Autism Based In Inability to Interact

The most basic feature of autism is an inability to interact with people. Autistic children seem to live in a world of their own, a world rarely opened to others - even family or friends.

Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism might be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism might appear to develop normally and then withdraw and become indifferent to the world "outside."

Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior like biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of "I" or "me."

Children with autism really don't know how to play with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.

Mark Simms, MD, MPH, Medical College of Wisconsin Professor of Pediatrics and Medical Director of the Child Development Center at Children's Hospital of Wisconsin, has many times noted the distinctive lack of interaction between autistic children and their parents when he observes them in his office.

"I've had children actually turn their backs on us," notes Dr. Simms. "They don't seem to have that need to be with other people. They are content to be left alone."

When playing, autistic children don't imitate their mother and father or other adults: they don't pretend to talk on a cell phone, take care of a baby doll, or make dinner, he said. Instead of this type of "mimic" or "representational" play, autistic children tend to get attached to objects such as paperclips or have a preoccupation with specific parts of objects.

The children often have an inflexible, rigid attitude when it comes to these objects. "Normally, little kids like their stuff, but this is different. It seems to be a reflection of how they understand their universe," said Simms, who explained that an autistic child who is attached to paperclips typically needs to have them in a certain order or arrangement.

Diagnosis
There is no lab test for autism; diagnosis is based on clinical judgment and detailed analysis of the child's behaviors. Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Dr. Simms said that the members of a multidisciplinary team - including a psychologist, neurologist, psychiatrist, and speech therapist - should work together to make the appropriate diagnosis.

Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism, including:

• impaired ability to make friends with peers
• impaired ability to initiate or sustain a conversation with others
• absence or impairment of imaginative and social play
• stereotyped, repetitive, or unusual use of language
• restricted patterns of interest that are abnormal in intensity or focus
• preoccupation with certain objects or subjects
• inflexible adherence to specific routines or rituals

"This is not a diagnosis that one individual should be making," Dr. Simms said. "Autism is not defined by a blood test. It's defined by behavior."

In addition to an evaluation of the child's development and behavior, a diagnosis often includes observations made by parents and doctors. Assessment of neurological function as well as cognitive and language testing may also be part of making a diagnosis.

Children who are being evaluated for autism should also have their hearing tested. "Almost all people with autism have some kind of language or communication deficit," Simms said, although hearing impairment in these children is rare.

Treatment
There is no single best treatment for all children with autism, but most will respond well to highly structured, specialized programs. One point that most professionals agree on is that early intervention is important.

The parents or caretakers of the child who is diagnosed with autism should immediately begin researching local schools and other programs to learn which might best fit the needs of the individual child.

The National Institute of Mental Health suggests a list of questions to ask when planning for a treatment program for an autistic child:

• How successful has the program been for other children?
• How many children have gone on to placement in a regular school and how have they performed?
• Do staff members have training and experience in working with children and adolescents with autism?
• How are activities planned and organized?
• Are there predictable daily schedules and routines?
• How much individual attention will my child receive?
• How is progress measured? Will my child's behavior be closely observed and recorded?
• Will my child be given tasks and rewards that are personally motivating?
• Is the environment designed to minimize distractions?
• Will the program prepare me to continue the therapy at home?
• What is the cost, time commitment, and location of the program?

For many children, autism symptoms improve with treatment and with age. However, autism is usually a life-long problem. Children whose language skills regress early in life, usually before the age of 3, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems. Parents of these children should be ready to adjust treatment for their child as needed.

Brendan O'Brien
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.