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What is Autism?

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What is Autism?
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To mark World Autism Day on 2nd April 2016, we review this diverse condition. We uncover some probable causes, help parents understand the condition and look at best practices for treatment.

What is Autism?

Defining and understanding autism is difficult, scientific research still has a long way to go to understand this complex condition. Autism itself is a wide term that encompasses different symptoms, from mild to severe, which is why it is more accurately called Autism Spectrum Disorder (ASD).

“Autism Spectrum Disorder (ASD) is characterized by early onset socialization and communication difficulties, associated with restricted interests and behavioural rigidities. This condition is among the least understood developmental disorders of childhood. There is growing body of research on ASD, making it critically important that paediatricians, family physicians, child psychiatrists, general psychiatrists, neurologists, clinicians, psychologists, teachers and family members are well informed about these conditions. Recent epidemiological studies show that 1 in 68 children have autism.”

Dr. Muhammad Waqar Azeem, Chair of the Department of Psychiatry at Sidra Medical and Research Center and Deputy Chair of WISH Autism Research Forum.

The Diagnostic and Statistical Manual for Mental Disorders (DSM Edition 5) defines Autistic Spectrum Disorder using two major categories of symptoms, communication and behaviour:

A. Persistent deficits in social communication and social interaction, including:
Reduced sharing of interests or emotions; lack of nonverbal communication; abnormalities in eye contact and body language; limited understanding and use of gestures; lack of facial expressions; problems in developing, maintaining, and understanding relationships; difficulties in imaginative play or making friends; absence of interest in peers.

B. Restricted, repetitive patterns of behaviour, interests, or activities, including at least two of the following: repetitive motor movements or phrases; insistence on sameness; inflexible adherence to routines; ritualized patterns of behaviour; difficulties with transitions; rigid thinking patterns; fixated interests that are abnormal in intensity or focus; unusual reactivity to sensory aspects of the environment (e.g. indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or movement).

To meet the definition criteria symptoms must:

  • Be present in the early developmental period (but may not become fully manifest until later)
  • Cause significant impairment in social or occupational functioning.
  • Not be attributable to another medical or neurological condition (e.g. intellectual disability, developmental delay, or another mental disorder).

Symptoms of Autism

Common signs of the disorder are displayed in early childhood, typically before the age of three. Children will usually display some of these characteristics with a huge variation in severity:

  • Reduced eye contact with familiar people.
  • Reduced response to facial expressions, such as returning a smile.
  • Reduced reciprocal response to emotions.
  • Increased amount of repetition.
  • Reduced response to their name and/or familiar voices.
  • Reduced use of gestures, such as pointing.
  • Use of attention seeking noises or baby talk.
  • Significant language delay.
  • Difficulty asking for help.
  • Increased sensitivity to sounds, light and touch

Concerned parents whose children display multiple signs or symptoms from this list of the DSM5 definition should seek medical advice promptly, since early detection improves treatment outcomes. [1]

Children in the spectrum develop differently; some find developing cognitive, motor, language and social skills harder than others. Learning and memory can be inconsistent and unpredictable because understanding and interacting is often difficult.

In mild cases, this might be seen as social clumsiness because they miss verbal and non-verbal communication cues. Acute symptoms make it seem like they are simply not interested in others, locked in a world of their own. Children may lack play and conversation skills, or seem stubborn and obsessive about specific interests. Intonation can often be incorrect and a symptom called echolalia, repeating specific words or phrases, is common. Empathy may be weaker or stronger than people outside the spectrum, making socialization difficult. At the less functional end, children may not be able to speak at all.

There may be sensory issues, which also affects how they react to sudden loud noises and smells, as well as variations in lighting or temperature. Changes in their environment, such as loud noises, smells or lights, can cause a sensory overload and cause emotional melt-downs, especially if changes are sudden.