Autism history and symptoms: Difference between revisions
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===Autism Spectrum Quotient=== | |||
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> | 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> | ||
* ''Format'' | * ''Format'' | ||
Revision as of 15:00, 12 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
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.
Common Symptoms
Social Development
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 neurotypicals as leaving her feeling "like an anthropologist on Mars".[1]
Social impairments become apparent early in childhood and continue through adulthood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. 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. 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. However, they do form attachments to their primary caregivers.[2] They display moderately less attachment security than usual, although this feature disappears in children with higher mental development or less severe ASD.[3] Older children and adults with ASD perform worse on tests of face and emotion recognition.[4]
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.
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.
Communication
About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs.[5] 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 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.[6][7]
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.
Repetitive Behavior
Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.
- Stereotypy is apparently purposeless movement, such as hand flapping, head rolling, or body rocking.
- Compulsive behavior is intended and appears to follow rules, such as arranging objects in a certain way.
- Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
- 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.[8]
- Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program.
- 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.[9]
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.[10]
Less Common Symptoms
Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family.[11] 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 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%.[12]
Unusual responses to 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.[13] 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).[14] Several studies have reported associated motor problems that include poor muscle tone, poor motor planning, and toe walking; ASD is not associated with severe motor disturbances.[15]
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;[9] 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;[16] studies report conflicting results, and the relationship between GI problems and ASD is unclear. 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 awakenings, and early morning awakenings. Dominick et al. found that about two-thirds of children with ASD had a history of sleep problems.[9]
Parents of children with ASD have higher levels of stress.[17] 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.[18]
Diagnostic Criteria
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.[19] 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.[20]
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.[21] 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.[22]
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.[23]
Autism Spectrum Quotient
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 disorders. 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.[24]
- Format
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.
- Use as a Diagnostic Tool
In the initial trials of the test,[25] 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.
A further research paper[24] 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.
References
- ↑ Sacks O (1995). An Anthropologist on Mars: Seven Paradoxical Tales. Knopf. ISBN 0679437851.
- ↑ Sigman M, Dijamco A, Gratier M, Rozga A (2004). "Early detection of core deficits in autism". Ment Retard Dev Disabil Res Rev. 10 (4): 221–33. doi:10.1002/mrdd.20046. PMID 15666338.
- ↑ Rutgers AH, Bakermans-Kranenburg MJ, van IJzendoorn MH, van Berckelaer-Onnes IA (2004). "Autism and attachment: a meta-analytic review". J Child Psychol Psychiatry. 45 (6): 1123–34. doi:10.1111/j.1469-7610.2004.t01-1-00305.x. PMID 15257669.
- ↑ Sigman M, Spence SJ, Wang AT (2006). "Autism from developmental and neuropsychological perspectives". Annu Rev Clin Psychol. 2: 327–55. doi:10.1146/annurev.clinpsy.2.022305.095210. PMID 17716073.
- ↑ Noens I, van Berckelaer-Onnes I, Verpoorten R, van Duijn G (2006). "The ComFor: an instrument for the indication of augmentative communication in people with autism and intellectual disability". J Intellect Disabil Res. 50 (9): 621–32. doi:10.1111/j.1365-2788.2006.00807.x. PMID 16901289.
- ↑ Landa R (2007). "Early communication development and intervention for children with autism". Ment Retard Dev Disabil Res Rev. 13 (1): 16–25. doi:10.1002/mrdd.20134. PMID 17326115.
- ↑ Tager-Flusberg H, Caronna E (2007). "Language disorders: autism and other pervasive developmental disorders". Pediatr Clin North Am. 54 (3): 469–81. doi:10.1016/j.pcl.2007.02.011. PMID 17543905.
- ↑ Lam KSL, Aman MG (2007). "The Repetitive Behavior Scale-Revised: independent validation in individuals with autism spectrum disorders". J Autism Dev Disord. 37 (5): 855–66. doi:10.1007/s10803-006-0213-z. PMID 17048092.
- ↑ 9.0 9.1 9.2 Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S (2007). "Atypical behaviors in children with autism and children with a history of language impairment". Res Dev Disabil. 28 (2): 145–62. doi:10.1016/j.ridd.2006.02.003. PMID 16581226.
- ↑ Bodfish JW, Symons FJ, Parker DE, Lewis MH (2000). "Varieties of repetitive behavior in autism: comparisons to mental retardation". J Autism Dev Disord. 30 (3): 237–43. doi:10.1023/A:1005596502855. PMID 11055459.
- ↑ Filipek PA, Accardo PJ, Baranek GT; et al. (1999). "The screening and diagnosis of autistic spectrum disorders". J Autism Dev Disord. 29 (6): 439–84. doi:10.1023/A:1021943802493. "Erratum". J Autism Dev Disord. 30 (1): 81. 2000. doi:10.1023/A:1017256313409. PMID 10638459. Unknown parameter
|quotes=ignored (help) This paper represents a consensus of representatives from nine professional and four parent organizations in the U.S. - ↑ Treffert DA (2007). "Savant syndrome: an extraordinary condition—a synopsis: past, present, future". Wisconsin Medical Society. Retrieved 2007-09-19.
- ↑ Rogers SJ, Ozonoff S (2005). "Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence". J Child Psychol Psychiatry. 46 (12): 1255–68. doi:10.1111/j.1469-7610.2005.01431.x. PMID 16313426.
- ↑ Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E (2008). "A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders". J Autism Dev Disord. doi:10.1007/s10803-008-0593-3. PMID 18512135.
- ↑ Ming X, Brimacombe M, Wagner GC (2007). "Prevalence of motor impairment in autism spectrum disorders". Brain Dev. 29 (9): 565–70. doi:10.1016/j.braindev.2007.03.002. PMID 17467940.
- ↑ Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ (2005). "Gastrointestinal factors in autistic disorder: a critical review". J Autism Dev Disord. 35 (6): 713–27. doi:10.1007/s10803-005-0019-4. PMID 16267642.
- ↑ Montes G, Halterman JS (2007). "Psychological functioning and coping among mothers of children with autism: a population-based study". Pediatrics. 119 (5): e1040–6. doi:10.1542/peds.2006-2819. PMID 17473077.
- ↑ Orsmond GI, Seltzer MM (2007). "Siblings of individuals with autism spectrum disorders across the life course" (PDF). Ment Retard Dev Disabil Res Rev. 13 (4): 313–20. doi:10.1002/mrdd.20171. PMID 17979200. Retrieved 2008-04-17.
- ↑ Tidmarsh L, Volkmar FR (2003). "Diagnosis and epidemiology of autism spectrum disorders". Can J Psychiatry. 48 (8): 517–25. PMID 14574827.
- ↑ Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ (2005). "The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study". Arch Pediatr Adolesc Med. 159 (1): 37–44. doi:10.1001/archpedi.159.1.37. PMID 15630056.
- ↑ Shattuck PT (2006). "The contribution of diagnostic substitution to the growing administrative prevalence of autism in US special education". Pediatrics. 117 (4): 1028–37. doi:10.1542/peds.2005-1516. PMID 16585296. Lay summary (2006-04-03).
- ↑ Pettus A (2008). "A spectrum of disorders". Harv Mag. 110 (3): 27–31, 89–91.
- ↑ "Uncovering autism's mysteries: Is there more autism? Or just a new definition?". Associated Press. 2003-03-02. Retrieved 2007-12-30.
'Autism is kind of a fashionable diagnosis,' Volkmar said. 'Everybody's interested in getting better services.'
- ↑ 24.0 24.1 M. Woodbury-Smith, J. Robinson and S. Baron-Cohen, Screening adults for Asperger Syndrome using the AQ : diagnostic validity in clinical practice, Journal of Autism and Developmental Disorders 35 331-335 (2005)
- ↑ S. Baron-Cohen, S. Wheelwright, R. Skinner, J. Martin and E. Clubley, 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)