VOL.

1, ISSUE 2

PUZZLE OF THE DISORDERS

A look into autism, and the

self admiration

DO YOU KNOW
ANYTHING ABOUT AUTISM?
Antecedentes

The semantic on itself should be explained, the term autism

first was used by psychiatrist Eugen Bleuler in 1908. He
used it to describe a schizophrenic patient who had with-
drawn into his own world. The Greek word ''autós'' meant
self and the word “autism” was used by Bleuler to mean
morbid self-admiration and withdrawal within self.

In 1943, the American psychiatrist Leo Kanner used

the term “early infantile autism” to describe children
who lacked interest in other people.

In 1944, an Austrian pediatrician, Hans Asperger, inde-

pendently described another group of children with similar
behaviors, but with milder severity and higher intellectual
abilities. Since then, his name has become attached to a
higher functioning form of autism, Asperger syndrome.
HANS ASPERGER

It was not until the 1980s that the

term pervasive developmental
disorders was first used.
 The tru th a bou t Etiology

the c a use
Thus for many years the origins of autism
were unknown, and was not until 1980 that
research was further developed, it was in-
creasingly believed that parenting had no role
in causation of autism and there were neuro-
logical disturbances and other genetic ail-
ments like tuberous sclerosis, metabolic dis-
turbances like PKU or chromosomal abnor-
malities like fragile X syndrome.

STELLA CNHESS

Stella Chess was the first to discover that autism

can be associated with neurological disease, in a se-
ries of children with congenital rubella.

The exact cause of autism and the other ASDs is still

not known. As research clearly indicates that the eti-
ology is multi-factorial with a strong genetic basis.

Family studies have demonstrated that autism is both familial and herit-
able. The recurrence rate in siblings of an autistic child is 2% to 8%,
which is higher than that of the general population. Other genetic stud-
ies suggest a complex mode of inheritance, with linkage studies suggest-
ing genetic loci on several chromosomes including chromosome 7 and
chromosome X.
 Diagnosis
Criteria of the DSM-IV

The definition and diagnosis of these disorders has been

broadened over the years to include milder forms of au-
tism. The term autism spectrum disorders (ASDs) is cu-
rrently used to describe three of the five pervasive develop-
mental disorders listed in the
The five pervasive developmental disorders.
Diagnostic and Statistical Ma-
nual of Mental Disorders,  Autistic Disorder
Fourth Edition (DSM-IV)
 Asperger disorder

 Rett disorder

 Childhood disintegrative disorder

 Pervasive developmental disorder- not

otherwise specified (PDD-NOS)

Criteria of the DSM-IV

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1),
and one each from (2) and (3):

(1) Qualitative impairment in social interaction, as manifested by at least

two of the following:

(a) Marked impairment in the use of multiple nonverbal behaviors such as

eye-to-eye gaze, facial expression, body postures, and gestures to regulate
social interaction
(b) Failure to develop peer relationships appropriate to developmental level
(c) A lack of spontaneous seeking to share enjoyment, interests, or achieve-
ments with other people (e.g., by a lack of showing, bringing, or pointing out
objects of interest)
(d) Lack of social or emotional reciprocity
 Diagnosis

(2) Qualitative impairments in communication as manifested

by at least one of the following:

(a) Delay in, or total lack of, the development of spoken language (not accom-
panied by an attempt to compensate through alternative modes of communi-
cation such as gesture or mime)
(b) In individuals with adequate speech, marked impairment in the ability to
initiate or sustain a conversation with others
(c) Stereotyped and repetitive use of language or idiosyncratic language
(d) Lack of varied, spontaneous make-believe play or social imitative play ap-
propriate to developmental level

B. Delays or abnormal functioning in at least one of the following

areas, with onset prior to age 3 years:

(1) Social interaction,

(2) Language as used in social communication
(3) Symbolic or imaginative play

C. The disturbance is not better accounted for by Rett's Disorder or Child-

hood Disintegrative Disorder.
Diagnosis
Red flags indicating possible au-
tism spectrum disorder

Pre-school children

Delayed or absent speechk

Communication im-
pairment Deficient nonverbal communication e.g. lack
pointing, difficulty following a point

Lack of response to others’ facial expression/

feeling
Lack of pretend play; little or no imagination
Social impairment
Lack of showing typical interest in or play near
peers purposefully

Lack of initiation of activity

Inability to share pleasure

Unusual or repetitive hand and finger manne-

Impairments of inter- rism
ests, activities and/ Liking sameness/inability to cope with change
or behaviors
Repetitive play with toys (eg, lining up toys; tur-
ning lights on and off)
 School-age children

Communication im- Abnormalities in language development inclu-

pairment ding muteness
Persistent echolali
Unusual vocabulary for child’s age/social group

Abnormalities in language development inclu-

ding muteness
Social impairment Persistent ecolalia

Unusual vocabulary for child’s age/social group

Abnormalities in language development inclu-

Impairments of inter- ding muteness
ests, activities and/
Persistent echolalia
or behaviors
Unusual vocabulary for child’s age/social group
 Adolescents

Problems with communication, even if wide vocabulary

and normal use of grammar. May be unduly quiet,
may talk at others rather than hold a to-and-fro con-
versation, or may provide excessive information on to-
pics of own interest.
Language, non- Unable to adapt style of communication to social situa-

verbal skills and tions (eg, may sound like ‘a little professor’ (overly for-

social communi- mal) or be inappropriately familiar.

cation May have speech peculiarities including ‘flat’, unmodu-

lated speech, repetitiveness, use of stereotyped phra-

May take things literally and fail to understand sar-

casm or metaphor
Unusual use and timing of non-verbal interaction
(eg, eye contact, gesture and facial expression).

Problems with communication, even if wide vocabulary and nomal

use of grammar. May be unduly quiet, may talk at others rather than
Social problems hold a to-and-fro conversation, or may provide excessive informa-
tion on topics of own interest.

Unable to adapt style of communication to social situations (eg,

may sound like ‘a little professor’ (overly formal) or be inappropria-
tely familiar.

May have speech peculiarities including ‘flat’, unmodulated speech,

repetitiveness, use of stereotyped phrases.
May take things literally and fail to understand sarcasm or me-
taphor.

Unusual use and timing of non-verbal interaction (eg, eye contact,

gesture and facial expression)
 Preference for highly specific, narrow interests or hob-
bies, or may enjoy collecting, numbering or listing.

Strong preferences for familiar routines, may have repe-

titive behaviors or intrusive rituals
Problems using imagination e.g. in writing, future plan-
Rigidity in thinking and
behavior May have unusual reactions to sensory stimuli (eg
sounds, tastes, smell, touch, hot or cold.
At present, there is no cure for the core symptoms of autism. However, several
groups of medications, including atypical neuroleptics, have been used to treat asso-

Research has shown that the most effective therapy is use of early intensive behavioral in-
terventions that aim to improve the functioning of the affected child. These interventions
focus on developing language, social responsiveness, imitation skills, and appropriate be-
haviors. Examples of these behavioral therapies include

ABA (Applied Behavior Analysis) TEACCH (Treatment and Educa-

approach involves teaching new The TEACCH approach takes

behaviors by explicit reinforcement;
problem behaviors are addressed by
analyzing triggers in order to
change factors in the environment
that are contributing to that behav-
ior.
advantage of relative strengths
in visual information pro-
cessing using strategies such as
visual schedules, clearly struc-
tured and organized class-
rooms, and highly structured
learning activities that are bro-
ken down into manageable,
visually organized steps.

These behavioral techniques should begin early in the pre-school period and be followed
by highly individualized educational intervention in the school.