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What is autism?
Autism is a developmental disorder that is characterized by impaired development in communication, social interaction, and behavior. Autism is classified as a Pervasive Developmental Disorder (PDD), which is part of a broad spectrum of developmental disorders affecting young children and adults--the Autistic Spectrum Disorders (ASD). The range of these disorders varies from severely impaired individuals with autism to other individuals who have abnormalities of social interaction but normal intelligence--Asperger's syndrome. The ways in which autism is exhibited can differ greatly. Additionally, autism can be found in association with other disorders such as mental retardation and certain medical conditions. The degree of autism can range from mild to severe. Mildly affected individuals may appear very close to normal. Severely afflicted individuals may be extremely retarded and unable to function in almost any setting.

In the past, autism has been confused with childhood schizophrenia or childhood psychosis. As additional research information about autism becomes available, the scope and definition of the condition continues to become more refined. Much of the past confusion about the disorder has been resolved.

What are the symptoms of autism?
The current Diagnosis and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) identifies three features that are associated with autism; impairment in social interaction, communication, and behavior. First, patients with autism fail to develop normal personal interactions in virtually every setting. This means that affected persons fail to form the normal social contacts that are such an important part of human development. This impairment may be so severe that it even affects the bonding between a mother and an infant. It is important to note that, contrary to popular belief, many, if not most, autistic children are capable of showing affection and do demonstrate affection and do bond with their mothers or other caregivers. This limited socialization may erroneously lead parents and pediatricians away from considering the diagnosis of autism. As the child develops, interaction with others continues to be abnormal. Affected behaviors can include eye contact, facial expressions, and body postures. There is usually an inability to develop normal peer and sibling relationships and the child often seems isolated. There may be little or no joy or interest in normal age-appropriate activities. Affected children do not seek out other children for play. In severe cases, they may not even be aware of the presence of other individuals.

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autism (ô'tĭzəm) , a developmental disability resulting from a neurological disorder that affects the normal functioning of the brain. It is characterized by the abnormal development of communication skills, social skills, and reasoning. Males are affected four times as often as females. Children may appear generally normal until around the age of 30 months, although studies have identified signs of autism in children under a year of age. Symptoms, which vary widely in severity, include impairment in social interaction, fixation on inanimate objects, inability to communicate normally, and resistance to changes in daily routine. Characteristic traits include lack of eye contact, repetition of words or phrases, unmotivated tantrums, inability to express needs verbally, and insensitivity to pain. Behaviors may change over time. Autistic children often have other disorders of brain function; about two thirds are mentally retarded; over one quarter develop seizures. The cause of autism remains unclear, but a psychological one has been ruled out. Neurological studies indicate a primary brain dysfunction, perhaps related to abnormalities that appear to occur in the way the autistic child's brain develops, and a genetic component is suggested by a pattern of autism in some families. Treatment in which autistic children are intensively and repetitively taught skills and behaviors from a young age appears to help some children with the disorder.

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Symptoms

DSM-IV criteria for autism are based on the absence or delay of certain developmental milestones. There is great diversity in the skills and behaviors of individuals diagnosed as autistic, and physicians will often arrive at different conclusions about the appropriate diagnosis.

Nevertheless, professionals within pediatric care and development often look for early indicators of autism in order to initiate treatment as early as possible. Some of these indicators include:

• Does not babble, point, or make meaningful gestures by 1 year of age
• Does not have "joint regard," in other words the ability attend to something at the request of someone else
• Does not speak single words by 16 months
• Does not combine two words by 2 years
• Does not respond to name

Other indicators:

• Lacks or avoids eye contact
• Does not play with toys functionally
• Excessively lines up toys or other objects, or may engage in other obsessive/compulsive behaviors
• Is attached to one particular toy or object
• Does not smile (socially, but may smile during periods of self-stimulatory behavior)
• Engages in perseverative and/or self-stimulatory behaviors
• Has tactile defensiveness

Social development

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to faces and seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and will avoid eye contact, seeming indifferent to other people.

Autistic children often appear to prefer being alone rather than in the company of others, may resist attention or passively accept such things as hugs and cuddling without caring. Later, they seldom seek comfort or respond to parents' displays of anger or affection in a typical way. Research has suggested that although autistic children are attached to their parents, their expression of this attachment is unusual and difficult to interpret. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.

Autistic children categorically lack 'theory of mind', meaning that they are incapable of behavior cited as exclusive to higher primates such as adult gorillas, adult chimpanzees, adult bonobos and children above the age of five. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people on the autism spectrum have difficulty seeing things from another person's perspective. Typical 5-year-olds understand that other people have different knowledge, feelings, and intentions. An autistic person lacks this understanding, an inability that leaves them unable to predict or understand other people's actions.

Although not universal, it is common for autistic people to have difficulty regulating their behavior. This can take the form of "immature" behavior such as crying in class or verbal outbursts that seem inappropriate to those around them. The autistic individual might also be disruptive and physically aggressive at times, making social relationships still more difficult. They have a tendency to "lose control," particularly when they are in a strange or overwhelming environment, or when angry and frustrated. They may at times break things, attack others, or hurt themselves. In their frustration, some bang their heads, pull their hair, bite their arms, or even cut themselves.

Imaginary friends

The social alienation of autistic and Asperger's people is so intense from childhood that many of them have imaginary friends as companionship. However, having an imaginary friend is not necessarily a sign of autism and may be common in neurotypicals.

Sensory Integration Dysfunction

A key indicator in clinicians making a proper assessment for autism would include looking for Sensory integration disorder. Children will exhibit problems coping with the normal sensory input.

Symptoms may include:

• Over sensitivity to touch, movement, sights, or sounds
• Under reactivity to touch, movement, sights, or sounds
• Specific learning difficulties/delays in academic achievement
• Inability to unwind or calm self
• Difficulty in making transitions from one situation to another
• Tendency to be easily distracted/Limited attention control
• Physical clumsiness or apparent carelessness
• Activity level that is unusually high or unusually low
• Social and/or emotional problems
• Poor self concept/body awareness
• Difficulty learning new movements
• Delays in speech, language, or motor skills
• Impulsive, lacking in self-control

Communication difficulties

By age 3, typical children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he or she hears his or her name, points when he or she wants a toy, and when offered something distasteful, makes it clear that the answer is "no."

Speech development in autism takes a different developmental path than in neurotypical children. Some autistics remain mute throughout their lives, while being fully literate and able to communicate in other ways — images, sign language, and typing are far more natural to them. Some infants who later show signs of autism coo and babble during the first few months of life, but stop soon afterwards. Others may be delayed, developing language as late as the teenage years. Still, inability to speak does not mean that autistics are unintelligent or unaware. Once given appropriate accommodations, many will happily "talk" for hours, and can often be found in autism-focused chat rooms, discussion boards, or websites, or even using communication devices at autism-community social events such as Autreat.

Those who do speak often use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat the same phrase over and over. However, 10% of autistic people are naturally bilingual, meaning they've learned a foreign language before learning their local language in their toddler years, the cause of this is completely unknown, but it may be a possible reason why autistic people use language differently than others. Some repeat what they hear, a condition called echolalia. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many autistics have a strong tonal sense, and can often understand spoken language better if it is sung to them.

Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. The "give and take" of conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to interact with other autistics, they comfortably do so in "parallel monologue" — taking turns expressing views and information. Just as neurotypicals are not designed to understand autistic body languages, vocal tones, or phraseology, autistics similarly have trouble with such things in neurotypicals. In particular, autistic language abilities tend to be highly literal; neurotypicals often inappropriately attribute hidden "meaning" to what autistics say or expect the autistic to sense such unstated meaning in their own words.

The body language of autistics can be difficult for neurotypicals to understand. Facial expressions, movements, and gestures may be easily understood by some other autistics, but do not match those used by neurotypicals. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the neurotypical auditory system often cannot sense the fluctuations. What seems to NTs like a high-pitched, sing-song, or flat, robot-like voice is common. Some children with relatively good language skills speak like little adults, rather than utilizing the immature "kid-speak" that is common in their neurotypical peers.

Since neurotypicals are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let others know what they need. As anybody might do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for neurotypicals to learn to communicate with them, autistics do whatever they can to get through to them. Communication difficulties may contribute to autistic people becoming anxious or depressed.

Repetitive behaviors

Although autistics usually appear physically normal and have good muscle control, unusual repetitive motions, known as self-stimulation or "stimming," may set them apart. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or wiggling their toes, others suddenly freeze in position.

As children, they might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of these toys, the child may be tremendously upset. Autistic children often need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, or going to school at a certain time and by the same route—can be extremely disturbing.

Repetitive behavior sometimes takes the form of a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Often they show great interest in numbers, symbols, or science topics.

Severity of symptoms

Autism presents in a wide degree, from those who are nearly dysfunctional and apparently mentally retarded to those whose symptoms are mild or remedied enough to appear unexceptional ('normal') to the general public. These autistic persons are often classified as "nerds" or "geeks" by their peers.

"Low-" and "high-functioning"

In terms of both classification and therapy, autistic individuals are often divided into those with an IQ<80 referred to as having "low-functioning autism" (LFA), while those with IQ>80 are referred to as having "high functioning autism" (HFA). Low and high functioning are more generally applied to how well an individual can accomplish activities of daily living, rather than to IQ. The terms low- and high-functioning are controversial and not all autistics accept these labels.

This discrepancy can lead to confusion among service providers who equate IQ with functioning and may refuse to serve high-IQ autistic people who are severely compromised in their ability to perform daily living tasks, or may fail to recognize the intellectual potential of many autistic people who are considered LFA. For example, some professionals refuse to recognize autistics who can speak or write as being autistic at all, because they still think of autism as a communication disorder so severe that no speech or writing is possible.

As a consequence, "high-functioning" autistic persons, and autistic people with a relatively high IQ, are under-diagnosed, thus making the claim that "autism implies retardation" self-fulfilling. The number of people diagnosed with LFA is not rising quite as sharply as HFA, indicating that at least part of the explanation for the apparent rise is probably better diagnostics.

Autism as a spectrum disorder

Another view of these disorders is that they are on a continuum known as autistic spectrum disorders. Another related continuum is Sensory Integration Dysfunction, which is about how well we integrate the information we receive from our senses. Autism, Asperger's syndrome, and Sensory Integration Dysfunction are all closely related and overlap.

Some high-achieving individuals are thought to have had some form of autism. However, this may be a favoured diagnosis due to the high current visibility of autism in the popular press.

There are two main manifestations of classical autism, regressive autism and early infantile autism. Early infantile autism is present at birth while regressive autism begins at approximately 18 months. There are also cases of children developing normally from birth but regressing around the age of 18 months, causing some degree of controversy as to when the neurological difference involved in autism truly began.

*** More to read at http://www.answers.com/topic/autism ***

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From the Autism Today Site

According to guidelines published by the New Hampshire Task Force on Autism, a child who has 1 or more indicators for autism (for example, delayed speech) should be referred for more evaluation. The authors (Bryan King, M.D., Carl Cooley, M.D.) then recommend a formal audiological evaluation and lead screening along with a specific tool for screening for autism (such as the Checklist for Autism in Toddlers (CHAT), Pervasive Developmental Disorder Scrrening Test, or Communication and Symbolic Behavior Scales Developmental Profile). Then, if there are still indications that autism is a possibility, the child should be evaluated more comprehensively (communication, sensory, motor, cognitive, social, emotional, behavioral, medical). And, finally, children with autism spectrum disorders can have good eye contact. It’s a matter of how they use their eye gaze (for example, does he look to you to signal enjoyment or to get your attention) and what strengths and challenges he has in other areas of communication and social interaction. Good luck with your little guy. Teresa Bolick, Ph.D.
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From www.childbrain.com

Jack was almost 5 when he was dx'd they could have done it with confidence anytime from shortly after his 1st birthday but we kept hearing that it was too early to dx'd autisim.Lucky for us he was getting early intervention for his other issues,ST,OT,PT, preschool special ed team saw him from 18 months.

i really hope this works out for you Gregsmom and going to the eval armed doesn't sound harsh it sounds sensible to me

best of luck

Dee

Going into an eval arms IS (IMO) THE MOST SENSIBLE thing a parent can do. Show them you are educating yourself. Show them you know what this stuff means. Show them you are serious and advocating for your child. Show them you wont back down or stop fighting for your child's NEEDS!

There are many doctors / specialists WELL EDUCATED in autism spectrum disorders - others are not. Our pediatrician never picked up on Tyler's problems even when he was screaming and non verbal headbanging on the cement floor over nothing. I brought him a daily food / behavior / sleep diary that I kept for months to EVERY APPOINTMENT. I BEGGED for help and finally he sent us to a behavioralist / child psyc.   -  THAT lady knew NOTHING - she said it can't be autism - you can tell hes not mentally retarded

Then theres the neurologist who basically misdiagnosed him as PDD NOS rather than autism which is now changed.... Although I had to go through an autism specialist who re diagnosed him with classic autism and then take that info with all the past evals and a print out of the DSM IV criteria and basically prove to the psyc he does meet all the criteria before he agreed!

So go armed and prepared to battle....  if we dont fight for our kids - who will??? GOOD LUCK!