Autism and Autistic Spectrum Disorders
There is increasing evidence that the lack of a theory of mind may be involved in the serious disorder known as autism. Children with autism have great difficulty communicating and interacting with others in socially appropriate ways. Recent work on theory of mind shows that children with autism are often unable to understand other people's thoughts; moreover, they don't seem to have much insight about their own mental states. Sometimes called mindblindness, such problems may be due to deficits in specific brain structures that have evolved to allow humans to interact socially with others (Baron-Cohen, 1995). Their problems may also be related to deficits in the executive functions, which limit these children's metacognitive skills (Pellicano, 2007).
Autism is a spectrum disorder, which means it can take forms that range from milder (such as Asperger's syndrome) to more severe (such as autistic disorder). For this reason, these disorders are also referred to as autistic spectrum disorders (ASDs) (NICHD, 2005). The table below lists some of the more common indicators of autistic disorders. Most children with autism show repetitive body motions or self-stimulation activities such as rocking their bodies or waving their fingers in front of their eyes. They are inflexible about their daily routines and become upset by changes such as a different bedtime, a new arrangement of furniture, or an attempt to take them shopping at a new store. Chilldren with autism score low on IQ tests (in the range of mental retardation), but a small percentage show exceptional splinter skills, such as an extraordinary gift for calculating dates and numbers or an exceptional memory for music. Language skills tend to be severely delayed in children with autism. Many of these children simply repeat back words and phrases they hear (a pattern called echolalia) without seeming to understand what is said.
Approximately 16 children per 10,000 have autism (Mash & Wolfe, 2007). It is four times more common among boys than girls, and in recent years the number of children identified with autism has increased. Autism has a strong genetic component, being shared much more often between identical than between fraternal twins (Bailey et al., 1995). Researchers are just beginning to understand the brain mechanisms associated with this disorder. Early evidence indicates immaturity in the limbic system and in the frontal and midbrain areas of the brain (Kabot, Masi, & Segal, 2003; Newsom, 1998). These areas regulate attention, emotion perception, and the control of planning and thought processes.
With autism, the effectiveness of treatment varies depending on the severity of the disorder in individual children (Newsom, 1998). With severe levels of autism, therapy focuses on teaching self-care skills and helping the child learn to live as independently as possible. Lifelong care and supervision will probably still be essential. With more moderate to mild levels, treatment can be more effective if it starts early and involves intensive one-to-one training and therapy, preferably 20 to 40 hours per week. The work focuses on improving language, teaching social skills, and helping the child learn the skills and behaviors necessary for preschool and early elementary school (Autism Society of America, 2002; Newsom, 1998; Whalen & Schreibman, 2003). Parent education and training are also important parts of effective therapy (Kabot et al., 2003; Whitaker, 2002). With this kind of training and therapy, children with autism can show impressive gains, although most will still not function like their more typical peers.
Indicators of Autistic Spectrum Disorders
Speech and Language
- Slow language and speech development:
- No meaningful gestures, no babbling by 1 year
- No words by 16 months
- No use of two-word combinations by 2 years
- Language skills seemed normal, but has regressed in use of words and other communication
- Does not respond to name
- Does not follow directions
- Is frequently not able to explain what is wanted
- At times seems to not hear well; other times hearing seems normal
- Shows poor eye contact when interacting with others
- Does not smile in return when smiled at
- Does not wave good-bye
- Has violent or otherwise intense tantrums
- Prefers to play alone; not interested in interacting with other children
- Often seems to be absorbed in his/her own world
- Decline in social skills
- Shows unusual attachment to a particular toy or object
- Shows unusual need for a certain order of activities (for example, becomes upset if asked to put on gloves before hat when she/he typically puts on hat first)
- Unusual amounts of time spent lining things up in a certain order
- Often repeats the same behaviors over and over; can't seem to move on to something else
- Seems unusually active; is uncooperative or resistant to requests or demands
- Frequently walks on his/her toes
- Is ahead of peers in many behaviors and seems very independent
Source: NICHD, 2005. Autism overview: What we know. www.nichd.gov/publications/pubs/autism_overview_2005.pdf
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