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What is Autism? by RALPH COBRINIK, M.D. Autism, or autistic disorder, has received a great deal of media attention of late because of some reports suggesting a possible link to the MMR (measles, mumps, rubella) vaccine and because of an alleged increase in its incidence over the past two decades. It is; therefore, important for both the public and physicians to have a clear understanding of what autism is, especially since the various terminologies and the enlarging scope of the diagnosis continue to be in flux. Autism is a very complex entity, so that only the most basic information can be included in this brief description. Autism is officially included under the broad category of Pervasive Development Disorder (PDD), although many use the terms interchangeably. It is manifested by three broad areas of severe, aberrant development: impairment of social interaction; impairment of communication skills; and restricted, peculiar (stereotypical) behavior, interests and activities. Unfortunately, autism is most often, but not always, associated with mental retardation, especially in the verbal area. Socially, there is often little or no awareness of other people, except perhaps as “tools.” Parents may feel they are merely “love machines” because of the child’s limited eye contact or blank gaze and lack of an affectionate cuddling response. Later, there is usually little or no interaction with peers. Impaired communication is both verbal and nonverbal, with delay or absence of development of spoken language. If the child does develop speech, it generally lacks relevance or social character and often has bizarre intonations. Echolalia, or the repetition of the last few words the autistic child hears, is a common phenomenon. The autistic child generally is unable to understand simple directions, questions, humor, or the simplest games of infancy and childhood.
These children may be extremely sensitive or insensitive to various sensory stimuli, including pain. Inappropriate mood swings and emotional reactions are common, for example, lack of fear of real danger and excessive fear for no reason. Self-injurious behaviors are common. At times, parents believe that “normal” development and behavior preceded onset of symptoms, although this is unlikely. Indeed, if this is the case, another diagnosis must be considered. Recognition, or acceptance, of “something wrong” by age 2 or 3 years is typical. Most often, autism is unassociated with any physical or laboratory abnormality, but on occasion these will prove revealing as to etiology and should be pursued. Although still under investigation, epidemiologic studies suggest that the apparent increase in the incidence of autism is more a product of increased recognition and reporting and expanded diagnostic criteria rather than an actual increase in numbers. Currently, most major medical organizations, such as the American Academy of Pediatrics, AMA, CDC, British Medical Research Council, and World Health Organization, state that they believe the available evidence does not support the hypothesis of a link between MMR and autism. The great majority of pediatricians recommend MMR and would welcome the opportunity to answer your questions. This issue is under continued surveillance. MMR has certainly proven to be very effective in preventing the scourges of measles, mumps and Rubella. Epidemiologic, twin and genetic studies implicate a genetic predisposition to autism, possibly in relation to environmental factors. Autism is not due to “bad” or “refrigerator” parents, as had been originally postulated. Parents can feel confident that it is not their fault. One form of PDD, in which the children are often quite bright and verbal but otherwise have features similar to those described above, is referred to as Asperger’s Disorder. There are other conditions that mimic autism. It is therefore important for children who present with suggestive features to be evaluated by physicians familiar with these disorders. Ultimate prognosis for autistic children depends primarily on two factors: actual level of intelligence and age and quality of language development. There is no known specific treatment, but early special educational intervention is deemed to be helpful. Parents who suspect their infant or child may show some of these features should discuss their concerns with their pediatrician. Fortunately, most of the time these concerns prove to be unfounded. For a referral to a Saint Barnabas pediatrician, please call [ top ] |
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The stereotypical interests and activities may manifest as total lack of awareness of things other children actively respond to, or as extreme preoccupation with such things, or as a strange approach to them. An example would be a young child who never rolls a truck along the floor, but rather holds the truck upside down close to his eyes, continuously turning a wheel with his finger. The preoccupation may involve narrowly focused interests and special skills in such things as dates and phone numbers. Some even develop advanced reading decoding skills, but without full understanding. Other features may include excessive lining up of items, smelling objects like blocks, or insisting on sameness in position of objects and routines. Excessive water play, often in toilets, is also often noted. Unusual body movements and positions such as tiptoe walking, arm flapping and rocking and strong attachments to inanimate objects, like a string, are also often seen. 
