Autism and the Autism Spectrum
Recent statistics indicate that autism is present in one percent of the population. Autism is a big word with a lot of questions and a lot of opinions attached to it. Primarily it is a label used when a child has not developed language at a time long past what would be considered developmentally normal. Other red flags have to do with behavior, a lack of connection to those around them and a preoccupation with gadgets or things that click, whirl, and move; continual self-stimulation and apparent lack of need for any type of peer play or even parallel play.
Perhaps some of the key issues for the autistic population is their seeming lack of desire to engage with those around them necessary for learning to occur. The question is which came first? The behavior that obviously curtails the presence of modeling and imitation, two of the main methods used to develop language. Or, is the language problem the primary issue and then the behavior. Given the rather young age when “autistic qualities” appear, the suspicion is that the behavior comes first. How does a child model and learn language when they spend no time looking at their parent, or anyone for that matter. If the child is constantly running and moving; they don’t stop long enough to watch those around them and consequently, learn. It would seem logical that a lack of connection results in a lack of learning.
Most in the field from neurologists to speech and language pathologists to psychologists agree that the autism spectrum emerges from numerous causal factors involving brain abnormalities from conception onward. There may be ongoing disorders such as sleep apnea or seizures that further impact brain functioning. There is general agreement on the specific impact to executive reasoning; the frontal processes in the brain.
The new, most recent concept is that autism is a neurodevelopmental disorder. As such, your child would benefit from neuropsychological evaluation if you see the following red flags.
What is Autism?
The ‘‘Red Flags of autism’’ alert any professional to the need for diagnosis and treatment when the following occurs:
- Communication concerns (poor response to name, highly delayed language).
- Social concerns (smiling socially, overly independent, poor eye contact, in own world and no interest in peer play).
- Behavioral concerns (tantrums, hyperactivity, oppositional, compulsive, oversensitive to texture and sounds, lack of play with toys).
- Complete lack of language development.
It is well known in the professional community that immediate evaluation is necessary when there is:
- No babbling or gesturing by 12 months,
- No single words by 16 months,
- No two word phrases by 24 months
Syndromes presenting as ‘‘autistic look alikes’’ are ADHD (Attention Deficit Hyperactivity Disorder), Tourette’s Syndrome(chronic motor or vocal tic disorder), and any birth or early brain injury. The DSM-IV-TR notes that individuals with autism may have a range of behavioral symptoms including hyperactivity, short attention span, impulsivity, aggressiveness, self-injurious behaviors and temper tantrums accompanied by sensory abnormalities (oversensitivity to being touched, high pain tolerance, food/texture sensitivity, oral sensitivity, reactivity to light, odors, and external stimuli) sleep, eating, and affect/emotional abnormalities. Prevalence is noted as five cases per 10,000 with rates ranging from 2 to 20 cases. The onset must be prior to three years of age, following a continuous course through the child’s lifetime.
Treatment aimed at behavior management is typically not as successful as treatment geared towards the causal factors affecting the brain. Autism is one of five disorders under the category of pervasive developmental disorder (PDD), three of which carry significant impact to the brain (autism, Asperger’s, childhood disintegrative disorder, Rett’s, and PDD-NOS-not otherwise specified).
Commonly seen day-to-day symptoms when there are cognitive and emotional deficits related to impaired executive reasoning; frontal processes that are characteristic of Autism and the Autism Spectrum:
- Difficulty learning any novel sequence of action.
- Problems learning any type of complex action unless over learned and part of a regular routine
- Tendency to confuse information, incorrect learning
- Misperceptions regarding social and life events or incidents
- Difficulty integrating newly learned information, cannot grasp the whole concept necessary to generalize learning.
- Problematic memory, poor memory efficiency
- Thinking rigidity, difficulties in shifting sets
- Becoming stuck in one idea, one plan, one thought
- Selective attention, difficulty focusing in on some stimuli and not other stimuli
- Continuous distractibility by anything novel in the environment
- Easily overwhelmed by too much information or stimuli
- Tendency to be drawn by novel stimuli or stuck in minor details
- Difficulty with internal regulation and external restraint of impulsive behavior
- Problems appreciating the feelings of others and developing empathy
- Problems understanding the emotional relevance of situations and vulnerability to illogical thinking
- Tendency to become bound to one thing, obsessed, and overly preoccupied with objects, thoughts, compulsively driven to act, without thinking of the consequences.
- Difficulty developing a sense of self over time