Autism affects the way a child perceives the world and makes communication and social interaction difficult. The child may also have repetitive behaviors or intense interests. Symptoms, and their severity, are different for each of the affected areas - Communication, Social Interaction, and Repetitive Behaviors. A child may not have the same symptoms and may seem very different from another child with the same diagnosis. It is sometimes said, that if you know one person with autism; you know one person with autism.
The symptoms of autism typically last throughout a person's lifetime. A mildly affected person might seem merely quirky and lead a typical life. A severely affected person might be unable to speak or care for himself. Early intervention can make extraordinary differences in a child's development. How a child is functioning now may be very different from how he or she will function later on in life.
From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile.
By contrast, most children with autism seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interactions. Even in the first year of life, many do not interact and avoid eye contact in a normal way. They may seem indifferent to other people, and prefer being alone. They may resist attention or passively accept hugs and cuddling. Later, they may fail to seek comfort or respond to parents' displays of anger or affection in a typical way. Research has suggested that although children with autism are attached to their parents, their expression of this attachment is unusual and difficult to “read”. To parents, it may seem as if their child is not connected at all. Parents who looked forward to the joys of cuddling, teaching and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.
Children with autism also are slower in learning to interpret what others are thinking and feeling. Subtle social cures such as a smile, a wave, or a grimace-may have little meaning to a child with autism. To a child who misses these cues, “Come here” may always mean the same thing, whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people with autism have difficulty seeing things from another person's perspective. Most five year olds understand that other people have different thoughts, feelings, and goals than they have. A child with autism may lack such understanding. This inability leaves them unable to predict or understand other people's actions.
Although not universal, it is common for people with autism to have difficulty regulating their emotions. This can take the form of “immature” behavior such as crying in class or verbal outbursts that seem inappropriate to those around them. Sometimes they may be disruptive and physically aggressive, making social relationships even more difficult. They have a tendency to “lose control”, particularly when they're in a strange or overwhelming environment, or when angry or frustrated. At times, they may break things, attack others or hurt themselves. In their frustration, some bang their heads, pull their hair or bite their arms.
By age three, most children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says a word or two, turns and looks when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is “no”.
Some people with autism remain mute throughout their lives; although the majority develops spoken language and all eventually learn to communicate in some way. Some infants who later show signs of autism “coo” and babble during the first few months of life, but they stop. Others may be delayed, developing language as late as age five to nine. Some children may learn to use communication systems such as pictures of sign language.
Children with autism who do speak often use language in unusual ways. They seem unable to combine words into meaningful sentences. Some speak only single words, while others repeat the same phrase over and over. They may repeat or “parrot” what they hear, a condition called echolalia. Although many children with autism go through a stage where they repeat what they hear, it normally passes by the time they are three.
Some children with autism who are only mildly affected may exhibit slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining a conversation. The “give and take” of normal conversations may be hard, although they may often carry on a monologue on a favorite subject, giving others little opportunity to comment. Another common difficulty is the inability to understand body language, tone of voice, or “phrases of speech.” For example, someone with autism might interpret a sarcastic expression such as “Oh, that's just great” as meaning it really is great.
While it can be challenging for others to understand what children with autism are less able to say, their body language may also be difficult to understand. Facial expressions, movements, and gestures may not match what they are saying. Also their tone of voice may fail to reflect their feelings. They may use a high-pitched, sing-song, or flat, robot-like voice. Some children with relatively good language skills speak like little adults, failing to pick up on the “kid-speak” that is common in their peers. Without meaningful gestures or the language to ask for things, people with autism are less able to let others know what they need. As a result, they may simply scream or grab what they want. Until they are taught better ways to express their needs, children with autism do whatever they can to get through to others. As they grow up, they can become increasingly aware of their difficulties in understanding others and in being understood. As a result, they are at greater risk of becoming anxious or depressed.
Although children with autism usually appear physically normal, odd repetitive motions may set them apart from other children. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals repeatedly flap their arms or walk on their toes. Some suddenly freeze in a position.
As children, individuals with autism might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone moves one of the toys, the children may be tremendously upset. Many children with autism need, and demand, absolute consistency in their environment. A slight change in routines, such as mealtimes, dressing, taking a bath, and going to school at a certain time or by the same route, can be extremely stressful.
Repetitive behavior sometimes takes the form of a persistent, intense preoccupation. These strong interests may be unusual because of their content (e.g. Being interested in fans or toilets) or because of the intensity of the interest (e.g. knowing much more detailed information about Thomas the Tank Engine than peers). For example, a child with autism might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Often older children with autism have a great interest in numbers/letters, symbols, dates or science topics.
Physical and Medical Issues that may Accompany Autism
Seizure Disorder, also called Epilepsy, occurs in as many as 39% of people with autism. It is more common in children who also have cognitive deficits than those without. Some researchers have suggested that it is more common when the child has shown a regression or loss of skills.
There are different types and subtypes of seizures and a child with autism may experience more than one type. The easiest to recognize are large “grand mal” (or tonic-clonic) seizures. Others include “petit mal” (or absence) seizures and subclinical seizures, which may only be apparent in an EEG (Electroencephalogram). It is not clear whether subclinical seizures have effects on language, cognition, and behavior.
The seizures associated with autism usually start either early in childhood or during adolescence, but may occur at any time. If there is a concern that a child may be having seizures, a referral to a neurologist is recommended. The neurologist may order tests which may include an EEG, an MRI (Magnetic Resonance Imaging), CT (Computed Axial Tomography) and a CBC (Complete Blood Count).
Children and adults with epilepsy are typically treated with anticonvulsant or seizure medicines to reduce or eliminate occurrence. If a child has epilepsy, it is important to work closely with a neurologist to find the medicine that works the best with the fewest side effects and to learn the best ways to ensure a child's safety during a seizure.
A small number of children with autism may also have an identifiable neurogenetic condition such as Fragile X Syndrome, Angelman's Syndrome, a neurocutaneous disorder called Tuberous Sclerosis, Chromosome 15 Duplication Syndrome or another chromosomal abnormality.
If a child has clinical features, such as a family history or physical symptoms, that are characteristic of one of these disorders, a pediatrician may order tests or may refer a family to a developmental pediatrician, a geneticist and/or a child neurologist for testing. The chance of having one of these abnormalities is a little higher if the child also has cognitive deficits or mental retardation. It is also higher if the child has certain physical features that are characteristic of a given syndrome.
While none of these conditions is curable, it is important to know if a child has one of these syndromes because there may be other medical issues that go along with some of them. Having a known genetic cause for autism may also change your risk of having another child with autism.
Many parents report gastrointestinal (GI) problems in their children with autism. The exact number of children with both gastrointestinal issues such as gastritis, chronic constipation, colitis, celiac disease and esophagitis and autism is unknown. Surveys have suggested that between 46 and 85% of children with autism have problems such as chronic constipation or diarrhea.
One recent study identified a history of gastrointestinal symptoms (such as abnormal pattern of bowl movements, frequent constipation, frequent vomiting, and frequent abdominal pain) in 70% of the children with autism, compared with 42% of children with other developmental disabilities and 28% of children without developmental disabilities.
If a child has symptoms such as chronic or recurrent abdominal pain, vomiting, diarrhea, or constipation, a consult with a gastroenterologist (preferably one that works with people with autism) is recommended. Sometimes the child's physician may be able to help find an appropriate specialist. Pain caused by GI issues is sometimes recognized because of a change in a child's behavior, such as an increase in self soothing, behaviors such as rocking or outbursts of aggression or self-injury. Bear in mind that a child may not have the language skills to communicate pain caused by GI issues. Treating GI problems may result in improvement in a child's behavior.
A popular dietary intervention for GI issues includes the elimination of dairy and gluten containing foods. As with any treatment it is best to consult the child's physician to develop a comprehensive plan. In February 2007, Autism Speaks initiated a campaign to inform pediatricians about the diagnosis and treatment of GI problems associated with autism. For additional information that can be shared with a child's doctor, please click here.
Sleep problems are common in children and adolescents with autism. Having a child with sleep problems can affect the whole family. It can also have an impact on the ability of a child to benefit from therapy. Sometimes sleep issues may be caused by medical issues such as obstructive sleep apnea or gastroesophageal reflux and addressing the medical issues may solve the problem. In other cases, when there is no medical cause, sleep issues may be managed with behavioral interventions including “sleep-hygiene” measures such as limiting the amount of sleep during the day, and establishing regular bedtime routines. There is some evidence of abnormality of
melatonin regulation in children with autism. While melatonin may be effective for improving the ability of children with autism to fall asleep, more study is needed. Melatonin or sleep aids of any kind should not be given without first consulting with the
Sensory Integration Dysfunction
Many children with autism experience unusual responses to sensory stimuli, or input. These responses are due to difficulty in processing and integrating sensory information. Vision, hearing, touch, smell, taste, the sense of movement (vestibular system) and the sense of position (proprioception) can all be affected. This means that while information is sensed normally, it may be perceived much differently. Sometimes stimuli that seem “normal” to others can be experienced aspainful, unpleasant or confusing by the child with Sensory Integration Dysfunction (SID), the clinical term for this characteristic. (SID may also be called Sensory Processing Disorder or Sensory IntegrationDisorder.)
SIDs can involve hypersensitivity, also known as sensory defensiveness, or hyposensitivity. An example of hypersensitivity would be the inability to tolerate wearing clothing, being touched, or being in a room with normal lighting. Hyposensitivity might be apparent in a child's increased tolerance of pain or a constant need for sensory stimulation. Treatment for Sensory Integration Dysfunction is usually addressed with occupational therapy and/or sensory integration therapy.
Pica is an eating disorder involving eating things that are not food. Children between 18 and 24 months old often eat non food items, but this is typically a normal part of development. Some children with autism and other developmental disabilities persist beyond the developmentally typical time frame and continue to eat items such as dirt, clay, chalk or paint chips. Children showing signs of persistent mouthing of fingers or objects, including toys, should be tested for elevated blood levels of lead, especially if there is a known potential for environmental exposure to lead.