Can your child be autistic?
Autism is a developmental disorder that affects the formation of social and communication skills. An autistic individual perceives the whole world in the direction of his/her own thoughts, emotions and desires. In addition, these individuals evaluate the incidents and objects under the light of their own feelings and thoughts instead of the reality shared by the people. Unresponsiveness to the environment, verbal or other types of communication difficulties, abduction of reality, being introverted, excessive indulgence and obsessive behavior towards objects are the phenomena that define the process of the disease. Children with this disorder, which generally develops in the first 2 or 3 years of life, usually have learning difficulties. While most of the autistic children have mental retardation, there are also children with autism having normal intelligence level. Some autistic people like Raymond (the autistic character of the movie Rain Man) can be incredibly talented in mathematics, music, or visual perception. However, unfortunately, many of them may not use their abilities in everyday life because of their inability to perceive the world as a whole, inability to generalize and their excessive obsession with details.
Autistic disorder criteria:
According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) published by the American Psychiatric Association in 2000 diagnostic criteria for autism are:
A- At least two of the following four symptoms must be present:
1- A certain deterioration in many non-verbal behaviors such as hand-arm movements, body position, facial expression and eye contact used in social communication.
2- Inability to develop relationships with peers as to be compatible with their age.
3- Not entertaining with other people, not seeking way to share own interests or achievements with other people spontaneously (i.e., not showing, bringing or indicating the objects of interest).
4- Not giving social or emotional responses
B - At least one of the following must be present:
1- Inability to talk in native language or retardation of talking.
2- Significant impairment in starting or continuing to talk to others when there is sufficient talk.
3- Speaking by repeating words or phrases in a row or using them meaninglessly.
4- Failure to play games complying with the age and the development level and the games requiring improvisation
C- In case of the presence of at least one of the following repetitive interests, activities and behaviors:
1- Restricting the focus of interest by engaging repetitively in a specific object or subject in terms of frequency and intensity.
2- Engaging in a successive, ordinary and certain activity that is not functional and does not serve any purpose at an unstoppable level.
3- Having repetitive body movements (ie., finger snapping, hand clapping or twisting, or other complex body movements).
4- Excessive and repetitive handling of certain parts of objects.
A total of at least six statements must be present from all the above-mentioned items.
In addition, the social interaction, language used in social communication and delayed or abnormal development before 3 years old at least in one of the symbolic/improvisational playing fields besides the relation of this disorder with another disease are some of other diagnosis criteria of the disease.
Reasons of autism:
Along with many assumptions about the reasons of this process, which is deemed as a common development disorder, the researches about the origins still continue. The frequent existence of mental deficiency and epileptic attacks are attention-grabbing in terms of the findings suggesting that the biological reasons might be prominent. Researches on siblings and twins preoccupy that genetic factors are significant. For many years, the lack of communication between the mother and the infant has been discussed as the reason for the autism and the term "refrigerator mother”is used to describe the inadequacy of mothers in establishing an emotional relationship with the child. However, later on, these data supporting this view was deemed inadequate as the other children from the same parents do not have similar problems and not all the mothers of autistic children comply with "refrigerator mother" model. The greater frequency of autism with some medical conditions and presence of epilepsy attacks in 25% of these children gain the attention for neurobiological field in quest of the reasons of autism.
Prevalence, gender and socio-economic factors in autism:
In the studies it is observed that the frequency of the occurrence of autism is increased. The initial value of 2500/1 that has been obtained during earlier researches has now reached to 1000/1. There are several assumptions about this increase over time. While it is defended that the process is progressively increasing due to pollution of nature, radioactive substances, changing of eating habits one hand, it is predicted that the ratio of frequency is increased by the fact that the process is better recognized over time and its mild forms are added to this number on the other hand.
Prevalence: Autism usually begins before 36 months old. However, it is after 36 months that the parents are aware of the disorder and that the severity is determined and diagnosed.
Gender: Autism is two or three times more common in boys. In the studies that were carried out in our Turkey boy-girl ratio was reported as 5/1. Although the rate of occurrence is lower than that of boys, girls experience the characteristics of autism more intensively and heavily than boys.
Socio-economic status: It is observed during the studies that the socio-economic status does not affect autism. The detected numerical differences are associated with the families, whose socio-economic status is low do not apply to a specialist for diagnosis and treatment.
Characteristics of children with autism:
It is observed that the infants with autistic characteristics show two types of behavior. The first group of babies constantly weep and are called bad-tempered. The second group spend the whole day in bed quietly. Autistic children have a very cute appearance while growing up are shorter than their peers. It has been observed that the speech and behavior of some of these children are normal, but they also lose language skills by breaking the social relations suddenly.
The most distinctive characteristics of an autistic child from normal child are as follows:
• Indifferent to others and does not communicate spontaneously. Shows more attention to non-living objects than people.
• Abstains from eye contact.
• Indicates demands using the hands of an adult.
• Shows retardation in talking compared to peers.
• Does not play with other children.
• Talks consistently about a specific subject. Cries and laughs without reason and shows motiveless behaviors.
• Repeats meaningless words. Makes up new meaningless words or misuse the words in sentences.
• Shows an unusually heightened attachment to specific objects (i.e. rope, a crown, a cap). Likes to hold these objects and keep them at all times.
• Does not like changes and abstains from them.
• Cannot play games requiring creativeness.
• Some of them perform some tasks that do not require creativity quite fast and well.
• Shows self-destructive behaviors.
• Shows frightening and anxious behavior.
• May give abnormal reactions to external stimulae such as light and sound.
Diagnosis and treatment of autism:
Although the symptoms show themselves in the majority of autistic children, families may not realize the situation as many factors cause retardation in the diagnosis of these symptoms. Education in autism, which is a lifelong process, is extremely important. Therefore, early diagnosis has a very important place in the treatment of this disease so that special education can be started as soon as possible. Research has demonstrated that following early diagnosis and treatment many significant progress can be achieved in the emotion and language skills of children with autism, and in cases where children do not receive treatment until the age of five or six, many existing behaviours can be decreased over time. The first and most important step in the treatment of autism is that the family plays an active role during the treatment, and should have knowledge about the condition. The most positive outcomes are achieved when family members accept and understand the condition and demonstrate patience and realistic expectations whilst cooperating and supporting the treatment team. In autism the treatment plan and types are determined according to the degree of functioning of each individual. The main types of treatment approach are as follows:
A. Education therapies:
Education: Special education programs for autistic children are applied to this approach. Children are taught how to operate in a group environment and receive training on individual interpersonal skills.
Language and communication therapy: Speech therapy is applied to improve social communication and to solve language problems.
Hearing and listening training: By reducing the susceptibility of autistic individuals against sound this approach aims to enhance an autistic child’s social behaviors.
B. Behavioral Therapy: The punishment-reward system is applied to the behaviors of the patient which require development.
C. Psychotherapy: Even if limited, personal psychotherapy can be performed with this group of patients.
D. Pharmacotherapy: Pharmacotherapy can be applied in order to prevent hyperactivity, burst of anger, withdrawal, aggression, self-destructive behaviors, depression and obsessive-compulsive behaviors in autistic patients.
The common goal of these treatment approaches is to ensure the adaptation of the individual to the external world. The outcome of the treatment depends on the intelligence level of the patient. The achievement of the treatment is quite low in children with low intelligence level and retardation in talking. While only 10% of autistic children live their lives without being in need for others in their future lives, unfortunately many of them cannot live independently without help.