Infos on autism

Autism is a neurological disorder which severely impairs a child's ability to communicate and interact socially. It is a developmental disability which affects thought, perception and attention; it is a broad spectrum of disorders that ranges from mild to severe. It is also referred to as a Pervasive Developmental Disorder (PDD). For more on neurological causes go to Conferences and Articles.

Autism Spectrum Disorder encompasses many different disorders all of them involving an impairment in social emotional skills . Different diagnosis are given according to the severity and or the specificity of the impairment. They include the following : ASD for Autism Spectrum Disorder, PDD-NOS for Pervasive Developmental Disorder Not Otherwise Specified, AS for Asperger Syndrome. Rett Syndrome, Smith Magenis Syndrome, Fragile X chromosome Syndrome also pertain to the spectrum of Autism Disorder. Even within the same diagnosis , people share as many characteristics as they display noticeable differences in their adaptive capacities.

Children with autism exhibit a wide range of behavioral deficiencies and excesses. (for more on behavioral deficiencies, click on Related Disorders) Autism is the third most common developmental disability today, affecting, in some estimates, as many as 1 in 166 children. It is four times more prevalent in boys than girls. This disorder seems linked to a Central Nervous System dysfunction resulting in a sensory/emotion processing and modulation impairment.

(for information on communication milestones in typical children , see Typical Child section

It refers to the capacity of the nervous system to continually and accurately register sensory information (external as well as internal) and modify or alter a person's perception of it, prior to responding.

Poor sensory modulation can occur within any of the sensory systems: tactile, motor (proprioceptive -i.e., related to body posture- and vestibular -related to balance), auditory, visual, smell or taste.

Often, the nervous systems of children with sensory processing problems may not modulate sensory information properly and may alert and arouse to the wrong cues or may fail to alert at all. Most oppositional behaviors could result from a difficulty in processing sensory input or emotions. A hypersensitivity to sounds makes sound production a painful process thus rendering speaking an aversive experience. Children with strong tactile defensiveness react very negatively to being held and cuddled. It seems as if children with Autism perceive (and/or react to) their environment in an altered or distorted manner.

Sensory information, after being processed in the corresponding sensory area, is relayed to the Amygdala which is the portal of the sensory regulation limbic system. The Amygdala is located deep within the temporal globe. It is responsible for arousal, control of autonomic responses associated with fear, emotional responses, formation and storage of memory associated with emotional events. The Amygdala is also involved in memory consolidation. Integrating information gathered through the individual previous experiences, the Amygdala sends cascading information to the autonomous nervous system to prepare the body response to the sensory stimuli.

Children with autism appear to distort emotional significance of sensory information, (displaying responses irrelevant with the stimuli, e.g., expression of fear triggered by the sight of certain food and absence of fear in front of an obviously mean dog). This could be the result of faulty connections (chemicals) in between the cortical areas that process information and the Amygdala, and/or between the Amydgala and the limbic system, and the frontal lobes that elaborate and regulate the resulting behaviors.

Self stimulatory behaviors are resulting from sensory impairment. They have a calming effect on individuals with autism performing them. They are in fact, (unsuitable) self regulating behaviors, in response to emotional distress. Unfortunately the high incidence of those behaviors prevents the individuals performing them from attending to their social environment causing further delay in learning. Concomitantly, they lead to a measurable reduction of skin conduction.

Distortion in sensory regulation was evaluated in children with autism by measuring the increase of their skin conductance while exposed to a variety of sensory information. The increase of skin conductance is caused by an increase in sweating. All the children had an overall increased autonomic response (heart beat, sweating) but their responses varied randomly, and disproportionably with the stimuli they were exposed to. They could be agitated when exposed to trivial events and display little reaction to arousing events. Their sensory landscape is obviously disrupted. Monitoring a child ‘skin conductivity could give valuable information aiming at preparing the child to regulate and integrate relevant sensory information that appear disruptive to them.

The disorder seems to affect the way emotions are perceived and expressed and the way in which the body regulates the emotional flow. Emotions whether primary, (happiness, fear, anger, sadness) or secondary (also called social emotions) are complicated productions of chemical and neural expressions forming a pattern.

All emotions have some kind of regulatory role to play; they should assist in the body's survival. The first biological function of an emotion is the regulation of the internal state of the body ( blood flow, temperature, heart beat , gastro intestinal motility, level of arousal…). The second function is to produce an appropriate external (social) reaction to an inducing situation. Most children with PDD display an emotional repertoire that seems to follow a very confused and confusing internal clock .

75% of them suffer from some gastro intestinal problem similar to those resulting from a very high stress level. The disorders range from allergies to various motility disorders. The gastro intestinal problems could account for many unexplained outbursts and for some of the poor sleep patterns many children under the autism spectrum disorders experience.

Self stimulating behavior such as hand flapping, rocking, biting the skin, clothes or objects may result from poor emotional and sensory regulation. Acting out and temper tantrums might be the consequences of high arousal levels to complex environments.

Children with autism have also a severe impairment in their ability to label emotions on others, leading to their social awkwardness.

Many children within the PDD range are also affected by dyspraxia, apraxia or both. Developmental dyspraxia is an impairment or immaturity of the organization of movement. It is an immaturity in the way that the brain processes information, which results in messages not being properly or fully transmitted. The term dyspraxia comes from the Greek word "praxis", which means doing, acting. Dyspraxia affects the planning of what to do and how to do it. It is associated with problems of perception and language.

Apraxia of speech is a disorder of the nervous system affecting the ability to sequence and say sounds, syllables and words. It is not due to a muscular weakness but it resides in the brain’s planning to move the parts of the body involved with the production of speech. The child might know what he is trying to say but the brain is not sending the proper motor instruction.

Hypotonia is a disorder involving decreased muscle tone, and hypertonia refers to an increased tightness of muscle tone . They are often diagnosed in children with autism. Both may suggest a central nervous system dysfunction.

There is no known single cause for autism, it seems largely a genetic and polygenic (involving several genes) disease. It is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in autistic versus non-autistic children. 30 to 70 % of children with autism have abnormal EEG ((Electroencephalogram) images displaying EEG spikes, and about one-third of children and adolescents with autism develop seizures.

There are clear evidence that children with Autism and PDD are born with the disorder or with the potential to develop it. Poor parenting cannot cause it: no psychological factors have proven to cause autism. Autism is a developmental disorder and not a mental illness. Children with autism are not unruly kids who choose not to behave.

Siblings of people with autism have a 3 to 10 percent chance of being diagnosed with the same disorder. The risk is higher if the first child being diagnosed is a girl. This is much greater than the 0.16 percent risk in the general population but much less than the 50% chance that would characterize a genetic disease caused by a single dominant mutation (in which one faulty gene, inherited from one parent is enough to cause the disorder), or the 25 percent chance that would characterize a single recessive gene (in which a copy of the faulty gene inherited by both parents is necessary to cause the disease).

In many families, there appears to be a pattern of related disabilities, supporting a genetic basis to the disorder. Evidence suggests that unaffected family members may share with their ill relatives genes that predispose for milder behavioral characteristics that are qualitatively similar to those of autism ( reading problem, certain sensory based avoidant behavior, deficit in attention, impaired social skills,) More than one gene and more than one chromosome are involved in that disorder. The huge discrepancy between the number of boys and girls affected could be caused by faulty recessive genes located in the chromosome X, which could not be counterbalanced in boys, having only one chromosome X. It could also explain why girls with the disorder tend to have more severe symptoms and greater cognitive impairment.

Researchers are searching for irregular segments of genetic code that autistic children may have inherited. The rate of people being diagnosed with autism has increased substantially over the past two decades. Although this may be in part due to improved diagnostic techniques and to changes in the criteria for autism spectrum disorders, the majority of experts agree that these changes are not enough to explain the epidemic rates at which autism is being diagnosed today.

Other causes might be Environmental (e.g. pollution, viral infections) and an immunity deficiency.

The question of a relationship between vaccines and autism continues to be debated. Large studies in the US have found no link between autism and MMR vaccine. (click on Conferences and Articles.. for more on vaccine,)

Intensive, early intervention during the toddler and preschool years improves behavioral and cognitive outcomes for most young children with autism.

Early diagnoses and early intervention show very encouraging results. Autism can be diagnosed by the age of 15 months. It is hoped that in most cases, with very early and proactive interventions, it is possible to reverse the course of the disorder due to the brain plasticity.

Interventions are behaviorally oriented rather than medically. Most of the therapies aim at “reshapping” the impaired behaviors.

Applied behavior analysis, verbal behavior, play therapy, are the most commonly implemented therapies. They must be associated with sensory integration therapy:

These strategies are often coupled with occupational therapy which addresses the sensory deficiencies and with speech therapy . Children with severe apraxia do poorly with traditional speech therapy and their language improves through play, songs, rhythmic activities. Children with dyspraxia need physical therapy as well.

Remember that, as for typical children, there are no two children alike and in spite of an Autism Disorder your child is first of all a child and needs your support and love.

He is the one suffering from a disability and he needs even more than a typical child that you become his facilitator to access and comprehend the outside world. His disability is why he is is acting strangely and in a challenging manner. He cannot be blamed for his disability neither can you. He can be helped in order to reach his potential. Children with Autism have to be shown in a very explicit way how to behave. This can be done addressing their various needs and capacities, steps by steps.

Autism being such a complex disorder, is better approached through as many angles a possible. Keep a very open mind but reappraise constantly your child’s needs and monitor the progress and the regression closely. A team approach is much more effective than many parallel approaches. Target which behavior the child needs to enhance or diminish and ask the therapist to develop a strategy for it, which has to be shared with all other therapists. Do not set goals to high, trust yourself as being the one who knows your child best.

- Whatever the therapist, the theory, the child should be engaged in social interaction as much as possible throughout the day. Joint attention has proven extremely effective to increase availability for learning, and social awareness. Due to the brain plasticity of young children , very early intervention is highly recommended..

However remain wary of therapies that could jeopardize your child's health, therapies that have not been subjected to any independent and scientific evaluation, and and overall of extremely expensive therapies. If they had proven useful, their use would have become more generalized and their cost would have diminished.

- Words and names are most of the time meaningless for a child with ASD. Use few of them, make few demands. They should be followed by clear, consistent and predictable consequences.

Do not repeat a command more than twice, then help your child comply with it and praise him when it is completed no matter how much you both struggled to do it.

Associate the child’s name with something enticing, or do not use it. He will then start to pay more attention to it being called.

- Children with Autism often have amazing and unusual visual processing’s skills. They may appear to have a tunnel-like vision but they often scan their environment very methodically , though not as a whole but as a succession of details . They use small and not relevant details to recognize an object or a person. The child might be fixated to a very small detail to identify the safe food or environment. Always teach your child in a variety of environment to allow him/her to generalize the use of an acquired skill.

- Eyes have a very aversive quality for children with autism. Accordingly eye contact is painful to sustain which hinder their ability to learn language and social codes through observation and imitation. Better to ask them to focus on somebody’s nose., or on an object held at face level.

- The best way to extinguish an oppositional behavior is to (pretend! to) ignore it. For example: Give no eye contact, no word, while you stop your child from climbing the window sill. Redirect him/her to an appropriate activity and then praise him/her.

- Try to be consistent! Celebrate every victory. You sometimes might feel helpless as children with Autism (as well as typical children) grow with regression, plateau, challenging behaviors, but remember they also have wonderful breakthrough, a unique quality of love and they offer another view of the world , of life.

[1] Skinner, Lovaas.

[2] Verbal behavior . BF Skinner, 1957

[3] The affect based language Curriculum , S. Greenspan, D. Lewis,

[4] Early social games and the acquisition of language, British Journal of developmental psychology Ciamoni.L, Laicardi .C..

Information on autism

(Autism spectrum disorders)

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