Many are familiar with Dustin Hoffman’s portrayal of a man with autism in the movie Rainman. We laughed as he repeatedly stated that he only buys his underwear at K-mart and were amazed that he could count the number of toothpicks on the floor with a single glance. Yet, we were mystified that he did not know the cost of a candy bar, how to converse with another person, or how to stop hitting himself when he was upset. Rainman did not pick up on the social nuances of everyday life and often had difficulty effectively communicating his wants and needs. He perseverated on topics that were often not of interest to others and had some unusual and repetitive behaviors. Rainman had autism.
Autism, one of several pervasive developmental disorders (others include Asperger’s syndrome, pervasive developmental disorder not otherwise specified, Rett’s disorder, and childhood disintegrative disorder), is a lifelong neurological disability that affects how the brain functions. It is characterized by delayed and atypical social and communication skills, as well as by the demonstration of repetitive behaviors and restricted interests, which begin before 3 years of age. To receive a diagnosis of autistic disorder, an individual must meet the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision; DSM-IV-TR). The criteria focus on qualitative impairments in (1) social interactions (e.g., failure to develop peer relationships, a lack of sharing enjoyment with others, and poor social reciprocity), (2) communication skills (e.g., delay in language, difficulty initiating or sustaining conversations, stereotypical or repetitive use of language, lack of make-believe play), and (3) repetitive and stereotypical patterns of behavior (e.g., preoccupations, inflexibility, repetitive motor movements).
Although each individual with autism is different, some hallmark characteristics and behaviors include poor eye contact, need for sameness, fascination with parts of objects, selective listening, repeating the same thing over and over, disliking to be touched, preoccupations, rocking, sensitivity to certain textures, hand flapping, delays in communication skills, lack of pretend play, and difficulty understanding social relationships. Individuals with autism have varying levels of cognitive and language abilities, ranging from significantly delayed to above-average abilities.
The prevalence rates for autism vary. Some speculate that 1 in 3,000 people has autism; others suggest that 1 in 250 has some form of autism. The numbers of individuals diagnosed with an autism spectrum disorder have increased over the past few decades. There are numerous theories on why the prevalence rate has increased so dramatically. The increase might be due to a better understanding and acceptance of autism in society, better tools for diagnosing, and the introduction of the autism category for serving children with disabilities in the schools. Autism tends to affect more males than females, although females tend to be more impaired by the disorder than males. Autism affects individuals of all cultures and socioeconomic levels.
The etiology of autism is not clearly understood. When it was initially diagnosed by Leo Kanner in 1943, autism was believed to be the result of unloving and detached parents. As opposed to environmental contributors, autism is now believed to have a biological cause. Although the exact biological cause is unknown, autism has been linked to brain abnormalities and genetic differences on a variety of chromosomes. Recent research suggests that there is a 3% to 7% chance of recurrence of autism in siblings, including fraternal twins. There is a 60% chance that if one identical twin has autism, so will the other. Autism has also been associated with disorders such as fragile X and tuberous sclerosis. Recently, there has been speculation that autism is caused by measles-mumps rubella (MMR) vaccinations, vitamin deficiencies, and food allergies; however, current scientific research does not support these theories.
Interventions For Individuals With Autism
There are currently no medical tests to measure the biological markers of autism. Instead, professionals must rely on observations and reports of behavior. There are various measures available to observe and assess the social, communication, and atypical behaviors of individuals with autism (e.g., Childhood Autism Rating Scale, Autism Diagnostic Observation Schedule—Revised, Checklist for Autism in Toddlers, Autism Diagnostic Interview—Revised). Recently, new instruments have been developed to screen for and detect behaviors and characteristics associated with autism in children as young as 12 months old. Skilled clinicians using available instruments can reliably diagnose children with autism as young as 18 months. Early diagnosis is essential to ensure that appropriate interventions are provided while the brain is still developing.
Although there is not yet a cure for autism, effective treatments to decrease the associated symptoms are available. Some of the more popular interventions include using behavioral techniques, particularly applied behavior analysis (ABA). When using ABA, the antecedents and consequences of behaviors are considered to determine the function of the behavior. For example, does the child engage in the behavior in order to avoid less preferred tasks, to obtain a desired object, to gain attention, or as a means of responding to sensory overload? ABA also focuses on breaking tasks into their component parts. Skills are then systematically taught using direct instruction. Frequent, positive reinforcement is offered. This technique is particularly useful if basic skills, such as eye contact and imitation, are being taught.
Another type of intervention for individuals with autism focuses on teaching developmentally appropriate skills within typical, daily activities. These programs often utilize typically developing peers to act as models for the child with autism. Highly structured classrooms with a small teacher-to-student ratio are essential.
Medical interventions, although not a cure for autism, assist in treating symptoms, such as anxiety, inattention, and obsessive-compulsive behaviors. Medications might include tranquilizers (e.g., haloperidol [Haldol], risperidone [Risperdol]), or selective serotonin reuptake inhibitors (e.g., fluvoxamine [Luvax], fluoxetine [Prozac]). Some of the more controversial treatments for autism include special diets (e.g., gluten-casein free) or high doses of vitamins (e.g., B6). Injections of secretin have also been attempted. These various treatments are considered controversial because there is not a research base supporting their effectiveness, particularly in young children with autism spectrum disorders. Information describing their effectiveness is based on informal data only.
In 2001, the National Research Council formed a committee to review existing literature and research on treatments for children with autism. Based on their findings, the committee put together a list of best practices for the education of children ages birth to 8 with autism. Their findings emphasize the importance of early intervention, 25 to 40 hours per week of intense intervention, one-on-one and small-group instruction to meet individual goals, and the use of planned teaching opportunities that focus on developmentally appropriate activities. Inclusion of families in the intervention processes is emphasized. The National Research Council further suggests that the priorities of intervention should focus on increasing (1) functional communication skills (using words, signing, visual supports), (2) social skills (eye contact, imitation, give-and-take of interactions, using communication skills to interact with others), (3) play skills (playing with a variety of toys, including others in play schemes), (4) cognitive development, and (5) strategies to address challenging behaviors.
Conclusion
Researchers are beginning to have a better understanding of the causes and treatments of autism. However, there is still so much to learn. Just as Rainman methodically looked at the world and recorded his observations, so must we if we are to make a difference in the lives of individuals with autism.
References:
- American Psychiatric (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
- Autism Research Institute, http://www.autism.com
- Autism Society of America, http://www.autism-society.org
- National Alliance for Autism Research, http://www.naar.org
- National Resource Council. (2001). Educating children with autism. Washington, DC: National Academy
- New York State Department of (1999). Clinical practice guideline: Autism/pervasive developmental disorders (No. 4215). Albany, NY: Health Education Services.
- Powers, D. (Ed.). (2000). Children with autism: A parent’s guide (2nd ed.). Bethesda, MD: Woodbine House.
- Wetherby & Prizant, B. (2000). Autism spectrum disorders: A transactional developmental perspective. Baltimore: Paul H Brookes.