An Introduction to Autism

At one point, autism was thought to be caused by lack of love and attention from the parents, particularly the mother. Bruno Bettleheim was the man behind this erroneous theory of the "refrigerator mother". Bruno was supposedly a Jewish psychiatrist who survived Nazi concentration camps in WWII. However, it was later proven that he wasn't a psychiatrist. He was in the construction business. His charismatic and commanding presence led others to believe him when he claimed that he was a psychiatrist. It was in the camps that he developed his theory about parents of individuals with autism by comparing the relationship between parent and child with autism to that of the Nazi officer and camp prisoner. He speculated that as the concentration camp prisoners withdrew and became socially aloof and selectively mute due to the cruel and unloving situation that they were in, that the same could be assumed of children with autism. He drew his conclusion from his own experience, not a study. He later noted that the parents of his patients with autism were "cold" and "detached" in his office. It is my experience that during diagnosis, parents can feel helpless and depressed due to their concern for their children. I know I was. However, Bettleheim concluded that this was why the child had autism; their parents were cold and uncaring. However, I believe that there was a causal relationship. Bruno just had it backwards: the parents were aloof and depressed because their children were not developing correctly and they didn't know how to help.

Parents of children with autism were to suffer from this misunderstanding for years to come. Many families had their children taken away and put in homes because the parents were believed to be detrimental to their own children. Luckily, this myth has been almost completely dispelled. However, there are many new emotional and psychological challenges that face parents today.

One of the major problems facing parents now is, "What causes autism?" Autism was once considered an uncommon disorder, affecting only one in 10,000 individuals in 1978. By 1999, some U.S. communities have reported that 1 in 300 children are diagnosed with an autistic disorder. Today the official Centers for Disease Control number is 1 in 150 children have autism. The cause of the increase is hotly debated by doctors, scientists, parents, schools, and the government. Some say that better diagnostic tools are being used or that doctor and family awareness is helping more children get diagnosed than before. However, several studies find that these theories are lacking the data to back up their claims. There is much speculation about environmental factors such as mercury and other heavy metal poisonings (from vaccinations, fish, pollution, RhoGam shots that pregnant mothers with Rh blood conditions received, dental amalgams containing mercury etc.), the MMR vaccine in particular due to the stress that the triple vaccine places on the young child's immune system (measles has been found in the bowels of many children with autism in Dr. Andrew Wakefield's studies), autoimmune deficiencies, and food allergies. There have been many reputable studies done that suggest that all of the above mentioned factors, when combined with an individual's genetic makeup and susceptibilities, could possibly trigger autism in different children. No one study has proven beyond a doubt that they are correct, but further studies should provide us with enough information to help treat underlying biological factors that can exacerbate an individual's autistic symptoms.

What is known now, is that autism has no racial or socio-economic boundaries. Autism is found in families in all classes and countries. Dependant upon where you live, the prevalence might vary, which is speculated to be based on environmental factors, rather than diagnostic techniques.

Autistic Disorder (the same as "autism") is defined by the DSM-IV-TR under the heading of Pervasive Developmental Disorders (PDD) as, "...the presence of markedly abnormal or impaired development in social interaction and communication and a marketedly restricted repertoire of activity and interests. Manifestations of the disorder vary greatly depending on the developmental level and chronological age of the individual." Also under the heading of PDD are other disorders on the autistic spectrum: Rett's Disorder, Childhood Disintegrative Disorder, Asperger's Disorder, and Pervasive Developmental Disorder, Not Otherwise Specified.

A developmental pediatrician, psychologist, psychiatrist, or neurologist who special in pediatrics can determine which, if any, of these diagnoses fit your children. Developmentally they are all very similar in the deficits and treatments.

Here's a breakdown of the differences in the disorders listed above. Rett's Disorder, according the DSM-IV-TR, is, "...the development of multiple specific deficits following a period of normal functioning after birth...Between ages 5 and 48 months, head growth decelerates. There is a loss of previously acquired purposeful hand skills between ages 5 and 38 months, with the subsequent development of characteristic stereotyped hand movements resembling hand-wringing or hand washing... Interest in social involvement diminishes... also severe impairment in expressive and receptive language development, with severe psychomotor retardation..." So far Rett's disorder has only developed in females, which is interesting, considering that in autistic disorders overall males outnumber females by four or five-to-one.

Childhood Disintegrative Disorder is defined as, "...a marked regression in multiple areas of functioning following a period of at least 2 years of apparently normal development...Most typically, acquired skills are lost in almost all areas," by the DSM-IV-TR. According to epidemiological data, Childhood Disintegrative Disorder appears to be much rarer than Autistic Disorders. The most recent data indicates that it is more common among males (DSM-IV-TR).

Asperger's Disorder is defined as, "...severe and sustained impairments in social interaction... and the development of restricted, repetitive patterns of behaviors, interests, and activities..." Unlike Autistic Disorder, individuals with Asperger's generally have no communication delay, though irony, slang, and other aspects of social interactions may be difficult for them to pick up. Asperger's individuals can sometimes have above average intelligence and quite expansive vocabularies, but be unable to interact with peers due to their social awkwardness. The data for Asperger's prevalence is small, so there is no definitive ratio of males to females affected. (DSM-IV-TR)

Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) is, "...when there are severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder...this category includes "atypical autism"..." Atypical autism is the diagnosis for an individual who doesn't meet the criteria for Autistic Disorder because of, "late age at onset, atypical symptomatology, or subthreshold sympomatology, or all of these." (DSM-IV-TR)

Getting a diagnosis is the first step to helping your child with autism, as to receive appropriate therapies, you need to have the proper strengths and weaknesses charted to know where to start. Also you'll need the diagnosis to receive certain benefits (such as SSI or Medicaid), entrance to certain schools or programs (which might be specifically for autism only), or to receive state or county funding for therapies and other resources.

The road to diagnosis and treatment is often a long and stressful one for caregivers and parents, but there is help. There are lots of websites and groups that offer help for those just starting this journey. Autism Society of America, www.autismsocietyofamerica.org, has local chapters throughout the country, and they are very helpful in providing specific local information about services and programs. The Autism Research Institute has a wealth of information about different therapies, advocacy, and research on its website, www.autism.com/ari.