A small fraction of individuals with Autism Spectrum Disorder show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.[36]

Sensory issues

Unusual responses to sensory stimuli are more common and prominent in autistic children, although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.[37] The responses may be more common in children: a pair of studies found that autistic children had impaired tactile perception while autistic adults did not. The same two studies also found that autistic individuals had more problems with complex memory and reasoning tasks such as Twenty Questions; these problems were somewhat more marked among adults.[33] Several studies have reported associated motor problems that include poor muscle tone, poor motor planning, and toe walking; Autism Spectrum Disorder is not associated with severe motor disturbances.[38]

Atypical eating behavior

Atypical eating behavior occurs in about three-quarters of children with Autism Spectrum Disorder, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;[29] this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual;[39] studies report conflicting results, and the relationship between GI problems and Autism Spectrum Disorder is unclear.[12]

Sleeping problems

Sleep problems are known to be more common in children with developmental disabilities, and there is some evidence that children with Autism Spectrum Disorder are more likely to have even more sleep problems than those with other developmental disabilities; autistic children may experience problems including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings. Dominick et al. found that about two-thirds of children with Autism Spectrum Disorder had a history of sleep problems.[29]

Stress

Parents of children with Autism Spectrum Disorder have higher levels of stress.[40] Siblings of children with Autism Spectrum Disorder report greater admiration of and less conflict with the affected sibling; siblings of individuals with Autism Spectrum Disorder have greater risk of negative well-being and poorer sibling relationships as adults.[41]

References

22. ^ a b c Filipek PA, Accardo PJ, Baranek GT et al. (1999). "The screening and diagnosis of autism spectrum disorders". J Autism Dev Disord 29 (6): 439–84. doi:10.1023/A:1021943802493. Erratum (2000). J Autism Dev Disord 30 (1): 81. doi:10.1023/A:1017256313409. PMID 10638459. This paper represents a consensus of representatives from nine professional and four parent organizations in the U.S.
23. ^ a b c London E (2007). "The role of the neurobiologist in redefining the diagnosis of autism". Brain Pathol 17 (4): 408–11. doi:10.1111/j.1750-3639.2007.00103.x. PMID 17919126.
24. ^ Sacks O (1995). An Anthropologist on Mars: Seven Paradoxical Tales. Knopf. ISBN 0679437851.
25. ^ Sigman M, Dijamco A, Gratier M, Rozga A (2004). "Early detection of core deficits in autism". Ment Retard Dev Disabil Res Rev 10 (4): 221–33. doi:10.1002/mrdd.20046. PMID 15666338.
26. ^ Rutgers AH, Bakermans-Kranenburg MJ, van IJzendoorn MH, van Berckelaer-Onnes IA (2004). "Autism and attachment: a meta-analytic review". J Child Psychol Psychiatry 45 (6): 1123–34. doi:10.1111/j.1469-7610.2004.t01-1-00305.x. PMID 15257669.
27. ^ a b c Sigman M, Spence SJ, Wang AT (2006). "Autism from developmental and neuropsychological perspectives". Annu Rev Clin Psychol 2: 327–55. doi:10.1146/annurev.clinpsy.2.022305.095210. PMID 17716073.
28. ^ a b c Burgess AF, Gutstein SE (2007). "Quality of life for people with autism: raising the standard for evaluating successful outcomes". Child Adolesc Ment Health 12 (2): 80–6. doi:10.1111/j.1475-3588.2006.00432.x.
29. ^ a b c d Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S (2007). "Atypical behaviors in children with autism and children with a history of language impairment". Res Dev Disabil 28 (2): 145–62. doi:10.1016/j.ridd.2006.02.003. PMID 16581226.
30. ^ Noens I, van Berckelaer-Onnes I, Verpoorten R, van Duijn G (2006). "The ComFor: an instrument for the indication of augmentative communication in people with autism and intellectual disability". J Intellect Disabil Res 50 (9): 621–32. doi:10.1111/j.1365-2788.2006.00807.x. PMID 16901289.
31. ^ a b c Tager-Flusberg H, Caronna E (2007). "Language disorders: autism and other pervasive developmental disorders". Pediatr Clin North Am 54 (3): 469–81. doi:10.1016/j.pcl.2007.02.011. PMID 17543905.
32. ^ a b Kanner L (1943). "Autistic disturbances of affective contact". Nerv Child 2: 217–50.
33. ^ a b c Williams DL, Goldstein G, Minshew NJ (2006). "Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing". Child Neuropsychol 12 (4–5): 279–98. doi:10.1080/09297040600681190. PMID 16911973.
34. ^ a b Bodfish JW, Symons FJ, Parker DE, Lewis MH (2000). "Varieties of repetitive behavior in autism: comparisons to mental retardation". J Autism Dev Disord 30 (3): 237–43. doi:10.1023/A:1005596502855. PMID 11055459.
35. ^ Lam KS, Aman MG (2007). "The Repetitive Behavior Scale-Revised: independent validation in individuals with Autism Spectrum Disorders". J Autism Dev Disord 37 (5): 855–66. doi:10.1007/s10803-006-0213-z. PMID 17048092.
36. ^ Treffert DA (2007). Savant syndrome: an extraordinary condition—a synopsis: past, present, future. Wisconsin Medical Society. Retrieved on 2007-09-19.
37. ^ Rogers SJ, Ozonoff S (2005). "Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence". J Child Psychol Psychiatry 46 (12): 1255–68. doi:10.1111/j.1469-7610.2005.01431.x. PMID 16313426.
38. ^ Ming X, Brimacombe M, Wagner GC (2007). "Prevalence of motor impairment in Autism Spectrum Disorders". Brain Dev. doi:10.1016/j.braindev.2007.03.002. PMID 17467940.
39. ^ Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ (2005). "Gastrointestinal factors in autistic disorder: a critical review". J Autism Dev Disord 35 (6): 713–27. doi:10.1007/s10803-005-0019-4. PMID 16267642.
40. ^ Montes G, Halterman JS (2007). "Psychological functioning and coping among mothers of children with autism: a population-based study". Pediatrics 119 (5): e1040–6. doi:10.1542/peds.2006-2819. PMID 17473077.
41. ^ Orsmond GI, Seltzer MM (2007). "Siblings of individuals with Autism Spectrum Disorders across the life course". Ment Retard Dev Disabil Res Rev 13 (4): 313–20. doi:10.1002/mrdd.20171. PMID 17979200.

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