Autism Awareness Month 2011

Here are some of the basics...
Not babbling by 12 months, not pointing, repetitive behaviors, headbanging, spinning, narrow range of interests of unusual intensity, frequent tantrums, poor social skills, impaired communication,does not respond to name (appears deaf at times), poor eye contact, lack of pretend play, pre-occupation with parts of objects (the wheels on the car as opposed to the car itself).

From the DSM IV (the criteria currently used)

"(I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)
(A) qualitative impairment in social interaction, as manifested by at least two of the following:
1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )
(B) qualitative impairments in communication as manifested by at least one of the following:
1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:
1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects
(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play
(III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder"

Reference:
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Read more: http://wiki.answers.com/Q/How_do_you_cite_the_DSM-IV#ixzz1I95fxGO5Here are the proposed revisions for the DSM V (Although DSM-5 will not be published until 2013)
"299.00
Autistic Disorder
Proposed Revision
Rationale
Severity
DSM-IV
Revised January 26, 2011
Autism Spectrum Disorder
Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:
1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.
3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people
B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).
2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).
3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).
C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)
D. Symptoms together limit and impair everyday functioning."

Reference:American Psychiatric Association. (proposed 2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author.

Image by OCAL

If you want to help the research efforts, I strongly encourage you to fully understand the organization you give to. Some, although they have good intentions may not be the right choice for you. I do not endorse any of the organizations, I nearly did, but the more I learned about them, the less I wanted to associate with them. Again, they have noble intentions, but many have been so passionate, that they have lost sight of the most important factors. You must also be cautious as they tend to mis-represent what people with ASD are truly like. Some still back outdated or flawed science, and many still push the old stereotypes.

Donating to Autism research is wonderful, absolutely, just be sure that you fully understand the agenda of the organization.

What else can you do?

If you know someone with ASD, make a conscious effort to include them in something! If the kid on your street with ASD in constantly excluded and standing alone making "robot moves", see if they will let you play robot too for a few minutes! Just something little to let them know that they are NOT insignificant!

If you see someone with ASD being bullied, say something.


Autism Awareness card by Sidther
More Autism Business Cards

The media and charities have been very focused on kids with ASD. They often forget to talk about adults with ASD. Kids grow up. Sometimes the symptoms improve - sometimes because of therapies, medications, some specific Autism Spectrum Disorders (Sotos etc) typically involve some improvement in symptoms during adolescence. Sometimes they get worse. Where do these kids go? Some are able to go to college, some are not. It is not uncommon for those with high functioning ASD to go to college, but be unable to live alone because of the social impairments, self care and being unable to identify danger.

Those with more profound ASD may end up in specialized homes, or if the family is able to provide for their needs at home, they may just stay. Some programs offer minimal assistance- a safe community where they check in on the person, kind of like a dorm where you must sign in and out etc while other programs offer round the clock care. The amount of care provided depends upon the needs of the individual.

Sometimes, adults with ASD are able to live on their own! They may work at a regular job. Often people with high functioning ASD or Aspergers prefer jobs like engineering, science, math, or computers. You will rarely find a person with Aspergers or HF ASD bartending or in sales positions- there are just too much interpersonal skill required.

The financial costs of providing for ASD for life are astronomical, yet they can be manageable. If your child is diagnosed with ASD, I strongly recommend seeking the advice of a financial planner who specializes in disability... there are ways to ensure that the savings you set up for your child do not affect their SSI qualification in the future, certain types of trusts and college savings accounts should be created- even if you can only afford enough to open it, it is important to establish something early. Also be sure that your will is arranged in a way that will allow them to receive any assistance they may need when they are adults (sometimes an inheritance can disqualify them, so please get help to set it up).

Most people just can't understand Sensory problems. Often, a person with ASD is also diagnosed with Sensory Integration Dysfunction (the exact name varies a little by country). The exact science is not helpful for most people, so.....

Try picking up a VERY light pencil and write your name with it. Now, try a heavy pen. Which looks better? Usually heavy pen.... This is a very basic demonstration of proprioception and how something so simple affects it. You were able to sense where your hand was better in relation to your body, therefore you controlled it better. With the light pencil, your hand can "drift or float" off of the page. People with poor proprioception experience this in a far more intense way. Imagine now if you multiplied that difference you felt by 100, or even 1000. A child with ASD may whack their hand walking through a doorway (often) because they do not sense how far their hand is from their body. They may appear to flail about and have illegible writing. Imagine how disconcerting it would be to feel this throughout your entire body at all times. This is why so many kids with sensory problems love weighted vests, blankets, belts etc. Some will "self medicate" by filling their backpacks with rocks or un-necessary books.

Vestibular Stimulation- Spinning!!!!! (swinging also) When you were a kid, did you like to spin? Do you remember that feeling? If you try to imagine how you felt before, after , during spinning and that one tiny moment that you felt perfect- the tiny moment is very intense for people with ASD, and the cravings for it are very strong. That perfect moment is so hard to describe, but it becomes an obsession.

Oral aversions: More than a "Picky Eater" Look at a piece of raw chicken liver. Would that feel good in your mouth? What can you think of that you just could not bear the feeling of in your mouth? So often, people who don't understand real oral aversion tell me "if he doesn't want it, that's fine, he will eat when he gets hungry enough". When you are dealing with a kid who has severe oral aversions, that philosophy just does not work. Cutie would prefer an IV to drinking liquid. I know this because we have tried that approach, it failed twice, both required medical intervention. He has asked me if he could just have an IV so he won't have to have food or drinks. It is not just the feeling in the mouth, it is also the feeling of swallowing. Imagine if you had heightened sensitivity to swallowing and you could feel the unpleasant food as it made it's way down your esophagus. Different textures, temperatures or shapes can affect the individual differently. For example, cutie will only eat dry carbs (voluntarily) while one of his best friends will only eat proteins like chicken (voluntarily).

Tactile: Textures produce different feelings. Many people cringe and get goosebumps when they hear fingernails on a chalkboard. Do you feel it? That kind of involuntary reaction (only more intense) is what a person with sensory problems experiences when touching certain textures. Even though every one has different triggers, here are a few examples: Denim, Canvas, Unfinished wood, clothing tags, the sound of a car horn, carpet, scraping metal or clanking, glue, egyptian cotton, polyester etc. The person may avoid touching the offending objects or cover their ears and scream if it is a sound. Some kids will become violent if you force them to wear offensive fabrics. Some kids will refuse shoes, some won't take them off. Some kids feel the need to always have their arms covered, even when it is too warm to reduce sensory disturbances.

Touching a person with Sensory problems: Sometimes, a light touch can actually feel like a wire brush, try to figure out their sensory needs. Many people with sensory problems prefer a firm touch (hand placed firmly on back or shoulder as opposed to light fingertip brush on the arm). If they don't like it at all.... don't do it unless you have a good reason (therapist, doctor, parent etc)!