Autism

from The New Book of Knowledge®

The word "autism" comes from the Greek word for "self." The syndrome of autism was first described in 1943 by Dr. Leo Kanner. He studied eleven children who had unusual behaviors and interests. They seemed unable to relate to people and situations in the ordinary way.

One of the children Dr. Kanner wrote about was a 6-year-old named Frederick. Frederick's mother said he was not good at playing with other children. He did not play with the usual childhood toys. He was terrified of machines such as elevators and vacuum cleaners. And he did not like change or to try new things.

Most of the time, Frederick ignored the people around him—even his grandparents. He spoke a few words before the age of 2. But after that he would seldom speak. When he did speak, he would often mix up his personal pronouns. For example, when receiving a gift he would say, "You say thank you."

Diagnosis of Autism and Related Conditions


Autism is now recognized as a group of conditions with similar behavioral characteristics. These conditions may be referred to as autism spectrum conditions or pervasive developmental disorders. Five conditions are formally grouped as pervasive developmental disorders. They are autism, Asperger's disorder, Childhood Disintegrative Disorder, Rett syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified.

As was the case with Frederick, children with autism have symptoms that can be grouped into three categories. First, they have problems with language and communication. Second, they have problems with social interaction. And third, they have unusual interests and behaviors.

Difficulties with language include delays speaking in sentences and confusion of pronouns such as "me" and "I." Children with autism may make up their own words for things. They may repeat the same words over and over again. And they may say words at unusual times. Nonverbal communication, such as shaking the head to mean "no" or pointing out objects to others, is frequently absent.

Even though they might want to have friends and play with others, children with autism have a difficult time doing so. They may avoid physical contact. And they may appear to ignore those around them. Some scientists think that people with autism cannot put themselves in another person's position.

The unusual interests and behaviors of people with autism might include a fascination with simple items such as string, traffic lights, or license plates. Or they may enjoy the way it feels when they twirl around. And so they repeat this action again and again.

Asperger's disorder takes its name from Dr. Hans Asperger. Dr. Asperger, like Dr. Kanner, wrote about children whose behaviors were unusual. Children with Asperger's disorder share certain behaviors with people who have autism. For example, they have unusual preoccupations and interests. And they have trouble understanding how their behavior is viewed by others. But children with Asperger's disorder do not have early language problems. They may learn to talk and read very early.

Childhood Disintegrative Disorder is characterized by the same symptoms as autism. However, with this disorder children seem to develop normally until about 2 years of age. Then they begin to lose many of the skills that had developed up to that time. They typically stop talking and playing normally as autistic behaviors appear.

Rett syndrome usually occurs in girls. The disorder was named for Dr. Andreas Rett, who described a group of girls who developed normally in early childhood but then lost all of their acquired skills. These skills included the use of their hands. The cause of Rett syndrome is now known to be an abnormal gene on the X chromosome.

There are other disorders that resemble autism. But children with these disorders lack all of the symptoms necessary for autism to be diagnosed. In these cases, the diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified is often made. This means that the person has an autism spectrum disorder. But the condition is different in some way from the other disorders described above.

How Common Is Autism?


Autism is probably more common than was once believed. Early studies suggested that five children out of 10,000 had the disorder. More recent studies suggest that as many as two out of every 1,000 children have a pervasive developmental disorder. The newer figure may reflect better recognition of milder cases.

Boys are four to five times more likely than girls to have a pervasive developmental disorder. Rett syndrome is the exception. It occurs in about one in 10,000 to one in 15,000 female children.

Causes and Treatment

Genes may be partially responsible for autism. They appear to have a role because autism can run in families. With identical twins, if one has autism, the other has a 50 percent chance of having it. Because the likelihood is not 100 percent, environmental factors may also play a role.

Autism is also associated with other neurological conditions. These include mental retardation and epilepsy. A link between autism and mercury in certain childhood vaccines has been suspected. According to a 2004 study by the Institute of Medicine, available evidence did not support such a link.

There are no specific cures for autism. But early and intensive behavioral therapy seems to be helpful. Different strategies are used. At school, children with autism may have special aides to help them with tasks that are especially challenging. There are therapies designed to help with speech and language, behavior, and physical skills. All these therapies may contribute to a child's treatment. But appropriate therapies may be hard to find. And they may not qualify for insurance coverage. In some situations, medication can be helpful.

People with Autism Have Strengths

People with autism share problems with language and social skills. But it is important to remember that every person with autism is unique. It makes no more sense to say that all tall people are alike than it does to suggest the same for people with autism. Some children with autism are talented artists. Some are amazing mathematicians. And some have exceptional memory. Like everyone, people with autism are relatives, neighbors, and friends.

—Bryan H. King, M.D.

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