Autism, disorder that severely impairs development of a person’s ability to communicate, interact with other people, and maintain normal contact with the outside world. The disorder was first described in 1943 by American psychiatrist Leo Kanner. One of the most common developmental disabilities, autism affects approximately 1 in 500 to 1 in 166 children and appears before the age of three. It is about four times more common in males than in females.
Autism is often referred to as a spectrum disorder—that is, a disorder in which symptoms can occur in any combination and with varying degrees of severity. Symptoms of autism usually begin during infancy. Autistic infants may stiffen or go limp when picked up by parents rather than clinging or cuddling up to them. Autistic infants often show little or no interest in other people and lack typical social behaviors. For example, they may not smile at their mother’s voice or make eye contact with caregivers. Autistic children fail to develop normal relationships with their parents, brothers or sisters, and other children. Often they seem unaware of the needs and feelings of other people, and may not respond if another person is hurt or in distress. They also fail to make friends.
Children with autism usually play alone. Often they engage in repetitious activities, such as arranging objects in meaningless patterns, flipping a light switch on and off, or staring at rotating objects. Some engage in repetitious body movements, such as spinning, flapping their arms, swaying, rocking, snapping their fingers, and clapping or flapping their hands. In some cases these movements may be harmful, involving repeated biting of their wrists or banging their head. Children with autism frequently become upset at minor changes in their surroundings and daily routines.
Autistic children also have difficulties with language. Some never learn to speak or develop very limited speech. An autistic child may say “you” when he means “I” and produce incorrectly formed sentences. For example, when the child wants a drink he may say, “You want a drink.” Autistic children may also demonstrate echolalia, mechanically repeating words or phrases that other people say.
About 75 percent of autistic children are classified as having mental retardation, meaning that they score well below average on a standard test of intelligence and that they have a significantly impaired ability to cope with common life demands. Many show great variability in their skill levels across different aspects of intelligence tests, characteristically scoring higher on tests of visual-spatial skills and rote memory than on tests of verbal skills and social understanding. Some experts argue that standard intelligence tests are inappropriate measures of an autistic person's intellectual abilities. These experts note that some symptoms of autism—such as speech and language problems, difficulty paying attention, and behavioral problems—may interfere with an autistic child's performance on standard intelligence tests.
Children and adults with autism who score in the average or high range on intelligence tests are considered to have high-functioning autism. About 10 percent of autistic individuals have extraordinary talents such as the ability to memorize long lists of information, the ability to make lightning-fast mathematical calculations, or precocious musical or artistic abilities. Experts call such individuals autistic savants. Savants may score above or below average on standard intelligence tests.
Scientists once regarded autism as a psychological disorder caused by traumatic experiences that forced a child to retreat into a world of fantasy. Some theorized that parents caused autism by unconsciously rejecting a child, or by failing to bond emotionally. These theories caused enormous guilt in parents and lacked any scientific validity. Scientists today still do not know what causes autism, but they have discredited and rejected theories about a parental cause.
Evidence indicates that autism results from biological abnormalities in brain structure and function. Studies have found that autistic people have abnormally low blood flow to certain parts of the brain and reduced numbers of certain brain cells. These studies suggest that mutations in genes are important in causing autism. Studies of families also support this possibility. For example, families with one autistic child are more likely to have a second autistic child. Other studies have linked some cases of autism with prenatal exposure to the rubella virus (see German Measles) and lack of oxygen during birth.
Another theory sees autism mainly as a problem of cognition. In this view, autism results from an inability to think in ways necessary for normal communication, sharing of experiences, and expression of emotions. Supporters argue that autistic people lack “a theory of the mind”—that is, they do not realize that other people have feelings, beliefs, needs, and an inner life. Without this conception of the minds of others, autistic people cannot predict or interpret the behavior of others and have severe problems in social interaction. Many experts criticize this theory, noting that autism appears at an early age when no children have a conception of the minds of others.
There is no cure for autism. But treatment may reduce symptoms and help people with autism function better. Experts disagree over the effectiveness of different treatments. Many treatments seemed promising when first introduced, but later proved disappointing. Because individuals respond in different ways, no single treatment works for everyone. Treatments include behavior modification, medication, facilitated communication, vitamin and mineral supplements, auditory training, and vision therapy.
Behavior modification involves analyzing the cause of an undesirable behavior, then using rewards and punishments or other approaches to replace the behavior with a more appropriate response. For instance, children who spin or flap their arms because of anxiety about a situation can be taught to say “stop” or point to a symbol for “stop.” Parents often collaborate with therapists in providing behavior therapy. Very intensive behavior programs, modeled on the teaching methods of American psychologist O. Ivar Lovaas, have yielded some of the best results. In such programs parents may provide therapy at home seven days a week for several years.
Physicians sometimes prescribe antipsychotic drugs, beta-blockers, anticonvulsants, and other medications to reduce self-abusive behavior, such as head banging and wrist biting. Some individuals with autism benefit from drugs that increase levels of serotonin, a brain chemical. These medications, which include fenfluramine (Pondimin), fluvoxamine (Luvox), and clomipramine (Anafranil), may reduce compulsive behavior and body movements. Other drugs that improve symptoms in some patients include naltrexone (ReVia), which blocks the action of natural opiate-like compounds in the brain, and haloperidol (Haldol), which interferes with the function of the neurotransmitter dopamine.
Facilitated communication is based on the idea that people with autism are unable to communicate because of impaired body coordination. In this technique, a trained professional, or facilitator, supports the person’s hand over an alphanumeric keyboard. The person with autism learns to type messages and responses to questions. Critics maintain that the facilitator, rather than the person with autism, is the true source of the messages.
Other treatments for autism include supplements of vitamin B6 and magnesium; auditory training for individuals who are hypersensitive to certain frequencies of sound; and vision training to correct eyesight problems.
Federal law in the United States requires that states provide early intervention services for children aged one to three with autism and other disabilities. These services try to help children with autism develop academic and social skills in the hopes of lessening the disorder’s long-term effects. States also must provide an individual education plan when these children begin school. Children with autism may attend regular or special schools. See also Education of Students with Mental Retardation; Special Education.
Some individuals with autism get jobs and live independently or semi-independently as adults. They often succeed in jobs that emphasize specific skills, rather than those that require complex interactions with other people. Others with autism must depend on outside support. They may live with family members, in group homes, or in residential care facilities.
A number of other disorders may include characteristics of autism. In fragile X syndrome, which results from a defective X chromosome, people may show poor eye contact, limited speech, hand flapping, and hyperactivity. People with Asperger’s disorder may show some symptoms of autism such as difficulties in social interactions, poor eye contact, repetitive body movements, and an insistence on routines and rituals. However, they have normal language development and do not have mental retardation. Rett’s disorder involves repetitive hand movements, social withdrawal, and impaired language development. The disorder appears before the age of four and affects only girls. Some experts regard these disorders as mild forms of autism rather than as separate disorders.
