Also known as "autistic disorder," classic autism affects millions of people worldwide. This developmental disorder, which is characterized by communication and social challenges and unusual behaviors, is something of a mystery to researchers. However, for individuals with autism and parents of children with the disorder, there is hope in the form of effective treatments and community support.
Symptoms and Characteristics of Classic Autism
The Centers for Disease Control and Prevention (CDC) estimates that one out of every 68 children has some type of autism spectrum disorder. Many of these children are diagnosed with classic autism, and the lifelong disorder also affects thousands of adults. If you're wondering whether you or your child might be among them, it's helpful to understand some of the distinct characteristics associated with autistic disorder. According to the Mayo Clinic, these are some of the signs that can indicate autism.
Communication and Language Challenges
People with autism may be completely non-verbal, or they may have an exceptional vocabulary but find it difficult to use language to communicate. Few people with classic autism experience all of the following communication challenges, but they may show some of these signs:
- Delayed talking, unable to speak two words by age two
- Echolalia, or the repeating of words or groups of words often out of context
- Difficulty making requests using language
- Lack of eye contact when speaking
- Lack of pointing or gesturing
- Challenges with back-and-forth conversation
- Mixing up pronouns, such as using "you" instead of "I"
- Loss of language skills at any age
- Difficulty with normal vocal intonation
- Difficulty interpreting facial expressions and tone of voice
Social Skills Challenges
Social skills are an area of challenge for individuals across the autism spectrum. Those with low-functioning autism may be more obviously impaired than those with milder autism, but all levels of functioning will display some difficulty with regular social interaction. These are a few of the signs:
- Failure to turn and look when name is called, despite normal hearing
- Dislike of cuddling or touching
- Failure to look at an object when someone points
- Lack of imitation
- Apparent lack of empathy or understanding of others' perspectives
- Preference for solo play
- Lack of peer relationships
- Limited eye contact, usually less than a few seconds
- Lack of showing objects or sharing achievements
- Lack of age-appropriate pretend play
Restrictive and Repetitive Behaviors
Most people are familiar with the image of autistic hand flapping, but there are actually a variety of behaviors that characterize this disorder. Some are restrictions and routine-based behaviors, and others are sensory-seeking or self-stimulatory behaviors. These symptoms include the following:
- Strict adherence to routine, distressed at changes in routine
- Foot-to-foot shifting or other whole-body movement
- Rocking body or flapping hands
- Inability to feel pain or cold
- Sensitive to and extremely distressed by bright lights, certain sounds, textures, and other sensory stimuli
- Interested in parts of a toy or object, such as the wheels on a toy truck
- Obsessed with topics of interest
- Aggressive toward other people or toward self
If you're concerned that you or your child may have classic autism or another autism spectrum disorder, it's important to talk to your doctor right away. Your doctor can then refer you to a specialist in the field of autism, such as a neurodevelopmental pediatrician, pediatric neurologist, or a neuropsychologist.
This specialist will then conduct some tests to see if you or your child meet the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders. These criteria include the following:
- Significant social impairment
- Significant language or communication impairment
- Restrictive or repetitive behaviors
- Developmental delays in language development, social interaction, or pretend play
Testing for Autism
In order to diagnose someone with autism, the specialist needs to do some testing. These tests will include physical examinations, interviews, questionnaires, observations, and sometimes blood tests and may be conducted by various specialists over the course of several visits. After the doctor has determined the results of the tests, he or she will meet with you to discuss whether you or your child meet the diagnostic criteria for autism.
According to the National Institute for Health, you or your child may receive the following tests:
- Hearing test to rule out hearing loss
- Blood test to check lead levels and rule out lead poisoning
- Complete physical exam
- Neurological exam
- Magnetic resonance imaging (MRI)
- Genetic testing for chromosomal abnormalities
- Electroencephalography (EEG) to check for seizure activity
- Autism Diagnostic Interview - Revised (ADI-R)
- Childhood Autism Rating Scale (CARS) or Gilliam Autism Rating Scale
- Autism Diagnostic Observation Schedule (ADOS)
Educational Label vs. Medical Diagnosis
It's important to understand that there's a difference between an educational label of autism and a medical diagnosis. If you are concerned about your child's development, the local school district is required to conduct an assessment and offer special education services to your child if needed. The school's assessment, while often very thorough and accurate, is not a medical diagnosis. It only means that your child may receive an Individualized Education Plan (IEP) to help him or her academically and socially. This type of testing and the educational label are not enough to give your child a medical diagnosis, which is required by some insurance companies. For that, you'll need to go through your family doctor or pediatrician and work with specialists in the field of autism.
Autism Functioning Levels
People with classic autism can range from those with above-average intelligence and verbal skills to those with cognitive impairments and a complete lack of spoken language. Where a person falls on this spectrum can determine the type of services he or she needs to succeed in life. Functioning level can and often does change with treatment, so a person diagnosed with low-functioning autism may eventually reach a higher level.
Specialists use the Gilliam Autism Rating Scale or Childhood Autism Rating Scale to determine a person's level of autism. In general, people with classic autism may have one of these functioning levels:
- High-functioning autism is characterized by average or above-average IQ, clear spoken language with some impairment in functional use, unusual social behavior, and repetitive or restrictive behavior patterns.
- Moderate autism involves normal or near-normal IQ, some language challenges, unusual social behavior, repetitive or restrictive behavior, and some emotional challenges.
- Low-functioning autism is diagnosed when IQ is average or below average, speech is limited or completely absent, social skills are very limited, and repetitive and restrictive behaviors and emotional challenges are extreme.
Treatments for Autistic Disorder
According to WebMD, early intervention can be very effective in improving the functioning level of people with autism. If you're concerned about your baby or child, getting help as soon as possible can dramatically improve your child's life. Treatment can also help older children and adults to learn coping mechanisms and improve skills that can help them be happy and successful. There are a number of treatments for classic autism and its associated challenges.
Occupational therapy, also known as "OT," targets two common challenges for people with autism. One is fine motor skills, such as tying shoes, writing, picking up small objects, and making gestures. The other is sensory issues. Many OTs work on sensory integration, or the idea that by manipulating the sensory environment, you can reduce the sensory-seeking or self-stimulatory behavior and the over-sensitivity to stimuli.
Many people with autism also struggle with gross motor skills. A physical therapist can help a child reach motor milestones like walking, riding a bike, and throwing or catching a ball.
Speech and Language Therapy
Perhaps one of the most important therapies for any person with autism, speech therapy focuses on language skills and communication. Through activities specially designed for the individual, the speech therapist can help the person improve his or her social communication and functional use of language.
For children with autism, play therapy is an essential part of treatment. A therapist or parent gets down on the floor to play with the child, using toys and subjects that are interesting to the child. Through these toys, the adult works to facilitate interaction and eye contact. This may involve turn-taking, pretending in play, and other types of age-appropriate social interaction.
Social Skills Groups
Many people with classic autism also rely on social skill groups to improve and practice the interactions they may have with other people. In these groups, therapists facilitate interaction between a number of individuals on the autism spectrum, coaching them through the various scenarios they may encounter.
Applied Behavior Analysis (ABA)
Applied Behavior Analysis involves a certified behavior therapist who works one-on-one with a child with autism. This approach relies on consistency, which may make it very reassuring and successful for some children and adults. However, ABA may not be covered by insurance and is usually not part of a school special education curriculum.
Although there is not medication that directly targets the symptoms of autism, there are some medications that can help with other conditions that often go hand-in-hand with the disorder. These conditions include attention deficit and hyperactivity disorder (ADHD), clinical depression, and anxiety. According to the Mayo Clinic, treating some of these other conditions can help with a person's overall functioning level.
Causes of Autism and Risk Factors
Although researchers are working hard to figure out what causes autism, there is no conclusive answer. According to a study published in Environmental Health Perspectives, autism is very likely caused by a combination of environmental and genetic factors. While researchers have not been able to conclusively prove that a particular environmental toxin or exposure is causing autism, a very important study in the journal Pediatrics found that autism does run in families.
According to the CDC, the following are risk factors for classic autism:
- Having a parent, sibling, or other close relative with autism
- Having a genetic condition like Fragile X Syndrome
- Being born to a mother over the age of 35
- Being exposed to certain drugs in the womb
- Being exposed to environmental toxins in the womb
- Having a complicated birth or being born prematurely
Although there are a lot of unknowns about the causes, what is known is that classic autism has nothing to do with parenting style.
Finding the Help You Need
A classic autism diagnosis can seem devastating, but treatments and therapies can dramatically improve functioning level and future success. If you're struggling with the diagnosis or concerned about your child, learn about the family services available from Autism Speaks. You can also find a local support group to help in your community. With proper emotional support, families can survive and thrive when one member has classic autism or any autism spectrum disorder.