What is Autism?
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
Difference in the Behaviors of Infants With and Without Autism
NOTE: This list is not intended to be used to assess whether a
particular child has autism. Diagnosis should only be done by a
specialist using highly detailed background information and behavioral
||Infants with Autism
|| Normal Infants
||Avoid eye contact Seem deaf Start developing language, then abruptly
stop talking altogether
||Study mother's face Easily stimulated by sounds Keep adding to
vocabulary and expanding grammatical usage
||Act as if unaware of the coming and going of others Physically
attack and injure others without provocation Inaccessible, as if
in a shell
||Cry when mother leaves the room and are anxious with strangers
Get upset when hungry or frustrated Recognize familiar faces and
|Exploration of environment
||Remain fixated on a single item or activity Practice strange actions
like rocking or hand-flapping Sniff or lick toys Show no sensitivity
to burns or bruises, and engage in self-mutilation, such as eye
||Move from one engrossing object or activity to another Use body
purposefully to reach or acquire objects Explore and play with toys
Seek pleasure and avoid pain
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.
By age 3, most children have passed several predictable milestones
on the path to learning language. One of the earliest is babbling.
By the first birthday, a typical toddler says words, turns when
he hears his name, points when he wants a toy, and when offered
something distasteful, makes it very clear that his answer is
no. By age 2, most children begin to put together sentences like
"See doggie," or "More cookie," and can follow simple directions.
Research shows that about half of the children diagnosed with autism
remain mute throughout their lives. Some infants who later show signs
of autism do coo and babble during the first 6 months of life. But they
soon stop. Although they may learn to communicate using sign language
or special electronic equipment, they may never speak. Others may be
delayed, developing language as late as age 5 to 8.
Those who do speak often use language in unusual ways. Some seem unable
to combine words into meaningful sentences. Some speak only single words.
Others repeat the same phrase no matter what the situation.
Some children with autism are only able to parrot what they hear,
a condition called echolalia. Without persistent training, echoing other
people's phrases may be the only language that people with autism ever
acquire. What they repeat might be a question they were just asked,
or an advertisement on television. Or out of the blue, a child may shout,
"Stay on your own side of the road!"-something he heard his father say
weeks before. Although children without autism go through a stage where
they repeat what they hear, it normally passes by the time they are
People with autism also tend to confuse pronouns. They fail to grasp
that words like "my," "I," and "you," change meaning depending on who
is speaking. When Alan's teacher asks, "What is my name?" he answers,
"My name is Alan."
Some children say the same phrase in a variety of different situations.
One child, for example, says "Get in the car," at random times throughout
the day. While on the surface, her statement seems bizarre, there may
be a meaningful pattern in what the child says. The child may be saying,
"Get in the car," whenever she wants to go outdoors. In her own mind,
she's associated "Get in the car," with leaving the house. Another child,
who says "Milk and cookies" whenever he is pleased, may be associating
his good feelings around this treat with other things that give him
It can be equally difficult to understand the body language of a person
with autism. Most of us smile when we talk about things we enjoy, or
shrug when we can't answer a question. But for children with autism,
facial expressions, movements, and gestures rarely match what they are
saying. Their tone of voice also fails to reflect their feelings. A
high-pitched, sing-song, or flat, robot-like voice is common.
Without meaningful gestures or the language to ask for things, people
with autism are at a loss to let others know what they need. As a result,
children with autism may simply scream or grab what they want. Temple
Grandin, an exceptional woman with autism who has written two books
about her disorder, admits, "Not being able to speak was utter frustration.
Screaming was the only way I could communicate." Often she would logically
think to herself, "I am going to scream now because I want to tell somebody
I don't want to do something." Until they are taught better means of
expressing their needs, people with autism dowhatever they can to get
through to others.
The Story of Temple Grandin
Temple Grandin, despite a lifelong struggle with autism, earned
a doctoral degree in animal science. Today, she invents equipment
for managing livestock and teaches at a major university. A woman
of extraordinary accomplishments, she has also written several
books on animal science, autism, and her own life. Yet at 6 months
old, Temple had many of the full-blown signs of autism. When held,
she would stiffen and struggle to be put down. By age 2, it was
clear that she was hypersensitive to taste, sound, smell, and
touch. Sounds were excruciating. Wearing clothes was torture:
the feel of certain fabrics was like sandpaper grating her skin.
Constantly buffeted by overpowering sensations, she screamed,
raged, and threw things. At other times, she found that by focusing
intently and exclusively on one item-her own hand, an apple, a
spinning coin, or sand sifting through her fingers-she could withdraw
into a temporary haven of order and predictability. As was customary
at the time, a doctor advised that Temple be institutionalized.
Her mother refused and placed her in a therapeutic program for
children who were speech impaired. The classes were small and
highly structured. Even though the program was not designed to
treat autism, the methods worked for Temple. By age 4, she began
to speak and by age 5 she was able to attend kindergarten in a
regular school. Temple attributes her success to several key people
in her life: her mother, who persisted in finding help; her therapist,
who kept her from withdrawing into an inner world; and a high
school teacher who helped transform her interest in animals into
a career in animal science. Temple's insights into the needs of
animals, a strongly developed ability to think visually "in pictures,"
and an awareness of her own special needs led her to invent equipment
that has helped both livestock and, remarkably, herself. After
seeing a device used to calm cattle, she created a "squeeze machine."
The machine provides self- controlled pressure that helps her
relax. She finds that after using the squeeze machine, she feels
less aggressive and less hypersensitive. With her love of animals
and her personal sensitivity as a guide, Temple has also designed
humane equipment and facilities for managing cattle that are used
all over the world. Her unusually strong visual sense allows her
to plan and design these complex projects in her head. She can
precisely envision new, complex facilities and how various pieces
of equipment fit together before she draws a blueprint. Temple
Grandin's story is a powerful affirmation that autism need not
keep people from realizing their potential.
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
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
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.
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.
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