Autism

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Autism is considered a neurodevelopmental disorder that manifests itself in marked problems with social relatedness, communication, interest, and behavior. The field of psychiatry has classified it in the DSM as one of the five types of pervasive developmental disorders (or autism spectrum disorders). The etiology and physiological basis for autism are unknown, and the psychiatric criteria for the diagnosis are based on behavioral attributes rather than clinical tests. Neurologists may or may not apply the DSM criteria but will more typically apply neurological criteria in determining a diagnosis of autism. Several now speculate that autism is in fact several distinct conditions that manifest themselves in similar ways rather than a single diagnosis.

Typically, autism spectrum disorders appear during the first three years of life. There are strong indications that the incidence is growing, and it is now estimated that it occurs in as many as 1 in 150 individuals, and is 4 times more prevalent in males than females. See autism epidemic for more information about the epidemiology of the condition.

There are reports that children have recovered from autism to the point that they can fully participate in "mainstream" education and social events, but there are lingering concerns that an absolute cure from autism is impossible since it involves aspects of neurological brain structure determined very early in development.

Some autistic people (and non-autistic allies) in the "autism rights movement" reject the premise that autism is a disorder that requires treatment or should be resolved through a cure. They see autism as a way of being, and reject attempts to cure or treat autism as morally and ethically equivalent to "curing" individuals based on personality differences.

Given the extent of uncertainty about the cause, progression, treatment, and prognosis of autism, virtually every aspect of the topic is subject to controversy. See also Controversies in autism.

Contents

1 History

2 Symptoms

2.1 Social development
2.2 Imaginary friends
2.3 Sensory Integration Dysfunction
2.4 Communication difficulties
2.5 Repetitive behaviors

3 Severity of symptoms

3.1 "Low-" and "high-functioning"

4 Asperger's and Kanner's syndrome

5 Autism as a spectrum disorder

6 Rare autism spectrum disorders

6.1 Rett syndrome
6.2 Childhood disintegrative disorder

7 Increase in diagnoses of autism

8 Remediation of autistic behaviors

8.1 Applied Behavior Analysis
8.2 Relationship Development Intervention
8.3 Son-Rise
8.4 Autism and computing
8.5 Gluten free casein free diet

9 Theories of the etiology of autism

9.1 Brain testosterone theory
9.2 Vaccine theory
9.3 Brain trauma
9.4 Viruses or bacterial infection

10 Proposed models of autism

10.1 The extreme male brain theory
10.2 The Preoperational-Autism Theory
10.3 Monotropism
10.4 Underconnectivity Theory
10.5 Mindblindness theory
10.6 Other Theories

11 Adults with an autism spectrum disorder

11.1 Biographies of autistic adults

12 Autistic savants

13 Aspies for freedom

14 Major autism events

15 See also

16 References

History

Hans Asperger

The classification of autism did not occur until the middle of the twentieth century, when in 1943, Dr. Leo Kanner of the Johns Hopkins Hospital studied a group of 11 children and introduced the label early infantile autism. At the same time a German scientist, Dr. Hans Asperger, described a different form of autism that became known as Asperger's syndrome — but the widespread recognition of Asperger's work was delayed by World War II in Germany.

Thus these two conditions were described and are today listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (fourth edition, text revision 1) as two of the five pervasive developmental disorders (PDD), more often referred to today as autism spectrum disorders (ASD). All these conditions are characterized by varying degrees of difference in communication skills, social interactions, and restricted, repetitive and stereotyped patterns of behavior.

Leo Kanner

Symptoms

DSM-IV criteria for autism are based on the absence or delay of certain developmental milestones. There is great diversity in the skills and behaviors of individuals diagnosed as autistic, and physicians will often arrive at different conclusions about the appropriate diagnosis.

Nevertheless, professionals within pediatric care and development often look for early indicators of autism in order to initiate treatment as early as possible. Some of these indicators include:

Does not babble, point, or make meaningful gestures by 1 year of age
Does not have "joint regard," in other words the ability attend to something at the request of someone else
Does not speak single words by 16 months
Does not combine two words by 2 years
Does not respond to name

Other indicators:

Lacks or avoids eye contact
Does not play with toys functionally
Excessively lines up toys or other objects, or may engage in other obsessive/compulsive behaviors
Is attached to one particular toy or object
Does not smile (socially, but may smile during periods of self-stimulatory behavior)
Engages in perseverative and/or self-stimulatory behaviors
Has tactile defensiveness

Social development

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most autistic children prefer objects to faces and seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and will avoid eye contact, seeming indifferent to other people.

Autistic children often appear to prefer being alone rather than in the company of others, may resist attention or passively accept such things as hugs and cuddling without caring. Later, they seldom seek comfort or respond to parents' displays of anger or affection in a typical way. Research has suggested that although autistic children are attached to their parents, their expression of this attachment is unusual and difficult to interpret. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.

Autistic children categorically lack 'theory of mind', meaning that they are incapable of behavior cited as exclusive to higher primates such as adult gorillas, adult chimpanzees, adult bonobos and children above the age of five. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people on the autism spectrum have difficulty seeing things from another person's perspective. Typical 5-year-olds understand that other people have different knowledge, feelings, and intentions. An autistic person lacks this understanding, an inability that leaves them unable to predict or understand other people's actions.

Although not universal, it is common for autistic people to have difficulty regulating their behavior. This can take the form of "immature" behavior such as crying in class or verbal outbursts that seem inappropriate to those around them. The autistic individual might also be disruptive and physically aggressive at times, making social relationships still more difficult. They have a tendency to "lose control," particularly when they are in a strange or overwhelming environment, or when angry and frustrated. They may at times break things, attack others, or hurt themselves. In their frustration, some bang their heads, pull their hair, bite their arms, or even cut themselves.

Imaginary friends

The social alienation of autistic and Asperger's people is so intense from childhood that many of them have imaginary friends as companionship. However, having an imaginary friend is not necessarily a sign of autism and may be common in neurotypicals.

Sensory Integration Dysfunction

A key indicator in clinicians making a proper assessment for autism would include looking for Sensory integration disorder. Children will exhibit problems coping with the normal sensory input.

Symptoms may include:

Over sensitivity to touch, movement, sights, or sounds
Under reactivity to touch, movement, sights, or sounds
Specific learning difficulties/delays in academic achievement
Inability to unwind or calm self
Difficulty in making transitions from one situation to another
Tendency to be easily distracted/Limited attention control
Physical clumsiness or apparent carelessness
Activity level that is unusually high or unusually low
Social and/or emotional problems
Poor self concept/body awareness
Difficulty learning new movements
Delays in speech, language, or motor skills
Impulsive, lacking in self-control

Communication difficulties

By age 3, typical children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he or she hears his or her name, points when he or she wants a toy, and when offered something distasteful, makes it clear that the answer is "no."

Speech development in autism takes a different developmental path than in neurotypical children. Some autistics remain mute throughout their lives, while being fully literate and able to communicate in other ways — images, sign language, and typing are far more natural to them. Some infants who later show signs of autism coo and babble during the first few months of life, but stop soon afterwards. Others may be delayed, developing language as late as the teenage years. Still, inability to speak does not mean that autistics are unintelligent or unaware. Once given appropriate accommodations, many will happily "talk" for hours, and can often be found in autism-focused chat rooms, discussion boards, or websites, or even using communication devices at autism-community social events such as Autreat.

Those who do speak often use language in unusual ways, retaining features of earlier stages of language development for long periods or throughout their lives. Some speak only single words, while others repeat the same phrase over and over. However, 10% of autistic people are naturally bilingual, meaning they've learned a foreign language before learning their local language in their toddler years, the cause of this is completely unknown, but it may be a possible reason why autistic people use language differently than others. Some repeat what they hear, a condition called echolalia. Sing-song repetitions in particular are a calming, joyous activity that many autistic adults engage in. Many autistics have a strong tonal sense, and can often understand spoken language better if it is sung to them.

Some children may exhibit only slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining typical conversations. The "give and take" of conversation is hard for them, although they often carry on a monologue on a favorite subject, giving no one else an opportunity to comment. When given the chance to interact with other autistics, they comfortably do so in "parallel monologue" — taking turns expressing views and information. Just as neurotypicals are not designed to understand autistic body languages, vocal tones, or phraseology, autistics similarly have trouble with such things in neurotypicals. In particular, autistic language abilities tend to be highly literal; neurotypicals often inappropriately attribute hidden "meaning" to what autistics say or expect the autistic to sense such unstated meaning in their own words.

The body language of autistics can be difficult for neurotypicals to understand. Facial expressions, movements, and gestures may be easily understood by some other autistics, but do not match those used by neurotypicals. Also, their tone of voice has a much more subtle inflection in reflecting their feelings, and the neurotypical auditory system often cannot sense the fluctuations. What seems to NTs like a high-pitched, sing-song, or flat, robot-like voice is common. Some children with relatively good language skills speak like little adults, rather than utilizing the immature "kid-speak" that is common in their neurotypical peers.

Since neurotypicals are often unfamiliar with the autistic body language, and since autistic natural language may not tend towards speech, autistic people often struggle to let others know what they need. As anybody might do in such a situation, they may scream in frustration or resort to grabbing what they want. While waiting for neurotypicals to learn to communicate with them, autistics do whatever they can to get through to them. Communication difficulties may contribute to autistic people becoming anxious or depressed.

Repetitive behaviors

Although autistics usually appear physically normal and have good muscle control, unusual repetitive motions, known as self-stimulation or "stimming," may set them apart. These behaviors might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or wiggling their toes, others suddenly freeze in position.

As children, they might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of these toys, the child may be tremendously upset. Autistic children often need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, or going to school at a certain time and by the same route—can be extremely disturbing.

Repetitive behavior sometimes takes the form of a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Often they show great interest in numbers, symbols, or science topics.

Severity of symptoms

Autism presents in a wide degree, from those who are nearly dysfunctional and apparently mentally retarded to those whose symptoms are mild or remedied enough to appear unexceptional ('normal') to the general public. These autistic persons are often classified as "nerds" or "geeks" by their peers.

"Low-" and "high-functioning"

In terms of both classification and therapy, autistic individuals are often divided into those with an IQ<80 referred to as having "low-functioning autism" (LFA), while those with IQ>80 are referred to as having "high functioning autism" (HFA). Low and high functioning are more generally applied to how well an individual can accomplish activities of daily living, rather than to IQ. The terms low- and high-functioning are controversial and not all autistics accept these labels.

This discrepancy can lead to confusion among service providers who equate IQ with functioning and may refuse to serve high-IQ autistic people who are severely compromised in their ability to perform daily living tasks, or may fail to recognize the intellectual potential of many autistic people who are considered LFA. For example, some professionals refuse to recognize autistics who can speak or write as being autistic at all, because they still think of autism as a communication disorder so severe that no speech or writing is possible.

As a consequence, "high-functioning" autistic persons, and autistic people with a relatively high IQ, are under-diagnosed, thus making the claim that "autism implies retardation" self-fulfilling. The number of people diagnosed with LFA is not rising quite as sharply as HFA, indicating that at least part of the explanation for the apparent rise is probably better diagnostics.

Asperger's and Kanner's syndrome

In the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the most significant difference between Autistic Disorder (Kanner's) and Asperger's syndrome is that a diagnosis of the former includes the observation of "[d]elays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play[,]" [1] (http://www.behavenet.com/capsules/disorders/autistic.htm) while in these areas a diagnosis of Asperger's observes "no clinically significant delay." [2] (http://www.behavenet.com/capsules/disorders/asperger.htm)

The DSM makes no mention of level of intellectual functioning, but the fact that Asperger's autistics as a group tend to perform better than those with Kanner's autism has produced a popular conception that Asperger's syndrome is synonymous with "higher functioning autism," or that it is a lesser disorder than autism. There is also a popular but not necessarily true conception that all autistic individuals with a high level of intellectual functioning have Asperger's autism or that both types are merely geeks with a medical label attached.

Autism has evolved in the public understanding, but the popular identification of autism with relatively severe cases as accurately presented in Rain Man has encouraged relatives of family members diagnosed in the autistic spectrum to speak of their loved ones as having Asperger's syndrome rather than autism.

As of 2003, psychiatric professionals have been considering redefining Asperger's autism and renaming it as Crypto Sensitivity Syndrome.

Autism as a spectrum disorder

Another view of these disorders is that they are on a continuum known as autistic spectrum disorders. Another related continuum is Sensory Integration Dysfunction, which is about how well we integrate the information we receive from our senses. Autism, Asperger's syndrome, and Sensory Integration Dysfunction are all closely related and overlap.

Some high-achieving individuals are thought to have had some form of autism. However, this may be a favoured diagnosis due to the high current visibility of autism in the popular press.

There are two main manifestations of classical autism, regressive autism and early infantile autism. Early infantile autism is present at birth while regressive autism begins at approximately 18 months. There are also cases of children developing normally from birth but regressing around the age of 18 months, causing some degree of controversy as to when the neurological difference involved in autism truly began.

Rare autism spectrum disorders

Rett syndrome

Rett syndrome is relatively rare, affecting almost exclusively females, one out of 10,000 to 15,000. After a period of normal development, sometime between 6 and 18 months, autism-like symptoms begin to appear. The little girl's mental and social development regresses; she no longer responds to her parents and pulls away from any social contact. If she has been talking, she stops; she cannot control her feet; she wrings her hands. Some of the problems associated with Rett syndrome can be treated. Physical, occupational, and speech therapy can help with problems of coordination, movement, and speech.

Scientists sponsored by the National Institute of Child Health and Human Development have discovered that a mutation in the sequence of a single gene can cause Rett syndrome. This discovery may help doctors slow or stop the progress of the syndrome. It may also lead to methods of screening for Rett syndrome, thus enabling doctors to start treating these children much sooner, and improving the quality of life these children experience.

Childhood disintegrative disorder

Very few children who have an autism spectrum disorder diagnosis meet the criteria for childhood disintegrative disorder (CDD). An estimate based on four surveys of ASD found fewer than two children per 100,000 with ASD could be classified as having CDD. This suggests that CDD is a very rare form of ASD. It has a strong male preponderance.** Symptoms may appear by age 2, but the average age of onset is between 3 and 4 years. Until this time, the child has age-appropriate skills in communication and social relationships. The long period of normal development before regression helps differentiate CDD from Rett syndrome.

*Rett syndrome. NIH Publication No. 01-4960. Rockville, MD: National Institute of Child Health and Human Development, 2001. Available at [3] (http://www.nichd.nih.gov/publications/pubskey.cfm?from=autism)

**Frombonne E. Prevalence of childhood disintegrative disorder. Autism, 2002; 6 (2): 149-157.

***Volkmar RM and Rutter M. Childhood disintegrative disorder: Results of the DSM-IV autism field trial. Journal of the American Academy of Child and Adolescent Psychiatry, 1995; 34: 1092-1095.

Increase in diagnoses of autism

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The number of reported cases of autism has increased dramatically over the past decade.

There has been an explosion worldwide in reported cases of autism over the last ten years. In the last decade, the population of the United States has increased by 13%. There has been an increase in non-autism-related disabilities of 16%. The increase in autism diagnoses is 173%. The more recent autism epidemic throughout the population has brought rise to different theories as to the nature of a sudden increase. The increase in autism diagnoses is reminiscent of increases in the diagnosis of schizophrenia and multiple personality disorder in the twentieth century.

Epidemiologists argue that the rise in diagnoses in the United States is either partly or entirely attributable to changes in diagnostic criteria, reclassifications, public awareness, and the incentive to receive federally mandated services.

A widely cited study from the M.I.N.D. Institute in California (Oct 17, 2002), claimed that the increase in autism is real, even after those complicating factors are accounted for (see reference in this section below).

Other researchers remain unconvinced (see references below), including Dr. Chris Johnson, a professor of pediatrics at the University of Texas Health Sciences Center at San Antonio and co-chair of the American Academy of Pediatrics Autism Expert Panel, who says "There is a chance we're seeing a true rise, but right now I don't think anybody can answer that question for sure." (Newsweek reference below).

The answer to this question has significant ramifications on the direction of research, since a real increase would focus more attention (and research funding) on the search for environmental factors, while a consensus for little or no real increase would direct more attention to genetics. On the other hand, it is conceivable that certain environmental factors (vaccination, diet, societal changes) may have a particular impact on people with a specific genetic constitution.

There is little public research on the effects of in-vitro fertilization on the number of incidences of autism.

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In 2001, Wired Magazine published an article entitled The Geek Syndrome (http://www.wired.com/wired/archive/9.12/aspergers_pr.html) exploring the surge in apparent autism in Silicon Valley.

Remediation of autistic behaviors

Remediation of the debilitating aspects of autism is hindered by widespread disagreement over its nature and causes, and by a lack of recognized and effective therapies.

The behavioral and cognitive functioning of individuals with autism can improve with the help of psychosocial and pharmacological interventions. Among psychosocial treatments, intensive, sustained special education programs and behavior therapy early in life can increase the ability of children with autism to acquire language and the ability to learn. In adults with autism, some studies have found beneficial effects of the antidepressant medications clomipramine and fluoxetine. There is also evidence that the antipsychotic medication haloperidol can be helpful; however, the risk of serious side effects is significant in children.

Dr. Bruno Bettelheim believed that autism was linked to trauma in early childhood, and his work was highly influential for decades. Parents, and especially mothers, of autistics were blamed for having caused their child's condition through the withholding of affection. Leo Kanner, who first described autism (Autistic disturbances of affective contact, 1943) originated the "refrigerator mother" hypothesis, which held that autism was at least partly caused by a lack of affection from the autistic child's mother. Although Kanner eventually renounced the concept and apologized publicly, Bettelheim took the theory further. These theories did nothing to address the fact that having more than one autistic child in a family is exceptional, not the rule. Treatments based on these theories failed to help autistic children.

Applied Behavior Analysis

A major breakthrough in the remediation of autistic behaviors came through work spearheaded by Ole Ivar Lovaas, who believed that success could be obtained by behavioral approaches.

Lovaas' approaches—often referred to as Discrete Trial, Intensive Behavior Intervention, and Applied Behavior Analysis—are some of the best known and most widely used in the field and focus on the development of attention, imitation, receptive or expressive language, and pre-academic and self-help skills. Using a one-to-one therapist-child ratio and the “antecedent-behavior-consequence” (ABC) model, interventions based on this work involve trials or tasks. Each consists of (a) an antecedent, which is a directive or request for the child to perform an action; (b) a behavior, or response from the child, which may be categorized as successful performance, noncompliance, or no response; and (c) a consequence, defined as the reaction from the therapist, which ranges from strong positive reinforcement to a strong negative response, “No!”(Autism Society of America, 2001).[4] (http://www.aann.org/ce/jnn04-02b.htm)

Lovaas' Applied Behavioral Analysis (ABA) methods were the first scientifically validated therapy for autism. Early intervention, generally before school-age, seems to be critical to achieving optimal outcomes.

ABA techniques based on B. F. Skinner's Verbal Behavior have succeeded in helping non-verbal children start to talk, typically going from zero words to several dozen. By allowing children to express their needs, even rudimentary speech can alleviate frustration and tantrums.

The scientific validity of Lovaas's methods is questioned by many professionals as well as parents and autistics themselves, however, who point out that early ABA was based around the use of aversives which could be experienced by an autistic person as confusing and painful [5] (http://www.sentex.net/~nexus23/naa_aba.html). Nevertheless, some believe that ethical reasons exist for applying Lovaas's techniques. Most contemporary behaviorist programs for autistics employ no aversives at all, and not all attempt to "extinguish" behaviors such as rocking or spinning that autistics use for calming purposes.

ABA may not be appropriate for every autistic or developmentally delayed child. ABA has come into widespread use only in the last decade and the demand is outstripping the supply of committed and experienced service providers. As a result, parents of children need to be extra vigilant in choosing appropriate treatments for their children and especially in choosing providers, who may be inexperienced, use questionable methods or even deceive parents that they are competent to run an ABA or any other program. Such problems have led to horror stories from some parents. [6] (http://users.1st.net/cibra/OpenLetter.htm) [7] (http://users.1st.net/cibra/warningindex.htm)

Relationship Development Intervention

Relationship Development Intervention (RDI) is a research-based treatment program developed by Dr. Steven E. Gutstein. Whereas ABA aims to teach social skills directly, RDI focuses on building the "dynamic intelligence" that underlies the acquisition of those social skills in neurotypical children. It also focuses on the building blocks of motivation by developing episodic memory (seen as impaired in autism) and filling it with the child's own personal stories of competence and mastery. RDI emphasizes declarative (as opposed to imperative) communication, and aims for an appropriate balance of verbal and non-verbal communication.

Dr. Gutstein claims that 70% of his patients improved their ADOS score within 18 months, which is unprecedented (it was previously thought that improvement on the ADOS was impossible), and that a similar proportion are able to enter school without a shadow teacher or other personal assistant.

Son-Rise

The Son-Rise program was developed by Barry Kaufman, who founded the Option Institute to promulgate his more general philosophy upon which the Son-Rise program is partially based, and to provide training in this treatment approach. It is a home-based program with emphasis on observing, accepting the child without judgement, and engaging the child in a non-coercive way. The Association for Science in Autism Treatment (ASAT)maintains (http://www.asatonline.org) a Description of the Son-Rise Program (http://www.asatonline.org/about_autism/autism_info13.html).

Son-Rise remains controversial, and makes a number of claims for itself that may be misleading. Parents who are considering committing their child and their money to this program should read this description of some of the more unrealistic aspects of Options (http://rsaffran.tripod.com/sonrise.html), written by an autistic individual. Options is considered a cult by some former members. (http://www.freedomofmind.com/resourcecenter/groups/o/option/oi_statements.htm)

Autism and computing

Computers can be an ideal environment for promoting communication, sociabilility, creativity, and playfulness for individuals even at the extreme of the autistic spectrum. This is the opinion of the non-profit group Autism and Computing. They argue that the central feature of autism is attention-tunneling, or monotropism. Computers would afford an easy way of joining attention tunnels with minimal mutual discomfort, circumventing some of the most disabling features of autistic spectrum disorders. The potential for computer use in treating autism would not just be educational but therapeutic. The group presents both theory and practice on its website Autism and Computing (http://www.autismandcomputing.org.uk/NAS/index.htm).

Gluten free casein free diet

Dr. Karl Ludwig Reichelt claims to have found peptides from casein and gluten that worsen the symptoms of autistic children. The peptides are casomorphines and gluten exorphines, which influence the brain. According to Dr. Reichelt, significant improvement has been seen in the symptoms of some of his patients with autism on a diet that omits these peptides. Some physicians see diet as a central part of the treatment, but in addition use many other treatments at the same time. Follow this link: http://www.autismwebsite.com/ari/dan/whatisdan.htm. No clinical trials or studies have been undertaken to confirm the reported benefits of restricted diets.

Theories of the etiology of autism

Brain testosterone theory

Simon Baron-Cohen proposes a model for autism based in his empathising-systemising (E-S) theory (http://www.guardian.co.uk/life/feature/story/0,13026,937913,00.html). His team at the Autism Research Centre in Cambridge, UK, measured testosterone levels in the amniotic fluid of mothers while pregnant. This is presumed to reflect levels in the babies themselves. The team found that the babies with higher fetal testosterone levels had a smaller vocabulary and made eye contact less often when they were a year old.

His group has looked at the original 58 children again, at age four. The researchers found that the children with higher testosterone in the womb are less developed socially, and the interests of boys are more restricted than girls. The results will be published in the Journal of Child Psychology and Psychiatry (2004).

Baron-Cohen theorizes that high fetal testosterone levels push brain development towards an improved ability to see patterns and analyse systems. Males supposedly tend to be better at these tasks than females. But the high levels are thought to inhibit the development of communication and empathy, which are allegedly typical female skills. (New Scientist, 24 May 2003). There is still no demonstrable evidence that testosterone levels affect brain development at all, let alone autism. Gender or bio-determinism is a fashionable explanation for many human behaviours, but has been challenged by other professionals (http://www.gender.org.uk/about/00_diffs.htm).

Vaccine theory

The Wakefield Study: Controversial research by Andrew Wakefield in the UK, published in The Lancet in February 1998 suggested a possible link between autism and the MMR vaccine. The original research has come under criticism, largely due to a conflict of interest on Wakefield's part [8] (http://briandeer.com/mmr-lancet.htm). In February 2004 The Lancet described the research as "entirely flawed", said that it should never have been published, and 12 of the original 14 authors of the paper retracted their claims. Critics with statistical skills have claimed that Wakefield's study contains many obvious flaws, including an inability to recognize bias in his sample. Controversy continues, with Wakefield continuing to defend his theory.

Contradictory evidence: Although the fact that the Wakefield study is flawed does not in itself prove that no autism-vaccine connection exists, further research suggests that the theory is most likely false. Several independent groups have conducted thorough investigations into the possible link, including the National Academy of Sciences, and concluded that the evidence does not support a link between the MMR vaccine and autism. Studies that offer contradictory evidence include:

--A study by Gillberg and Heijbel (1998) examined the prevalence of autism in children born in Sweden from 1975-1984. There was no difference in the prevalence of autism among children born before the introduction of the MMR vaccine in Sweden and those born after the vaccine was introduced.

--Madsen et al. (2002) conducted a study of all children born in Denmark from January 1991 through December 1998. There were a total of 537,303 children in the study; 440,655 of the children were vaccinated with MMR and 96,648 were not. The researchers did not find a higher risk of autism in the vaccinated than in the unvaccinated group of children.

Research in the US suggesting a similar link between autism and DPT vaccine. It isn't however the large majority of autism that would come from vaccines, unlike early claims from Wakefield.

Brain trauma

Susan Bryson has said that some autistics have evidence of trauma to the brain stem in early development, and that a small portion of the thalidomide victims have become autistic. The victims' limbs were normal unless thalidomide use continued later in the pregnancy. The brain stem anomaly's most striking feature is inability to focus attention away from a stimulus in a short time like neurotypicals, as demonstrated in a psychological test.

Neurology-skilled Aspies claim the inability to shift attention quickly interferes with the ability to read nonverbal language where fast attention shifts are needed (such as eye language), suggesting that being nonverbal is not a primary feature of autism. Strong and shiftless focus is however a benefit in some areas like science, programming, and advanced mathematics. This is supported by the monotropism hypothesis.

Dr. Bernard Rimland's influential research and his book Infantile Autism (1967) argued that autism was not caused by childhood trauma or abuse, but by damage to certain areas of the brain, particularly the reticular formation which associates present sensory input with memories of past experiences. Dr. Rimland is a foremost advocate of the theory that autism may be precipitated by mercury and heavy metal toxicity.[9] (http://www.curezone.com/art/read.asp?ID=79&db=2&C0=735) He also is prominent in increasingly common claims of successful treatment of autism in children—particularly regarding improvements in ability to comprehend the spoken word—with the gluten-free, casein-free diet and mercury chelation therapy.

Neurobiology-skilled Aspies have often claimed Dr. Bernard Rimland's methods alleviate the symptoms of heavy metal poisoning, but not autism. Curing heavy metal poisoning when it is present is a worthy goal (it helps with IQ and other learning difficulties as well as general health), but claiming a cure for autism is a misrepresentation. Heavy metal poisoning may be more common among autistics due to a severe metallothionein deficiency, but more evidence is needed to substantiate the idea that heavy metals cause autism. It is still being studied. The presence of heavy metals, particularly mercury, might make an autism diagnosis more likely, however.

Viruses or bacterial infection

A growing body of peer-reviewed studies published in mainstream journals has shown that many common diseases of unknown origin are in fact caused by the presence of slowly acting viruses. For example, cervical cancer is caused by the human papilloma wart virus; some cases of liver cancer are caused by hepatitis C or B; Schizophrenia may be caused by Borna virus. Paul W. Ewald, among others, argues that the available data on the origin of autism is consistent with it being caused by a virus or infection.

Plague Time, Paul Ewald (http://www.centurytel.net/tjs11/bug/ewald1.htm)

PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci) and PITAND (Paediatric Infection-triggered Autoimmune Neuropsychiatric Disorders) (http://www.webpediatrics.com/pandas.html)

Closer to Truth: PBS, with Paul Ewald (http://www.pbs.org/kcet/closertotruth/explore/show_05.html)

Proposed models of autism

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Autism_genome_screen.jpg

A genome screen of autism. Most chromosomes seem related to autism, in particular chromosomes 2, 7 and 15.

The causes and origins of autism and Asperger's syndrome are a source of continuing conjecture and debate. Amongst several competing theories are the underconnectivity theory (http://www.cmu.edu/PR/releases04/040727_autism.html) developed by cognitive scientists at Carnegie Mellon University and the University of Pittsburgh, the Neanderthal theory (http://www.rdos.net/eng/asperger.htm), the extreme male brain theory by Simon Baron Cohen, the lack of theory of mind, and the Preoperational-autism theory.

The extreme male brain theory

The extreme male brain theory of autism, proposed by Simon Baron-Cohen in accordance with his empathizing-systemizing theory, (http://www.guardian.co.uk/print/0,3858,4649492-111414,00.html) suggests that autistics have extreme forms of what he describes as the male brain: they're good (often very good) at systemising, and very bad at empathizing. The poetry composed by autistics who can communicate by writing (http://www.autistics.org/library/tito-can.html) would seem to challenge this idea, but the scientific jury is still out.

The Preoperational-Autism Theory

The Preoperational-Autism theory states that autistic people are those who get neurologically stuck at the pre-operational stage of cognitive development, where much of information processing is at a wholistic-visual level and largely musical and non-verbal. This also addresses the issue of the theory of mind where children at the pre-operational stage of cognitive development have not attained decentralization from egocentrism.

Monotropism

The monotropism hypothesis argues that the central feature of autism is attention-tunneling, or monotropism. The hypothesis is founded on the model Mind as a Dynamical System: Implications for Autism (http://www.autismandcomputing.org.uk/mind.htm). In this model of mind, the fundamental and limited resource is mental attention. Mental events compete for and consume attention. In a polytropic mind, many interests are aroused to a moderate degree. In a monotropic mind, few interests are very highly aroused. When many interests are aroused, multiple complex behaviours emerge. When few interests are aroused, a few intensely motivated behaviours are engendered. From monotropism hypothesis, autism results from different strategies of distributing attention in the brain.

Underconnectivity Theory

The underconnectivity theory indicates a deficiency in the coordination among brain areas (the brain is known to be modular). With the aid of (fMRI), it was seen that white matter, which connects various areas of the brain like cables, has abnormalities in people with autism.

The underconnectivity theory holds that autism is a system-wide brain disorder that limits the coordination and integration among brain areas. This theory is parsimonious, in that it explains why autistic people are matured on certain dimensions eg: visual information processing and logical analysis, and yet are socially and sometimes neuro-physiologically, significantly younger than their chronological age. The underconnectivity theory can be regarded as monotropism in the brain.

Mindblindness theory

The analysis of autism as "mind blindness"—the inability to create models of other people's thoughts. The typical example of this is "where does X look for the object they stored, but which was moved by Y"—see theory of mind. Not all autistics fit this pattern, however.

Other Theories

Other theories address the rise of autism in recent times. They suggests the rise of visual media and thereby the increasing central role of visual information processing in the breakdown of language and the rise of autism.

Adults with an autism spectrum disorder

Some autistic adults, especially those with high-functioning autism or with Asperger's syndrome, are able to work successfully in mainstream jobs (though many are unemployed). Nevertheless, communication and social problems often cause difficulties in many areas of life.

Many other autistics are capable of employment in sheltered workshops under the supervision of managers trained in working with persons with disabilities. A nurturing environment at home, at school, and later in job training and at work, helps autistic people continue to learn and to develop throughout their lives.

In the United States, the public schools' responsibility for providing services ends when the autistic person is in their 20s, depending on each state. The family is then faced with the challenge of finding living arrangements and employment to match the particular needs of their adult child, as well as the programs and facilities that can provide support services to achieve these goals.

Biographies of autistic adults

Both Oliver Sacks and Torey Hayden have written about their autistic patients or pupils, respectively. Temple Grandin has also written about her own life as a person with autism. Donna Williams in her books, including Autism: an inside-out approach (ISBN 1-85302-387-6), gives an interesting perspective on the experience of a person with autism and the degree to which recovery is possible. Many other people who have autism have written books on the condition (and on other topics).

Autistic savants

The autistic savant phenomenon is sometimes seen in autistic people. The term is used to describe a person who is autistic who has extreme talent in a certain area of study. Although there is a common association between savants and autism (an association created by the 1988 film "Rain Man"), most autistic people are not savants. Calendar calculators and fast programming skills are the most common form. Some famous examples are Daniel Tammet, the subject of the documentary film The Brain Man [10] (http://www.guardian.co.uk/weekend/story/0,3605,1409903,00.html) and Kim Peek, the inspiration for Dustin Hoffman's character in the film Rain Man. It is estimated that 10% of autists are savants, compared to 1/2% of other people.

Aspies for freedom

In August 2004, a Wiki was started at Aspiesforfreedom (http://www.aspiesforfreedom.com/wiki/index.php/Main_Page) (or AFF). Its aim is to be an Autism Encyclopedia, and indeed some content has been copied from Wikipedia. One of the core differences, however, is that all articles are written from an autistic advocacy point of view. Another difference is the room for personal experiences. Aspies For Freedom uses the same Mediawiki software as Wikipedia.

See AFF's article on Autism (http://www.aspiesforfreedom.com/wiki/index.php/Autism).

Major autism events

2002 was declared Autism Awareness Year in the United Kingdom - this idea was initiated by Ivan and Charika Corea, parents of an autistic child, Charin. Autism Awareness Year was led by the British Institute of Brain Injured Children, Disabilities Trust, National Autistic Society, Autism London and 800 organizations in the United Kingdom. It had the personal backing of the British Prime Minister Tony Blair and parliamentarians of all parties in the Palace of Westminster.

Autistic Pride Day, an initiative from Aspies For Freedom, is on 18 June each year, starting in 2005. It is to celebrate the positive side of being autistic and having Asperger's, to raise awareness of issues relating to autism, and to seek acceptance for differences, with an aim to bring an end to discrimination. It is hoped that events will be held worldwide, such as parades, marches, and parties. The theme for 2005 is "Acceptance not cure", the main event is a parade in Seattle, Washington,USA.

References

Donna Williams. Autism: an inside-out approach, ISBN 1853023876 (gives an interesting perspective on her own experiences as a person with autism)
Unraveling the Mystery of Autism and Pervasive Developmental Disorder: A Mother's Story of Research and Recovery, by Karyn Seroussi. Published by Simon & Schuster, ISBN 0684831643 (Apparent cure through early diagnosis, dairy and gluten restriction and education)
A Boy Beyond Reach, Cheri Florance, Simon & Schuster, 2003, ISBN 0743221079 (Another apparent cure through a person-centred approach)
The ADHD-Autism Connection: A Step toward more accurate diagnosis and effective treatment, by Diane M. Kennedy, ISBN 1578564980 (The aim of this book is to explore the similarities that attention deficit hyperactivity disorder (ADHD) shares with a spectrum of disorders currently known as pervasive developmental disorders.)
Shadow Syndromes: The Mild Forms of Major Mental Disorders That Sabotage Us, by John J. Ratey and Catherine Johnson, ISBN 0553379593. Note the chapter "Autistic Echos" about subclinical autism, autistic traits, and various case studies of people with different degrees of autism.
Understanding and Working with the Spectrum of Autism - An Insider's View by Wendy Lawson, ISBN 1853029718. Wendy Lawson is diagnosed with autism and is currently working for her PhD on Autism and Stress.
Thinking in Pictures: And Other Reports from My Life With Autism, by Temple Grandin, ISBN 0679772898. Grandin (http://www.grandin.com/) is diagnosed with autism and holds a PhD in animal science.
Genius May be an Abnormality: Educating Students with Asperger’s Syndrome or High Functioning Autism, Temple Grandin (http://www.grandin.com/), http://trainland.tripod.com/temple.htm
Autism: Explaining the Enigma, by Uta Frith, Blackwell Publishers, ISBN 0631168249 de:Autismus

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