Autism

Autism is a brain disorder that affects a person's ability to communicate, form relationships
with others, and respond appropriately to the external world. People with the condition often
exhibit repetitive behavior or narrow, obsessive interests. Other characteristics of autism include
problems with verbal and nonverbal communication and social interaction. Scientists aren't
certain what causes the disorder, but it's likely that both genetics and environment play a role.
A. What Is Autism?
Autism is a brain disorder that too often results in a lifetime of impaired thinking, feeling, and
social functioning -- our most uniquely human attributes. It typically affects a person's ability to
communicate, form relationships with others, and respond appropriately to the external world.
The disorder becomes apparent in children generally by the age of 3.
Autism (sometimes called "classical autism") is the most common condition in a group of
developmental disorders known as the autism spectrum disorders.
Experts estimate that three to six children out of every 1,000 will have autism. Males are four
times more likely to have it than females. Girls with autism tend to have more severe symptoms
and greater cognitive impairment.
B. Characteristic Behaviors of Autism
Autism is characterized by three distinctive behaviors. Autistic children:

Have difficulties with social interaction

Display problems with verbal and nonverbal communication

Exhibit repetitive behaviors or narrow, obsessive interests.

Some people with the condition can function at a relatively high level, with speech and
intelligence intact. Others have serious cognitive impairments and language delays, and
some never speak.

In addition, individuals with autism may seem closed off and shut down, or locked into repetitive
behaviors and rigid patterns of thinking. An infant may avoid eye contact, seem deaf, and
abruptly stop developing language. The child may act as if unaware of the coming and going of
others, or physically attack and injure others without provocation. Infants with autism often
remain fixated on a single item or activity, rock or flap their hands, seem insensitive to burns and
bruises, and may even mutilate themselves.
Autism is a highly variable neurodevelopmental disorder that first appears during infancy
or childhood, and generally follows a steady course without remission. Overt symptoms
gradually begin after the age of six months, become established by age two or three years, and
tend to continue through adulthood, although often in more muted form. It is distinguished not by
a single symptom, but by a characteristic triad of symptoms: impairments in social interaction;
impairments in communication; and restricted interests and repetitive behavior. Other aspects,

such as atypical eating, are also common but are not essential for diagnosis. Autism's individual
symptoms occur in the general population and appear not to associate highly, without a sharp
line separating pathologically severe from common traits.
C. What Causes It?
Scientists aren't certain what causes autism, but it's likely that both genetics and environment
play a role.
Causes
It has long been presumed that there is a common cause at the genetic, cognitive, and neural
levels for autism's characteristic triad of symptoms. However, there is increasing suspicion that
autism is instead a complex disorder whose core aspects have distinct causes that often cooccur.
Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear
whether ASD is explained more by rare mutations with major effects, or by rare multigene
interactions of common genetic variants Complexity arises due to interactions among multiple
genes, the environment, and epigenetic factors which do not change DNA but are heritable and
influence gene expression. Studies of twins suggest that heritability is 0.7 for autism and as high
as 0.9 for ASD, and siblings of those with autism are about 25 times more likely to be autistic
than the general population.However, most of the mutations that increase autism risk have not
been identified. Typically, autism cannot be traced to a Mendelian (single-gene) mutation or to a
single chromosome abnormality like fragile X syndrome, and none of the genetic syndromes
associated with ASDs have been shown to selectively cause ASD. Numerous candidate genes
have been located, with only small effects attributable to any particular gene The large number
of autistic individuals with unaffected family members may result from copy number variations
spontaneous deletions or duplications in genetic material during meiosis. Hence, a substantial
fraction of autism cases may be traceable to genetic causes that are highly heritable but not
inherited: that is, the mutation that causes the autism is not present in the parental genome.
Several lines of evidence point to synaptic dysfunction as a cause of autism. Some rare
mutations may lead to autism by disrupting some synaptic pathways, such as those involved
with cell adhesion. Gene replacement studies in mice suggest that autistic symptoms are
closely related to later developmental steps that depend on activity in synapses and on activitydependent changes. All known teratogens (agents that cause birth defects) related to the risk of
autism appear to act during the first eight weeks from conception, and though this does not
exclude the possibility that autism can be initiated or affected later, it is strong evidence that
autism arises very early in development.
Although evidence for other environmental causes is anecdotal and has not been confirmed by
reliable studies, extensive searches are underway. Environmental factors that have been
claimed to contribute to or exacerbate autism, or may be important in future research, include
certain foods, infectious disease, heavy metals, solvents, diesel exhaust, PCBs, phthalates and
phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking,

illicit drugs, vaccines, and prenatal stress, although no links have been found, and some have
been completely disproven.
Parents may first become aware of autistic symptoms in their child around the time of a routine
vaccination. This has led to unsupported theories blaming vaccine "overload", a vaccine
preservative, or the MMR vaccine for causing autism. The latter theory was supported by a
litigation-funded study that has since been shown to have been "an elaborate fraud".Although
these theories lack convincing scientific evidence and are biologically implausible, parental
concern about a potential vaccine link with autism has led to lower rates of childhood
immunizations, outbreaks of previously controlled childhood diseases in some countries, and
the preventable deaths of several children.

D. Treatment for Autism

There is no cure for the disorder. Therapies and behavioral interventions are designed to
remedy specific symptoms and can bring about substantial improvement.
The ideal treatment plan coordinates therapies and interventions that target the core symptoms
of the condition:

Impaired social interaction

Problems with verbal and nonverbal communication

Obsessive or repetitive routines and interests.

Most professionals agree that the earlier the intervention, the better.
E. Other symptoms
Autistic individuals may have symptoms that are independent of the diagnosis, but that can
affect the individual or the family.[21] An estimated 0.5% to 10% of individuals with ASD show
unusual abilities, ranging from splinter skills such as the memorization of trivia to the
extraordinarily rare talents of prodigious autistic savants.[38] Many individuals with ASD show
superior skills in perception and attention, relative to the general population.[39] Sensory
abnormalities are found in over 90% of those with autism, and are considered core features by
some,[40] although there is no good evidence that sensory symptoms differentiate autism from
other developmental disorders.[41] Differences are greater for under-responsivity (for example,
walking into things) than for over-responsivity (for example, distress from loud noises) or for
sensation seeking (for example, rhythmic movements).[42] An estimated 60%80% of autistic
people have motor signs that include poor muscle tone, poor motor planning, and toe walking;[40]
deficits in motor coordination are pervasive across ASD and are greater in autism proper.[43]
Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it
was formerly a diagnostic indicator. Selectivity is the most common problem, although eating

rituals and food refusal also occur;[29] this does not appear to result in malnutrition. Although
some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published
rigorous data to support the theory that autistic children have more or different GI symptoms
than usual;[44] studies report conflicting results, and the relationship between GI problems and
ASD is unclear.[45]
Parents of children with ASD have higher levels of stress.[46] Siblings of children with ASD report
greater admiration of and less conflict with the affected sibling than siblings of unaffected
children or those with Down syndrome; siblings of individuals with ASD have greater risk of
negative well-being and poorer sibling relationships as adults.[47]

Language Development in Autistic Children

Although the cause of problems with language development in autistic children is unknown,
many experts believe that the difficulties result from a variety of conditions which occur before,
during, or after birth affecting brain development. Language development in autistic children
varies, depending upon the intellectual and social development of the individual. Problems
associated with language development in autistic children include difficulty with word and
sentence meaning, intonation, and rhythm.
Language Development in Autistic Children: Understanding Normal Development
The most intensive period of speech and language development is during the first three years of
life, a period when the brain is developing and maturing. These skills appear to develop best in
a world that is rich with sounds, sights, and consistent exposure to the speech and language of
others. At the root of this development is the desire to communicate or interact with the world.
The beginning signs of communication occur in the first few days of life when an infant learns
that a cry will bring food, comfort, and companionship. Newborns also begin to recognize
important sounds such as the sound of their mother's voice. They begin to sort out the speech
sounds (phonemes) or building blocks that compose the words of their language. Research has
shown that by 6 months of age, most children recognize the basic sounds of their native
language.
As the speech mechanism (jaw, lips, tongue, and throat) and voice mature, an infant is able to
make controlled sound. This begins in the first few months of life with "cooing," a quiet,
pleasant, repetitive vocalization. Usually by 6 months of age an infant babbles or produces
repetitive syllables such as "ba, ba, ba" or "da, da, da." Babbling soon turns into a type of
nonsense speech called jargon that often has the tone and cadence of human speech but does
not contain real words. By the end of their first year, most children have mastered the ability to
say a few simple words. Children are most likely unaware of the meaning of their first words, but
soon learn the power of those words as others respond to them.
By 18 months of age most children can say 8 to 10 words and, by age 2, are putting words
together in crude sentences such as "more milk." During this period children rapidly learn that
words symbolize or represent objects, actions, and thoughts. At this age they also engage in
representational or pretend play.

At ages 3, 4, and 5 a child's vocabulary rapidly increases, and he or she begins to master the
rules of language. These include the rules of:

Phonology (speech sounds)

Morphology (word formation)

Syntax (sentence formation)

Semantics (word and sentence meaning)

Prosody (intonation and rhythm of speech)

Pragmatics (effective use of language).

Education: Music Therapy and Language

Music Therapy is the unique application of music to enhance personal lives by creating positive
changes in human behavior. It is an allied health profession utilizing music as a tool to
encourage development in social/ emotional, cognitive/learning, and perceptual-motor areas.
Music Therapy has a wide variety of functions with the exceptional child, adolescent and adult in
medical, institutional and educational settings. Music is effective because it is a nonverbal form
of communication, it is a natural reinforcer, it is immediate in time and provides motivation for
practicing nonmusical skills. Most importantly, it is a successful medium because almost
everyone responds positively to at least some kind of music.
The training of a music therapist involves a full curriculum of music classes, along with selected
courses in psychology, special education, and anatomy with specific core courses and field
experiences in music therapy. Following coursework, students complete a six-month full time
clinical internship and a written board certification exam. Registered, board certified
professionals must then maintain continuing education credits or retake the exam to remain
current in their practice.
Music Therapy is particularly useful with autistic children owing in part to the nonverbal, non
threatening nature of the medium. Parallel music activities are designed to support the
objectives of the child as observed by the therapist or as indicated by a parent, teacher or other
professional. A music therapist might observe, for instance, the child's need to socially interact
with others. Musical games like passing a ball back and forth to music or playing sticks and
cymbals with another person might be used to foster this interaction. Eye contact might be
encouraged with imitative clapping games near the eyes or with activities which focus attention
on an instrument played near the face. Preferred music may be used contingently for a wide
variety of cooperative social behaviors like sitting in a chair or staying with a group of other
children in a circle.
Music Therapy is particularly effective in the development and remediation of speech. The
severe deficit in communication observed among autistic children includes expressive speech
which may be nonexistent or impersonal. Speech can range from complete mutism to grunts,
cries, explosive shrieks, guttural sounds, and humming. There may be musically intoned
vocalizations with some consonant-vowel combinations, a sophisticated babbling interspersed
with vaguely recognizable word-like sounds, or a seemingly foreign sounding jargon. Higher
level autistic speech may involve echolalia, delayed echolalia or pronominal reversal, while
some children may progress to appropriate phrases, sentences, and longer sentences with non
expressive or monotonic speech. Since autistic children are often mainstreamed into music
classes in the public schools, a music teacher may experience the rewards of having an autistic
child involved in music activities while assisting with language.
It has been noted time and again that autistic children evidence unusual sensitivities to music.
Some have perfect pitch, while many have been noted to play instruments with exceptional
musicality. Music therapists traditionally work with autistic children because of this unusual
responsiveness which is adaptable to non-music goals Some children have unusual sensitivities

only to certain sounds. One boy, after playing a xylophone bar, would spontaneously sing up the
harmonic series from the fundamental pitch. Through careful structuring, syllable sounds were
paired with his singing of the harmonics and the boy began incorporating consonant-vowel
sounds into his vocal play. Soon simple 2-3 note tunes were played on the xylophone by the
therapist who modeled more complex verbalizations, and the child gradually began imitating
them.
Since autistic children sometimes sing when they may not speak, music therapists and music
educators can work systematically on speech through vocal music activities. In the music
classroom, songs with simple words, repetitive phrases, and even repetitive nonsense syllables
can assist the autistic child's language. Meaningful word phrases and songs presented with
visual and tactile cues can facilitate this process even further. One six-year old echolalic child
was taught speech by having the therapist/teacher sing simple question/answer phrases set to a
familiar melody with full rhythmic and harmonic accompaniment The child held the objects while
singing:
Do you eat an apple? Yes, yes.
Do you eat an apple? Yes, yes.
Do you eat an apple? Yes, yes.
Yes, yes, yes.
and
Do you eat a pencil? No, no.
Do you eat a pencil? No, no.
Do you eat a pencil? No, no.
No, no, no.
Another autistic child learned noun and action verb phrases . A large doll was manipulated by
the therapist/teacher and a song presented:
This is a doll.
This is a doll.
The doll is jumping.
The doll is jumping.
This is a doll.
This is a doll.
Later, words were substituted for walking, sitting, sleeping, etc. In these songs, the bold words
were faded out gradually by the therapist/teacher. Since each phrase was repeated, the child
could use his echolalic imitation to respond accurately. When the music was eliminated
completely, the child was able to verbalize the entire sentence in response to the questions,
"What is this?" and "What is the doll doing?"

Other autistic children have learned entire meaningful responses when both questions and
answers were incorporated into a song. The following phrases were sung with one child to the
approximate tune of Twinkle, Twinkle, Little Star and words were faded out gradually in
backward progression. While attention to environmental sounds was the primary focus for this
child, the song structure assisted her in responding in a full, grammatically correct sentence:
Listen, listen, what do you hear? (sound played on tape)
I hear an ambulance.
(I hear a baby cry.)
(I hear my mother calling, etc.)
Autistic children have also made enormous strides in eliminating their monotonic speech by
singing songs composed to match the rhythm, stress, flow and inflection of the sentence
followed by a gradual fading of the musical cues. Parents and teachers alike can assist the child
in remembering these prosodic features of speech by prompting the child with the song.
While composing specialized songs is time consuming for the teacher with a classroom full of
other children, it should be remembered that the repertoire of elementary songs are generally
repetitive in nature. Even in higher level elementary vocal method books, repetition of simple
phrases is common. While the words in such books may not seem critical for the autistic child's
survival at the moment, simply increasing the capacity to put words together is a vitally
important beginning for these children.
For those teachers whose time is limited to large groups, almost all singing experiences are
invaluable to the autistic child when songs are presented slowly, clearly, and with careful
focusing of the child's attention to the ongoing activity. To hear an autistic child leave a class
quietly singing a song with all the words is a pleasant occurrence. To hear the same child
attempt to use these words in conversation outside of the music class is to have made a very
special contribution to the language potential of this child.
Surprising Language Abilities In Children With Autism
What began as an informal presentation by a clinical linguist to a group of philosophers, has led
to some surprising discoveries about the communicative language abilities of people with
autism.
Several years back, Robert Stainton, now a philosophy professor at The University of Western
Ontario, attended a presentation by his long-time friend Jessica de Villiers, a clinical linguist now
at the University of British Columbia. The topic was Autism Spectrum Disorder (ASD). De Villiers
explained that many individuals with ASD have significant difficulties with what linguists call
"pragmatics." That is, people with ASD often have difficulty using language appropriately in
social situations. They do not make appropriate use of context or knowledge of what it would be
"reasonable to say." Most glaringly, many speakers with ASD have immense trouble
understanding metaphor, irony, sarcasm, and what might be intimated or presumed, but not
stated.

Drawing on his philosophical training, however, Stainton noticed less-than-obvious pragmatic

abilities at work in de Villiers' examples, which were drawn from transcripts of conversations
with 42 speakers with ASD -- abilities that had been missed by clinicians.
Thus began research to more clearly understand and define the conversational abilities and
challenges of people with Autism Spectrum Disorder (ASD). Stainton and de Villiers' research,
in collaboration with Peter Szatmari, a clinical psychiatrist at McMaster University, has shown
that indeed, many individuals with ASD do have "a rich array of pragmatic abilities."
These researchers do not contest the well-established claim that people with ASD have difficulty
with non-literal pragmatics, such as metaphors ("Juliet is the sun") or irony/sarcasm ("Boy, is
that a good idea"). They have, however, found that many speakers with ASD do not show the
same difficulty with literal pragmatics. An example is the phrase, "I took the subway north" from
a transcript of a conversation with a research participant with ASD. The use of the word "the"
could indicate there is only one subway in existence going north. "The subway" could also be
referring to a subway car, a subway system or a subway tunnel. Taking account of the context
and the listener's expectations, however, the individual using the phrase was able to convey the
specific meaning he intended. That is, he used pragmatics effectively.
In short, Stainton and his colleagues produced surprising evidence to show that speakers with
ASD use and understand pragmatics in cases of literal talk, as in the subway example.
Stainton, who is also Acting Associate Dean of Research in the Faculty of Arts and Humanities
at Western, says, "It is especially gratifying and encouraging, because this is an Arts and
Humanities contribution to clinical research. Without a philosophical perspective, this discovery
might not have been made."
Related research allowed de Villiers and Szatmari to develop a rating scale of pragmatic
abilities that can be used in the clinical assessment of people with ASD. Stainton says, "In the
short term, their new tool will help identify where an individual fits on that spectrum. In the longer
term, however, by making use of recent results in philosophy of language, it may contribute to
our theoretical understanding of the boundary between knowledge of the meanings of words,
and non-linguistic abilities -- specifically pragmatics."
Stainton believes that both clinicians who work with people with ASD, and language theorists
who are interested in pragmatics for philosophical reasons, will find these results striking.
ASD affects approximately one in 165 people. The results of the research, conducted from a
study of 42 children with autism and Asperger's Syndrome, has been published in the journal,
Midwest Studies in Philosophy.
Autistic language
People whose language is a mixture of strung together sentences (the system I learned after
age 9), their own made up words and stored phrases from songs/jingles, heard conversations,
documents (my language age 5-9), parallel systems (ie saying 'airports' to describe different
pathways of information) etc are always misunderstood by those using non-autistic language
systems (even many with Asperger's Syndrome who don't have a Semantic Pragmatic language
disorder).

people either
1) think they always know the social implications of their literal speech
2) that stored phrases used to fill retrieval or syntax gaps are always fully meant as traditionally
used
3) that the person is not stable.
Fact is, none of these are consistently true, if ever true.
When I worked as a waitress, I got beaten up once by a work colleague for repeating a funny
phrase at her mother, saying 'Marion, you old chook'.
I meant 'Marion, your laugh is so funny, it sounds like chickens'.
I didn't have that syntax or if I did, the stored phrase of 'you old chook' seemed to capture my
meaning 'sounds like chickens' and all I had to do was add her name so she knew who I was
referring to and it'd all be understood. Little did I know.
When Marion didn't cope, I thought she was just being 'too serious'... she'd said that to people
'oh don't be so serious', so it seemed right to help her chill out and repeat my gem so she could
'share the joy'. After all, its very exciting and funny if someone sounds like chickens. Quite a
skill. Might even be employable somewhere.
I ended up punched up by Marion's daughter and then after I ran down several flights of stairs to
my boss, her mother, was sacked by the mother who had apparently 'held her temper' and
'completely understood her daughters feelings about this'.
So sometimes its so hard, I think I've learned a new word, or a new sentence (which I get in rote
learning style) but then when I apply them they are hit and miss whether they will go down well
at all. My language is like a make-do patchwork quilt.
Remember just always check what that person meant and if in doubt, don't take it too
personally.