Autism

Type of psychology: Psychopathology

Psychopathology

Field of study: Childhood and adolescent disorders

Childhood and adolescent disorders
Aspects of autism, a poorly understood, nonschizophrenic psychosocial disorder, include

great social unresponsiveness, speech and language impairment, ritualistic play

activity, and resistance to change. The causes of and treatments for autism have not

been conclusively determined, although behavior therapy is a promising alternative.

Key concepts

• affective

• cognitive

• dopamine

• echolalia

• electroencephalogram (EEG)

• epileptic seizure

• norepinephrine

• schizophrenia

• secretin

• serotonin

The modern term “autism” was originated by Leo Kanner in the 1940’s. In

“Autistic Disturbances of Affective Contact” (1943), he described a group of

autistic children; he viewed them as much more similar to one another than

to schizophrenics, with whom they generally had been associated. Until that

time, the classical definition for autism (still seen in some dictionaries) was

“a form of childhood schizophrenia characterized by acting out and withdrawal

from reality.” Kanner believed that these children represented an entirely

different clinical psychiatric disorder. He noted four main symptoms

associated with the disease: social withdrawal or “extreme autistic aloneness”;

either muteness or failure to use spoken language “to convey meaning

to others”; an “obsessive desire for maintenance of sameness”; and preoccupation

with highly repetitive play habits, producing “severe limitation

of spontaneous activity.” Kanner also noted that autism—unlike other types

of childhood psychoses—began in or near infancy and had both cognitive

and affective components.

Over the years, several attempts have been made to establish precise diagnostic

criteria for autism. Among the criteria given in the American Psychiatric

Association’s Diagnostic and Statistical Manual of Mental Disorders (rev.

4th ed., 2000, DSM-IV-TR) are pervasive lack of responsiveness to other people;

gross deficits in language development; if speech is present, peculiar

patterns (such as echolalia and pronoun reversals); bizarre reaction to environmental

aspects (resistance to change); and the absence of any symptoms

of schizophrenia. These criteria are largely a restatement of Kanner’s viewpoint.

The prevalence of autism is generally estimated at between 3 to 9 percent

of the population of the United States. Study of the sex distribution shows

that it is 2.5 to 4 times as common in males as in females. The causes of autism

have not been conclusively determined, although the possibilities are

wide-ranging and said to be rooted in both biology and environment. As an

example of the latter, one of the most widely cited causes has been vaccination,

particularly the mumps, measles, and rubella (MMR) vaccine that is

given at approximately eighteen months of age and often corresponds with

the earliest detected symptoms of autism. Still, researchers in the United

States and Europe have determined that this vaccine does not cause autism,

based on the fact that vaccination rates held steady throughout the 1990’s at

almost 97 percent of children, yet the rate of autism diagnosis increased

sevenfold during the same time period.

Possible physiological causes include genetics (siblings of autistic children

are two hundred times more likely than the general population to be

diagnosed with autism themselves), neurochemistry (abnormal levels of the

neurotransmitters norepinephrine, serotonin, and dopamine have been established

in children with autism as well as their relatives), low birth weight,

older mothers, and brain abnormalities such as reduction of tissue in the

cerebellum and enlarged ventricles in the cerebrum.

Largely because of Kanner’s original sample (now known to have been

atypical), many people believe that autistic children come from professional

families. Subsequent studies have indicated that this is not so. Rather, autistic

children come from families within a wide socioeconomic range, and

more than 75 percent of them score in the moderately mentally retarded

range on intelligence tests prior to or in the absence of effective treatment.

The behavior that characterizes the autistic personality strongly suggests

that the disorder is related to other types of neurologic dysfunction. Identified

neurological correlations include soft neurologic signs (such as poor

coordination), seizure disorders (such as phenylketonuria), abnormal electroencephalograms,

and unusual sleep patterns. This emphasis on neurologic—

or organic—explanations for autism is relatively new; autism was previously

thought to be an entirely emotional disorder.

The difficulties that autistic children show in social relationships are exhibited

in many ways. Most apparent is a child’s failure to formsocial bonds.

For example, such youngsters rarely initiate any interactions with other children.

Moreover, unlike nonautistic children, they do not seek parental company

or run to parents for solace when distressed. Many sources even point

to frequent parental statements that autistic children are not as “cuddly” as

normal babies and do not respond to their mothers or to affectionate actions.

Autistic children avoid direct eye contact and tend to look through or

past other people. In addition, autistic children rarely indulge in any cooperative

play activities or strike up close friendships with peers.

Sometimes speech does not develop at all. When speech development

does occur, it is very slow and may even disappear again. Another prominent

speech pathology in autism is either immediate or delayed repetition of

something heard but simply parroted back (such as a television commercial),

phenomena called immediate and delayed echolalia, respectively. Yet

another problem seen is lack of true language comprehension, shown by

the fact that an autistic child’s ability to follow instructions is often dependent

on situational cues. For example, such a child may understand the request

to come and eat dinner only when a parent is eating or sitting at the

dinner table.

Behavior denoting resistance to change is often best exemplified by rigid

and repetitive play patterns, the interruption of which results in tantrums

and even self-injury. Some autistic children also develop very ritualistic preoccupations

with an object or a schedule. For example, they may become extremely

distressed with events as minor as the rearrangement of furniture in

a particular room at home.