Infantile Autism
ICD 299.0

Article by:
Sarah Morales, BS
Children's Speech Care Center

Autism, sometimes referred to as infantile autism or autistic spectrum disorder, is a disorder that impairs neurologic, intellectual (cognitive functioning, cognition) and social/emotional development and functioning to varying degrees. Speech and language are impaired as a result of these difficulties. Autism is a variable and complex disorder, and thus professionals say that it exists on a spectrum. This means that the disorder can occur in many forms, ranging from mild to severe.

Research has examined several factors in a search to find the cause of autism. Genetic factors and maternal illness during pregnancy (i.e. rubella) are two potential causes. Fragile X syndrome (a genetic disorder frequently causing intellectual disability, or other physical, behavioral and developmental characteristics) occurs rarely with autism. Other potential causes include traumatic birth and maternal use of medication during pregnancy.

Autism is typically diagnosed before the child is 3 years old, although about 80 percent of autistic children develop signs of the disorder in the first year of life. It is marked by a child’s lack of communicative/language and social development as well as the presence of repetitive, stereotyped patterns of behavior and restricted interests. For example, the child may, but not always, prefer being alone and show withdrawal, isolation and aloofness. They may have a preoccupation with inanimate objects, such as looking at and/or spinning the wheels on a toy car, and exhibit ritualistic behaviors, such as endlessly arranging toys or objects by size, color, or shape. Repetitive behaviors may be seen such as hand flapping or flicking the fingers in front of the eyes. They may have an intense aversion to change, and significant difficulties with transition. Children with autism may have hypo or hyper reactions to sensory stimuli. A child may fail to produce speech (i.e. babbling, first words) or respond to language spoken to him/her. If language is present, if may be atypical and/or restricted. Autistic children’s play skills are also impaired; the child may avoid engaging in social play or do so inappropriately. Object play may consist of repetitive, meaningless motions as opposed to appropriate use of toys (i.e. banging a toy truck on the floor instead of rolling it). The child’s play interests are typically narrow; play itself may lack variety and sequence.

Behavioral symptoms are another mark of autism. Violent or self-injurious behaviors may be seen, as is a low tolerance for frustration. Many autistic persons are hypersensitive (overly sensitive) to light, sound, or touch; in children, this hypersensitivity may lead to behaviors and reactions that occur, seemingly, for no reason. Hyposensitivity (e.g. lack of or a depressed response) may also exist and result in behavioral issues. Behaviors may also result as a reaction to changes in routine. For example, a child may cry if his/her parent takes a different route to the grocery store. Certain behavioral issues may be viewed as underdeveloped communication attempts, and it is common among professionals to try to assess behavioral reactions in order to optimize intervention settings and assist the individual with development of more effective management/communication tools, as well as identify and treat the source of the behaviors.

As noted, speech and language development may be delayed or absent—up to 40% of autistic persons remain without speech (Gail Richards, 2000). If speech does occur, the child’s utterances may be meaningless, repetitions of commercials or others’ speech (called “scripting”). The presence of echolalia (echoing others’ responses) is not uncommon. Speech may be present but socially inappropriate. The prosody (intonation, melody, tone of voice) of autistic persons’ speech may be monotonous or sing-song in quality.

Language and communication difficulties are hallmark in those with autism. An infant or child may not develop the natural precursors to verbal language, e.g., shared attention to an activity, turn taking, pointing and/or gesturing to engage with another in a reciprocal interaction or to request. A child may gain language, but as it becomes increasingly complex, may fail to master language as it moves from more concrete terminology to the understanding and use of abstract terms and ideas. Language may be a challenge throughout life as it becomes more inferential. A person with autism may have difficulty using language for such functions as reasoning, problem solving and identifying and verbalizing feelings. Language may also become complicated when verbal demands are placed on an individual within social, reciprocal interactions.

Higher-functioning persons may exhibit a formal, atypical quality when expressing themselves (i.e. Asperger Syndrome). Those with Asperger Syndrome may produce long monologues of well-formed and organized language, but be unable to pay attention to the needs of the listener. A person with autism may fail to maintain a topic initiated by another person in conversation and have a lack of interest in others’ topics. Lack of eye contact may be evident. They also may have difficulty understanding humor or telling jokes.

Individuals with high functioning autism frequently show issues with the social use of language, or pragmatics. These issues include those mentioned in the above paragraph. This may range from difficulties in initiating and maintaining a topic to commenting appropriately and asking and answering questions appropriately in conversation, to nonverbal behaviors (including eye contact, body proximity, facial expression and general body language). Poorly developed pragmatics would be included in impaired social skills. Reduced understanding and use of social skills are seen even in the most high-functioning persons.

Autism is usually treated in a team approach, meaning that the disorder is treated by a team of professionals. For example, a psychiatrist or psychologist diagnoses autism, a speech-language pathologists implements speech/language therapy, an occupational therapist may attend to sensory-motor and other issues, and a behavioral therapist may implement cognitive and behavioral therapy. An interesting link that includes information on autism and many other disorders is www.medical-library.org. However, access to this website requires “registration” which includes a $9.95 annual fee.

Other informative links are
www.autism.com
www.autisminfo.com