By Rachael Heilman; Undergraduate Student, University of Florida

Autism is classified as a Pervasive Developmental Disorder and is the result of a neurological disorder that affects the normal functioning of the brain. (1) People who have autism have difficulty in the social arena, with verbal and nonverbal interactions, and display repetitive behaviors and narrow interests. (2) Out of the five total Pervasive Developmental Disorders, autism is the most common, affecting one out of every 150 births. This would translate to about 1.5 million people in the United States having autism. This number is projected to increase ten to 17 percent per year, according to different governmental agencies. (1) In order to understand autism in further depth, the symptoms, causes, varying lifestyles, and treatments of those with autism will be explored.

Most people are diagnosed with autism between the ages of three and four years old, although it can be diagnosed even sooner. There are certain developmental milestones that mark each age, and if those milestones are not reached, then it is recommended that the child be evaluated for autism. For example, most children babble and coo, gesture and wave by age one. At 16 months, most children have spoken a single word and by age two, it is developmentally appropriate for a child to use two word phrases. If a child has not reached these milestones at the average age then it is suggested that the child is seen by a physician to be assessed for autism. (2)

The three main developmental areas that children with autism have trouble in are social interaction, language, and behavior. For example, it is common for children with autism to avoid making eye contact with others, to choose playing on their own rather than with other children, to have abnormal or a lack of social play, to not respond when someone calls their name, and to have a difficult time being able to understand other people’s feelings or point of view. (3) A child with autism may not gain any insight into the difference between hearing a tone of voice that is angry versus one that is happy. Expressions such as frowns and smiles are not always interpreted or picked up on by a child with autism. (4) In general, it is difficult for children with autism to interpret the world around them and to respond appropriately to outside cues. All of these characteristics make it hard for a child with autism to form connections and meaningful relationships with others.

Communication is another major difficulty for a child with autism. They may be delayed in talking or do not talk at all. For some children it may be difficult to express needs and wants that they have in both a verbal and non verbal way. Some children may speak with a tone or rhythm that is abnormal, such as speaking like a robot or with a singsong voice. It is possible that a child may learn certain words or sentences, but at a later time, be unable to access them. They also may have difficulty understanding how to use words to communicate ideas, and may instead repeat certain words or phrases over and over again. Being able to start a conversation or to keep one going is a difficulty. (3) These difficulties with language are probably not only frustrating for the child with autism when he or she tries to communicate with others but are yet another social barrier.

Additionally, children with autism may exhibit abnormal behaviors such as movements that are repetitive, like rocking or spinning. Some children with autism express great distress if a routine is altered, as routines and rituals are markedly a characteristic of autism. Other unusual behaviors that many children with autism share is a need to move constantly, focusing on parts of a toy, such as just the propellers of a model airplane, rather than the whole, having restricted and narrow interests and being unusually sensitive to light, sound, and touch. (3) An example of how sound, a sensory experience, can be amplified by someone with autism, can be illustrated by Temple Grandin, who has autism, and is a savant, meaning she has an area of specialized genius.

Temple stated, "One of my sensory problems was hearing sensitivity, where certain loud noises, such as a school bell, hurt my ears. It sounded like a dentist drill going through my ears." (5) Due to these altered sensory experiences, children may react in a way that we perceive as extreme, and may even, for example, avoid certain people who have voices that are high in pitch.

While autism results from a neurological abnormality, it is unknown as to what causes these problems with the nervous system. Researchers have, however, discovered that genetics are greatly involved. Evidence suggests that it is not just one gene, but a combination of many, that increase one's risk for autism. For example, in a family that has one child with autism, the risk of having another child with autism is three to eight percent. There is a thirty percent chance that if one monozygotic twin has autism that the other one will as well. Exposure to certain things in the environment may interact with genetics and is another factor that increases the likelihood of autism. (2)

Additionally, underlying medical conditions do not cause but are linked to autism. Some of these medical conditions include metabolic disorders, congenital infections, genetic disorders, developmental brain abnormalities, and neurological disorders occurring after birth. (2) In a normal, developing brain, serotonin levels decline. Some children with autism do not have this decrease in serotonin, leading researchers to wonder if chemicals in the brain may be linked to autism. (6) Race, ethnicity, and socioeconomic levels are not linked to causing autism; however, gender is a factor. Boys are three to four times more likely than girls to have autism. (2)

The number and severity of the symptoms for a person with autism vary greatly, although in order to be diagnosed with autism one must show significant challenges and delays in his or her social interactions, communication (both verbal and nonverbal), and show repetitive as well as restrictive behavioral patterns. Most children who have autism need more time to learn something and to acquire new skills due to their developmental disabilities. (3)

Depending on how severely each area is affected, as well as the combination of deficits that each person has, largely influences their lifestyle and capabilities. Some people who are higher functioning manage to live independent lives, meaning they have a job and live on their own. Other people with autism who are lower functioning will always depend on others for care.

Seventy-five percent of people with autism have IQs below average, while the other twenty-five percent have an average or above average IQ. A very small number of people with autism are also savants, and excel in one given area such as math, art, or music. Some people with autism become aware that they are different than others and become anxious or depressed. The most common time for this to occur is during the teenage years. (2) Although autism is a lifelong challenge, there are many opportunities for growth and learning new skills and appropriate behaviors.

People with autism each need a treatment plan that fits their specific needs and is directly tailored to help them with their weaknesses. There is not a "one shoe fits all" treatment plan but research has shown that the earlier a person with autism gets the treatment they need, the better the outcome is for them in the long run. Ideally, children should begin treatment during or before preschool age. (2) According to the American Academy of Pediatrics, children should be involved in behavioral training and management, special therapies, and may need to take medication. (7)

The purpose of behavioral training and management is to improve communication and behavior. Some methods of doing this are through positive reinforcement, self help, and teaching social skills. (7) Research that has been done over the past 30 years has shown that this method has positive results, which include an improvement in communication, learning, adaptive behavior, and a decrease in socially unacceptable behaviors. (2) One of the goals in behavior therapy, for example, may be to teach the child how to respond appropriately in a given social situation, or to help them communicate ideas or feelings that they have. Another goal may be to try to eliminate certain behaviors that are inappropriate, or to reward behaviors that are socially acceptable.

Speech, occupational and physical therapy are helpful for people who have autism. The aim of speech therapy would be to teach the person how to use language and how to apply it to social situations, so they could be more effective communicators. Occupational and physical therapy would both serve to improve motor skills and coordination. Occupational therapy may additionally help a person with autism to better deal with their skewed sensory perceptions. (7)

Another component to a treatment plan may be the use of medications. Medications should be considered if the person suffers from anxiety, depression, hyperactivity, and obsessive compulsive type behaviors, in order to help manage those symptoms. (7)

Educational therapies are yet another way that children with autism can thrive and grow to their fullest potential. Special education programs that cater to the child’s needs are not only a necessary component to the child’s progress and development, but are required by law through the Individuals with Disabilities Education Act (IDEA). (2) Children with autism do well when in education programs that are highly structured, have routine built into the day, engage their attention, break down tasks into simpler steps, and reinforce behavior. The success of such programs often hinges on a team of specialists that can initiate activities geared to improve social skills, communication and behavior. It is important that parents are involved in their children’s learning, and that they incorporate behaviors and communication skills that their children learned with daily home life. (2)

Finally, physical activity is beneficial for any child, but is especially helpful for people with autism. The upward trend in weight gain among children with autism has lead to more than half of children with autism being either overweight or at risk of being overweight. The primary factor that has been suggested to account for this trend is a decrease in the amount of physical activity that children with autism partake in. Children with autism need to have an exercise program included in their regular routine in order to help manage their weight and to try to avoid health problems such as diabetes, cardiovascular disease, bone and joint problems, and even depression. (8)

While physical activity may initially be a challenge for a person with autism, over time, if the program is properly implemented, it can help the person to overcome difficulties such as limited motor functioning, low motivation, difficulty in planning and self monitoring, a limited attention span, and enhanced auditory, visual and tactile stimuli. Research has shown how aerobic exercise can significantly help to control repetitive behaviors such as body rocking, head-nodding, spinning, hand flapping, and object tapping, thus making it easier for a child with autism to learn and display positive social behavior. Exercise also has been shown to decrease aggressive and self-injurious behavior. It is thought that a highly structured and repetitive exercise routine is helpful due to it distracting from or being similar to the self-stimulating, repetitive behaviors that are associated with autism. (8)

Exercise is additionally beneficial in that it can help release some of the energy in people who are hyperactive and release frustrations, as well as boosting moods in people who are depressed. Physical activity can be used in conjunction with physical therapy to help develop coordination and body awareness. Playing simple games challenge children with autism in a number of ways. When playing a game, one must first know the rules. This requires the child with autism to understand each of the steps and then apply them in the game. This requires that they use their memory and have mental organization.

Playing a game additionally requires cooperation and communication. For example, in order for a child to receive a ball from someone who is rolling it, it is necessary that they pay attention to when the other person is about to roll it, to signal with a gesture or communicate with words when they are ready to receive the ball, or to communicate if they are not ready. Since children with autism have trouble picking up on body language and general communication skills, this task would challenge them and help them with every day social interactions. Gaining ability in a sport may give a child better self esteem, a sense of belonging, and they may even have some fun along the way. Even if the child does not take to playing a sport with other children, it is still beneficial for them to do physical activities such as running or swimming. (8)

The incidences of autism are relatively high and are expected to grow. This is only an additional incentive as to why awareness about the basic facts and needs of people with autism should become basic knowledge. People who have autism each have their own talents and level of potential, and it is our responsibility to continue to educate others and make sure that people with autism are given the opportunities that they need to thrive.



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