Is your child suffering from Autism Spectrum Disorder?

After my last article on Autism and the responsibilities of parents, I have had several calls and even visits from people who asked me to share with them the main characteristics of autistic children.

Because the prevalence of autism is so high in the developed world (1 out of 88 American children, 1 in more than 10 UK children, 1 out of 150 French children, etc.) many parents are afraid that they may not know whether their child has an autistic issue.

As we look at some of the most commonly observed characteristics of children with autism spectrum disorders, we need to remember that some children on the spectrum are only mildly affected while others are very severely affected in most or all domains of functioning. There is considerable overlap of the conditions along the spectrum; this means that children with different diagnoses may share many characteristics. On the other hand, no two children with the same diagnosis may be affected in exactly the same ways. “There is no single behaviour that is always typical of autism and no behaviour that would automatically exclude an individual child from a diagnosis of autism” (USA National Research Council, 2001, p. 11).

The first sign that a child is suffering from ASD is when he has a problem of social interaction. This means that the child has difficulty making eye contact with others, shows little body language or facial expressions when interacting, has difficulty developing relationships with peers, seems uninterested in sharing experiences or engages less in give-and-take social interaction with caregivers, siblings and other close relations.

On the other hand, if the child has speech, language, and communication impairments, he may have difficulty communicating with speech or with gestures, may have difficulty understanding what others are saying to him, may have difficulty using the language he has to interact with others, may have difficulty starting or continuing a conversation, may have difficulty using his own sentences, and instead, may repeat what others say.

Finally the child may have stereotyped or repetitive behaviour and may show interest in very few objects or activities and play with them in repetitive ways and perform repetitive routines and have difficulty with changes in these routines or spends time in repetitive movements (such as waving a hand in front of his face).

Children with autism may display some or many of the characteristics noted above. They may have severe forms of one or more of the characteristics, or may have only mild impairments related to these characteristics. It is important to note that if the child’s difficulty is identified early enough, if both parents (especially the mother) focus their attention on the needs of that child, and with early education focused on a child’s needs, many of these behaviours can be modified.

Below is a more detailed description of the problems facing a child suffering from ASD.

Impaired Social Relationships

Some children with ASD have difficulty perceiving the emotional state of others, expressing emotions, and forming attachments and relationships. Some children may not even feel their parents’ attempts to cuddle and show affection to them and thus may display a profound lack of interest. The child seems not to know or care whether he is alone or in the company of others.

Some children with ASD fail to exhibit social gestures such as showing and pointing things out to others or waving and nodding their head at others. Although some children with ASD demonstrate basic gestures such as pulling, pushing, or leading others by the hand to get things they want, the use of these gestures might lack any social component; the child might be using the adult just as a means to an end.

Deficits in joint attention are quite common in children with ASD. Joint attention refers to such behaviors as looking where someone else is looking, as when a baby notices that his mother has turned her head to look at something and does the same, or when the baby turns its head or eyes in the direction that someone is pointing. Joint attention allows the young child and another person to interact with the same frame of reference, an important factor in the development of language and social skills.

Communication and Language Deficits

About half of children with autistic disorder do not speak much, but they may hum or occasionally utter simple sounds. The speech of those who do talk may consist largely of verbatim repetitions of what people around them have said without any apparent communicative purpose. Some children with ASD have acquired an impressive vocabulary; they can read many words in books but do not use them in appropriate or useful ways. One of the most common deficits of children with autism is their lack of understanding of the social meanings of language.

Intellectual Functioning

Children with autism spectrum disorders span the entire range of IQ. A diagnosis of autism can be made in a child with severe or profound mental retardation as well as in a child who is intellectually gifted. Although autism spectrum disorders occur across the full range of intellectual abilities, between 70% and 80% of individuals with autistic disorder may also have some form of mental retardation.

Uneven skill development is a common characteristic of autism, and about 10% to 15% of children exhibit “splinter skills”—areas of relatively superior performance that are unexpected compared to other domains of functioning.

A very few persons are autistic savants, people with extraordinary ability in an area such as memorization, mathematical calculations, or musical ability while functioning at the mental retardation level in all other areas. The betting calculations by Raymond in the movie Rain Man are illustrative of savant syndrome.

Many children with autism exhibit over-selectivity, the tendency to focus on a minute feature of an object or a person rather than the whole. For example, if shown a guitar for the first time, a child might focus on the sound hole and not consider anything else about the instrument, such as its size, shape, other parts, or even the sound that it makes. This over-selectivity interferes with the child’s understanding of what a guitar is—the totality of its parts and function. The tendency to over-select hinders his learning of new concepts and interferes with his ability to interpret relevant meaning from the environment.

Another tendency often seen in individuals with autism spectrum disorder is obsessive attention on a specific object or activity. This focused attention may last for a long time if uninterrupted and is often very difficult to break. For instance, if a child with autism has focused his attention on trains, he may continually choose to play with trains and resist playing with other toys. Focused attention may impede his ability to shift attention to other people or activities, such as a parent who is entering the room or another child who is attempting to join his play.

Unusual Responsiveness to Sensory Stimuli

It is believed that autistic children have some excessive sensory responsiveness. Some may have their auditory sense extremely sensitive that they cannot stand any loud noise. Their ears are like microphones picking up all sounds with equal intensity. Others have a strong visual sense of detail and even minute objects can be magnified by their eyes. This is what therapists call over- and under-responsiveness to sensory stimulation.

An under-responsive (hyposensitive) child appears oblivious to sensory stimulation to which most people react. Some children with autism do not seem to feel pain in a normal way. Some under-responsive children will spin round and round, rock back and forth, or rub and push things hard into their skin to create additional forms or higher intensities of stimulation. It is not uncommon for an individual with autism to display a combination of both over- and under-responsiveness—for example, being hypersensitive to tactile stimulation but unresponsive to many sounds.

Insistence on Sameness and Perseveration

Children with autism often demonstrate an obsessive need for sameness. They may have great difficulty when home or classroom routines are changed. They may insist upon having everything in the same place all the time and get very upset if anything is moved. Sometimes a verbal child with autism may show this desire for sameness in a preoccupation with a certain subject or area of interest to the exclusion of all others.

Problem Behaviour

Some children with some severe form of autism may exhibit behaviour problems that might take the form of aggression toward others and/or themselves. Often parents report that the child sometimes bites himself so severely that he bleeds, or that he beats his head against walls or sharp pieces of furniture so forcefully that large lumps rise and his skin turns black and blue. He may beat his face with his fists. Sometimes the child’s aggression will be directed outward against his parents or teachers in the most primitive form of biting, scratching, and kicking. Some of these children absolutely tyrannize their parents by staying awake and making noises all night, tearing curtains off the window, spilling flour in the kitchen, etc.

Positive Attributes and Strengths of Students with ASD

Reading descriptions of communication impairments, skill deficits, and behavioural excesses experienced by individuals with ASD, we may find it easy to overlook their strengths and positive attributes. Not all individuals with ASD are always unattached to those around them or behave in a stilted manner. Children with autism are very loving and caring, thoughtful and creative.

As we might expect, there is a noticeable difference between descriptions of autism and Asperger syndrome by people with and without the conditions. While people without the disabilities tend to focus on the impairments to normal functioning, a number of people with autism and Asperger syndrome have described positive features associated with their disability.

For example, Temple Grandin (1995), an adult with autism who has a Ph.D. in animal science and designs environments and equipment to improve the humane and healthful handling of livestock, describes positive features associated with her disability: “I think in pictures. Words are like a second language to me. I translate both spoken and written words into full-color movies, complete with sound, which run like a VCR tape in my head. When somebody speaks to me, his words are instantly translated into pictures. Language-based thinkers often find this phenomenon difficult to understand, but in my job as an equipment designer for the livestock industry, visual thinking is a tremendous advantage.”

Liane Willy (2001), a woman with Asperger syndrome, writes: “We can describe a situation like no one else. We can tell you what intangibles feel like and secret flavors taste like. We can describe for you, in unbelievable depth, the intricate details of our favorite obsessions.”

Therefore if ever your child is diagnosed as having ASD, do not despair. Rather, concentrate all your energies on helping that child, on identifying his strengths, on developing his diverse skills rather than fault finding, on making him as independent as possible so that you can turn your child into a genius or at least helping him live a meaningful life. You put this child on this earth: it becomes your responsibility to making him live HIS life fully.

 


* Published in print edition on 16 May 2014

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