INTRODUCTION

Autism (sometimes called “classical autism”) is

the most common condition in a group of
developmental disorders known as the autism
spectrum disorders (ASDs). Autism is
characterized by impaired social interaction,
problems with verbal and nonverbal
communication, and unusual, repetitive, or
severely limited activities and interests. Other
ASDs include Asperger syndrome, Rett
syndrome, childhood disintegrative disorder, and
pervasive developmental disorder not otherwise
specified (usually referred to as PDD-NOS).
Experts estimate that three to six children out of
every 1,000 will have autism.A child with
autism may be perfectly happy one moment, but
all of a sudden become sad or angry, or even
have a tantrum. This may be because they can't
tell people what they want. Taking the wrong
turning, or a certain noise could trigger this
reaction, or simply parking the car on the wrong
side of the road.
CLASSIFICATION

Autism is one of the five pervasive

developmental disorders (PDD)characterized by
widespread abnormalities of social interactions
and communication.Of the five PDD forms,
Asperger syndrome is closest to autism in signs
and likely causes; Rett syndrome and childhood
disintegrative disorder share several signs with
autism, but may have unrelated causes.The
terminology of autism can be bewildering, with
autism, Asperger syndrome and others often
called the autism spectrum disorders (ASD),
introduced by Leo Kanner.
Autism can be divided
into syndromal and non-syndromal autism; the
syndromal autism is associated with severe or
profound mental retardation or a congenital
syndrome with physical symptoms and non-
syndromal autism is unclear.

CHARCTERISTICS
Autism is a highly variable brain development
disorder that first appears during infancy or
childhood, and generally follows a steady course
without remission.Overt symptoms gradually
begin after the age of six months, become
established by age two or three years, and tend
to continue through adulthood, although often in
more muted form.It is distinguished not by a
single symptom, but by a characteristic triad of
symptoms: impairments in social interaction;
impairments in communication; and restricted
interests and repetitive behavior.

Social development

Social deficits distinguish autism and the related

autism spectrum disorders from other
developmental disorders.Autistic infants show
less attention to social stimuli, smile and look at
others less often, and respond less to their own
name. Autistic toddlers differ more strikingly
from social norms; for example, they have less
eye contact and turn taking, and are more likely
to communicate by manipulating another
person's hand.Three- to five-year-old autistic
children are less likely to exhibit social
understanding, approach others spontaneously,
imitate and respond to emotions, communicate
nonverbally, and take turns with others.Older
children and adults with ASD perform worse on
tests of face and emotion recognition.A 2008
Swedish study found that, of individuals aged 15
or older discharged from hospital with a
diagnosis of ASD, those who committed violent
crimes were significantly more likely to have
other psychopathological conditions such as
psychosis.

Communication

About a third to a half of individuals with autism

do not develop enough natural speech to meet
their daily communication needs. Differences in
communication may be present from the first
year of life, and may include delayed onset of
babbling, unusual gestures, diminished
responsiveness, and vocal patterns that are not
synchronized with the caregiver. In the second
and third years, autistic children have less
frequent and less diverse babbling, consonants,
words, and word combinations; their gestures
are less often integrated with words. Autistic
children are less likely to make requests or share
experiences, and are more likely to simply
repeat others' words or reverse pronouns
In a pair of studies, high-functioning autistic
children aged 8–15 performed equally well, and
adults better than individually matched controls
at basic language tasks involving vocabulary and
spelling. Both autistic groups performed worse
than controls at complex language tasks such as
figurative language, comprehension and
inference.

Repetitive behavior

Autistic individuals display many forms of

repetitive or restricted behavior, which the
Repetitive Behavior Scale-Revised categorizes
as follows:

• Stereotypy is repetitive movement, such as

hand flapping, making sounds, head rolling,
or body rocking.
• Compulsive behavior is intended and
appears to follow rules, such as arranging
objects in a certain way.
 • Ritualistic behavior involves the
performance of daily activities the same
way each time, such as an unvarying menu
or dressing ritual. This is closely associated
with sameness and an independent
validation has suggested combining the two
factors.
• Restricted behavior is limited in focus,
interest, or activity, such as preoccupation
with a single television program or toy.
• Self-injury includes movements that injure

or can injure the person, such as eye poking,

skin picking, hand biting, and head banging.

CAUSES

Scientists aren’t certain what causes autism, but

it’s likely that both genetics and environment
play a role. Researchers have identified a
number of genes associated with the disorder.
Studies of people with autism have found
irregularities in several regions of the brain.
Other studies suggest that people with autism
have abnormal levels of serotonin or other
neurotransmitters in the brain. These
abnormalities suggest that autism could result
from the disruption of normal brain development
early in fetal development caused by defects in
genes that control brain growth and that regulate
how neurons communicate with each other.
While these findings are intriguing, they are
preliminary and require further study. The
theory that parental practices are responsible for
autism has now been disproved.

SYMPTOMS

There are three distinctive behaviors that

characterize autism.Autistic children have
difficulties with social interaction, problems
with verbal and nonverbal communication, and
repetitive behaviors or narrow, obsessive
interests. These behaviors can range in impact
from mild to disabling.
Some of these are:
• Avoids cuddling or touching
• Frequent behavioral outbursts, tantrums
• Inappropriate attachments to objects
• Maintains little or no eye contact
 • Over- or undersensitivity to pain, no fear of
danger
• Sustained abnormal play
• Uneven motor skills
• Unresponsiveness to normal teaching
methods and verbal clues (may appear to be
deaf despite normal hearing)
Symptoms of autism may increase in severity
when the child enters adolescence and often
decrease in severity during adulthood.

DIAGNOSIS

Doctors will often use a questionnaire or other

screening instrument to gather information about
a child’s development and behavior. Some
screening instruments rely solely on parent
observations; others rely on a combination of
parent and doctor observations. If screening
instruments indicate the possibility of autism,
doctors will ask for a more comprehensive
evaluation.A comprehensive evaluation requires
a multidisciplinary team including a
psychologist, neurologist, psychiatrist, speech
therapist, and other professionals who diagnose
children with ASDs. The team members will
conduct a thorough neurological assessment and
in-depth cognitive and language testing. .
TREATMENT

Treatment includes the following:

• Behavior modification
• Communication therapy
• Dietary modifications
• Medication

Behavior modification

Most types of behavior modification are based

on the theory that rewarded behavior is more
likely to be repeated than behavior that is
ignored. This theory is called applied behavior
analysis (ABA).Behavior modification often
involves highly structured, skill-oriented
activities that are based on the patient's needs
and interests. It usually requires intense, one-on-
one training with a therapist and extensive
caregiver involvement.
Sensory integration
therapy is a type of behavior modification that
focuses on helping autistic patients cope with
sensory stimulation. Treatment may include
having the patient handle materials with
different textures or listen to different sounds.
Play therapy is a type of
behavior modification that is used to improve
emotional development, which in turn, improves
social skills and learning.
Communication therapy

Communication therapy is used to treat autistic

patients who are unable to communicate
verbally, or to initiate language development in
young children with the disorder. Speech
therapy may be used to help patients gain the
ability to speak.
Picture exchange
communication systems (PECS) enable autistic
patients to communicate using pictures that
represent ideas, activities, or items. The patient
is able to convey requests, needs, and desires to
others by simply handing them a picture.

Dietary modifications

Researchers have found elevated levels of

proteins found in wheat, oats and rye (gluten)
and casein (protein in dairy products)
byproducts in patients with autism, suggesting
that the incomplete breakdown or excessive
absorption of these substances may affect brain
function. Eliminating foods that contain gluten
and casein from the diet may cause side effects
and should not be done without the advice of a
health care practitioner.
Studies have shown
that vitamin B, magnesium (improves the effects
of vitamin B), and cod liver oil supplements
(which contain vitamins A and D) may improve
behavior, eye contact, attention span, and
learning in autistic patients. Vitamin C has been
shown to improve depression and lessen the
severity of symptoms in patients with autism.

Medication
Medication may be used to treat various
symptoms of autism (e.g., attention difficulties,
anxiety) and can also be used to treat conditions
that may accompany the disorder (e.g.,
epilepsy).Depression, obsessive-compulsive
behavior, and anxiety may be treated using
antidepressants. These drugs often reduce the
frequency and intensity of repetitive behavior;
decrease irritability, tantrums, and aggression;
and improve eye contact and responsiveness.
Side effects include headache, insomnia,
dizziness, and drowsiness. Medications include
the following:

• Amitriptyline (Elavil®)
• Bupropion (Wellbutrin®)
• Clomipramine (Anafranil®)
• Fluvoxamine (Luvox®)
• Fluoxetine (Prozac®)

CONCLUSION

Our perception of autism has evolved over time.

Sixty years ago autism was nothing more than
an unrecognized developmental delay generally
lumped in with mental retardation. Today it is
recognized as an independent neurologically
based disorder of significance, a major public
health problem, and a topic of much research.
Researchers have struggled to find a cause for
the disorder without great success. Despite this
difficulty, research continues in ever more
sophisticated directions. Numerous treatments
have been developed that help autistic and PDD
diagnosed children to maximize their potential
to learn and become socially fluent, no matter
how impaired they may be. Though no
breakthroughs appear likely to occur any time
soon, there is cause for hope.