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| {{Autism}} | | {{Autism}} |
| {{CMG}}
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| | {{CMG}}; {{AE}}{{HK}} |
| ==Overview== | | ==Overview== |
| Autism is distinguished by a pattern of symptoms rather than one single symptom. The main characteristics are impairments in social interaction, impairments in communication, restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis. Individual symptoms of autism occur in the general population and appear not to associate highly, without a sharp line separating pathological severity from common traits.
| | The characteristic behaviors of autism spectrum disorder may be apparent in [[infancy]] (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years). The three core symptoms associated with autism can be broadly classified as difficulties in social interaction, communicative challeneges and repetitive behaviors. Neuro-psychiatric and gastrointestinal symptoms along with sleep disturbances and facial dysmorphism may accompany the behavioral symptoms in autism |
| ==History== | | ==History== |
| Autism is defined in the [[DSM-IV-TR]] as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior. | | When evaluating a patient suspected to be suffering from autism, a detailed history should be obtained from the primary caregiver with focus on the following areas:<ref name="pmid261140962">{{cite journal |vauthors=Kong MY |title=Diagnosis and History Taking in Children with Autism Spectrum Disorder: Dealing with the Challenges |journal=Front Pediatr |volume=3 |issue= |pages=55 |date=2015 |pmid=26114096 |pmc=4462094 |doi=10.3389/fped.2015.00055 |url=}}</ref><ref name="pmid1483172">{{cite journal |vauthors=Baron-Cohen S, Allen J, Gillberg C |title=Can autism be detected at 18 months? The needle, the haystack, and the CHAT |journal=Br J Psychiatry |volume=161 |issue= |pages=839–43 |date=December 1992 |pmid=1483172 |doi= |url=}}</ref> |
| ===Autism Spectrum Quotient=== | | ===Past medical history=== |
| The Autism Spectrum Quotient, or AQ, is a questionnaire published in 2001 by [[Simon Baron-Cohen]] and his colleagues at the Autism Research Centre in [[Cambridge]], UK. Consisting of fifty questions, it aims to investigate whether normal adults have symptoms of [[autism]] or one of the other [[autism spectrum disorder]]s. The test was popularised by [[Wired Magazine]] in December 2001 when published alongside their article, "The Geek Syndrome" and is commonly used for [[self diagnosis]] of [[Asperger Syndrome]].<ref name="smith">M. Woodbury-Smith, J. Robinson and S. Baron-Cohen, [http://www.autismresearchcentre.com/docs/papers/2005_Woodbury-Smith_etal_ScreeningAdultsForAS.pdf Screening adults for Asperger Syndrome using the AQ : diagnostic validity in clinical practice], ''Journal of Autism and Developmental Disorders'' '''35''' 331-335 (2005) </ref>
| | *History of: |
| * ''Format'' | | **[[Fever]] |
| | **[[Vomiting]] |
| | **Poor oral intake |
| | ===Behavioral history=== |
| | *Developmental [[Regression (medicine)|regression]] (History of global developmental delay) |
| | *Restricted eye contact |
| | *Repetitive behaviors (hand flapping, arranging toys in long lines etc.) |
| | *Absence of gestures |
| | *Absence of symbolic play |
| | *Aloof |
| | *Resists change |
| | *Inconsolable crying |
| | *Agitation |
| | *Self-injurious |
| | *Unable to understand sarcasm or irony |
| | *Poor language skills |
|
| |
|
| The test consists of fifty statements, each of which is in a forced-choice format. Each question allows the subject to indicate "Definitely agree", "Slightly agree", "Slightly disagree" or "Definitely disagree". Approximately half the questions are worded to elicit an "agree" response from normal individuals, and half to elicit a "disagree" response. The subject scores one point for each question which is answered "autistically" either slightly or definitely. The questions cover five different domains associated with the autism spectrum: social skills; communication skills; imagination; attention to detail; and attention switching/tolerance of change.
| | === Family history === |
| | * ASD |
| | * Language disorders |
| | * [[Intellectual impairment|Intellectual]] disabilities |
| | * Learning problems |
| | * [[Attention-deficit hyperactivity disorder|ADHD]] |
| | * [[Depression]] |
| | * [[Schizophrenia]] or other mental illnesses |
| | * [[Obsessive-compulsive disorder|Obsessive compulsive disorder]] |
| | * [[Genetic disorder|Genetic disorders]] |
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| |
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| * ''Use as a Diagnostic Tool'' | | ===Socioeconomic status=== |
| | | *Poor [[Socio-economic status|socioeconomic status]] is associated with autism. |
| In the initial trials of the test,<ref>S. Baron-Cohen, S. Wheelwright, R. Skinner, J. Martin and E. Clubley, [http://www.autismresearchcentre.com/docs/papers/2001_BCetal_AQ.pdf The Autism Spectrum Quotient (AQ) : Evidence from Asperger Syndrome/High Functioning Autism, Males and Females, Scientists and Mathematicians], ''Journal of Autism and Developmental Disorders'' '''31''', 5-17 (2001)</ref> the average score in the control group was 16.4, with men scoring slightly higher than women (about 17 versus about 15). 80% of adults diagnosed with autism spectrum disorders scored 32 or more, compared with only 2% of the control group. The authors cited a score of 32 or more as indicating "clinically significant levels of autistic traits". However, although the test is popularly used for self-diagnosis of [[Asperger Syndrome]], the authors caution that it is not intended to be diagnostic, and advise that anyone who obtains a high score and is suffering some distress should seek professional medical advice before jumping to any conclusions.
| | ==Symptoms== |
| | | *The characteristic behaviors of autism spectrum disorder may be apparent in [[infancy]] (18 to 24 months), but they usually become clearer during early childhood (24 months to 6 years). |
| A further research paper<ref name="smith"/> indicated that the questionnaire could be used for screening in clinical practice, with scores of 26 or lower indicating that a diagnosis of Asperger Syndrome can effectively be ruled out.
| | ==='''Social interaction difficulties'''=== |
| ==Common Symptoms== | | Impaired social communication is one of the most common presentations of autism.<ref name="pmid145507032">{{cite journal |vauthors=Volkmar FR, Pauls D |title=Autism |journal=Lancet |volume=362 |issue=9390 |pages=1133–41 |date=October 2003 |pmid=14550703 |doi=10.1016/S0140-6736(03)14471-6 |url=}}</ref><ref name="pmid98262992">{{cite journal |vauthors=De Giacomo A, Fombonne E |title=Parental recognition of developmental abnormalities in autism |journal=Eur Child Adolesc Psychiatry |volume=7 |issue=3 |pages=131–6 |date=September 1998 |pmid=9826299 |doi= |url=}}</ref><ref name="pmid92116802">{{cite journal |vauthors=Rapin I |title=Autism |journal=N. Engl. J. Med. |volume=337 |issue=2 |pages=97–104 |date=July 1997 |pmid=9211680 |doi=10.1056/NEJM199707103370206 |url=}}</ref> |
| ===Social Development=== | | *Absent, preferential or inconsistent social smile. |
| People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic [[Temple Grandin]] described her inability to understand the social communication of [[neurotypical]]s as leaving her feeling "like an anthropologist on Mars".<ref>{{cite book|title=[[An Anthropologist on Mars]]: Seven Paradoxical Tales|author=[[Oliver Sacks|Sacks O]]|publisher=Knopf|date=1995|isbn=0679437851}}</ref>
| | *Reduced ability to do non-verbal communication (problems with eye-contact, body language and facial expressions). |
| | | *Inappropriate response to social overtures: |
| Social impairments become apparent early in childhood and continue through adulthood. Autistic people are prone to commit social ''[[faux pas]]'' because of an inability to predict others' reactions. Autistic infants show less attention to social stimuli, smile and look at others less often, may also neglect social niceties like knocking or returning a greeting and respond less to their own name. Similarly, they may be overly trusting or paranoid of strangers. It may be best summed up as an inability to understand/perceive the intent or emotional wants and needs of others around them. Autistic toddlers have more striking social deviance; for example, they have less [[eye contact]] and anticipatory postures and are more likely to communicate by manipulating another person's hand. This leads others to conclude that they are shy, uninterested or evasive. Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. They may appear somewhat removed or [[Dissociation (psychology)|dissociated]] or dreamy at times, especially when in [[sensory overload]] or from a perception of extreme social pressure. However, they do form [[Attachment (psychology)|attachments]] to their primary caregivers.<ref>{{cite journal|journal=Ment Retard Dev Disabil Res Rev|date=2004|volume=10|issue=4|pages=221–33|title=Early detection of core deficits in autism|author=Sigman M, Dijamco A, Gratier M, Rozga A|doi=10.1002/mrdd.20046|pmid=15666338}}</ref> They display moderately less [[Attachment in children#Secure attachment|attachment security]] than usual, although this feature disappears in children with higher mental development or less severe ASD.<ref>{{cite journal|journal=J Child Psychol Psychiatry|date=2004|volume=45|issue=6|pages=1123–34|title=Autism and attachment: a meta-analytic review|author=Rutgers AH, Bakermans-Kranenburg MJ, van IJzendoorn MH, van Berckelaer-Onnes IA|doi=10.1111/j.1469-7610.2004.t01-1-00305.x|pmid=15257669}}</ref> Older children and adults with ASD perform worse on tests of face and emotion recognition.<ref name=Sigman>{{cite journal |journal= Annu Rev Clin Psychol |year=2006 |volume=2 |pages=327–55 |title= Autism from developmental and neuropsychological perspectives |author= Sigman M, Spence SJ, Wang AT |doi=10.1146/annurev.clinpsy.2.022305.095210 |pmid=17716073}}</ref>
| | **Aloofness |
| | | **Shyness or fussiness (in forced interactions) |
| Unlike those with low-functioning autism, people with high-functioning autism are not [[Mental retardation|mentally retarded]]; persons with high-functioning autism have an IQ at the average to above-average range. High-functioning autism (HFA) is an informal term applied to individuals with [[autism]], an [[IQ]] of 80 or above, and the ability to speak, read, and write.<ref>[http://www.nichd.nih.gov/news/releases/autism_affects_brain.cfm Study Provides Evidence That Autism Affects Functioning of Entire Brain: Previous View Held Autism Limited to Communication, Social Behavior, and Reasoning] National Institute of Health News, Aug. 16, 2006</ref> HFA may simply refer to autistic people who have normal overall intelligence; that is, are not cognitively challenged.<ref>[http://www.maapservices.org/MAAP_Sub_Find_It_-_Publications_Volkmar_Article.htm Validity and Neuropsychological Characterization of Asperger Syndrome: Convergence with Nonverbal Learning Disabilities Syndrome] A. Klin et al (1995) The Journal of Child Psychology and Psychiatry and Allied Disciplines, Vol. 36, No. 7, pp. 1127-1140, 1995. Reprinted with permission from Cambridge University Press. See section titled "Validity of Asperger syndrome"</ref>
| | **Reduced [[attention span]] |
| Although they may have an adequate vocabulary, they may have a delay in communicating events and use less emotional content in their speech. They may also appear not to notice non-verbal cues from others such as when others have become bored with the topic of conversation they appear oblivious and continue.
| | *Inability to initiate a social encounter properly |
| | | *Social awkwardness and behaviors mistaken to be ranging from extreme friendliness to aggressive beaviors such as; |
| Contrary to common belief, autistic children do not prefer to be alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they are.
| | **Inappropriate touching |
| | | **Stroking |
| There are many anecdotal reports, but few systematic studies, of aggression and violence in individuals with ASD. The limited data suggest that in children with mental retardation, autism is associated with aggression, destruction of property, and tantrums. Dominick ''et al.'' interviewed the parents of 67 children with ASD and reported that about two-thirds of the children had periods of severe tantrums and about one-third had a history of aggression, with tantrums significantly more common than in children with a history of language impairment.
| | **Pushing or hitting others |
| | | *Reduced ability to develop friendships. |
| Generally, there are difficulties with social interaction. This might not adversely affect their ability to interact with others on a day-to-day basis at a basic working level, although they may be seen as being overly serious or earnest, and as being without any "small talk" in conversation. In many instances though, these individuals have such severe social delays and difficulties that interaction within a "normal" social setting can be severely hampered.
| | *Indifference or excessive clinginess |
| | | *Excessive familiarity, absence of social inhibitions and [[stranger anxiety]] |
| They may have difficulty initiating love and friendship relationships, often being rejected because potential partners perceive them as being either too "nerdy" or too intelligent. This can lead to low self esteem or loneliness, which further impairs their ability to find meaningful companionship.
| | ===Communicative challenges=== |
| | | *Meaningful speech does not develop in 30–50% cases. |
| People may label HFA people as "oddballs" or worse, and HFA people can easily become the target of bullying. This can be especially true from primary school through the late teens. Young, intelligent HFA people usually do best by seeking out the company of their intellectual peers or by joining hobby groups, while avoiding their age-group peers. Exposure to an age equivalent peer group within the autism spectrum on a regular basis can be especially beneficial.
| | *Language is usually delayed or deviant.<ref name="pmid179679202">{{cite journal |vauthors=Johnson CP, Myers SM |title=Identification and evaluation of children with autism spectrum disorders |journal=Pediatrics |volume=120 |issue=5 |pages=1183–215 |date=November 2007 |pmid=17967920 |doi=10.1542/peds.2007-2361 |url=}}</ref><ref name="pmid244722582">{{cite journal |vauthors=Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M |title=Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder |journal=J Am Acad Child Adolesc Psychiatry |volume=53 |issue=2 |pages=237–57 |date=February 2014 |pmid=24472258 |doi=10.1016/j.jaac.2013.10.013 |url=}}</ref><ref name="pmid281627682">{{cite journal |vauthors=Miller M, Iosif AM, Hill M, Young GS, Schwichtenberg AJ, Ozonoff S |title=Response to Name in Infants Developing Autism Spectrum Disorder: A Prospective Study |journal=J. Pediatr. |volume=183 |issue= |pages=141–146.e1 |date=April 2017 |pmid=28162768 |doi=10.1016/j.jpeds.2016.12.071 |url=}}</ref><ref name="pmid129088282">{{cite journal |vauthors=Emerich DM, Creaghead NA, Grether SM, Murray D, Grasha C |title=The comprehension of humorous materials by adolescents with high-functioning autism and Asperger's syndrome |journal=J Autism Dev Disord |volume=33 |issue=3 |pages=253–7 |date=June 2003 |pmid=12908828 |doi= |url=}}</ref> |
| | | '''Verbal communication''' |
| Given the proven crucial role of body language in job interviews, lack of eye contact in such a situation may be perceived by potential employers as indicating that the candidate is "not telling the truth" or "uninterested in the job", and thus lead to a cumulative difficulty in finding [[employment]]. Attending social and business events to network is also proven to play a crucial role in job hunting, but events such as these are the type that HFA people usually avoid due to their unease with the complex social interactions required. Difficulties with such pre-employment factors may contribute to comparative [[poverty]], although intelligent HFA adults can usually find a good job if they can specialise in their area of interest. Once in a good job, however, their talents may lead to promotion and they may find themselves in a new job description that does not fit their personality.
| | *Children may only exhibit abnormal sounds. These are considered persistent if seen beyond 3 years: |
| | | **Meaningless speech |
| Some may have minor to moderate difficulty with motor skills and co-ordination. This may manifest itself as mere clumsiness or awkwardness but in some instances can be found at a level where the child is a danger to themselves (this is especially true when younger), but may manifest itself in adulthood by "bumping into walls" and doors or other people without intention. "Sensory motor dysfunction" is a comorbid diagnosis that is increasingly being associated with individuals with HFA. Many of these motor skills and functional issues can be helped through the use of regular physical therapy.
| | **[[Echolalia]] (repetitive speech) |
| | | **[[Neologism|Neologisms]] (word substitution by sounds) |
| Alongside deficiencies they may simultaneously benefit from some of the more positive aspects of autism. For example, they may have the ability to focus intensely and for long periods on a difficult problem. There is often an enhanced learning ability, although this often is not applied to subjects they are uninterested in. They often present no problems in a supportive, well-resourced educational institution and often do well academically if they can be stimulated by good teachers. People with HFA often have intense and deep knowledge of an obscure or difficult subject and a passion for pursuing it in an organized and scholarly manner.
| | *Reduced ability to hold conversations |
| | | *Inability or difficulty in understanding sarcasm, jokes or indirect speech |
| They are usually intelligent, [[gifted]], honest, hard workers when interested in a task and excellent problem solvers. People with HFA are thought to become excellent scientists and engineers or enter other professions where painstaking, methodical analysis is required. Some believe this particular assertion is a stereotype, as some HFA adults tend to struggle with the traditional work setting and the surrounding societally accepted ways of behaving.
| | *Excessive inquisitiveness or talking only about restricted topics |
| | | '''Non-verbal communication''' |
| Speech and diction can be unusually precise in some individuals with HFA but this may be delayed or awkward in many other individuals.
| | *Reduced ability to understand gestures |
| | | *Absence of or decreased pointing (either for expressing desire or sharing interest). They may keep crying without pointing or go to great extents to obtain something in order to avoid asking for assistance |
| ===Communication=== | | *Forcefully ask someone to help indicate something (even trying to drag them) |
| About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs.<ref>{{cite journal |journal= J Intellect Disabil Res |date=2006 |volume=50 |issue=9 |pages=621–32 |title= The ComFor: an instrument for the indication of augmentative communication in people with autism and intellectual disability |author= Noens I, van Berckelaer-Onnes I, Verpoorten R, van Duijn G |doi=10.1111/j.1365-2788.2006.00807.x |pmid=16901289}}</ref> Differences in communication may be present from the first year of life, and may include delayed onset of [[babbling]], unusual gestures, diminished responsiveness, and the desynchronization of vocal patterns with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words ([[echolalia]]) or [[Pronoun reversal|reverse pronouns]]. Joint attention seems to be necessary for functional speech, and deficits in joint attention seem to distinguish infants with ASD: for example, they may look at a pointing hand instead of the pointed-at object, and they consistently fail to point to "comment" about or "share" an experience at age-appropriate times. Autistic children may have difficulty with imaginative play and with developing symbols into language.<ref name=Landa>{{cite journal |journal= Ment Retard Dev Disabil Res Rev |date=2007 |volume=13 |issue=1 |pages=16–25 |title= Early communication development and intervention for children with autism |author= Landa R |doi=10.1002/mrdd.20134 |pmid=17326115}}</ref><ref name=Tager-Flusberg>{{cite journal |journal= Pediatr Clin North Am |year=2007 |volume=54 |issue=3 |pages=469–81 |title= Language disorders: autism and other pervasive developmental disorders |author= Tager-Flusberg H, Caronna E |doi=10.1016/j.pcl.2007.02.011 |pmid=17543905}}</ref>
| | ===Repetitive behaviors=== |
| | | Repetitive behaviors are among one of the most common presentations of autism and usually include: |
| In a pair of studies, high-functioning autistic children aged 8–15 performed equally well, and adults better than individually matched controls at basic language tasks involving vocabulary and spelling. Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends.
| | *Stereotyped behaviors<ref name="pmid163221742">{{cite journal |vauthors=Mandell DS, Novak MM, Zubritsky CD |title=Factors associated with age of diagnosis among children with autism spectrum disorders |journal=Pediatrics |volume=116 |issue=6 |pages=1480–6 |date=December 2005 |pmid=16322174 |pmc=2861294 |doi=10.1542/peds.2005-0185 |url=}}</ref><ref name="pmid174679402">{{cite journal |vauthors=Ming X, Brimacombe M, Wagner GC |title=Prevalence of motor impairment in autism spectrum disorders |journal=Brain Dev. |volume=29 |issue=9 |pages=565–70 |date=October 2007 |pmid=17467940 |doi=10.1016/j.braindev.2007.03.002 |url=}}</ref><ref name="pmid212850332">{{cite journal |vauthors=Barrow WJ, Jaworski M, Accardo PJ |title=Persistent toe walking in autism |journal=J. Child Neurol. |volume=26 |issue=5 |pages=619–21 |date=May 2011 |pmid=21285033 |doi=10.1177/0883073810385344 |url=}}</ref> |
| | | *Insistence on sameness |
| ===Repetitive Behavior===
| | *Restricted interests |
| [[Image:Autistic-sweetiepie-boy-with-ducksinarow.jpg|thumb|left|A young boy with autism, and the precise line of toys he made]]
| | *Sensory perception<ref name="pmid109531762">{{cite journal |vauthors=Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin SW, Tuchman RF, Volkmar FR |title=Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society |journal=Neurology |volume=55 |issue=4 |pages=468–79 |date=August 2000 |pmid=10953176 |doi= |url=}}</ref><ref name="pmid92428592">{{cite journal |vauthors=Kientz MA, Dunn W |title=A comparison of the performance of children with and without autism on the Sensory Profile |journal=Am J Occup Ther |volume=51 |issue=7 |pages=530–7 |date=1997 |pmid=9242859 |doi= |url=}}</ref> |
| Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.
| | ===Neurological symptoms=== |
| *''[[Stereotypy]]'' is apparently purposeless movement, such as hand flapping, head rolling, or body rocking.
| | '''(a) Cognitive Impairment [Global developmental delay (GDD) or Intellectual disability (ID)]:''' |
| *''[[Compulsive behavior]]'' is intended and appears to follow rules, such as arranging objects in a certain way.
| | *This has been reported in 50–70% individuals. The wide variability is due to difference in evaluation methods. Assessment should be done by tools that rely predominantly on non-verbal based skills.<ref name="pmid145507032" /><ref name="pmid98394152">{{cite journal |vauthors=Dawson G, Meltzoff AN, Osterling J, Rinaldi J |title=Neuropsychological correlates of early symptoms of autism |journal=Child Dev |volume=69 |issue=5 |pages=1276–85 |date=October 1998 |pmid=9839415 |pmc=4084601 |doi= |url=}}</ref><ref name="pmid109531762" /><ref name="pmid17871382">{{cite journal |vauthors=Ozonoff S, Pennington BF, Rogers SJ |title=Executive function deficits in high-functioning autistic individuals: relationship to theory of mind |journal=J Child Psychol Psychiatry |volume=32 |issue=7 |pages=1081–105 |date=November 1991 |pmid=1787138 |doi= |url=}}</ref><ref name="pmid92604402">{{cite journal |vauthors=Minshew NJ, Goldstein G, Siegel DJ |title=Neuropsychologic functioning in autism: profile of a complex information processing disorder |journal=J Int Neuropsychol Soc |volume=3 |issue=4 |pages=303–16 |date=July 1997 |pmid=9260440 |doi= |url=}}</ref> |
| *''Sameness'' is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
| | '''(b) Epilepsy:''' |
| *''Ritualistic behavior'' involves the performance of daily activities the same way each time, such as an unvarying menu or dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.<ref>{{cite journal |journal= J Autism Dev Disord |date=2007 |volume=37 |issue=5 |pages=855–66 |title= The Repetitive Behavior Scale-Revised: independent validation in individuals with autism spectrum disorders |author= Lam KSL, Aman MG |doi=10.1007/s10803-006-0213-z |pmid=17048092 |url=http://springerlink.com/content/v03747x60562638m/fulltext.html}}</ref>
| | *All types of seizures are seen in 25–30% with [[Bimodal distribution|bimodal]] presentation ([[infancy]] and [[adolescence]]). |
| *''Restricted behavior'' is limited in focus, interest, or activity, such as preoccupation with a single television program.
| | '''(c) Psychiatric Illnesses:''' |
| *''[[Self-injury]]'' includes movements that injure or can injure the person, such as biting oneself. Dominick ''et al.'' reported that self-injury at some point affected about 30% of children with ASD.<ref name=Dominick/>
| | *[[Attention-deficit hyperactivity disorder|Attention deficit hyperactivity disorder]] |
| No single repetitive behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.<ref name=RBS-R>{{cite journal |journal= J Autism Dev Disord |date=2000 |volume=30 |issue=3 |pages=237–43 |title= Varieties of repetitive behavior in autism: comparisons to mental retardation |author= Bodfish JW, Symons FJ, Parker DE, Lewis MH |doi=10.1023/A:1005596502855 |pmid=11055459}}</ref>
| | *[[Depression]] |
| | | *[[Anxiety]] |
| Autistic people are prone to commit social ''[[faux pas]]'' because of an inability to predict others' reactions. They may also neglect social niceties like knocking or returning a greeting. Similarly, they may be overly trusting or paranoid of strangers. It may be best summed up as an inability to understand/perceive the intent or emotional wants and needs of others around them.
| | *[[Obsessive-compulsive disorder|Obsessive-Compulsive disorder]] |
| | |
| They may appear somewhat removed or [[Dissociation (psychology)|dissociated]] or dreamy at times, especially when in [[sensory overload]] or from a perception of extreme social pressure. They may make little eye contact, leading others to conclude that they are shy, uninterested or evasive.
| |
| | |
| Unlike those with low-functioning autism, people with high-functioning autism are not [[Mental retardation|mentally retarded]]; persons with high-functioning autism have an IQ at the average to above-average range. High-functioning autism (HFA) is an informal term applied to individuals with [[autism]], an [[IQ]] of 80 or above, and the ability to speak, read, and write.<ref>[http://www.nichd.nih.gov/news/releases/autism_affects_brain.cfm Study Provides Evidence That Autism Affects Functioning of Entire Brain: Previous View Held Autism Limited to Communication, Social Behavior, and Reasoning] National Institute of Health News, Aug. 16, 2006</ref> HFA may simply refer to autistic people who have normal overall intelligence; that is, are not cognitively challenged.<ref>[http://www.maapservices.org/MAAP_Sub_Find_It_-_Publications_Volkmar_Article.htm Validity and Neuropsychological Characterization of Asperger Syndrome: Convergence with Nonverbal Learning Disabilities Syndrome] A. Klin et al (1995) The Journal of Child Psychology and Psychiatry and Allied Disciplines, Vol. 36, No. 7, pp. 1127-1140, 1995. Reprinted with permission from Cambridge University Press. See section titled "Validity of Asperger syndrome"</ref>
| |
| Although they may have an adequate vocabulary, they may have a delay in communicating events and use less emotional content in their speech. They may also appear not to notice non-verbal cues from others such as when others have become bored with the topic of conversation they appear oblivious and continue.
| |
| | |
| As with people elsewhere on the autistic spectrum, people with high-functioning autism generally prefer routine and order, and this usually begins in early childhood. They may, for example, write an alphabetized index of their [[comic book]] collection, or they may stick to a limited wardrobe.
| |
| | |
| Generally, there are difficulties with social interaction. This might not adversely affect their ability to interact with others on a day-to-day basis at a basic working level, although they may be seen as being overly serious or earnest, and as being without any "small talk" in conversation. In many instances though, these individuals have such severe social delays and difficulties that interaction within a "normal" social setting can be severely hampered.
| |
| | |
| They may have difficulty initiating love and friendship relationships, often being rejected because potential partners perceive them as being either too "nerdy" or too intelligent. This can lead to low self esteem or loneliness, which further impairs their ability to find meaningful companionship.
| |
| | |
| People may label HFA people as "oddballs" or worse, and HFA people can easily become the target of bullying. This can be especially true from primary school through the late teens. Young, intelligent HFA people usually do best by seeking out the company of their intellectual peers or by joining hobby groups, while avoiding their age-group peers. Exposure to an age equivalent peer group within the autism spectrum on a regular basis can be especially beneficial.
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| Given the proven crucial role of body language in job interviews, lack of eye contact in such a situation may be perceived by potential employers as indicating that the candidate is "not telling the truth" or "uninterested in the job", and thus lead to a cumulative difficulty in finding [[employment]]. Attending social and business events to network is also proven to play a crucial role in job hunting, but events such as these are the type that HFA people usually avoid due to their unease with the complex social interactions required. Difficulties with such pre-employment factors may contribute to comparative [[poverty]], although intelligent HFA adults can usually find a good job if they can specialise in their area of interest. Once in a good job, however, their talents may lead to promotion and they may find themselves in a new job description that does not fit their personality.
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| Some may have minor to moderate difficulty with motor skills and co-ordination. This may manifest itself as mere clumsiness or awkwardness but in some instances can be found at a level where the child is a danger to themselves (this is especially true when younger), but may manifest itself in adulthood by "bumping into walls" and doors or other people without intention. "Sensory motor dysfunction" is a comorbid diagnosis that is increasingly being associated with individuals with HFA. Many of these motor skills and functional issues can be helped through the use of regular physical therapy.
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| Some may also nurture a complex habitual movement (termed "[[stimming]]") at which they become adept, for example, pen spinning, while otherwise being prone to clumsiness.
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| They do not lack empathy (although they may have difficulty expressing it), and can thus enjoy films and stories with emotional content. Some may gain the bulk of their insight into why people behave the way they do through watching movies that provide a forceful and musically-cued "capsule lesson" in human emotions (e.g. [[melodrama]]s).
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| Alongside deficiencies they may simultaneously benefit from some of the more positive aspects of autism. For example, they may have the ability to focus intensely and for long periods on a difficult problem. There is often an enhanced learning ability, although this often is not applied to subjects they are uninterested in. They often present no problems in a supportive, well-resourced educational institution and often do well academically if they can be stimulated by good teachers. People with HFA often have intense and deep knowledge of an obscure or difficult subject and a passion for pursuing it in an organized and scholarly manner.
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| They are usually intelligent, [[gifted]], honest, hard workers when interested in a task and excellent problem solvers. People with HFA are thought to become excellent scientists and engineers or enter other professions where painstaking, methodical analysis is required. Some believe this particular assertion is a stereotype, as some HFA adults tend to struggle with the traditional work setting and the surrounding societally accepted ways of behaving.
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| Speech and diction can be unusually precise in some individuals with HFA but this may be delayed or awkward in many other individuals.
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| ==Less Common Symptoms==
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| Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family.<ref name=Filipek>{{cite journal |author= Filipek PA, Accardo PJ, Baranek GT ''et al.'' |title= The screening and diagnosis of autistic spectrum disorders |journal= J Autism Dev Disord |date=1999 |volume=29 |issue=6 |pages=439–84 |doi=10.1023/A:1021943802493}} {{cite journal |title=Erratum |quotes=no |date=2000 |journal= J Autism Dev Disord |volume=30 |issue=1 |pages=81 |doi=10.1023/A:1017256313409 |pmid=10638459}} This paper represents a consensus of representatives from nine professional and four parent organizations in the U.S.</ref> Unusual responses to [[Stimulus (physiology)|sensory stimuli]] are more common and prominent in autistic children, although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.<ref>{{cite journal|journal=J Child Psychol Psychiatry|date=2005|volume=46|issue=12|pages=1255–68|title=Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence|author=Rogers SJ, Ozonoff S|doi=10.1111/j.1469-7610.2005.01431.x|pmid=16313426}}</ref> Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for seeking (for example, rhythmic movements).<ref>{{cite journal |journal= J Autism Dev Disord |date=2008 |title= A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders |author= Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E |doi=10.1007/s10803-008-0593-3 |pmid=18512135}}</ref>
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| Several studies have reported associated motor problems that include [[poor muscle tone]], [[Apraxia|poor motor planning]], and [[toe walking]]; ASD is not associated with severe motor disturbances.<ref>{{cite journal |journal= Brain Dev |date=2007 |volume=29 |issue=9 |pages=565–70 |title= Prevalence of motor impairment in autism spectrum disorders |author= Ming X, Brimacombe M, Wagner GC |doi=10.1016/j.braindev.2007.03.002 |pmid=17467940}}</ref>
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| Atypical eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur;<ref name=Dominick/> this does not appear to result in [[malnutrition]]. Although some children with autism also have [[gastrointestinal]] (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual;<ref>{{cite journal|journal=J Autism Dev Disord|date=2005|volume=35|issue=6|pages=713–27|title=Gastrointestinal factors in autistic disorder: a critical review|author=Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ|doi=10.1007/s10803-005-0019-4|pmid=16267642}}</ref> studies report conflicting results, and the relationship between GI problems and ASD is unclear.
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| [[Sleep]] problems are known to be more common in children with developmental disabilities, and there is some evidence that children with ASD are more likely to have even more sleep problems than those with other developmental disabilities; autistic children may experience problems including difficulty in falling asleep, frequent nocturnal [[Wakefulness|awakenings]], and early morning awakenings. Dominick ''et al.'' found that about two-thirds of children with ASD had a history of sleep problems.<ref name=Dominick>{{cite journal|journal=Res Dev Disabil|year=2007|volume=28|issue=2|pages=145–62|title=Atypical behaviors in children with autism and children with a history of language impairment|author=Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S|doi=10.1016/j.ridd.2006.02.003|pmid=16581226}}</ref>
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| Parents of children with ASD have higher levels of stress.<ref>{{cite journal |journal=Pediatrics |date=2007 |volume=119 |issue=5 |pages=e1040–6 |title= Psychological functioning and coping among mothers of children with autism: a population-based study |author= Montes G, Halterman JS |doi=10.1542/peds.2006-2819 |pmid=17473077 |url=http://pediatrics.aappublications.org/cgi/content/full/119/5/e1040}}</ref> Siblings of children with ASD report greater admiration of and less conflict with the affected sibling; siblings of individuals with ASD have greater risk of negative well-being and poorer sibling relationships as adults.<ref>{{cite journal |journal= Ment Retard Dev Disabil Res Rev |date=2007 |volume=13 |issue=4 |pages=313–20 |title= Siblings of individuals with autism spectrum disorders across the life course |author= Orsmond GI, Seltzer MM |doi=10.1002/mrdd.20171 |pmid=17979200 |url=http://waisman.wisc.edu/family/pdf/MRDDRR-OrsmondSeltzer2007.pdf |format=PDF |accessdate=2008-04-17}}</ref>
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| Behaviorally, certain characteristics identify the autism spectrum. The type, severity and/or number of autistic traits present determines the severity of [[autism]] in the individual. These autistic traits may be beneficial for some disciplines like [[science]], [[mathematics]], [[engineering]] and [[computer programming]]. Some autistic individuals might show a marked proficiency in rote memorization which may help learn the foundation of these subjects; however, the exceptionally good aptitude (in these subjects) of high functioning autistic spectrum persons may be due to their ability to readily identify patterns and apply them consistently to new situations outside of established knowledge or teaching. These [[autistic savant|savant]] skills, although popularly considered to be a major part of autistic disorders, are evident only in a small fraction of autistic individuals, with estimates of the fraction ranging from 0.5% to 10%.<ref>{{cite web |author= Treffert DA |title= Savant syndrome: an extraordinary condition—a synopsis: past, present, future |publisher= Wisconsin Medical Society |date=2007 |url=http://www.wisconsinmedicalsociety.org/savant_syndrome/overview_of_savant_syndrome/synopsis |accessdate=2007-09-19}}</ref>
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| ===Diagnostic Criteria===
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| When the rising [[prevalence]] of autism spectrum disorders sparked research in the late 1990s, medical opinion initially attributed the increase to improved diagnostic screening or changes in the definition of autism. In [[1994]], the fourth major revision of the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM-IV) was published with updated criteria for the diagnosis of autism and autism spectrum disorders.<ref>{{cite journal |author= Tidmarsh L, Volkmar FR |title= Diagnosis and epidemiology of autism spectrum disorders |journal= Can J Psychiatry |volume=48 |issue=8 |pages=517–25 |date=2003 |pmid=14574827 |url=http://ww1.cpa-apc.org:8080/Publications/Archives/CJP/2003/september/tidmarsh.asp}}</ref> Professional medical associations, including the [[American Academy of Pediatrics]], say that this revision was an important factor in increasing the apparent prevalence of autism and a 2005 study by [[Mayo Clinic]] researchers found increases in autistic spectrum disorder diagnoses followed the revisions in DSM criteria and changes in funding for special education programs.<ref>{{cite journal |journal= Arch Pediatr Adolesc Med |date=2005 |volume=159 |issue=1 |pages=37–44 |title= The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study |author= Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ |doi=10.1001/archpedi.159.1.37 |pmid=15630056 |url=http://archpedi.ama-assn.org/cgi/content/full/159/1/37}}</ref>
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| An increased awareness of autistic spectrum disorders by parents and pediatricians may have also led to increased reporting of Autism due to 'case substitution', which occurs when children with other disorders are identified as autistic.<ref>{{cite journal |journal=Pediatrics |date=2006 |volume=117 |issue=4 |pages=1028–37 |title= The contribution of diagnostic substitution to the growing administrative prevalence of autism in US special education |author= Shattuck PT |doi=10.1542/peds.2005-1516 |pmid=16585296 |url=http://pediatrics.aappublications.org/cgi/content/full/117/4/1028 |laysummary=http://www.news.wisc.edu/12368 |laydate=2006-04-03}}</ref> This misdiagnosis may occur for several reasons including an increase in government funding for care of children diagnosed as autistic, but not for children with a similar degree of disability and need. If this is occurring, it means that children who in the past would probably have been diagnosed as having a learning disability or a psychiatric disorder, or not diagnosed at all, are recorded as cases of autistic spectrum disorder.<ref>{{cite journal |journal= Harv Mag |date=2008 |volume=110 |issue=3 |pages= 27–31, 89–91 |title= A spectrum of disorders |author= Pettus A |url=http://harvardmagazine.com/2008/01/a-spectrum-of-disorders.html}}</ref>
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| Children who are not primarily autistic, e.g. those with [[Fragile-X Syndrome]] (with characteristics that fit the criteria for autism) and even [[Down's Syndrome]] may have the diagnostic group with the best funding assigned. Dr. Fred Volkmar, a Yale University autism researcher, has said that "[[diagnostic substitution]]" was prompted by better services for autism.<ref name="cnn2003">{{cite news
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| |title=Uncovering autism's mysteries: Is there more autism? Or just a new definition?
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| |url=http://edition.cnn.com/2003/HEALTH/conditions/03/02/autism.ap/
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| |publisher=Associated Press
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| |date=2003-03-02
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| |accessdate=2007-12-30
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| |quote='Autism is kind of a fashionable diagnosis,' Volkmar said. 'Everybody's interested in getting better services.'
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| }}</ref>
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| Care should be exercised when attempting to determine whether a person with autism is "high functioning" or "low functioning" based on an IQ score since it is sometimes difficult to measure IQ in autistic persons accurately using standard measurement instruments. The amount of language processing necessary on the tests and the large quantity of verbal instructions involved in the testing process even on the "non-verbal" portion of standard intelligence measures can produce a misleadingly low score. There can be a significant difference between an autistic person's measured IQ scores when comparing standard testing methods and a truly non-verbal method such as the Leiter-R.
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| A diagnosis of high-functioning autism exists in neither the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV-TR]] nor the [[ICD|ICD-10]], which have diagnoses of autistic disorder and childhood autism respectively. Analogous to ''high-functioning'' when applied to [[schizophrenia]] and other psychiatric disorders, the term high-functioning autism started out as a shorthand to describe diagnosed autistic individuals who could nevertheless speak and carry on with many day-to-day activities like eating and dressing independently. ''Low-functioning autism'' was the conceptual opposite. Researchers then began using ''high-functioning autism'' as a quasi-diagnostic label itself, along with ''low-functioning autism'' and sometimes also [[Asperger's Syndrome]], to distinguish relative levels of adaptation and development.
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| There is some evidence that the label has wrongly become a catch-all diagnosis for badly-behaved children. In 2000 in the [[UK]], the lead clinician and autism specialist at Northgate and Prudhoe [[NHS]] Trust in [[Morpeth, Northumberland|Morpeth]], Dr Tom Berney, published a paper commenting on this. He wrote in the prestigious ''British Journal of Psychiatry'':- "There is a risk of the diagnosis of autism being extended to include anyone whose odd and troublesome personality does not readily fit some other category. Such over-inclusion is likely to devalue the diagnosis to a meaningless label."
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| | '''(d) Feeding Disturbances:''' |
| | *Decreased chewing |
| | *Poor food acceptance |
| | *Picky eater |
| | *Food aversion |
| | *Meal time misbehavior |
| | ===Gastrointestinal symptoms=== |
| | *Frequent [[vomiting]] |
| | *[[Gastro-esophageal reflux disease|Gastro-esophageal reflux]] |
| | *Recurrent [[diarrhea]] |
| | *Chronic [[constipation]] |
| | *Recurrent [[abdominal pain]] |
| | ==='''Sleep Disturbances:'''=== |
| | Difficulty in falling asleep, repeated nocturnal awakenings, unusual bedtime routines lead to increased daytime behavioral issues and parental stress. |
| | ==='''Dysmorphism''':=== |
| | This is observed in 18–20% individuals (syndromic or non-specific [[Dysmorphic feature|dysmorphic]] features). |
| ==References== | | ==References== |
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