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Symptoms of Autism

Autism is a developmental brain disorder that usually occurs in children under three years old.  The disease can affect various parts of the brain and result in symptoms such as restricted movement, repetitive movement and impairment of communication and social interaction. 

Some individuals have severe issues with Autism, such as movements involving flapping and rocking.  Others have various communication issues.  Individuals with Autism vary in the amount of assistance they need with daily living.  Some individuals need help with most all of their daily living skills, whereas others might only need occasional supervision to be successful. 

An individual with Autism usually has a pattern of several symptoms rather than just one symptom.  Symptoms usually occur during childhood and can continue through adulthood.  Some symptoms, for instance are showing less attention and reaction to stimuli than other people, not smiling, looking at others or using eye contact with others. 

Quite often, individuals with autism are quite intelligent but have few ways to show their intelligence.  They can understand more than what the people around them such as family, friends and caregivers realize, and in many cases have special abilities ranging from memorization of facts, unique use of computers, and even being a prodigy at music, art or in other areas. 

At least half of parents notice their child’s Autistic symptoms by 18 months and more parents are aware of these symptoms by 24 months of age.  It is essential that diagnosis and treatment be sought right away so that symptoms can be addressed – and minimized – to the fullest extent.

Symptoms that a majority of parents have reported include no babbling or baby talk by age 12 months, no pointing or waving – such as waving goodbye – by 12 months, not trying to say single or individual words by 12 months, no two-word combinations – especially spontaneously – by 24 months, and/or any loss of language or social skills at any age.

If your child – or a child you know – has these symptoms it is essential for them to be seen by their family doctor and/or a specialist as soon as possible so that they can be diagnosed, addressed and hopefully decreased.  There is more information regarding Autism every day, and there are promising treatments to help control or diminish symptoms when they are dealt with early.

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How is Autism Diagnosed?

Since Autism varies from individual to individual, doctors rely on some basic, core behaviors to diagnose Autism. The earlier Autism is diagnosed, the more effective the treatment intervention can.  With more effective intervention comes better skills and less challenging behaviors, making the child with autism much more successful on a daily basis.

The behaviors that doctors look for in order to diagnose Autism include difficulty making friends or connecting with peers,  difficulty initiating or maintaining conversations; minimal patterns of interest – especially when they are abnormal in the amount of focus or intensity, sticking to an inflexible routine or pattern, such as in eating or dressing or other areas of life; staying very preoccupied with or focused on certain specific objects or subjects; using repetitive, stereotyped or unusual language; inability or impairment with regard to social play or imagination. 

Sometimes doctors use questionnaires along with other diagnostic tools.  Questionnaires and other screening tools rely on parents and/or caregiver’s experience and observations of the child.  This input is extremely important because there are many observations that parents and caregivers see on a day-to-day basis that will help the doctor determine helpful information that will enhance the doctor’s evaluation, especially in areas where there might be a question.

Autism is complex and requires not only the child’s doctor, but a team approach including specialists such as a therapist, psychologist, psychiatrist, neurologist, speech therapist and others.  Usually, your child’s primary care physician will gather this team together.  Since Autism affects so many aspects of the individual’s life, having a team of specialists that can compare notes and work together should ensure that the individual is cared for in every aspect of the disease.  This will create the best chance for the biggest improvement.

For information on Autism two of the best resources are Autism Society of America at 1-800-328-8476 or on the web at www.autism-society.org and Autism Research Institute at 1-619-281-7165 or on the web at www.autismresearchinstitute.com.

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Social Impairments in Children With Autism

Social impairments are one of the main symptoms in children with autism. Children with autism do not have merely social difficulties like shyness. The social impairments they have can be challenging enough to cause serious problems in everyday life. A typical infant is very interested in the world and people around them. By a child’s first birthday, he/she will try to imitate words, uses simple gestures, and smile at people. But a child with autism may have a hard time learning to interact with other people. Many young children interact with others by imitating actions like clapping when mom claps. Children with autism may not do this, and they may not show interest in social games like peek-a-boo or pat-a-cake. Although the ability to play games is not an important life skill, the ability to imitate is. Some children with autism appear as though they are not interested in other people at all. Some might want friends but have social problems that make those relationships difficult. They might not make eye contact and might just want to be alone. Many children with autism have a very hard time learning basic social skills like taking turns and sharing.

Children with autism may also have problems with expressing their feelings. They might have trouble understanding other people’s feelings or talking about their own feelings. Many are very sensitive to being touched and might not want to be held or cuddled, which is often a form of social affection people use with each other.

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Extreme Resistance to Change

One symptom of autism is an extreme resistance to change of any kind. Children with autism tend to prefer established behavior patterns and a set environment. They develop rituals in play, oppose change, and may become obsessed with one particular topic.

Autism Research Centre, Department of Psychiatry, University of Cambridge, UK believes that the extreme resistance to change in children with autism is rooted in atypical processing of unexpected stimuli. They have done testing on this topic using auditory event-related MRI to determine regional brain activity associated with passive detection of infrequently occurring frequency-deviant and complex novel sounds in a no-task condition.

Children with autism showed reduced activation of the left anterior cingulate cortex during both deviance and novelty detection. The study confirms previous evidence of atypical brain function related to automatic change detection in autism. Abnormalities involved a cortical network known to have a role in attention switching and attentional resource distribution. These results show a connection to the neurophysiological processes and a child with autism’s resistance to change.

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Signs of Autism

Each child with autism has different communication skills. Some children may have relatively good verbal skills, with only a slight language delay. Whereas others may be not speak at all or have limited ability or interest in communicating and interacting with others. About 40% of children with autism do not talk at all. Another 25%–30% of children with autism have some words at 12 to 18 months of age and then lose them. Other children may speak, but not until later in childhood.Children with autism who do speak may use language in unusual ways. They may not be able to combine words into meaningful sentences. Some children with autism speak only single words, while others repeat the same phrases over and over. Some children repeat what others say. The repeated words might be said right away or at a later time. Although many children without autism go through a stage where they repeat what they hear, it normally passes by age 3. Some children with autism can speak well but may have a hard time listening to what other people say.

Children with autism may have a hard time using and understanding gestures, body language, or tone of voice. Also, facial expressions, movements, and gestures may not match what they are saying. Their voices might sound flat, robot-like, or high-pitched. Children with autism might stand too close to people they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. 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.

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What is “theory of mind?”

You will often hear professionals refer to the term “theory of mind.” Some think of this as being one of the core deficits for individuals with autism. 

Theory of mind is the ability for one person to understand that another person has different thoughts, feelings, and agendas.  For example, I know that I like to eat mayonnaise on crackers.  Even though I love this snack, I also know that not everybody likes this snack.  I understand through theory of mind that just because I like something does not mean that everybody else likes it too!  If I had a party with my friends over, I would make sure that I had more snacks available than just crackers and mayonnaise.

For an individual with autism, they can have a very difficult time with this.  For example, you might have a teenager who loves to talk about computers.  He wants to talk about computers with everybody all the time.  Because of his poor theory of mind, he thinks that because he likes computers that everybody should like computers and want to hear him talk about computers.

As you can imagine because of this challenge with theory of mind, individuals with autism can have difficulty making and maintainting social relationships. Visual supports are available to help teach individuals with autism how to have better theory of mind. 

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Process of Diagnosing Autism

In order to accurately diagnosis autism, there must be an observation of the child’s communication, behavior and developmental levels. One brief observation cannot show a good picture of the child’s true abilities and behaviors. An important component to the diagnosis of autism is the input of the caregiver and a developmental history of the child. There are no specific medical test for autism. However, because many of the behaviors associated with autism are shared by other disorders, various medical tests may be ordered to rule out or identify other possible causes of the symptoms being exhibited. At first glance, some persons with autism may appear to have mental retardation, a behavior disorder, problems with hearing, or even odd and eccentric behavior. To complicate matters further, these conditions can co-occur with autism.

There are several different types of professional that may be better able to observe and test a child in specific areas. A development pediatrician has experience treating health problems of children with developmental delays or handicaps. A child psychiatrist may be involved in the initial diagnosis. They can prescribe medication and provide help in behavior, emotional adjustment and social relationships. A clinical psychologist can help in understanding the nature and impact of developmental disabilities. They can perform psychological and assessment tests, as well as help with behavior modification and social skills training. An occupational therapist will focuses on practical, self-help skills that will aid in daily living, such as dressing and eating. They will also work on sensory integration, coordination of movement, and fine motor skills. A physical therapist will helps to improve the use of bones, muscles, joints, and nerves to develop muscle strength, coordination and motor skills. A speech therapist  will be involved in the improvement of communication skills, including speech and language. A social worker may provide counseling services or act as case manager helping to arrange services and treatments.

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Autism and Social Behavior

Social skills deficit is thought by many to be the key defining feature of autism. Numerous reports written by parents and researchers describe this challenge. However, like other characteristics of autism, social skills is on continuum for these children, they all face different challenges with social skills.

Some children with autism may avoid virtually all forms of social interaction.  They might have tantrums or run away when someone tries to interact with them. As infants, they may arch their back from a caregiver to avoid contact. Other children with autism might appear socially indifferent because they do not seek social interaction with others (unless it is for a specific need). These chidlren do not seem to mind being with people; but at the same time, they do not mind being by themselves. Other children with autism may try very hard to have friends, but they have a difficult time knowing how to get and maintain relationships. This challenge is common among those with Asperger Syndrome. One reason for their failure to make enduring social relationships with others may be the lack of reciprocity in their interactions, since their conversations often revolve around themselves and their own interests.

Recent research shows that many individuals with autism do not realize that other people have their own thoughts, plans, and points of view.  Researchers term this as “theory of mind.” These individuals also appear to have difficulty understanding other people’s beliefs, attitudes, and emotions. As a result, they may not be able to anticipate what others will say or do in various social situations, making social situations very challenging for them.

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Early Signs of Autism

Autism is usually diagnosed when the child is 3 to 4 years old, but most parents sense that something is wrong much earlier. On average, parents start to worry about their child’s development by 18 months of age and voice some of their concerns to a doctor or another professional by age 2. Many physicians and professionals are hesitant to diagnose autism at very early ages. If the child is labeled with a problem too early, parents may reduce expectations for the child and restrict the child’s access to typical experiences and opportunities. Thus, professionals may take on a “wait and see” stance that delays diagnosis, and ultimately the commencement of intervention services. Although such concerns are valid, the benefits of early diagnosis vastly outweigh the risks. As many studies have now shown, early intervention is critical for the best outcome in children with autism, and many believe the earlier the better. Only with a diagnosis can parents begin to obtain necessary intervention services for their child. If you have concerns that a child may have autism, there are five big questions you can ask yourself.

1) Does the baby respond to his or her name when called by the caregiver? Typical babies are very responsive to the voices of familiar people, and often respond with smiles and looks within the first few months of life. They also respond to their own name by looking to the person who called them
2) Does the young child engage in “joint attention”?  Typical towards the end of their first year, infants begin to shift their gaze from toys to people, follow other’s points, monitor the gaze of others, point to objects or events to share interest, and show toys to others.
3) Does the child imitate others? Typical infants can imitate body and facial movements. Another way an infant imitates is with common infant games such as pat-a-cake.
4) Does the child respond emotionally to others? Typical infants are aware of the emotions of others, They smile when others smile at them, or if an infants observe another child crying, they may cry themselves, or looked concerned.
5) Does the baby engage in pretend play? Typically pretend play doesn’t begin until the end of the first year. Their first actions may involve pretending to feed themselves, their mother or a doll, brush the doll’s hair, or wipe the doll’s nose.

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Autism in Infants & Toddlers: What Should you Look for?

Today, it’s really not possible to diagnose an infant younger than 18 months with autism. If you are concerned, however, you can always monitor and track your child’s growth and development milestones.

There are some very useful checklists as well as growth and development tables available at http://www.cdc.gov/ncbddd/autism/ActEarly/ccp/downloadmaterials.html for children of all ages. These milestones do not apply to just autism.

You should look to see if your infant is not meeting any of these normal milestones. It is important to remember, however, that all children and infants develop at a different pace. Just because your infant does not reach a certain milestone on the normal cycle does not mean your child has autism or any other condition, it just might mean you should consult your physician.

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