'A lot of good dialogue going on! Here's a little info from my 15 years of research. This is off the top of my head, so I'm sure I'll leave things out.
To solve a problem, first define the terms:
What is Autism?
Autism is diagnosed by _behavior_ rather than by medical test. That means there could be many different descriptions and different causes. Typical diagnostic criteria:
positive behaviors (things autistic people do)
* repetitive, self-stimulatory behavior ("stims") such as rocking, hand-flapping, spinning, humming, or hitting self rhythmically; (self-injurious behavior, such as head-banging, falls in here as well as in "poor communication" and "increased sensory acuity");
* obsessive-compulsive behaviors, such as having to count all the ceiling tiles, opening and closing the door or turning the locks a certain number of times, doing a "dance" over thresholds or cracks in the sidewalk, having to retrace your path exactly or cause objects to retrace their's (i.e., a soda can that rolls under the table must be rolled back under and picked up from the spot where it fell);
* insistence on sameness and order, for example, lining up toy cars by color rather than pretending they are real cars, or sorting Halloween candy and being able to tell instantly if one piece out of hundreds has been disturbed; freaking out if a different route is taken to a familiar place, or if a familiar room or person is changed -- i.e., new glasses or a chair moved;
* sensory hyperacuity/confusion: as someone said, autistic people really do perceive the world more intensely. Gentle touches may be painful. A human voice may sound like a freight train, and rain, like machine gun fire. Stimuli may cross sensory perceptions; a loud sound may be perceived as a flash of light, or a color may give a tactile sensation or taste. "Enhanced" does not necessarily mean "better"; this is often reported as the most painful part of autism, and results in some of the self-stimulatory behaviors (to control what is perceived) and sensory shut-down typically associated with autism;
* perseverative interest in unusual topics. Often, autistic people are fascinated with trains, vacuum cleaners, locks (in waterways), and radio transmitters/transformer towers and may collect these things or pictures of them. They may also fixate on topics; for instance it is not unusual for verbal autistic children to know the names of all the Presidents, dinosaurs, states, or countries of the world before starting kindergarten.
* hyperlexia. More on this below.
* savant skills. About 10% of autistic people have one thing they do remarkably well, usually related to something mathematical, such as calendar calculations, multiplication, or music.
* appearance. It's odd that someone called autism "unattractive" and someone else responded it has nothing to do with looks. Some forms of autism actually seem associated with unusually good looks -- a large-eyed, youthful appearance, with unusually perfect symmetry. (One explanation is that unattractive people are diagnosed "retarded".)
* literalism. (Is this a trait or a deficit?) An autistic person may answer, "Would you like to take the trash out?" with "No" rather than understanding it as a request; "What's the big idea?!" may garner the response, "Well, what were the smaller ideas?" Autistic humor is generally associated with literal interpretation of things "normies" use figuratively. (In my opinion, it is this keen sense of irony that distinguishes the autistic from the mentally retarded.)
* geeky relatives. Autism is more common in the families of engineers, programmers, classical musicians, and college professors. About 65% of the Nobel Prize winners for science have an autistic brother, son, uncle, or nephew. (More on that later.)
negative behaviors (things autistic people do not do)
* regressive onset; autism is frequently characterized by normal or even gifted development for 12 to 18 months, followed by regression in language and other skills, usually between 12 and 36 months.
* speech is often absent or delayed. Emotive language, in particular, is difficult. Conversational rhythms (turn-taking, etc.) are absent.
* generalizing across environments. An autistic person may have trouble recognizing a teacher encountered at the grocery store, or may not realize this is the same "father" he's always had, since the last one had a beard and this one doesn't. Similarly, if an autistic person knows how to wash his hands in the bathroom, he may need help to wash them under the kitchen sink; the skill is specific to the environment. (Hence the need for consistency.)
* trouble interpreting social cues. An autistic person may not know if someone is being sarcastic or sincere, if they are interested or bored. They have difficulty recognizing faces (faces change), and even more difficulty recognizing facial or postural expressions of emotion.
* lack of "hard wired" social behavior. The expressive side of the above; an autistic person may not automatically cry or say "ouch" when in pain. They may laugh or give no expression when frightened. They probably won't look at a person who's speaking to them, even if they are paying attention: after all, you hear with your ears, not your eyes, right?
* lack of self-awareness. Autistic people often do not know they need to eat, drink, and sleep. This could explain reliance on consistent schedule. When they eat, they may fill their mouths to the point of gagging, because they can't feel the food. When in pain, they are more likely to be generally anxious or irritable (possibly violent) than to be able to identify a specific area of pain (i.e., sore throat, ear infection, ingrown toenail). They are often not aware of the volume of their speech. They often hear through bone conduction rather than aural passage, so they tend to talk in the back of their mouths, much like a deaf person, and to mumble.
* chunking things down: an autistic person either fixates on one detail to the exclusion of the bigger picture (teacher points to picture of policeman and asks, "What is this?" Autistic child responds, "Button."), or sees the big picture and is literally incapable of seeing the details (i.e., room is a mess. Cannot clean whole room at once and cannot pick out trash to throw away, then clothes to put away, then dishes to take to kitchen, one thing at a time. Cannot mop floor because it is too big; cannot mentally divide floor into sections.)
All these behaviors are normal, to some extent, at a level. Disability is a matter of degree: If you jiggle your leg or chew your pencil sometimes, you're normal; if you cannot eat because you have to be rocking and pounding yourself on the chin, you're disabled. Being excited about a pet project is normal; being unable to listen to something that's important to your friend is disabling. If you like a neat room, that's normal; if you can't go swimming because your winter gloves aren't where you remember putting them, that's not.
Disability is environmentally dynamic. Deaf people who sign are not disabled at Galaudet (hearing people who do not sign _are_). A geeky kid may be fine in a geeky household; only when he enters kindergarten do the parents get an inkling that their child is "different". Someone suicidally miserable in a public high school may find a job and subculture perfectly suited to his functioning -- and prosper. My son is considered low-functioning and severely autistic. A social worker observed, "He's not disabled at home."
Subtypes of autism:
* PKU. Yes, phenolkeytonuria was originally "autism". In a database started by an M.D. (Bernard Rimland; Autism Research Institute) with an autistic son, someone noticed mothers reporting a "chemical" smell in the diapers of their autistic children. That subset was identified and tested, and diagnosed with an inability to metabolize the amino acid phenolalinine. Their bodies created phenolykeytones which caused progressive, irreversible brain damage, following the pattern of regression often seen in autism -- language loss and loss of skills around 18 to 36 months. Now every child born in a US hospital is tested at birth, and dietary restrictions prevent this damage. There is every reason to believe that other metabolic differences are responsible for some other cases of autism.
* Kanner's Syndrome. Named by Leo Kanner in the 1940's, this is the classic autism; non-verbal or barely verbal, usually retarded, rocking. This is one type associated with unusual attractiveness. (There was, at one point, a study to determine if the pupils of autistic children were actually larger than those of non-autistic controls. It was given up when it was determined that it was physically impossible to measure the pupils of autistic children without doing something that would change pupillary dilation. Those who work with them will understand.)
* Asperger's Syndrome. Not just high-functioning Kanner's Syndrome, people with AS tend to have little or no speech delay, but unusual speech patterns and interests. They also tend to have unusually attractive faces.
* Landau-Kleffner Syndrome. This looks like autism, but is actually a seizure disorder -- deep seizures that may not show up on a normal EEG. About 1/3 of people with autism have some kind of seizures, usually starting at adolescence.
* Soto's Syndrome. This is characterized by a large head (many autistic people have unusually large cranial circumference) and characteristic sworls on the feet. Clearly, it is a genetic condition, and almost always accompanied by severe retardation.
* Angelman's, or "Happy Puppet" Syndrome. This sub-type is characterized by extreme hypotonia (low muscle tone) and giggly behavior, possibly from an imbalance in the serotonin system.
* Hyperlexia. I don't know that this is formally recognized yet, but there are a great many children who read at an advanced level long before entering kindergarten. These children learn to process language as a visual entity. For them, speaking/hearing is a foreign language; they must perceive it, translate it to visual, formulate a visual response, and translate that to spoken word. They seem slow, and often can take in only part (usually the very first or very last) of what is said to them. Because their "reality" is visual/static, they are often out of sync with the labile, flowing world of auditory language users. They usually get surprisingly good grades (book work; stuff that stays) but have trouble socially, and may be accused of plagiarism because their verbal/spontaneous abilities are so far below their written performance.
Great Plains Laboratory has identified two or three other actual causes/types of autism -- a couple of which are curable (metabolically based). I can't remember those right now, though.
Prevalence (or "Is autism really increasing? Is it "epidemic"?): Survey studies (that is, researchers looked at every child in multiple, specific geographic areas born within two specific years and evaluated all of them on the same tests) showed 2-3 autistic children per 10,000 in the 1960's. Similar studies in the 1990's showed 70 cases of autism per 10,000 population. Going by school district records now, the rate is about 1 in 150 for general population; 1 in 70 if we're just looking at boys. Autism is 3-4 times more common in boys. (These numbers cover Colorado, California, New Jersey, England, and Scotland. Those are the areas with which I'm most familiar and I have reason to suspect numbers are similar elsewhere.)
Interestingly, other forms of auto-immune disease, such as lupus, multiple sclerosis, and some forms of depression, are 3-4 times more common in females than males. There is conjecture that autism is an auto-immune disorder (discussed more under Pt 2: Causes -- if all goes as planned). Notably, while male brains tend to be larger, female brains have ten times the percentage of matter devoted to translation of emotions/sensory perceptions into language. This could account for the difference in manifestation of similar insults to the brain.
This got long. Sorry! This subject puts a nickel in my juke box. I hope someone found information they can use. Next I'll tackle causes, treatments, and cures. 'Probably be as long-winded as this one, though.
Slashdot Mirror
'A lot of good dialogue going on! Here's a little info from my 15 years of research. This is off the top of my head, so I'm sure I'll leave things out. To solve a problem, first define the terms: What is Autism? Autism is diagnosed by _behavior_ rather than by medical test. That means there could be many different descriptions and different causes. Typical diagnostic criteria: positive behaviors (things autistic people do) * repetitive, self-stimulatory behavior ("stims") such as rocking, hand-flapping, spinning, humming, or hitting self rhythmically; (self-injurious behavior, such as head-banging, falls in here as well as in "poor communication" and "increased sensory acuity"); * obsessive-compulsive behaviors, such as having to count all the ceiling tiles, opening and closing the door or turning the locks a certain number of times, doing a "dance" over thresholds or cracks in the sidewalk, having to retrace your path exactly or cause objects to retrace their's (i.e., a soda can that rolls under the table must be rolled back under and picked up from the spot where it fell); * insistence on sameness and order, for example, lining up toy cars by color rather than pretending they are real cars, or sorting Halloween candy and being able to tell instantly if one piece out of hundreds has been disturbed; freaking out if a different route is taken to a familiar place, or if a familiar room or person is changed -- i.e., new glasses or a chair moved; * sensory hyperacuity/confusion: as someone said, autistic people really do perceive the world more intensely. Gentle touches may be painful. A human voice may sound like a freight train, and rain, like machine gun fire. Stimuli may cross sensory perceptions; a loud sound may be perceived as a flash of light, or a color may give a tactile sensation or taste. "Enhanced" does not necessarily mean "better"; this is often reported as the most painful part of autism, and results in some of the self-stimulatory behaviors (to control what is perceived) and sensory shut-down typically associated with autism; * perseverative interest in unusual topics. Often, autistic people are fascinated with trains, vacuum cleaners, locks (in waterways), and radio transmitters/transformer towers and may collect these things or pictures of them. They may also fixate on topics; for instance it is not unusual for verbal autistic children to know the names of all the Presidents, dinosaurs, states, or countries of the world before starting kindergarten. * hyperlexia. More on this below. * savant skills. About 10% of autistic people have one thing they do remarkably well, usually related to something mathematical, such as calendar calculations, multiplication, or music. * appearance. It's odd that someone called autism "unattractive" and someone else responded it has nothing to do with looks. Some forms of autism actually seem associated with unusually good looks -- a large-eyed, youthful appearance, with unusually perfect symmetry. (One explanation is that unattractive people are diagnosed "retarded".) * literalism. (Is this a trait or a deficit?) An autistic person may answer, "Would you like to take the trash out?" with "No" rather than understanding it as a request; "What's the big idea?!" may garner the response, "Well, what were the smaller ideas?" Autistic humor is generally associated with literal interpretation of things "normies" use figuratively. (In my opinion, it is this keen sense of irony that distinguishes the autistic from the mentally retarded.) * geeky relatives. Autism is more common in the families of engineers, programmers, classical musicians, and college professors. About 65% of the Nobel Prize winners for science have an autistic brother, son, uncle, or nephew. (More on that later.) negative behaviors (things autistic people do not do) * regressive onset; autism is frequently characterized by normal or even gifted development for 12 to 18 months, followed by regression in language and other skills, usually between 12 and 36 months. * speech is often absent or delayed. Emotive language, in particular, is difficult. Conversational rhythms (turn-taking, etc.) are absent. * generalizing across environments. An autistic person may have trouble recognizing a teacher encountered at the grocery store, or may not realize this is the same "father" he's always had, since the last one had a beard and this one doesn't. Similarly, if an autistic person knows how to wash his hands in the bathroom, he may need help to wash them under the kitchen sink; the skill is specific to the environment. (Hence the need for consistency.) * trouble interpreting social cues. An autistic person may not know if someone is being sarcastic or sincere, if they are interested or bored. They have difficulty recognizing faces (faces change), and even more difficulty recognizing facial or postural expressions of emotion. * lack of "hard wired" social behavior. The expressive side of the above; an autistic person may not automatically cry or say "ouch" when in pain. They may laugh or give no expression when frightened. They probably won't look at a person who's speaking to them, even if they are paying attention: after all, you hear with your ears, not your eyes, right? * lack of self-awareness. Autistic people often do not know they need to eat, drink, and sleep. This could explain reliance on consistent schedule. When they eat, they may fill their mouths to the point of gagging, because they can't feel the food. When in pain, they are more likely to be generally anxious or irritable (possibly violent) than to be able to identify a specific area of pain (i.e., sore throat, ear infection, ingrown toenail). They are often not aware of the volume of their speech. They often hear through bone conduction rather than aural passage, so they tend to talk in the back of their mouths, much like a deaf person, and to mumble. * chunking things down: an autistic person either fixates on one detail to the exclusion of the bigger picture (teacher points to picture of policeman and asks, "What is this?" Autistic child responds, "Button."), or sees the big picture and is literally incapable of seeing the details (i.e., room is a mess. Cannot clean whole room at once and cannot pick out trash to throw away, then clothes to put away, then dishes to take to kitchen, one thing at a time. Cannot mop floor because it is too big; cannot mentally divide floor into sections.) All these behaviors are normal, to some extent, at a level. Disability is a matter of degree: If you jiggle your leg or chew your pencil sometimes, you're normal; if you cannot eat because you have to be rocking and pounding yourself on the chin, you're disabled. Being excited about a pet project is normal; being unable to listen to something that's important to your friend is disabling. If you like a neat room, that's normal; if you can't go swimming because your winter gloves aren't where you remember putting them, that's not. Disability is environmentally dynamic. Deaf people who sign are not disabled at Galaudet (hearing people who do not sign _are_). A geeky kid may be fine in a geeky household; only when he enters kindergarten do the parents get an inkling that their child is "different". Someone suicidally miserable in a public high school may find a job and subculture perfectly suited to his functioning -- and prosper. My son is considered low-functioning and severely autistic. A social worker observed, "He's not disabled at home." Subtypes of autism: * PKU. Yes, phenolkeytonuria was originally "autism". In a database started by an M.D. (Bernard Rimland; Autism Research Institute) with an autistic son, someone noticed mothers reporting a "chemical" smell in the diapers of their autistic children. That subset was identified and tested, and diagnosed with an inability to metabolize the amino acid phenolalinine. Their bodies created phenolykeytones which caused progressive, irreversible brain damage, following the pattern of regression often seen in autism -- language loss and loss of skills around 18 to 36 months. Now every child born in a US hospital is tested at birth, and dietary restrictions prevent this damage. There is every reason to believe that other metabolic differences are responsible for some other cases of autism. * Kanner's Syndrome. Named by Leo Kanner in the 1940's, this is the classic autism; non-verbal or barely verbal, usually retarded, rocking. This is one type associated with unusual attractiveness. (There was, at one point, a study to determine if the pupils of autistic children were actually larger than those of non-autistic controls. It was given up when it was determined that it was physically impossible to measure the pupils of autistic children without doing something that would change pupillary dilation. Those who work with them will understand.) * Asperger's Syndrome. Not just high-functioning Kanner's Syndrome, people with AS tend to have little or no speech delay, but unusual speech patterns and interests. They also tend to have unusually attractive faces. * Landau-Kleffner Syndrome. This looks like autism, but is actually a seizure disorder -- deep seizures that may not show up on a normal EEG. About 1/3 of people with autism have some kind of seizures, usually starting at adolescence. * Soto's Syndrome. This is characterized by a large head (many autistic people have unusually large cranial circumference) and characteristic sworls on the feet. Clearly, it is a genetic condition, and almost always accompanied by severe retardation. * Angelman's, or "Happy Puppet" Syndrome. This sub-type is characterized by extreme hypotonia (low muscle tone) and giggly behavior, possibly from an imbalance in the serotonin system. * Hyperlexia. I don't know that this is formally recognized yet, but there are a great many children who read at an advanced level long before entering kindergarten. These children learn to process language as a visual entity. For them, speaking/hearing is a foreign language; they must perceive it, translate it to visual, formulate a visual response, and translate that to spoken word. They seem slow, and often can take in only part (usually the very first or very last) of what is said to them. Because their "reality" is visual/static, they are often out of sync with the labile, flowing world of auditory language users. They usually get surprisingly good grades (book work; stuff that stays) but have trouble socially, and may be accused of plagiarism because their verbal/spontaneous abilities are so far below their written performance. Great Plains Laboratory has identified two or three other actual causes/types of autism -- a couple of which are curable (metabolically based). I can't remember those right now, though. Prevalence (or "Is autism really increasing? Is it "epidemic"?): Survey studies (that is, researchers looked at every child in multiple, specific geographic areas born within two specific years and evaluated all of them on the same tests) showed 2-3 autistic children per 10,000 in the 1960's. Similar studies in the 1990's showed 70 cases of autism per 10,000 population. Going by school district records now, the rate is about 1 in 150 for general population; 1 in 70 if we're just looking at boys. Autism is 3-4 times more common in boys. (These numbers cover Colorado, California, New Jersey, England, and Scotland. Those are the areas with which I'm most familiar and I have reason to suspect numbers are similar elsewhere.) Interestingly, other forms of auto-immune disease, such as lupus, multiple sclerosis, and some forms of depression, are 3-4 times more common in females than males. There is conjecture that autism is an auto-immune disorder (discussed more under Pt 2: Causes -- if all goes as planned). Notably, while male brains tend to be larger, female brains have ten times the percentage of matter devoted to translation of emotions/sensory perceptions into language. This could account for the difference in manifestation of similar insults to the brain. This got long. Sorry! This subject puts a nickel in my juke box. I hope someone found information they can use. Next I'll tackle causes, treatments, and cures. 'Probably be as long-winded as this one, though.