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Autism

Autism refers to a pervasive developmental syndrome characterized by a distinct group of behaviors and cognitive differences. It often is associated with genetic and acquired conditions that affect brain development. The etiology of autism is unclear. The complexity and spectrum of autistic function suggest diversity in causal relationships/factors. It has been posited that the brains of individuals with autism may demonstrate abnormal micro-architecture and/or disturbances in select neurotransmitter metabolism. There are many factors which influence the degree of expression of autism, such as co-morbidity of mental retardation and/or Fragile-X syndrome. Age also appears to be a determinant of autistic expression; symptoms often improve as a child develops language skills and thus gains some control of his or her environment. Symptoms of autistic expression are typically strongest between the ages of four to five years. It is estimated that autism affects approximately 1-2 persons per thousand, with males being affected approximately 3.5 times as frequently as females.

(See the DSM-IV-R for expanded diagnostic criteria.) www.msnusers.com/TheAutismHomePage/communicationsymptomsdsmiv.msnw

Persons with autistic disorder often display one or more of the following: impaired development of social skills; impaired development of verbal and nonverbal communication skills; ritualistic and perseverative behavior; resistance to environmental change or change in daily routines; gaps in intellectual development; poorly developed play skills; pronomial reversal; labile mood; and unusual responses to sensory experiences. Poor motor coordination may also be present, especially in individuals diagnosed with Asperger's Syndrome (an autistic spectrum disorder).

Healthcare providers should be aware that persons with autistic disorders may experience alterations in the processing of sensory stimulation. Sensations of touch, hearing, smell, and taste may be perceived very differently by a person with autism than others. An individual may demonstrate a higher tolerance for pain, yet at the same time experience "light" touch or loud sounds as painful or intolerable. Avoidance of tactile sensory stimulation may be quite significant in some individuals with autism-thus it may be necessary to modify examination procedures. It is also very important for providers to consider the potential for increased pain tolerance when conducting diagnostic evaluation of persons with autistic disorder.

Another important issue to consider when working with individuals having autistic disorders revolves around communication. Persons with autism frequently display differences in communication skills. Nonverbal communication may be used extensively, depending on the level of autistic expression and/or presence of mental retardation. It is important to understand that many seemingly unrelated behaviors may express communicative intent in individuals with autism. Several helpful strategies exist for relating to persons with autism. One strategy is to use pictorial scripts, such as social stories, which help explain to the patient what will happen during the examination. Another helpful strategy involves the demonstration of procedures on another person, typically a parent.

Huebner, R.A., and Dunn, W. (2001). Introduction and basic concepts. In Huebner, R.A., (Ed.), Autism: A sensorimotor approach to management (pp. 3-40). Gaithersburg, MD: Aspen Publishing, Inc.

For further information on autism see:
Autism Q&A from the National Institute of Child Health and Human Development (NICHD): http://www.nichd.nih.gov/publications/pubs/autismQA.pdf