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The term Autism Spectrum Disorder is used because there is great variation from person to person depending on the severity and combination of each area of impairment. Autism Spectrum Disorder may also coexist with other conditions or disorders, including intellectual disability, speech and language disorders, anxiety and depression (especially in adolescents and adults), epilepsy, attention disorders, Tourette Syndrome and Down Syndrome.
In Autism the impairments in the social and communication areas are severe and sustained and clearly present before the age of three years. The child is often anxious, has poor attention and motivation, responds unusually to many different stimuli and is observed as being 'different' from other children. Speech is delayed, or largely absent. A strong reliance on routine is apparent, and the child can have a range of ritualistic behaviours such as toe walking, hand flapping and finger gazing. The child/adult with Autism may also be intellectually disabled.
High Functioning Autism is a loosely used term (not defined in the diagnostic criteria) to describe a child or adult who meets the criteria for a diagnosis of Autism, but is not as severely affected as the more classically autistic person.
In Asperger Syndrome there are severe and sustained social impairments, but impairments are not as severe in the language and communication area. Speech usually develops within the normal age range, but the ability to communicate effectively (known as language pragmatics) is impaired. The impairments seem more subtle in the very young child, and become more apparent as the child reaches pre school and school age. A person with Aspergers is usually in the normal intelligence range.
Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) is the diagnosis given for children who present with some of the characteristics of either Autism or Asperger Syndrome, but not severe enough for a diagnosis of either of these conditions. In the ICD 10 and previous editions of the DSM this diagnosis was referred to as Atypical Autism.
To receive a diagnosis of Autism there are 3 main areas of challenge professionals look for. These are:
- Social interaction
- Delayed communication
- Ritualistic and Stereotyped Interests or Behaviours
Many other abnormalities are associated with Autism, such as unusual dietary habits, sleep disturbance, abnormalities of mood and self-injurious behaviour. Perceptual abnormalities such as lack of response to pain, heightened sensitivity to sound and preoccupation with tactile stimulation are also common. These features are not specific to individuals with Autism and may occur in other children with intellectual disability.
The majority of children with Autism have intellectual disability. A recent review of the literature found that in most samples approximately 50% of cases exhibit severe intellectual disability, 30% mild to moderate disability and the remaining 20% have IQ’s in the normal range.
The exact causes of Autism are unknown. We do know that it is a biological condition that children are born with. Genetic factors play an important role in the causation of Autism, although which genes are involved has not been determined. People with Autism probably share certain features of abnormal brain function, but the nature of these remains elusive and controversial.
Recent international research (Chakrabarti and Fombonne, 2005) now suggests that the best estimate for the prevalence of all Autism spectrum disorders is 60 per 10,000 population. A three year study commissioned by the Australian Advisory Board on Autism Spectrum Disorders into the prevalence of Autism, concluded that there is a prevalence of 62.5 per 10,000 or one in 160 Australian children aged between 6 and 12 years have an Autism spectrum disorder (ASD) (Wray and Williams, 2007).
The following characteristics are typical of a child with Autism. Children will not generally demonstrate all of the below characteristics but most children will demonstrate some element or combination of these.
- Poor social interaction
- Lack of interest in other children
- Lack of seeking to share own enjoyment
- Failure to develop peer relations
- Failure to join in activities of others
- Failure to direct adult’s attention to own activity
- Does not direct the attention of others
- Does not hold up arms to be lifted up
- Does not show affection
- Does not seek or offer comfort
- Dislikes social touch and being held
- Lack of social responsiveness
- Ignores people
- Lack of social play
- Being in own world
- Prefers being alone
- Indifferent to others
- Does not differentiate between people
- Lack of attention to voices
- No use or understanding of gestures
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- No social smile
- Lack of eye contact
- Lack of gesture
- Lack of facial expression
- No greeting behaviours
- Lack of verbal communication
- No social chat
- Lack/limited range of facial expression
- No/abnormal eye contact
- No or “empty” smiling
- Loss of previously acquired words
- Problems with language comprehension
- Does not express emotion
- Poor imitation
- Use of other’s body as a tool
- Lack of infant babble
- Echolalia (mimicking speech)
- No gaze monitoring
- No pointing to express interest
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The following features are not necessarily present in very young children. This may be because there is a developmental process in the emergence of these Autism symptoms.
- Verbal rituals
- Hand and finger mannerisms
- Whole body mannerisms
- Unusual/repetitive preoccupations
- Unusual/repetitive attachment to objects
- Lack of spontaneous play
- Lack of imitative play
- No pretend play
- Sensitivity to noise
- Insensitivity to pain/cold
- Unusual sensory interests
- Deafness suspected
- Mouthing of objects
- Unusual looking at objects/patterns/movements
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- Distractibility
- Behavioural variability
- Sleep problems
- Self-injury
- Food fads
- Unusual fears
- Lack of curiosity
- Lack of response to name
- Running away
- Overly quiet
- Indifferent to animals
- Having an intelligent looking face
- Overexcited when tickled
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Some of the features listed above are also present in young children with developmental delay. Therefore, studies that have compared the behaviour of young children with Autism with those who have developmental delay without Autism provide the best information on the features and symptoms of Autism in infants and preschool children.
The absence of stereotyped and repetitive behaviour in very young children does not exclude the possibility of Autism. The presence of obsessional behaviour may be dependent upon more advanced language and cognitive skills and emerge later as the child makes developmental gains. Deficits in basic communication and social skills are apparent in the first two years of life in young children with Autism (Gray & Tonge, 2001; Zwaigenbaum, 2001).
Parents of young children with Autism often report delayed speech as their first concern, but speech delay is not specific to Autism. Delayed speech is also present in young children with global developmental delay caused by intellectual disability and those with severe to profound hearing loss. Children with speech delays or hearing loss are usually able to compensate for their limited or lack of speech by the use of non verbal communication skills such as using gestures (e.g. pointing), eye contact and facial expression to get their message across. These children also respond to praise, can empathise, imitate and engage in make believe play.
Children with developmental delay will also usually attain these skills when their developmental level passes about 12 months of age. However, the child with Autism continues to have ongoing problems with delayed and disordered language, social communication skills, empathy and pretend play skills regardless of developmental level (Charman & Baird, 2002). These findings have implications for early screening and diagnosis in very young children.
Sensational Kids specialises in the assessment and treatment of children with Autism. We are equipped with the assessment tools and knowledge necessary to form a thorough and complete diagnosis. If you are concerned your child may be showing signs of Autism please contact our friendly administration staff to book a consultation with one of our Psychologists to discuss your concerns further.
We offer:
- Assessment and diagnosis of Autism & Aspergers Disorders
- Individual sessions with a Speech Pathologist, Occupational Therapist and/or Psychologist to work on specific skills
- Social skills groups
- Information evenings
References:
Prof. Bruce Tonge & Dr Avril Brereton
Austim Victoria
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