Consumer

Behaviour
assignment on:-


AUTISM



SUBMITTED BY:-
SHREYAS PENDHARKAR
ROLL NO: 610027







What is autism?
Autism is a disorder of neural development characterized by impaired social
interaction and communication, and by restricted and repetitive behaviour. These signs all begin
before a child is three years old. Autism affects information processing in the brain by altering how
nerve cells and their synapses connect and organize; how this occurs is not well understood. t is one
of three recognized disorders in the autism spectrum (ASDs), the other two being Asperger
syndrome, which lacks delays in cognitive development and language, and Pervasive Developmental
Disorder-Not Otherwise Specified (commonly abbreviated as PDD-NOS), which is diagnosed when
the full set of criteria for autism or Asperger syndrome are not met.
Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear
whether ASD is explained more by rare mutations, or by rare combinations of common genetic
variants. n rare cases, autism is strongly associated with agents that cause birth
defects. Controversies surround other proposed environmental causes, such as heavy
metals, pesticides or childhood vaccines; the vaccine hypotheses are biologically implausible and lack
convincing scientific evidence. The prevalence of autism is about 12 per 1,000 people worldwide;
however, the Centres for Disease Control and Prevention (CDC) reports an approximate of 9 per
1,000 children in the United States are diagnosed with ASD. The number of people diagnosed with
autism has increased dramatically since the 1980s, partly due to changes in diagnostic practice; the
question of whether actual prevalence has increased is unresolved.
Parents usually notice signs in the first two years of their child's life. The signs usually develop
gradually, but some autistic children first develop more normally and then regress. Although there is
no known cure, early behavioural or cognitive intervention can help autistic children gain self-care,
social, and communication skills. Not many children with autism live independently after reaching
adulthood, though some become successful. An autistic culture has developed, with some individuals
seeking a cure and others believing autism should be accepted as a difference and not treated as a
disorder.


Autism Overview

Autism is a complex developmental disorder that has the following three defining core features:
1. Problems with social interactions
2. mpaired verbal and nonverbal communication
3. A pattern of repetitive behaviour with narrow, restricted interests
A number of other associated symptoms frequently coexist with autism. Most people with autism have
problems using language, forming relationships, and appropriately interpreting and responding to the
external world around them.
Autism is a behaviorally defined developmental disorder that begins in early childhood. Although the
diagnosis of autism may not be made until a child reaches preschool or school age, the signs and
symptoms of autism may be apparent by the time the child is aged 12-18 months, and the behavioral
characteristics of autism are almost always evident by the time the child is aged 3 years. Language
delay in the preschool years (younger than 5 years) is typically the presenting problem for more
severely affected children with autism. Higher functioning children with autism are generally identified
with behavioral problems when they are aged approximately 4-5 years or with social problems later in
childhood. Autism disorder persists throughout the person's lifetime, although many people are able to
learn to control and modify their behavior to some extent.


Autism Causes
Although autism is the result of a neurologic abnormality, the cause of these problems with the
nervous system is unknown in most cases. Research findings indicate a strong genetic component.
Most likely, environmental, immunologic, and metabolic factors also influence the development of the
disorder.
O There is probably no single gene or genetic defect that is responsible for autism. Researchers
suspect that there are a number of different genes that, when combined together, increase the risk
of getting autism. n families with one child with autism, the risk of having another child with autism
is 3% to 8%. The concordance of autism in monozygotic twins is 30%. A number of studies have
found that first-degree relatives of children with autism also have an increased risk of autism
spectrum disorders.
O n some children, autism is linked to an underlying medical condition. Examples include metabolic
disorders (untreated phenylketonuria [PKU]), congenital infections (rubella, cytomegalovirus
[CMV],toxoplasmosis), genetic disorders (fragile X syndrome, tuberous sclerosis), developmental
brain abnormalities (microcephaly, macrocephaly, cerebral dysgenesis), and neurologic disorders
acquired after birth (lead encephalopathy, bacterial meningitis). These medical disorders alone do
not cause autism as most children with these conditions do not have autism.
O Environmental factors and exposures may interact with genetic factors to cause an increased risk
of autism in some families.


Over time, many different theories have been proposed about what causes autism. Some of these
theories are no longer accepted, however.
O Emotional trauma: Some believed that emotional trauma at an early age, especially bad parenting,
was to blame. This theory has been rejected.
O Vaccines: Although the mercury preservative used in some vaccines is known to be neurotoxic, the
most recent research on this subject does not suggest a specific link between vaccines and
autism.


Characteristics
Autism is a highly variable neurodevelopmental disorder that first appears during infancy or childhood,
and generally follows a steady course without remission. Overt symptoms gradually begin after the
age of six months, become established by age two or three years, and tend to continue through
adulthood, although often in more muted form. t is distinguished not by a single symptom, but by a
characteristic triad of symptoms: impairments in social interaction; impairments in communication; and
restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common
but are not essential for diagnosis. Autism's individual symptoms occur in the general population and
appear not to associate highly, without a sharp line separating pathologically severe from common
traits.




SociaI deveIopment
Social deficits distinguish autism and the related autism spectrum disorders from other developmental
disorders. People with autism have social impairments and often lack the intuition about others that
many people take for granted. Noted autistic Temple Grandin described her inability to understand
the social communication of neurotypicals, or people with normal neural development, as leaving her
feeling "like an anthropologist on Mars".
Unusual social development becomes apparent early in childhood. Autistic infants show less attention
to social stimuli, smile and look at others less often, and respond less to their own name. Autistic
toddlers differ more strikingly from social norms; for example, they have less eye contact and turn
taking, and do not have the ability to use simple movements to express oneself, such as the
deficiency to point at things. Three- to five-year-old autistic children are less likely to exhibit social
understanding, approach others spontaneously, imitate and respond to emotions, communicate
nonverbally, and take turns with others. However, they do form attachments to their primary
caregivers. Most autistic children display moderately less attachment security than non-autistic
children, although this difference disappears in children with higher mental development or less
severe ASD. Older children and adults with ASD perform worse on tests of face and emotion
recognition.
Children with high-functioning autism suffer from more intense and frequent loneliness compared to
non-autistic peers, despite the common belief that children with autism prefer to be alone. Making and
maintaining friendships often proves to be difficult for those with autism. For them, the quality of
friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as
those resulting in invitations to parties, may affect the quality of life more deeply.
There are many anecdotal reports, but few systematic studies, of aggression and violence in
individuals with ASD. The limited data suggest that, in children with mental retardation, autism is
associated with aggression, destruction of property, and tantrums. A 2007 study interviewed parents
of 67 children with ASD and reported that about two-thirds of the children had periods of severe
tantrums and about one-third had a history of aggression, with tantrums significantly more common
than in non-autistic children with language impairments. A 2008 Swedish study found that, of
individuals aged 15 or older discharged from hospital with a diagnosis of ASD, those who committed
violent crimes were significantly more likely to have other psychopathological conditions such as
psychosls.





Communication
About a third to a half of individuals with autism do not develop enough natural speech to meet their
daily communication needs. Differences in communication may be present from the first year of life,
and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal
patterns that are not synchronized with the caregiver. n the second and third years, autistic children
have less frequent and less diverse babbling, consonants, words, and word combinations; their
gestures are less often integrated with words. Autistic children are less likely to make requests or
share experiences, and are more likely to simply repeat others' words (echolalia) or reverse
pronouns. Joint attention seems to be necessary for functional speech, and deficits in joint attention
seem to distinguish infants with ASD: for example, they may look at a pointing hand instead of the
pointed-at object, and they consistently fail to point at objects in order to comment on or share an
experience. Autistic children may have difficulty with imaginative play and with developing symbols
into language.
n a pair of studies, high-functioning autistic children aged 815 performed equally well as, and adults
better than, individually matched controls at basic language tasks involving vocabulary and spelling.
Both autistic groups performed worse than controls at complex language tasks such as figurative
language, comprehension and inference. As people are often sized up initially from their basic
language skills, these studies suggest that people speaking to autistic individuals are more likely to
overestimate what their audience comprehends.

Repetitive behaviour
Autistic individuals display many forms of repetitive or restricted behaviour, which the Repetitive
Behaviour Scale-Revised (RBS-R) categorizes as follows.


A young boy with autism, and the precise line of toys he made
Stereotypy is repetitive movement, such as hand flapping, making sounds, head rolling, or body
rocking.
CompuIsive behaviour is intended and appears to follow rules, such as arranging objects in
stacks or lines.
Sameness is resistance to change; for example, insisting that the furniture not be moved or
refusing to be interrupted.
RituaIistic behaviour involves an unvarying pattern of daily activities, such as an unchanging
menu or a dressing ritual. This is closely associated with sameness and an independent
validation has suggested combining the two factors.
[35]

Restricted behaviour is limited in focus, interest, or activity, such as preoccupation with a single
television program, toy, or game.
SeIf-injury includes movements that injure or can injure the person, such as eye poking, skin
picking, hand biting, and head banging. A 2007 study reported that self-injury at some point
affected about 30% of children with ASD.
No single repetitive or self-injurious behaviour seems to be specific to autism, but only autism appears
to have an elevated pattern of occurrence and severity of these behaviours.

Other symptoms
Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the
individual or the family. An estimated 0.5% to 10% of individuals with ASD show unusual abilities,
ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of
prodigious autistic savants. Many individuals with ASD show superior skills in perception and
attention, relative to the general population. Sensory abnormalities are found in over 90% of those
with autism, and are considered core features by some, although there is no good evidence that
sensory symptoms differentiate autism from other developmental disorders. Differences are greater
for under-responsivity (for example, walking into things) than for over-responsivity (for example,
distress from loud noises) or for sensation seeking (for example, rhythmic movements). An estimated
60%80% of autistic people have motor signs that include poor muscle tone, poor motor planning,
and toe walking; deficits in motor coordination are pervasive across ASD and are greater in autism
proper.
Unusual eating behaviour occurs in about three-quarters of children with ASD, to the extent that it was
formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and
food refusal also occur; this does not appear to result in malnutrition. Although some children with
autism also have gastrointestinal (G) symptoms, there is a lack of published rigorous data to support
the theory that autistic children have more or different G symptoms than usual; studies report
conflicting results, and the relationship between G problems and ASD is unclear.
Parents of children with ASD have higher levels of stress. Siblings of children with ASD report greater
admiration of and less conflict with the affected sibling than siblings of unaffected children or those
with Down syndrome; siblings of individuals with ASD have greater risk of negative well-being and
poorer sibling relationships as adults.

Classification
Autism is one of the five pervasive developmental disorders (PDD), which are characterized by
widespread abnormalities of social interactions and communication, and severely restricted interests
and highly repetitive behaviour. These symptoms do not imply sickness, fragility, or emotional
disturbance.
Of the five PDD forms, Asperger syndrome is closest to autism in signs and likely causes; Rett
syndrome and childhood disintegrative disorder share several signs with autism, but may have
unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism) is diagnosed
when the criteria are not met for a more specific disorder. Unlike with autism, people with Asperger
syndrome have no substantial delay in language development. The terminology of autism can be
bewildering, with autism, Asperger syndrome and PDD-NOS often called the autism spectrum
disorders (ASD) or sometimes the autistic disorders, whereas autism itself is often called autistic
disorder, childhood autism, or infantile autism. n this article, autism refers to the classic autistic
disorder; in clinical practice, though, autism, ASD, and PDD are often used interchangeably. ASD, in
turn, is a subset of the broader autism phenotype, which describes individuals who may not have ASD
but do have autistic-like traits, such as avoiding eye contact.
Some studies have reported diagnoses of autism in children due to a loss of language or social skills,
as opposed to a failure to make progress, typically from 15 to 30 months of age. The validity of this
distinction remains controversial; it is possible that regressive autism is a specific subtype, or that
there is a continuum of behaviors between autism with and without regression.


Causes
t has long been presumed that there is a common cause at the genetic, cognitive, and neural levels
for autism's characteristic triad of symptoms. However, there is increasing suspicion that autism is
instead a complex disorder whose core aspects have distinct causes that often co-occur.


Deletion (1), duplication (2) and inversion (3) are all chromosome abnormalities that have been implicated in autism.
[62]

Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear
whether ASD is explained more by rare mutations with major effects, or by rare multigene interactions
of common genetic variants. The large number of autistic individuals with unaffected family members
may result from copy number variationsspontaneous deletions or duplications in genetic material
during melosls. Hence, a substantial fraction of autism cases may be traceable to genetic causes that
are highly heritable but not inherited: that is, the mutation that causes the autism is not present in the
parental genome.
Although evidence for other environmental causes is anecdotal and has not been confirmed by
reliable studies, extensive searches are underway. LnvlronmenLal that have been claimed to
contribute to or exacerbate autism, or may be important in future research, include certain
foods, infectious disease, heavy metals, solvents, diesel exhaust, PCBs, phthalates and phenols used
in plasLlc products, pesticides, brominates flame retardants, alcohol, smoking, illicit
drugs, vaccines, and prenatal stress, although no links have been found, and some have been
completely dis-proven.
Parents may first become aware of autistic symptoms in their child around the time of a routine
vaccination. This has led to theories blaming vaccine "overload", a vaccine preservative or the MMR
vaccine for causing autism. The latter theory was supported by litigation-funded study that has since
been shown to have been "an elaborate fraud". Although these theories lack convincing scientific
evidence and are biologically implausible, parental concern about a potential vaccine link with autism
has led to lower rates of childhood immunizations, outbreaks of previously-controlled childhood
diseases in some countries, and the preventable deaths of several children.



Autism Treatment
A paediatrician will refer the caregiver and the child to a specialist in developmental disorders for the
assessment. Some people may want to have this specialist treat their child's condition, but they are
free to seek treatment elsewhere.
O There is no standard treatment for autism, and different professionals have different philosophies
and practices in caring for their patients.
O You may want to talk to more than one specialist to find the one with whom you feel most
comfortable.
O Ask family members, friends, and the health care practitioner to obtain referrals. Call autism
groups or check the nternet for referral services.
When seeking a specialist to treat a child's autism, the opportunity should be available to ask
questions and discuss the treatments available to the child. Be aware of all the options so that an
informed decision can be made.
O A reputable specialist will present each type of treatment, provide the pros and cons, and make
recommendations based on published treatment guidelines and his or her own experience.
O The decision of which treatment to pursue is made with this specialist (with input from other
members of the professional care team) and family members, but the decision is ultimately the
caregivers'.
O Be certain to understand exactly what will be done and why, and what can be expected from the
choices.
There is no cure for autism, nor is there a standard therapy that works for all people with autism. A
number of different treatment approaches have evolved over time as we have learned more about
autism.
O Different approaches work for different people. Accepted interventions may work for some and not
for others.
O Different professionals, each with excellent credentials and experience, may disagree about what
is the best approach for the child.
O As a parent or caregiver, one will learn to weigh each treatment recommendation in light of what
he or she knows about their child and what makes sense for him or her.
Whatever approach is used for the child, an individualized treatment plan designed to meet his or her
unique needs is essential.
O Most people with autism show developmental progress and respond to a combination of treatment
and education.
O The traditional approach for a child with autism includes special education and behavioural
management. There is some evidence that the earlier behavioural, educational, speech, and
occupational therapy is begun, the better the long-term outcome. This is often an intensive and
long-term commitment, and there is no easy answer. Behavioral treatments, medications, and
other treatments may help manage some of the problems associated with autism.
Treatment strategies used in autism include behavioral, educational, biomedical, and complementary
therapies. Some of these are supported by scientific studies, while others are not. t is important to
discuss and consider the research support for the treatments chosen.

oIIow-up
Once treatment begins, the multidisciplinary team will recommend regular assessments to check your
child's progress. These should be built into the treatment plan.
The best thing you can do to help your child is to work with the professional team. Be informed of the
issues surrounding your child's treatment and outlook. Be sure you are clear about the goals of
therapy and how they are to be achieved. Be organized and cooperative in supplying all information
required by the team. Communicate your questions and reservations about the treatment plan so they
can be addressed.

OutIook
Although, to different degrees of severity, the core features of autism are life-long, predicting the
course for an individual with autism is very difficult. Many different variables enter into each person's
experience with autism, including the symptoms and associated behaviors and their severity, the
family environment, and the types of interventions used. An individual's Q (particularly verbal Q) is
often a predictor of future functioning, with increasing Q and communication skills associated with an
increased ability to live independently. Some people with autism are able to develop their
communication and social skills to a degree that allows them a fair degree of independence. Others
can learn some skills but still require ongoing support from their family and others throughout their
lives.

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