Autism

Autism

Autism and autism spectrum disorder (ASD) are both general terms for a group of complex disorders of brain development. These disorders are characterized in varying degrees by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors. The disorders that were merged into one umbrella diagnosis of ASD with the May 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include autistic disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger syndrome.

Statistics from the U.S. Centers for Disease Control and Prevention (CDC) in 2016 identified approximately 1 in 68 American children as on the autism spectrum affecting over 3 million individuals in the United States. Studies show that autism is four to five times more common among boys than girls.1 ASD occurs in every racial and ethnic group and across all socioeconomic levels.

Much research is being done to discover the causes of autism, and most scientists believe that both genetics and the environment likely play a role in ASD. A number of genes associated with ASD have been identified, and imaging studies have found differences in the development of several regions of the brain.2 Environmental stresses combined with genetic risk factors appear to indicate a relationship to events before and after birth, parental age, maternal illness, medications taken by the mother, and other factors that may increase the risk of developing autism.3 Multiple studies have shown that vaccinations to prevent childhood infectious diseases do not increase the risk of autism, and the theory that parental practices are responsible for ASD has long been disproved.4

The three core areas characterizing autism spectrum disorder are social-interaction difficulties, communication challenges, and a tendency to engage in repetitive behaviors. Not all three are found in every case and the symptoms may result in relatively mild challenges for those on the high functioning end of the spectrum, while others may have more severe symptoms that interfere with their everyday life.

The social challenges for a child with ASD can cause him to feel overwhelmed and frustrated. Children with autism tend to have difficulty interpreting what others are thinking and feeling and seeing things from another’s perspective. They can have difficulty understanding social cues, such as a smile, a frown, or a wave, which convey little meaning to them. This interferes with their ability to predict or understand other’s actions, and the world can seem bewildering to them. They can seem disconnected with others, and they may have difficulty regulating their emotions resulting in outbursts and disruptive behavior.

Young children with autism tend to be delayed in babbling as infants, although some children seem to have the ability to coo and babble during their first few months of life before losing these communicative behaviors. Most children with autism are able to develop communication skills, but they may use speech in unusual ways, such as speaking only single words or repeating the same phrase over and over. Some mildly affected children may only have slight delays in language, and some even develop unusually large vocabularies and precocious language, yet they still may have difficulty sustaining a conversation. Often they have the inability to understand body language, tone of voice, and expressions that are not intended to be taken literally. They have difficulty understanding the subtle changes in facial expressions and gestures, and their own body language may not match what they are trying to say.

Unusual repetitive behaviors that are common with children with ASD include hand-flapping, rocking, jumping and twirling, arranging and rearranging objects, and repeating sounds, words, or phrases. Also children with autism may engage in a restricted range of activities, such as spending hours lining up toys in a specific way instead of using them for pretend play. Many with autism need extreme consistency in their environment and daily routines, and slight changes to their order can be extremely upsetting to them. Repetitive behaviors can result in intense preoccupations or obsessions. They can result in becoming extremely knowledgeable about their interests.5

The CDC reported in 2016 that autism can sometimes be detected at 18 months or younger, but can be reliably diagnosed by the age of 2 years. The CDC suggests children should begin to be screened for developmental delays and disabilities during regular well-child doctor visits at 9 months, 18 months, and 24 or 30 months, and specifically be screened for ASD at 18 months and 24 months. Since there is no medical test to diagnose ASD, the doctor will rely on observing the child’s behavior and development to make a diagnosis.6

The “red flags” that may indicate a child is at risk for autism spectrum disorder may include some of the following:

  • No big smiles or other warm, joyful expressions by 6 months or thereafter
  • No back-and-forth sharing of sounds, smiles, or other facial expressions by 9 months
  • No babbling by 12 months
  • No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
  • No words by 16 months
  • No meaningful, two-word phrases (not including imitating or repeating) by 24 months
  • Any loss of speech, babbling, or social skills by any age.7

Later indicators for older children include:

  • 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
  • Repetitive or unusual use of language
  • Abnormally intense or focused interest
  • Preoccupation with certain objects or subjects
  • Inflexible adherence to specific routines or rituals.

Parental observations along with evaluations from professionals, such as psychologists, neurologists, psychiatrists, speech therapists, and others who diagnosis and treat children with ASD, can aid in making the correct assessments of the child’s symptoms.8

Early intensive behavioral intervention improves learning, communication, and social skills in young children with ASD, and most professionals believe the earlier, the better. There are many different types of treatments available, such as auditory training, discrete trial training, vitamin therapy, anti-yeast therapy, facilitated communication, music therapy, occupational therapy, physical therapy, and sensory integration. Some medications can sometimes help those with ASD to manage issues with high energy levels, inability to focus, depression, or seizures. Just as each person with autism has different challenges, there are many treatments that can be tried to improve attention, learning, and related behaviors, and treatment programs may need to be changed as the child ages.9

For normally-functioning children, play is a lifelong activity that serves to develop their social, emotional, cognitive, language, and cultural abilities. Play also encourages creative thinking, creates rapport and cultivates trust, helps develop critical thinking, and alleviates stress. However, children with autism face a significant amount of problems interacting with others and lack the spontaneous desire to seek to share enjoyment, interests, or achievement with others. Following rules is problematic and engaging in pretend play or make-believe with others is difficult. There are various play interventions for children with ASD that focus on how to allow children to learn how to play and acquire social and cognitive competence through play skills.10

Playgrounds have often proven to be a challenge for families of children with autism, and they can be overstimulating and loud for the child who has trouble processing all the activity. It has been reported that nearly half of the children with autism tend to wander, which causes immense stress for their families when trying to enjoy the playground. To better address the needs of children with sensory processing disorders, playground equipment manufacturers began creating many new play elements that provide fun for all and are especially welcoming to children with autism.

The Inclusive Play Design Guide, developed by a group of playground and child development experts, suggests a fun and safe playground for children with autism should have these elements:

  1. Enclosed by a fence to limit wandering.
  2. A wide path all the way around the play equipment, which allows the child to understand the dynamics of the playground from a safe distance.
  3. Activities, such as sand play, water play, musical play with instruments, and imaginative play with themed play equipment as well as ample room for running.
  4. Cozy spaces for children to chill out.
  5. Equipment with lots of movement that allows children to spin, swing, sway, rock, and jump.
  6. Design of the playground for line of sight for parents to be able to observe the children without blocked vision.
  7. Good landscaping and nature play that set a serene, calming tone.
  8. Muted colors rather than bright-colored playground equipment.
  9. Play activities that promote social play, such as seesaws.
  10. Sensory rich playgrounds that include different activities focused on the senses.11

Children on the autism spectrum can be encouraged to engage in physical activity that can boost their confidence and self-esteem by engaging in sports and activities that fit their needs. Swimming is a whole-body sport that is often sensory rewarding for children with autism. Martial arts, gymnastics, bowling, golf, and track and field are great activities for individual-minded athletes. Rock climbing, hiking, bicycle riding, and horseback riding are all good outdoor activities that can be enjoyed by the whole family.12

  • 1. “What is Autism?” Autism Speaks. < https://www.autismspeaks.org/what-autism > 21 June 2016.
  • 2. “Autism Spectrum Disorder Fact Sheet.” National Institute of Neurological Disorders and Stroke. < http://www.ninds.nih.gov/disorders/autism/detail_autism.htm > 21 June 2016.
  • 3. Op. cit., “What is Autism?”
  • 4. Op. Cit., “Autism Spectrum Disorder Fact Sheet.”
  • 5. “Symptoms.” Autism Speaks. < https://www.autismspeaks.org/what-autism/symptoms > 21 June 2016.
  • 6. “Screening and Diagnosis.” Centers for Disease Control and Prevention. < https://www.cdc.gov/ncbddd/autism/screening.html > 21 June 2016.
  • 7. “Learn the Signs of Autism.” Autism Speaks < https://www.autismspeaks.org/what-autism/learn-signs > 21 June 2016.
  • 8. Op. cit., “Autism Spectrum Disorder Fact Sheet.”
  • 9. “Treatment.” Centers for Disease Control and Prevention. < http://www.cdc.gov/ncbddd/autism/treatment.html > 21 June 2016.
  • 10. Gomez, Jacqueline Lorraine. “Autism and Play.” Autism Society. < https://asa.confex.com/asa/2011/webprogramarchives/Paper1762.html > 21 June 2016.
  • 11. Kaplan, Mara. “Ten tips for choosing a playground for a child with autism.” Playworld. 9 April 2013. < http://playworld.com/blog/ten-tips-for-choosing-a-playground-for-a-child-with-autism/ > 21 June 2016.
  • 12. Bishop, Carrie. “Ten Sport Suggestions for Kids with Autism.” Indy’s Child. < https://indyschild.com/Articles-i-2011-05-01-252090.112112-Ten-Sport-Suggestions-for-Kids-with-Autism.html > 26 May 2011.