Autistic Disorder, or autism, is a pervasive developmental disorder found in both children and adults but always diagnosable during childhood. It is characterized by impaired communication and social interaction, uneven cognitive skills, and limited interests (American Psychiatric Association, 2000). Autistic Disorder is sometimes referred to as “Kanner’s autism” to distinguish it from the other variations of the disorder, including Asperger’s Disorder (Mesibov, Adams, & Klinger, 1997).
Autism occurs more often in males. However, it tends to be more severe when it occurs in females (Mesibov, Adams, & Klinger, 1997). Although some autistic people have savant skills like the extraordinary counting ability of Raymond in the movie Rain Man, the actual incidence of savants among the autistic population is about 10 percent (Grandin, 1995). Autism was originally considered a psychotic disorder. In the DSM-III, published in 1980, it was finally classified as a pervasive developmental disorder (Mesibov, Adams, & Klinger, 1997).
Autism as a disorder first appeared in the scientific literature in 1943, when Leo Kanner published his paper “Autistic Disturbances of Affective Contact.” This study gave case descriptions for 11 children who showed similar behaviors and cognitive processes but did not qualify for a diagnosis of childhood schizophrenia. Kanner used the word “autism,” which specifically describes withdrawal within oneself, because he considered social withdrawal to be the defining characteristic of this disorder. Kanner specified social withdrawal, insistence on sameness of routine, and abnormal use of language as the three areas in which autistic children were different from normally developing children (Mesibov, Adams, & Klinger, 1997).
In 1944, unaware of Kanner’s research on autism, Austrian physician Hans Asperger published a paper in German discussing what he termed “autistic psychopathy.” The fact that both Kanner and Asperger used the word “autistic” is said to be a coincidence. In 1981 Lorna Wing published an article building on the information described by Asperger decades earlier. Wing’s article brought to public attention the disorder that came to be known as Asperger’s syndrome. Experts do not agree whether this is a disorder distinct from autism, with different symptomology, or whether Asperger’s is simply a less severe form of autism (Mesibov, Adams, & Klinger, 1997). However, some consider motor clumsiness to be a primary feature of Asperger’s, while it does not occur with high frequency in autistic people (Mesibov, Adams, & Klinger, 1997).
In the years following Kanner’s research, psychologists approached the concept of autism through a psychoanalytic view, which held that autistic behavior in children was a result of difficulty relating to cold and unresponsive parents, particularly the mother (Mesibov, Adams, & Klinger, 1997). Bruno Bettelheim compared the withdrawal of autistic children to similar behaviors that he had witnessed in concentration camps, concluding that autism was a result of emotional deprivation (Mesibov, Adams, & Klinger, 1997). However, initial research on autistic children began to show that most families only had one child with autism, which conflicted with the view of autism as a reaction to cold parenting. Comparisons to children raised in emotionally deprived institutional settings, who tended to have delayed language but not abnormal use of language, also suggested that parenting style was not to blame for this disorder. In 1979, a qualitative study demonstrated that parents of autistic children did not interact any differently with their children than parents of normal children, while a different study involving the administration of the Minnesota Multiphasic Personality Inventory to parents of autistic children also showed their relative normalcy (Mesibov, Adams, & Klinger, 1997).
Later, more attention was paid to the possible biological nature of autism. Researchers noticed that many autistic children also have seizure disorders. Although seizures do not cause autism, it is likely that both disorders stem from similar brain abnormalities (Mesibov, Adams, & Klinger, 1997). Many autistic people lack the sensation of nystagmus, which is the temporary neurological disturbance (such as dizziness or loss of balance) that occurs when the body’s equilibrium is disturbed. Thus, autistic children often enjoy spinning in circles repeatedly without getting the dizzy feeling that normal children experience when doing so (Mesibov, Adams, & Klinger, 1997).
Twin studies investigated a possible genetic link in autism. Studies in the 1970s found that in pairs of twins, if one twin was autistic, the other twin was likely to also be autistic. However, this was not true in every case. Researchers theorized that perhaps it was not autism disorder specifically that was passed down genetically, but instead a broad linguistic or cognitive impairment that is just one feature of autism. This was supported by the fact that some of the non-autistic twins of autistic children did have some degree of social or cognitive disturbance that did not qualify as full-blown autism. A 1989 study showed that autism is much more likely to occur in siblings of autistic people than in the general population (Mesibov, Adams, & Klinger, 1997).
Autism frequently occurs along with gene disorders. These include Fragile X syndrome, which is marked by enlarged testicles, mutations of face and ear shape, hyperactivity, and mental retardation; phenylketonuria (PKU), which is an inability to break down an amino acid found in many foods that leads to mental retardation; and tuberous sclerosis, in which patients demonstrate lesions on the skin and brain as well as mental retardation and seizures (Mesibov, Adams, & Klinger, 1997).
Autism in children can sometimes be confused with Attention Deficit/Hyperactivity Disorder (ADHD). Autistic children often have difficulty following spoken instructions, have trouble concentrating, appear not to listen when addressed, and seem generally spacey. These qualities are also commonly found in ADHD children. However, the autistic child exhibits these symptoms for different reasons than the ADHD child. Lovaas suggested that when autistic children are presented with multiple stimuli at once, they only respond to a limited number of stimuli. He called this concept the stimulus overselectivity theory (Mesibov, Adams, & Klinger, 1997).
Autism can also be confused with Obsessive-Compulsive Disorder (OCD) because the autistic person’s behaviors, such as repetitive rocking and excessive interest in a limited topic, can seem similar to OCD behaviors. However, OCD individuals usually do not have the impaired communication and social relations seen in autistic individuals. OCD people also tend to be distressed by their ritual behaviors, whereas autistic people find comfort in sameness and repetition (Mesibov, Adams, & Klinger, 1997).
Another disorder that overlaps with autism is mental retardation. They share several symptoms, including self-stimulation and self-injuring, attention problems, and echolalia (repeating words that they hear). However, there are many autistic people of normal or above-normal intelligence, as well as many mentally retarded people who do not have autism. A 1984 study reported that 23 percent of autistic people have normal or near-normal intelligence; about 50 percent have IQs that fall between 50 and 70, and about 27 percent are severely mentally retarded (Mesibov, Adams, & Klinger, 1997).
Some researchers consider autism to be present from birth. Many autistic infants resist being touched and pull away from the parent’s embrace (Grandin, 1995). However, symptoms of the disorder are not immediately apparent in infancy and typically show up clearly in early childhood (Happé, 1994). Temple Grandin, an extremely high-functioning autistic woman with a doctorate in animal science, writes that she showed the classic signs of autism at the age of two years: “no speech, poor eye contact, tantrums, appearance of deafness, no interest in people, and constant staring off into space.” Doctors at the time did not know about autism, and Grandin was labeled as “brain damaged” for several years (Grandin, 1995).
Donna Williams, who wrote an autobiography detailing her experience as an autistic person, lists several autistic behaviors she exhibited frequently while growing up: compulsive blinking (to make events seem as if they are happening in slow motion), switching lights on and off, repetitive dropping of objects, jumping from heights (which she says felt similar to rocking back and forth), rocking from one foot to another, tapping her chin repeatedly, head-banging, looking “past” or “through” people instead of making eye contact, and feeling connections with significant favorite objects rather than with people (Williams, 1992). Temple Grandin reports that she still feels more of an emotional connection with places than with people (Grandin, 1995).
A primary feature of autism is impairment in social functioning. However, this is not necessarily a global impairment; autistic people may respond differently to different people or types of interaction, and many of them do willingly interact with others, although in strange or inappropriate ways (Happé, 1994). Donna Williams says that she was unable to remember all of the specific behavioral rules for each situation and also unable to generalize about social behavior (Williams, 1992). Likewise, the communication impairment in autistic people covers a broad range of behaviors, from total muteness to echolalia to verbal interaction of limited coherence (Happé, 1994).
Children with autism generally do not engage in imaginative play. Rather than pretending to drive and crash a toy car, the autistic child may simply spin the car’s wheels over and over again (Happé, 1994). Temple Grandin remembers that as a child she would sit for hours dribbling sand through her fingers, watching each individual grain of sand fall (Grandin, 1995). Autistic people tend not to be interested in fictional stories, instead preferring to memorize facts regarding a specific topic (Happé, 1994).
Autistic people frequently demonstrate uneven cognitive skills, being unusually good at one type of thought process while being unusually bad at others. For example, they often do better on nonverbal, visually-based tasks than on language tasks (Mesibov, Adams, & Klinger, 1997). Temple Grandin writes, “I think in pictures. Words are like a second language to me” (Grandin, 1995). Many people with autism have an exceptionally good rote memory and enjoy reciting detailed mundane information such as bus schedules (Mesibov, Adams, & Klinger, 1997).
People with autism tend to show extreme responses to sensory input. They may be hypersensitive to sound, touch, and light (Mesibov, Adams, & Klinger, 1997). They may show flat or inappropriate affect (Mesibov, Adams, & Klinger, 1997). Hyperactivity and aggressive or impulsive behavior are also common (Mesibov, Adams, & Klinger, 1997).
The DSM-IV-TR requires all of the following for a diagnosis of Autistic Disorder. First, social impairment may include failure to use nonverbal behaviors to communicate, inability to develop friendships with peers, failure to try to point out interesting things to others, and failure to respond reciprocally to social or emotional overtures. Second, communicative impairment is demonstrated by delay or lack of spoken language, inability to start or participate in a conversation, repetitive or odd use of language, or the absence of pretend play. Third, a narrow pattern of interests and behaviors is shown by preoccupation with at least one abnormally intense fascination with a topic or activity, rigid adherence to rituals or daily routines, and repeated distinct movements of a body part or whole-body movement. There should also be abnormality or delay, starting before age 3, of social relations, use of language in interacting with others, or pretend play (American Psychiatric Association, 2000).
It has been noted that autism should not be diagnosed hastily or based on one source of information. Diagnosis should be based on behavioral observations, parent interviews, and structured measurement instruments such as the Childhood Autism Rating Scale (CARS) (Mesibov, Adams, & Klinger, 1997).
In the 1960s, the Lovaas method of treating autism was developed based on behavioral learning theory. It focused on stopping unwanted behaviors (such as rocking or head-banging) by using behavior modification techniques. Unwanted behaviors were not rewarded, while desirable behaviors were positively reinforced. While this treatment did have some effect, Lovaas felt it was not effective enough, especially pertaining to self-injurious behavior. He began to institute punishments, such as spanking or electric shock, in attempts to stop this kind of behavior in autistic children (Mesibov, Adams, & Klinger, 1997).
These days, operant conditioning techniques are often used with autistic children. For instance, if the child can properly name a toy during a language session, he or she is rewarded by being allowed to play with the toy (Mesibov, Adams, & Klinger, 1997). Some experts feel that early intervention is the key to preventing developmental losses caused by the onset of autism, while others feel that this type of program is unnecessarily intensive and that there is no “magic window” for stopping autism in its tracks (Mesibov, Adams, & Klinger, 1997).
Especially with adults, medication is often used to treat the symptoms of autism. There is no pill that will cure autism, but certain antidepressants have been shown to be effective in reducing sensitivities and social anxiety associated with autism. Autistic people often respond to these medications at one-quarter the normal dose. Neuroleptic medication such as Haldol, which is frequently given to institutionalized autistics, can be toxic to the nervous system and lead to a disorder similar in symptomology to Parkinson’s disease (Grandin, 1995).
Dr. Stephen Edelson, of the Center for Study of Autism in Salem, Oregon, believes that upon learning that their child is autistic, parents should take three immediate steps. The first step is to make sure that the child has no health conditions that could cause autistic symptoms, such as food allergies or exposure to toxins. The second step is to begin an intensive behavioral intervention program. Finally, parents should attempt to alleviate sensory hypersensitivity in any way possible (Edelson, 2006).