The latest statistics are staggering. 1 in 150 children is diagnosed with autism. If you’re a boy, the odds are even greater at 1:99. As a pediatric speech-language pathologist, I work with families everyday whose lives have been changed forever by this diagnosis.
There are many sites dedicated solely to providing information about autism. The audience for this site includes families who are in the initial phases of wondering, “Does my child have a communication problem?” The statistics tell us that some of these families will indeed find out that autism is the reason their child is not talking. For these readers I wanted to provide a framework for understanding autism. It was written by a colleague, Laurie Mount Grimes, Ph.D., MPH, a pediatric psychologist who also practices in Louisville, KY. She has graciously given me permission to reprint this information.
Conceptual Background on the Autism Spectrum
Autism, also referred to as Pervasive Developmental Disorder (PDD) or Autism Spectrum Disorder (ASD), is a term for a spectrum of handicaps in which there are impairments in social communication. The level and nature of impairment varies from child to child so that no two people with autism have the same blend of communication challenges. Social communication includes behaviors such as facial expression, emotional gesture, melody (prosody) of speech, and knowledge of social rules (pragmatics) of communication that are used in human interaction to convey cognitive and emotional information. Social communication skills develop early in life and are a primary mode for learning about the environment through non-verbal means. Babies are behaviorally programmed to learn from and interact with their caregivers in ways that allow them to discriminate important facial, gestural, and voice cues to use in non-verbal interaction. By 18 months of age children typically have command of an extensive repertoire of social communication skills and knowledge that is paired with their burgeoning spoken language. Children who are not driven to interact with others in this way will fail to develop normal social communication skills and will exhibit autistic behaviors.
Later in the preschool years children develop new skills of understanding other people and other things; they learn that other’s behaviors are driven by inner motives and can begin to guess the motives of others by reading their non-verbal cues within the social context (“folk psychology”), and they develop an interest in learning about how things work, about facts, and about inanimate objects (“folk physics”). Most children develop equal skills in understanding other people and understanding the world of objects though children with PDD may have good folk physics in the absence of abilities in folk psychology.
Autism is sometimes associated with a lack of language skills, odd and stereotyped behaviors, profound inability at social interaction, and/or mental retardation. While some children may have varying degrees of some of these problems, others have normal intelligence and language with only mild deficits in social interaction skills. What is shared by all people with autism are handicaps in dealing with other people due to their inability to use and understand common verbal, gestural, and expressive communication.? Current research uses four domains to evaluate social communication:
- Affective Reciprocity – one’s ability to send and receive social signals?to and from?others using facial expression, tone of voice, and social and emotional gestures.
- Emotional Joint Attention – one’s ability to share interests with others such as to show things, talk reciprocally, smile socially, direct others’ attention to objects of interest, and to show affection.
- Verbal Joint Attention – One’s ability to be verbally social, to give and take in conversation, to show one’s interest in others.
- Theory of Mind– In young children seen as social imagination; one’s ability to converse appropriately; one’s ability to infer another’s intentions.
While there may be handicaps in affective reciprocity in young children with PDD or in severely autistic persons, there may be mostly joint attention and theory of mind deficits in moderated affected individuals, or, in the mildest cases, only poor theory of mind (i.e., poor “folk psychology”).
For comprehensive information about dealing with autism in young children, I highly recommend the book Engaging Autism by Dr. Stanley Greenspan. This easy-to-read book is written specifically for parents and is very helpful even before a formal evaluation is conducted. The treatment approach outlined in this book is helpful for ALL children with severe language delays regardless of the diagnosis of autism (or not).
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