Understanding the Problem
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
As a parent, teacher, or caregiver you may know the frustration of
trying to communicate and connect with children or adults who have autism.
You may feel ignored as they engage in endlessly repetitive behaviors.
You may despair at the bizarre ways they express their inner needs.
And you may feel sorrow that your hopes and dreams for them may never
But there is help-and hope. Gone are the days when people with autism
were isolated, typically sent away to institutions. Today, many youngsters
can be helped to attend school with other children. Methods are available
to help improve their social, language, and academic skills. Even though
more than 60 percent of adults with autism continue to need care throughout
their lives, some programs are beginning to demonstrate that with appropriate
support, many people with autism can be trained to do meaningful work
and participate in the life of the community.
Autism is found in every country and region of the world, and in families
of all racial, ethnic, religious, and economic backgrounds. Emerging
in childhood, it affects about 1 or 2 people in every thousand and is
three to four times more common in boys than girls. Girls with the disorder,
however, tend to have more severe symptoms and lower intelligence. In
addition to loss of personal potential, the cost of health and educational
services to those affected exceeds $3 billion each year. So, at some
level, autism affects us all.
Research on autism and related disorders is also sponsored by the
National Institute of Child Health and Human Development (NICHD), National
Institute on Deafness and Other Communication Disorders (NIDCD), and
National Institute of Neurological Disorders and Stroke (NINDS).
NIMH scientists are dedicated to understanding the workings and interrelationships
of the various regions of the brain, and to developing preventive measures
and new treatments for disorders like autism that handicap people in
school, work, and social relationships.
Up-to-date information on autism and the role of NIMH in identifying
underlying causes and effective treatments are included in this pamphlet.
Also described are symptoms and diagnostic procedures, treatment options,
strategies for coping, and sources of information and support.
The individuals referred to in this article are not real, but their
stories are based on interviews with parents who have children with
Paul has always been obsessed with order. As a child, he lined up blocks,
straightened chairs, kept his toothbrush in the exact same spot
on the sink, and threw a tantrum when anything was moved. Paul
could also become aggressive. Sometimes, when upset or anxious,
he would suddenly explode, throwing a nearby object or smashing
a window. When overwhelmed by noise and confusion, he bit himself
or picked at his nails until they bled. At school, where his schedule
and environment could be carefully structured, his behavior was
more normal. But at home, amid the unpredictable, noisy hubbub
of a large family, he was often out of control. His behavior made
it harder and harder for his parents to care for him at home and
also meet their other children's needs. At that time-more than
10 years ago-much less was known about the disorder and few therapeutic
options were available. So, at age 9, his parents placed him in
a residential program where he could receive 24-hour supervision
As an infant, Alan was playful and affectionate. At 6 months old, he
could sit up and crawl. He began to walk and say words at 10 months
and could count by 13 months. One day, in his 18th month, his
mother found him sitting alone in the kitchen, repeatedly spinning
the wheels of her vacuum cleaner with such persistence and concentration,
he didn't respond when she called. From that day on, she recalls,
"It was as if someone had pulled a shade over him." He stopped
talking and relating to others. He often tore around the house
like a demon. He became fixated on electric lights, running around
the house turning them on and off. When made to stop, he threw
a tantrum, kicking and biting anyone within reach.
From the day she was born, Janie seemed different from other infants.
At an age when most infants enjoy interacting with people and exploring
their environment, Janie sat motionless in her crib and didn't respond
to rattles or other toys. She didn't seem to develop in the normal sequence,
either. She stood up before she crawled, and when she began to walk,
it was on her toes. By 30 months old, she still wasn't talking. Instead,
she grabbed things or screamed to get what she wanted. She also seemed
to have immense powers of concentration, sitting for hours looking at
a toy in her hand. When Janie was brought to a special clinic for evaluation,
she spent an entire testing session pulling tufts of wool from the psychologist's
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