Autism: Gaining Awareness

Note: This is the first in a series of articles dealing with autism. Subsequent articles will go into greater detail on the spectrum itself, from Asperger's Syndrome to PDD-NOS to ASD, treatments, and living with autism from parents' perspectives.

For many people over age 35, our first understanding of autism came from Hollywood when Dustin Hoffman played the role of Raymond Babbitt, an autistic savant living in a mental institution.  Now, with as many as one in 100 children being diagnosed, and that number rising, doctors and parents of children with autism would like the world to have a better understanding of this complex condition.

Autism is a neurobiological disorder marked by impairments in three main categories - social interaction, communication/language, and behaviors that the Autism Program at Yale's Child Study Center calls 'insistence of sameness'.  This can be a repetitive behavior, like hand flapping or rocking, or a resistance to change. Within these three broad areas are multiple characteristics that doctors look for in evaluating children.

The diagnosis of autism has been on the rise in recent years, yet it's not clear whether the incidence of autism itself is on the rise or if there's just increased awareness.  Clinicians' understanding of the full spectrum of autistic disorders is broadening, so as the rate of autism diagnosis is rising, other diagnoses are actually decreasing - like mental retardation and learning disabilities.  At the same time, more parents are seeking evaluations.  And with more services becoming available, more parents than ever before are pushing to get a diagnosis in order to get help for their children.

"Years ago, parents might not have picked up on certain behaviors," says Dr. Julie Wolf, PhD, an associate research scientist and clinical psychologist at the Yale Child Study Center who works in their Autism Program.  "And kids who today would be considered 'high functioning' might have gone through life struggling."

There is controversy over whether or not increased awareness can account for the dramatic rise in cases.  Many parents and scholars point to environmental factors. However, Dr. Wolf says that as of now, "the research has not borne out an environmental link to autism, and anyone who suggests there might be a link is just speculating."  She also says that one of the biggest myths is the belief that there is a link between autism and immunizations.  Not only is this not true, but the study some doctors cite to draw that conclusion has recently been called into question.

According to the DSM-IV, there must be a total of six (or more) characteristics with at least 2 falling under the social interaction category, and at least one each from both the communication and 'insistence of sameness' categories.  And symptoms must have been present before the age of three.  Further, there must be no evidence of certain other conditions that may be similar.  For full diagnostic criteria, click here.

Dr. Wolf encourages concerned parents to look for these signs:

Under age 3

• No eye contact
• No pointing
• No joint attention (When babies want something, they'll look back and forth between their caregiver and the object. Kids with autism don't do this.)
• Delay in language development - not using single words by 18 - 24 months

Ages 3 and over

• Language delays - not speaking as much as their peers
• Repetitive behaviors (this can be developmentally appropriate in children under 3)
• Trouble drawing child's attention to a particular object
• Trouble making friends, not showing an interest in peers
• Not sharing an interest with other people, content to solitary pursuits

She also notes that autism shares a lot of features with other disorders, like ADHD or Sensory Processing Disorder (SPD), and the diagnostician must determine what accounts for these characteristics.  The social piece, however, is the distinguishing factor between autism and, say, anxiety or SPD.

Even if you aren't raising a child with autism, chances are very good that a friend, neighbor or member of your community is.  And what's more, your child will likely spend time in a classroom with someone neurologically different than him or herself.  The more we can understand, and accept, the diversity in thinking and behaviors among us, the better off we'll all be.