The information provided in this article is for educational purpose and can not be meant to diagnose or treat and must not take the place of personal consultation, as applicable, with a qualified healthcare professional.
1. Understanding Autism: What is Autism?
2nd April is worldwide celebrated as World Autism Awareness Day. This is to bring sentience and cognizance among society to be more sensitive for needs and betterment of those suffering from Autism. In the year 2017, the Autism Societies across the globe have launched programs like ‘Autism Awareness Month’, ‘Autism Awareness Campaigns’ and ‘Autism Speaks’ in order to draw the attention of masses towards acceptance and awareness of the disease.
What’s Autism?
Autism is a lifelong condition that cannot be cured but managed through various supportive therapies and learning programs. It comes under the category of development disorder and characterized by deficit in cognitive, emotional, social and personal development. The people with autism have impaired ability to communicate and interact.
The Different Types of Autism:
Autism is a lifelong neurological disorder that comes under a broader group of disorders called “Pervasive Development Disorders”. The five disorders or five types of autism included under the family of Pervasive Developmental Disorders are-
✔ Autism
✔ Asperger’s Syndrome (Autism Aspergers)
✔ Rett’s Disorder
✔ Childhood Disintegrative Disorder (CDD) and
✔ Pervasive Developmental Disorder-Not Otherwise Specified (often written as PDD-NOS).
This classification in in accordance to DSM-IV criteria. In order to create a more dimensional classification system, the global changes in DSM-5 gave the diagnostic label of ‘Autism Spectrum Disorder’ to three conditions-Autistic Disorder, Asperger’s Disorder and PDD-NOS. The Rett’s disorder and CDD have been excluded in the DSM-5 criteria.
What is Autism Spectrum Disorder?
The Autism Spectrum Disorder (Autism) is a range of disorders in which symptoms vary in a continuum from severe to less severe impairments. The disease usually affects children by 3 years of age and is characterized by persistent deficit in social communication and social interaction. There are unusual repetitive and restricted behavioral activities with no obvious purpose. The child lives in his/her own world and may show little or no interest in people around him.
2. Characteristics of Autism : Autism Checklist
The characteristic symptoms of autism in children and adults are-
1. Deficit social communication
2. Deficit non-verbal communication
3. Lack of social interaction
4. Difficulty in maintaining relationships
5. Lack of social and emotional reciprocity
6. Repetitive rigid behavior and interests
7. Hyper or hypo sensitivity to sensory stimuli
8. Predictability and symmetry in routine
9. Restricted and fixated interests
10. Stereotyped motor and verbal behavior
3. Signs and Symptoms of Autism
The early signs and symptoms of autism can be seen in babies and toddlers as the disease usually manifests itself in the initial years of life. The disorder that usually starts in early childhood manifests itself fully in later life when social demands exceed the limited capacities of an autistic adult.
The clinical picture of autism is studied under the following headings-
A) Persistent deficit in social communication and social interaction across multiple contexts
Deficit socio-emotional reciprocity:
This is exhibited as failure of normal back-and-forth conversation, reduced sharing of interest, emotions or affect, lack of initiation and response to social interactions.
Deficit non-verbal communicative behaviors:
The symptoms are- poorly integrated verbal and non-verbal communication, lack of facial expressions, difficulty in maintaining eye-contact, and limited use of gestures and body language.
Deficit in developing, maintaining and understanding relationships:
There is a lack of interest in peer group, difficulty in making friends and adjusting behaviors according to varying social context.
B) Restrictive and repetitive behavioral interests and activities
Stereotyped or repetitive motor movements:
This is displayed as lining up toys, flipping objects, use of idiosyncratic phrases and echolalia.
Ritualized pattern of verbal and non-verbal behavior:
For example, adherence to routines, insistence on sameness, eating same food or taking same route daily, rigid thinking patterns and unusual distress with little changes.
Rigid and fixated interests:
This is shown as strong attachment to objects and excessively circumscribed or perseverative interests.
Unusual interests in sensory environment:
The symptoms include marked indifference to pain / temperature, visual fascination with lights and movements and adverse response to a specific sound or texture.
The above symptoms are usually associated with marked impairment in social, educational, occupational and other functioning domains of life of an autistic person.
4. What causes Autism?
The following are some key theoretical perspectives, which attempt to explain the autistic behaviors-
1. The Mindblindness theory (The Theory of Mind, ToM; Simon Baron-Cohen, 2009)
The Mindblindness theory, also known as ‘mentalising’ or ‘mindreading’ theory, proposes that the autistic individuals have a delayed development of ToM and as a result they are unable to understand the motives, intentions and beliefs of others. They are incapable of understanding the perspective of others; especially if that perspective is different from their own. This is the reason that they find behaviors of others confusing, unpredictable and even frightening.
2. Central Coherence Theory (Frith, 1989)
According to the Central Coherence Theory, the autistic people lack central coherence due to which they cannot integrate information and remain focused on the small-localized details only. They perceive information of environment in small discrete fragments and are incapable of making a global and integrated interpretation. This theory explains communication deficits and echolalia in autistic individuals as they focus on the part of conversation instead of making meaning of the entire message.
3. Executive function theory
Executive Function is the higher–order cognitive functioning of the brain that controls and directs thought processes, movement and attention. In other words, executive function is a term that encompasses a variety of mental processes responsible for purposeful activity, such as planning, memory and activity focused attention. Proponents of this theory assume that the autistic people have impaired executive functions and thus, are poor in planning, self-organization, and directing and switching attention from one task to the other.
Despite recent advances in our knowledge of etiology, the exact cause of autism remains unknown and theories partially explains the cause of the disorder. Many researchers also believe that autism is genetic in nature and consider it a hereditary disorder. However, the true cause of the disease remains elusive.
5. Treatment of Autism : Treatment, Cure & Therapy for Austism
‘Can autism be cured?’ – A question that a clinical psychologist commonly encounters when dealing with the family and friends of people with autism. Unfortunately, till date, cure for autism does not exists. It is a lifelong neurological deficit that cannot be completely cured. However, early intervention and therapies can help an autistic child to develop the full potential. Thus, the goal of treatment is to improve the overall capability of the child to function to an optimum level. The following interventions help in the treatment of autism-
1. Diagnosing Autism:
The diagnosis of autism is possible even at ages as young as six months. It is highly recommended to screen and diagnose the children at an early age so that interventions can be started as early as possible. The diagnosis is usually done on the basis of DSM-5 criteria of the disease.
2. Autism Spectrum Therapies:
Autism spectrum therapies is a group of therapies given to children and adults suffering from autism in order to make them functional and improve their living standards. Applied Behavioral Analysis (ABA) is a widely adopted behavioral training program based on the principles of learning. ABA fosters positive behaviors, eliminates negative behaviors, and inculcates a variety of desirable skills in an autistic child. The child learns the skills and apply in new situations. The various types of ABAs used in the treatment clinics and schools are- Early Intensive Behavioral Intervention (EIBI), Discrete Trial Teaching and Pivotal response Training. The techniques use rewards, reinforcements, prompts as useful means to shape the behavior of a child.
3. Speech therapy:
As autism leads to deficit social communication and interaction, early speech therapy can help a child to be expressive of needs and desires. Training in verbal and nonverbal communication skills improves the ability of a child to connect with the environment.
4. Occupational therapy:
Occupational therapy is advisable for improving sensorimotor issues and sensory integration in autism. Learning to perform fine motor movements like dressing, using utensils, writing etc. makes a child independent and grow confident. Research shows that occupational therapy helps in improving the quality of life of autistic individuals.
5. Physical therapy:
Physical therapy teaches an autistic child to be more skilled in everyday activities like walking, sitting, hand-to-eye-coordination, balancing and better sense of positioning of the body in space. Physical therapy is generally included in the early intervention treatment program of autism.
6. Parental involvement and Community support:
Parental support and involvement are essential for the care of an autistic child. Parents should be taught to provide intensive care and training to the child. Besides, community awareness and acceptance of autism is essential for the suffering people to better adapt and thrive with the disorder.
7. Pharmaceutical treatment:
Though no medicine can permanently cure autism, certain drugs are helpful in ameliorating the behavioral symptoms. In the more severe forms, medications are required to control aggression, irritability, temper tantrums and self-injurious behaviors of autism.
6. Living with Autism: Teaching children in classroom settings
The issue of teaching children with autism through mainstreaming in classroom settings is a controversial debate in academia and practical settings. Whether autistic children should be taught in general education settings along with their neurotypical peers or they should receive individualized instructions in special education classrooms is a matter of research that requires thorough investigation.
Presently, the increasing trend of mainstreaming disabled children with full inclusion is a mandate of government laws that facilitates students with disabilities to receive education in general settings. The criteria of full inclusion entails that there should be no special separate classes for children with disabilities. These children should attend local neighborhood schools and receive training and education in general education curriculum. The principle of least restrictive environment (LRE) states that the children with disabilities are to be taught with children without disabilities to the maximum extent possible. Only in certain extreme circumstances where the nature of disability is such that the supplementary aids and services are required for a disabled child, he/she should be put to a special school.
Many benefits of mainstreaming and full inclusion are documented in the literature. The mainstreaming helps autistic children to engage and learn behavior from their neurotypical peers Imitation of behavior through observational learning helps them perform tasks in better ways. There is a greater acceptance of both the groups for each other and they learn to be familiar with people who are different from them. Acceptance of autistic children by their neurotypical classmates develop their self-esteem and leads to better academic learning.
The social interaction of autistic children also improves while engaging with non- autistic children. The environment of special school exposes them to similar kinds of children and they have fewer opportunities to have social conversations with neurotypical peers. However, mainstreaming makes these opportunities wider and they have a chance to communicate with children without disabilities.
Besides these benefits, there are many drawbacks associated with the mainstreaming. There is a risk of autistic children being rejected from their classmates. Neglect is a common occurrence in schools where special training is not provided to teachers, supporting staff and students’ associations regarding the ways to proper mainstreaming of autistic children. In such a case, autistic children are disregarded and no attention is given to their needs. They feel sad, depressed and may get detached with the school environment.
It is also seen that the autistic children do not take initiation to interact and be friends with other children. Besides the fact that they are surrounded by their peers, they are disinterested in conversing with them. Many a times, the general educational classroom environment overstimulates them. The loud noise of peers, colorful materials and fast-paced talking of other children are disturbing and painful for them. The physical organization of classroom disorients them and they are not able to decide where to go and what route to take. Their physical and psychological equilibrium is disturbed due to this overstimulating environment. This makes them further unwilling to engage in activities with their peers and leave them aloof and shelved.
Further, children with autism have cognitive impairments due to which they are not able to cope up with the general curriculum. Language deficits make them unable to understand verbal instructions of the teacher clearly. Poor and slow imitation keep them at a distance from their peers in classroom activities. They require individualized instructions of a special educator who can present information in a form that they can comprehend. They require prompts and cues to understand and perform the tasks. At times, they need to be skilled in a special activity which is not possible in a regular classroom.
The training of regular teachers is also an issue worth considering. The research indicates that the regular classroom teachers are not sufficiently trained to educate autistic children along with their neurotypical peers. They are apprehensive of classroom modifications and required support services for autistic children. There is a dearth of arrangements in the schools such that both regular classroom teacher and the special educator can perform their individual roles in inculcating appropriate skills in these children.
There are benefits and drawbacks of mainstreaming and full inclusion of autistic children. Till date, disadvantages outweigh advantages. However, future research should propose an integrated model so that mainstreaming can help these autistic children to better adapt in their academic, social and occupational environments.
7. Famous People with Autism
The following are a list of some well known personalities who had Autism.
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