Autism and Related Disorders

Rebecca S. Blakeman, PhD
Licensed Psychologist

Autism is a neurological disorder that causes impairments in communication and social development, and is associated with restricted, repetitive and stereotyped patterns of behavior, interests, and/or activities.  Individuals with “classic” Autism have virtually no language development, show no interest or ability to interact with others, and exhibit repetitive motor movements such as hand flapping.  Individuals with “classic” In recent years our knowledge and understanding of Autism has grown substantially, such that the professional fields of psychology and medicine now recognized that individuals can be affected by Autism to greater and lesser degrees.  It is now recognized that the difficulties with communication, socialization, and repetitive behaviors occur on a continuum, with some individuals showing more impairment in one area or another.  The terms “Autism Spectrum” and “Autism Umbrella” are used to signify the fact that individuals present with a variety of difficulties that are all really manifestations and expressions of  the same underlying deficits in communication, social skills, and behavior.  The most common diagnoses made related to Autism Spectrum Disorders are Autism, Asperger’s Syndrome, and Pervasive Developmental Disorder NOS.  In Asperger’s Syndrome, children typically do not exhibit early delays in language development, though they may exhibit language peculiarities.  In addition, individuals with Asperger’s Syndrome tend to develop obsessive-like interests in topics, such that they may only be able to talk about, play, and think about one topic for weeks or months at a time.  Individuals with Asperger’s Syndrome are often very bright though their social skills are very poor.  They often do not know how to have a conversation with same age peers, and often miss the “obvious” aspects of social situations that let us know what behavior would be appropriate.  Finally, individuals with Asperger’s Syndrome often have a need for sameness, and can become very upset when their routine is changed.  Pervasive Developmental Disorder NOS (PDD NOS) is simply a catch-all term used when an individual does not exactly meet criteria for Autism or Asperger’s Syndrome, but clearly exhibits impairments in the three component areas involved in Autism Spectrum Disorders.

Great attention has been given in the media to the rising rate of autism diagnosis. Current data from the Center for Disease Control (CDC) estimates that 1 in 150 children will be diagnosed  with an Autism Spectrum Disorder.  Thus, more children will be diagnosed with Autism than will be diagnosed with cancer or injured in a car accident.

This rise in rates of autism has not come without considerable controversy, as there is great debate as to why the numbers of autism related diagnoses are on the rise.  Some argue that the rise in autism disorders is “real,” and that something in the environment is causing more children to develop the disorder than ever before.  Many individuals who believe the rise in

autism disorder to be “real” believe that exposure to toxins, such as Mercury, is to blame.  Numerous studies have investigated the possible link between vaccines and autism disorders.  However, these studies have failed to find evidence supporting the notion that vaccines are to blame for the increase in autism diagnoses.  Despite these studies, many still believe that mercury and other toxins are to blame for autism.  Future research may find that other sources of mercury or toxin exposure is to blame...but as of now, we simply do not know what triggers autism disorders.

On the flip side of the debate, many argue that the rise in autism disorders is not “real,” but rather is the result of changing diagnostic criteria.  As recently as 15 years ago only the most severe cases of Autism received a diagnosis.  These children were typically completely nonverbal and had almost no relationship with others.  Most of these children were considered to have very low intellectual abilities, and many were considered to have Mental Retardation.  Today, we now understand that symptoms of autism occur on a continuum, such that some individuals exhibit more severe impairment in all areas, while others exhibit less severe impairment.  Professionals now recognize that individuals with average to above average intellectual abilities can also exhibit the social, emotional, behavioral, and language impairments associated with autism related disorders.  This recognition that individuals can have varying degrees of autism related impairments has naturally resulted in more individuals qualifying for autism related disorders, compared to previous decades.  In fact, there are adults who have been misdiagnosed for much of their life, who are now being recognized as having difficulties consistent with Autism Spectrum Disorders.

Although we do not know what causes Autism, we do know that there is a genetic component.  Children who have a sibling with Autism are more likely to have Autism or an Autism related disorder than children who do not have a sibling with Autism.  It is not uncommon for adult relatives of children diagnosed with an Autism related disorder to show similar characteristics, though they might not have received a formal diagnosis.
 

Regardless of whether the rate of autism is truly on the rise, or we are simply better at recognizing the difficulties, it is crucial that parents, physicians, and teachers learn to recognize the early signs of Autism related difficulties, as early intervention is  critical for providing the best opportunities for growth and success.

While we do not yet know what causes Autism, and we have not yet identified a “cure,” we do know that early intervention provides the best outcome for individuals with autism related disorders.  The deficits in social functioning and communication, as well as the restricted and repetitive behaviors exhibited in Autism Spectrum Disorders are neurologically based. That is, they are simply manifestations of changes in brain functioning.  Although we do not know exactly where all of these changes are occuring, or why they are occurring, we know that the brain is involved. Although most of our brains are “wired” similarly, our brains do have “plasticity.”  This means that the brain can change its course of development if there has been an injury to part of the brain.  However, the plasticity of our brain, or it’s ability to change its wiring, decreases with age.  Hence, young children who experience a brain injury are more likely to recover (because their brain finds an unused area to use in place of the damaged brain area) than older individuals.  It is because of this greater plasticity of the young brain that early intervention is vital in Autism Spectrum Disorders.  By identifying children very early, appropriate interventions can begin while the brain is still developing and can more easily be “rewired.”    Historically, it was believed that autism could not be diagnosed until 3 years of age...fortunately, we have learned to recognize the warning signs much early than age 3, so that intervention can begin even before the 2nd birthday.  If you, as a parent, have concerns about your child’s development, speak to your pediatrician and seek an evaluation by a child psychologist or developmental pediatrician.  Research has shown that parents who express concerns about their child’s development and/or learning before 7 years of age are generally right to be concerned.  Parents know their children far better than any “expert” could know them, and they are therefore better able to recognize early signs that things are “not right” in the development process.  As a parent, you do not have to have determine the diagnosis before seeing a specialist...having concerns is enough, and the specialist can determine what, if any, diagnosis is appropriate.  You may learn that your child does not have an autism related disorder, but instead has a language disorder or motor delay.  You may learn that your child exhibits characteristics of an autism related disorder.  Either way, you will know what steps to take to help your child live a life as close to “normal” as possible.

Potential Signs of an Autism Spectrum Disorder
*Poor eye contact
*Does not respond to name by age 1
*Seems to be in his/her "own world"
*Not interested in toys as an infant
*Does not play with toys in intended fashion
*Fascinated by running water or spinning objects to the exclusion of age appropriate 
      activities
*Resists affection, not cuddly
*Extreme inflexibility with changes in routine
*Unusual habits (e.g., hand flapping, running in circles at same time each day,
      carrying objects such as a rock for no known purpose, eating non-food items)
*Limited or no pretend play
*Echoes/repeats what others say or what is said on TV
*Extreme sensitivity to textures, tastes, sounds, etc.
*Little or no interest in making friends
*Talks in unusual manner (e.g., exaggerated pronunciation, sing-song voice, choppy,
      like a robot)
*Develops "obsessions" about topics and does not want to play or talk about any-
      thing else