What is autism?
Although anecdotal cases about individuals presenting with behaviours similar to what we now call autism have been documented for over a century, the first formal written documentation defining autism as a distinct condition was by Leo Kanner in the early 1940s. Individuals with autism have difficulties with communication and social interaction, and display restricted, repetitive patterns of interest and activity. Autism is thought to be present at or soon after birth, with the characteristics of the disorder becoming apparent in the first three years of life. Parents are often aware of early signs in their child’s lack of or unusual verbal and non-verbal communication, delayed or unusual play skills and limited response to other people.
Individuals with autism have impairments in their social development and social understanding, and find relating to people extremely difficult. They will often avoid basic interactions such as eye contact, and are frequently described as being in their own world. Some individuals with autism appear aloof, displaying almost complete indifference to other people, or using them to meet their own needs but not for the purpose of interacting and sharing experiences. Others can attempt to join in with those around them, but due to an inability to grasp the complex rules of everyday social behaviours do so in a manner that is odd, repetitive and at times inappropriate. People with autism often have difficulty understanding and responding to other people’s thoughts and feelings, and can be described as having limited empathy and sympathy. This means that people with autism have difficulty understanding and predicting what other people’s actions and comments may mean. They often need to learn in a structured way, situation by situation, many of the social behaviours that other people acquire incidentally.
The communication impairment in autism is very complex, and affects the whole communication system. This includes the understanding and use of speech and non-verbal modes of communication such as eye contact and gesture. Most individuals with autism find communication difficult, and most have a language disorder. Expressive language, or what a person says, varies from complete mutism to verbal fluency. Some people with autism who are able to speak mainly echo back what is said to them, and so do not use their speech in a functional manner. People with autism who have functional speech often use their language in an odd and limited manner. They often engage in repetitive questioning or talking excessively about favoured topics that hold little interest for others and have little desire to use their language to socially interact with others or to have a reciprocal conversation. They also have difficulties understanding and using non-verbal communication, such as facial expression, gesture, and body language.
Restricted and Repetitive Interests and Activities
Individuals with autism have difficulty making sense of the world around them, and this may account, in part, for the obsessive and rigid nature of their behaviour. They appear to cope best when their environment is predictable. In day-to-day activities, many people with autism impose routines upon themselves and their families. They usually display limited play skills and little imaginative play, tending to repeat the same theme or re-enact situations, such as reciting a "Thomas the Tank" episode they have seen, rather than developing their own stories and extending their games.
People with autism spend much of their time in repetitive activities with which they are often said to be ‘obsessed’. Examples of activities are playing with the same toy in an odd manner, watching the same video repeatedly, flicking string, or lining up or spinning objects. In higher functioning people, this behaviour is reflected in their tendency to amass facts about topics such as bus or train routes and timetables, or dinosaurs.
People with autism often insist on following routines or rituals, and can be distressed over changes to small details of the environment, such as wanting to keep to the same route to the shops or eat dinner from the same plate. They may strongly resist attempts to redirect them from these behaviours or to change their routines. It is thought that people with autism feel tremendous anxiety at the unpredictability of daily life, and these rituals and routines remove some of the uncertainty for them about what will happen next.
Varying degrees of sensory impairments are also common in individuals with autism, with under or over reactions to sound, touch, taste, smell, pain, temperature and visual stimuli being observed. An overreaction to sensory input can cause some individuals with autism to become overwhelmed or frightened by what they are feeling, and can result in anxiety or a panic response. This can be frustrating for both people with autism and those who care for and work with them, as these reactions can vary from day to day.
Some individuals with autism have obvious, stereotypic motor movements, such as arm flapping or rocking. Self-injurious behaviour, including head banging and hand biting, can also be seen in individuals with autism.