Diagnosis & Common Characteristics
Currently, diagnosis of autism is based solely on observation of behaviors detailed in the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (2000). Because symptoms vary considerably from individual to individual, diagnosis can be quite difficult. In the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (2000), autism falls under the clinical categorization of Pervasive Developmental Disorders. Other autism spectrum disorders which fall under the same umbrella category are Asperger’s Syndrome, Childhood Disintegrative Disorder, Rett's Syndrome, and Pervasive Developmental Disorder: Not Otherwise Specified (PDD-NOS).

According to the Diagnostic and Statistical Manual of Mental Disorders - IV-TR (2000), individuals with autism can, although do not always, exhibit the following behaviors: difficulty using nonverbal behaviors for social purposes, difficulty developing appropriate peer relationships, does not appear to share enjoyment with others, lack of social/emotional reciprocity, difficulty in development of spoken language, impairment in sustaining conversation with others, stereotyped and repetitive use of language, lack of spontaneous social play, abnormal preoccupation with patterns of interest, inflexible adherence to routines, repetitive motor behaviors, and preoccupation with objects.

Because there is such a large degree of heterogeneity possible among those with autism, a description of clinical behavioral symptoms does not suffice in answering the question, “What is autism?” Individuals with autism will vary tremendously in the type of, number of, and severity of symptoms that they present, in cognitive abilities, and in the type of other medical conditions and challenges that they have. Additionally, because it is a developmental disability, autism will affect an individual differently at different stages of their lifespan.

Recent inquiries are investigating physiological differences as they relate to sensorimotor difficulties in autism, while deemphasizing the deficiency model of autism. There are a number of movement differences exhibited by individuals with autism that may reflect an underlying problem with the regulation of movement. Movement difficulties demonstrated by some people with autism include repetitive movements, abnormal gait, abnormal ways of rolling or crawling, abnormality in muscle tone, lack of imitation, self injurious behavior, echolalia, and difficulty initiating, stopping, or switching actions (Donnellan & Leary, 1995). Movement difficulty can affect one's actions, posture, speech, perception, thought, consciousness, motivation, and emotion. It is important to emphasize that the behaviors of an individual with autism in each of these areas may not be under the individual's voluntary control (Donnellan & Leary, 1995). Thus, they may not reflect an individual's abilities, intentions, or motivations.

This view of autism as a movement disorder holds that individuals with autism may have competencies that are not readily apparent through observation of their performance alone due to their movement difficulties, and that it is crucial to consider the physiological underpinning of the behavior. It is speculated that these movement difficulties might be the result of abnormalities in certain structures of the brain which control movement.

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Autism-related Conditions

Fragile X : Fragile X is a genetically-inherited condition in which the affected individual experiences some degree of mental impairment, delays in speech and language development, and behavioral challenges. Common symptoms can include: autistic behaviors, sensory integration difficulties, sensory motor problems, tactile defensiveness, anxiety, unstable mood, attention deficit, hyperactivity, seizures, mental impairment, long face shape, prominent ears, and hyperextensible joints. There is a great deal of heterogeneity in terms of the way that Fragile X presents itself in each individual. Typically, boys are more severely affected by Fragile X than are girls.

Related conditions which fall under the category of Pervasive Developmental Disorders are: Asperger’s Syndrome, Childhood Disintegrative Disorder, Rett's Syndrome, and Pervasive Developmental Disorder: Not Otherwise Specified. These are briefly described below:

Asperger’s Syndrome: Individuals with Asperger’s often have serious deficits in social skills and often demonstrate obsessive, repetitive routines or preoccupations with particular parts of objects. Individuals with Asperger's may also demonstrate poor coordination and poor concentration. They do not demonstrate a delay in spoken language development or in cognitive development.

Childhood Disintegrative Disorder: People with Childhood Disintegrative Disorder often develop normally for two to four years and then before age 10 begin to lose language, social skills, interest in play, motor skills, and self-care abilities.

Rett's Syndrome: People with Rett's Syndrome often develop normally until 6 to 8 months of age at which point they experience a developmental regression. This is often accompanied by a deceleration of head growth, loss of acquired hand skills and social engagement skills, stereotypic hand movements, poorly coordinated gait, and impaired language development. Rett's is significantly more common in girls than in boys.

Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS): People with Pervasive Developmental Disorder - Not Otherwise Specified are those who exhibit many symptoms of autistic disorder but who do not demonstrate the degree of impairment described in any of the other four categories of Pervasive Developmental Disorders.

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Prevalence
Autism is no longer considered a rare disorder. Although it is not known if autism spectrum disorders are actually becoming more common in the United States, it is known that more and more children are being identified as having an autism spectrum disorder than in the past. According to the CDC (2004), in the United States during the 2000-2001 school year, more than 15,000 children 3 through 5 years of age and more than 78,000 children and adults 6 through 21 years of age were classified as having autism under the Individuals with Disabilities Education Act (IDEA). These numbers are believed to be an underestimation of the prevalence of autism because some children with autism spectrum disorders are categorized under a different IDEA disability category, others may have been misclassified and others have yet to be diagnosed. In a study conducted in 1998 in Brick Township, NJ, the CDC (2004) found that 6.7 of every 1,000 children 3 through 10 years of age had at least one autism spectrum disorder. This translates roughly into 1 in every 166 children.

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Cause, Cure, and Interventions
Although many theories regarding the etiology of autism have been proposed, the cause is not yet clear. It has been suggested that autism may be caused by genetic, immunological, metabolic, and environmental factors. This issue is the topic of much debate and is currently the focus of many autism research endeavors. Additionally, there is no known cure for autism. However, common treatments and interventions target early and intensive education which can help the individual improve their social, communication, and cognitive skills. Common treatments and interventions include sensory integration therapy, nutritional therapy, intensive educational therapy, detoxification, music therapy, play therapy, Developmental Individual-Difference Relationship-based Model/Floortime, Relationship Development Intervention, augmentative communication strategies, including facilitated communication, applied behavior analysis, pharmacological treatments, individualized education programs, and comprehensive treatment programs.

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Autism Across the Lifespan

Autism is a developmental disorder which affects an individual throughout the lifespan; however, only a very small proportion of autism research, education, and service endeavors address issues that affect adults with autism. The vast majority of autism research focuses on children with autism, a disproportionate number of interventions for autism are appropriate only for children, and most autism services available are geared primarily towards children. The reality is that these children with autism do grow up to become adults with autism who are then left with significantly fewer resources and options.

As an individual with autism transitions from high school, there are a number of post-school issues that must be considered, such as postsecondary education, vocational training, supported employment, independent living, and community participation. As individuals with autism and their parents or caregivers get older, the issue of long-term life planning becomes more salient. Caregivers must ensure that the needs and desires of their loved one with special needs will be addressed once they are gone. This can be a complex process as the individual and caregiver must make decisions regarding the individual's medical care, living arrangements, daily activities, community participation, employment, religious involvement, guardianship, and trustees. As more communication strategies become available, individuals with autism are increasingly able to communicate their own lifespan needs and desires and take a more active role in the decision-making process.

Many questions regarding the cause, characteristics, and appropriate interventions for individuals with autism remain unanswered. While interest in and understanding of autism has grown tremendously in recent years, future research into understanding autism, including its etiology and treatment is very much needed.

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References

American Psychiatric Association, Taskforce on DSM-IV (2000). Diagnostic and Statistical Manual of Mental Disorders IV-TR. Washington, DC: American Psychiatric Association.

Center for Disease Control (2004). About Autism. Retrieved February 4, 2005, from Center for  Disease Control: Autism Information Center. Website: http://www.cdc.gov/ncbddd/dd/aic/about/default.htm

Donnellan, A.D., & Leary, M.R. (1995). Movement differences and diversity in autism/mental retardation. San Diego, CA: DRI Press.

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