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Autism is a brain disorder that typically affects a person's ability to communicate, form relationships with others, and respond appropriately to the environment. Some people with autism are relatively high-functioning, with speech and intelligence intact. Others are mentally retarded, mute, or have serious language delays. For some, autism makes them seem closed off and shut down; others seem locked into repetitive behaviors and rigid patterns of thinking.

Although people with autism do not have exactly the same symptoms and deficits, they tend to share certain social, communication, motor, and sensory problems that affect their behavior in predictable ways.

Isolated in worlds of their own, people with autism appear indifferent and remote and are unable to form emotional bonds with others. Although people with this baffling brain disorder can display a wide range of symptoms and disability, many are incapable of understanding other people's thoughts, feelings, and needs. Often, language and intelligence fail to develop fully, making communication and social relationships difficult. Many people with autism engage in repetitive activities, like rocking or banging their heads, or rigidly following familiar patterns in their everyday routines. Some are painfully sensitive to sound, touch, sight, or smell.

Children with autism do not follow the typical patterns of child development. In some children, hints of future problems may be apparent from birth. In most cases, the problems become more noticeable as the child slips farther behind other children the same age. Other children start off well enough. But between 18 and 36 months old, they suddenly reject people, act strangely, and lose language and social skills they had already acquired.

From the start, most infants are social beings. Early in life, they gaze at people, turn toward voices, endearingly grasp a finger, and even smile.

In contrast, most children with autism seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and they avoid eye contact. They seem to prefer being alone. They may resist attention and affection or passively accept hugs and cuddling. Later, they seldom seek comfort or respond to anger or affection. Unlike other children, they rarely become upset when the parent leaves or show pleasure when the parent returns. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of response.

Children with autism also take longer to learn to interpret what others are thinking and feeling. Subtle social cues-whether a smile, a wink, or a grimace-may have little meaning. To a child who misses these cues, "Come here," always means the same thing, whether the speaker is smiling and extending her arms for a hug or squinting and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering.

To compound the problem, people with autism have problems seeing things from another person's perspective. Most 5-year-olds understand that other people have different information, feelings, and goals than they have. A person with autism may lack such understanding. This inability leaves them unable to predict or understand other people's actions.

Some people with autism also tend to be physically aggressive at times, making social relationships still more difficult. Some lose control, particularly when they're in a strange or overwhelming environment, or when angry and frustrated. They are capable at times of breaking things, attacking others, or harming themselves. Alan, for example, may fall into a rage, biting and kicking when he is frustrated or angry. Paul, when tense or overwhelmed, may break a window or throw things. Others are self-destructive, banging their heads, pulling their hair, or biting their arms.

What Are the Signs Of Autism?

When an infant or toddler:

• does not cuddle or respond to affection and touching.



• does not make eye contact.



• appears to be unable to communicate.



• displays persistent failure to develop two-way social relationships in any situation.



• does not show a preference for parents over other adults.



• does not develop friendships with other children.



• has poor language skills; or nonexistent ones.



• shows unusual, extreme responses to objects – either avoidance or preoccupation.



• finds moving objects, such as a fan, hold great fascination.



• may form an unusual attachment to odd objects such as a paper or rubber band.



• displays repetitive activities of a restrictive range.



• spins and repeats body movements, such as arm flapping.



• may repeat television commercials.



• may indulge in complex bedtime rituals.

The symptoms of autism range from mild to severe. Although symptoms of the disorder sometimes can be seen in early infancy, the condition may appear after months of normal development. About 7 in every 10 children and adolescents with autism also have mental retardation or other problems with their brain function or structure.

Repetitive behaviors and obsessions
Although children with autism usually appear physically normal and have good muscle control, odd repetitive motions may set them off from other children. A child might spend hours repeatedly flicking or flapping her fingers or rocking back and forth. Many flail their arms or walk on their toes. Some suddenly freeze in position. Experts call such behaviors stereotypies or self-stimulation.

Some people with autism also tend to repeat certain actions over and over. A child might spend hours lining up pretzel sticks. Or, like Alan, run from room to room turning lights on and off.

Some children with autism develop troublesome fixations with specific objects, which can lead to unhealthy or dangerous behaviors. For example, one child insists on carrying feces from the bathroom into her classroom. Other behaviors are simply startling, humorous, or embarrassing to those around them. One girl, obsessed with digital watches, grabs the arms of strangers to look at their wrists.

For unexplained reasons, people with autism demand consistency in their environment. Many insist on eating the same foods, at the same time, sitting at precisely the same place at the table every day. They may get furious if a picture is tilted on the wall, or wildly upset if their toothbrush has been moved even slightly. A minor change in their routine, like taking a different route to school, may be tremendously upsetting.

Scientists are exploring several possible explanations for such repetitive, obsessive behavior. Perhaps the order and sameness lends some stability in a world of sensory confusion. Perhaps focused behaviors help them to block out painful stimuli. Yet another theory is that these behaviors are linked to the senses that work well or poorly. A child who sniffs everything in sight may be using a stable sense of smell to explore his environment. Or perhaps the reverse is true: he may be trying to stimulate a sense that is dim.

Imaginative play, too, is limited by these repetitive behaviors and obsessions. Most children, as early as age 2, use their imagination to pretend. They create new uses for an object, perhaps using a bowl for a hat. Or they pretend to be someone else, like a mother cooking dinner for her "family" of dolls. In contrast, children with autism rarely pretend. Rather than rocking a doll or rolling a toy car, they may simply hold it, smell it, or spin it for hours on end.

Sensory Symptoms
When children's perceptions are accurate, they can learn from what they see, feel, or hear. On the other hand, if sensory information is faulty or if the input from the various senses fails to merge into a coherent picture, the child's experiences of the world can be confusing. People with autism seem to have one or both of these problems. There may be problems in the sensory signals that reach the brain or in the integration of the sensory signals-and quite possibly, both.

Apparently, as a result of a brain malfunction, many children with autism are highly attuned or even painfully sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin so disturbing that they can't focus on anything else. For others, a gentle hug may be overwhelming. Some children cover their ears and scream at the sound of a vacuum cleaner, a distant airplane, a telephone ring, or even the wind. Temple Grandin says, "It was like having a hearing aid that picks up everything, with the volume control stuck on super loud." Because any noise was so painful, she often chose to withdraw and tuned out sounds to the point of seeming deaf.

In autism, the brain also seems unable to balance the senses appropriately. Some children with autism seem oblivious to extreme cold or pain, but react hysterically to things that wouldn't bother other children. A child with autism may break her arm in a fall and never cry. Another child might bash his head on the wall without a wince. On the other hand, a light touch may make the child scream with alarm.

In some people, the senses are even scrambled. One child gags when she feels a certain texture. A man with autism hears a sound when someone touches a point on his chin. Another experiences certain sounds as colors.

Unusual Abilities
Some people with autism display remarkable abilities. A few demonstrate skills far out of the ordinary. At a young age, when other children are drawing straight lines and scribbling, some children with autism are able to draw detailed, realistic pictures in three-dimensional perspective. Some toddlers who are autistic are so visually skilled that they can put complex jigsaw puzzles together. Many begin to read exceptionally early-sometimes even before they begin to speak. Some who have a keenly developed sense of hearing can play musical instruments they have never been taught, play a song accurately after hearing it once, or name any note they hear. Like the person played by Dustin Hoffman in the movie Rain Man, some people with autism can memorize entire television shows, pages of the phone book, or the scores of every major league baseball game for the past 20 years. However, such skills, known as islets of intelligence or savant skills are rare.

How Common Is Autism?
Recent studies estimate that as many as 14 children out of 10,000 may have autism or a related condition. About 125,000 Americans are affected by these disorders, and nearly 4,000 families across the country have two or more children with autism. Three times as many boys as girls have autism.

What Causes Autism?
Researchers are unsure about what causes autism. Several studies suggest that autistic disorder might be caused by a combination of biological factors, including exposure to a virus before birth, a problem with the immune system, or genetics.

Treatments
Parents who suspect autism in their child should ask their family doctor or pediatrician to refer them to a child and adolescent psychiatrist, who can accurately diagnose the autism and the degree of severity, and determine the appropriate educational measures.

Drugs are of minor importance in the treatment of autism. Antidepressants occasionally help a little. Standard antiviolence agents, especially antipsychotic drugs, lithium, and beta-blockers, may be needed for autistic persons who strike out at themselves or others. Conventional anti-psychotic drugs are often highly sedative and have serious side effects, including body movement disorders. Anticonvulsants may be useful; some researchers have suggested that unrecognized partial complex epileptic seizures, which cause changes in consciousness but not physical convulsions, are one source of autistic behavior problems.

Little is known about the long-term effects of drugs on autistic persons. They should be used only for specific symptoms, not merely to keep a child docile or quiet the anxiety of a parent or doctor.

Autism Effects the Whole Family
In addition to working with autistic child, the child and adolescent psychiatrist can help the family resolve stress – for example, a feeling among the siblings that they are being neglected in favor of the autistic child, or embarrassment about bringing their friends home. The child and adolescent psychiatrist can help parents with the emotional problems that may arise as a result of living with an autistic child and also help them provide the best possible nurturing and learning environment for the child.