Breaking Down Barriers

Autism is a developmental disability, characterized by abnormal communications and unique social behaviors, that affects one out of every 166 births.1 At least nine out of 10,000 individuals are impacted, and it is four times more common among males.1 The number of cases is increasing by more than 10% each year.1 Autism can be found in any community, regardless of socioeconomic status, lifestyle or ethnicity. In the next decade, it is projected that the number of cases in the United States could reach four million.1,2

     First described in 1943, autism is one of five disorders that fall under the heading of Pervasive Developmental Disorders, or PDD. These include a number of neurologic conditions involved with developmental impairment, including social interaction and communication. The four remaining PDDs include Asperger's Disorder, Childhood Disintegrative Disorder (CDD), Rett's Syndrome, and PDD-Not Otherwise Specified (PDD-NOS).1-3

Cause
     A single specific cause for autism has not been identified, although a number of possible causes have been explored.1,3 Years ago, it was suspected that cold, rejecting mothers, sometimes referred to as "refrigerator mothers," caused autism in children. It was also suspected that autism was the result of parental emotional or psychological deficits. These theories have been proved to be incorrect.1-3

     Contemporary theories for possible causes include genetic predisposition; obstetric complications; administration of vaccinations such as measles, mumps and rubella (MMR); and toxic exposures.1-6 Fragile X syndrome, tuberous sclerosis and congenital rubella syndrome have also been investigated.1-7 It is believed that the symptoms associated with autism result from alterations in cerebral (brain) structure or function.1-6 (Table I) provides a list of resources that can be consulted for additional information regarding causes and effects of autism.

Signs and Symptoms
     Autism is considered a "spectrum" disorder.1-13 Signs and symptoms can range from mild to severe, and no two cases are identical (Table II). A comprehensive assessment will need to be conducted to determine if the symptoms are related to autism or other medical conditions. Factors like the frequency of occurrence of symptoms, their severity, sequence of symptoms, cerebral development, patient's age and patient's baseline health will need to be considered.1-3,12,13

Language, Body Movements, Social Interactions
     Language abnormalities, rigid or repetitive patterns of behavior, and unique social interactions are seen in children with autism.1-3 Language and communication skills may be limited. Nearly 40% of children with autism are either unable to speak or experience significant speaking challenges.3,13 If they are able to speak, the speech may appear to be abnormal.3,13 For example, they may not appear to be able to control the volume of their speech and may experience pronominal reversals, such as saying "you" instead of "I."3,13 When engaged in conversation, they may dwell on the same topic rather than having a back-and-forth dialogue and may exhibit echolalia--the act of repeating what was just asked. Alternative language and communication skills, including sign language and pictures, may be used to support their ability to communicate.3,13

Body movements and behavior
     Abnormal movements and behavior may be observed, such as hand-flapping, when the child raises and lowers his/her arm rapidly. The wrist is often flaccid so it appears to be flapping in the wind. Hand-flapping may be most frequently observed when the individual is happy or excited. Unusual arm movements may also occur in combination with the child moving the entire body, such as jumping or spinning around in circles. Basic gestures like waving hello or good-bye may not make sense to autistic children. At social events, they may display "inappropriate" behaviors, such as wanting to be left alone or masturbating in public. Motor tics and the inability to remain still may occur, as well.3,13