What Doctors Know About Autism by AudioLearn

What Doctors Know about Autism www.AudioLearn.com

Rett Syndrome Symptoms ............................................................................................. 61 Childhood Disintegrative Disorder or CDD .................................................................. 63 Kanner’s Syndrome ........................................................................................................ 64 Pervasive Developmental Disorder NOS ....................................................................... 66 Major Symptoms seen in ASD in Adults ....................................................................... 67 Famous Autistic Adults .................................................................................................. 70 Autistic Savants .............................................................................................................. 75 Things to Remember from this Section: ....................................................................... 79 Diagnosis of Autism ..................................................................................80 Screening for Autism .....................................................................................................80 Diagnosing Autism in Children ..................................................................................... 84 The DSM-5 Diagnosis of ASD ........................................................................................ 89 Diagnosing Autism in Adults ......................................................................................... 90 Things to Remember from this Section ......................................................................... 94 Treatment Options for Autism .................................................................. 95 Behavioral Management Therapy ................................................................................. 96 Pivotal Response Treatment .......................................................................................... 97 Cognitive Behavior Therapy .......................................................................................... 98 Early Intervention in Autism Therapy .......................................................................... 99 Educational and School-spaced Therapies.................................................................. 100 Joint Attention Therapy................................................................................................101 Medication Management ..............................................................................................101 Nutrition Therapy ........................................................................................................ 103 Occupational Therapy .................................................................................................. 104

Parent-mediated Therapy ............................................................................................ 105 Physical Therapy .......................................................................................................... 105 Social Skills Training ................................................................................................... 106 Relationship Development Intervention or RDI ......................................................... 106 Speech and Language Therapy .................................................................................... 108 The TEACCH Autism Program .................................................................................... 109 Verbal Behavior Therapy ..............................................................................................110 Floortime Therapy ........................................................................................................ 111 Treatment Options for Adults with ASD ...................................................................... 112 Autism Complications and their Management.......................................... 119 GI or Gastrointestinal Diseases .................................................................................... 119 Autism and Epilepsy .................................................................................................... 120 Feeding or Eating Problems ......................................................................................... 121 Sleep Issues with Autism ............................................................................................. 122 ADHD and Autism ....................................................................................................... 122 Anxiety in Autism ........................................................................................................ 123 Depression in Autism................................................................................................... 123 Obsessive Compulsive Disorder and Autism............................................................... 124 Schizophrenia and Autism ........................................................................................... 125 Bipolar Disorder and Autism ....................................................................................... 125 Medication Use in Autism ........................................................................................... 126 Things to Remember from this Section ....................................................................... 129 Living with Autism .................................................................................. 130 Living with Childhood Autism ..................................................................................... 130

Free Government Resources in the US ....................................................................... 136 Living with Autism as an Adult ................................................................................... 138 Autism Resources for Families ..................................................................................... 141 Important Things to Remember from this Section ..................................................... 145 Current Research on Autism ................................................................... 146 Things to Remember from this Section ....................................................................... 150 The Future for Autistic Children and their Families ................................. 151 Things to Remember from this Section ....................................................................... 153 Conclusion .............................................................................................. 154

PREFACE If you have decided to listen to this audiobook on what doctors know about autism, you likely have more questions about this disorder than you can get from a basic website. These websites will help you understand the most simple aspects of what autism is and what it might look like but they often do not help you understand why your child or loved one has this disorder and what you can do about it. In this audiobook, we will delve deeper into what the science of autism tells us about the people who have it. You will see that it is not just one disease but is a spectrum of disease states we now call autism spectrum disorder or ASD. To be fair, this is an area of medical research that is going on all the time because doctors know that they do not yet know all there is to know about these disorders. Yes, there are many ideas and much that we do know but, to date, nothing has been found so far on autism spectrum disorder that has made any headway into preventing these disorders or in curing them. Doctors call autism spectrum disorder or ASD a neurodevelopmental disorder, which is a disorder of the brain in the developing child. Breaking these words down, you can see that it involves the neurological systems of the body. In the case of ASD, this means the core of the problem is in the brain itself. It is not the same thing as a psychological disease like anxiety or depression that generally occur later in life. The second part of the term is “developmental”, meaning that it occurs as a part of a child’s early developmental months or years. Rarely in today’s time is autism diagnosed in an adult and it does not exist in any adult who did not already have the disorder in childhood. As you will see in this audiobook, some parents say they can see evidence of autism in their baby from birth, while others don’t see it until the child is a toddler. Just because autism isn’t always seen from birth doesn’t mean that something happened to a normal child sometime early in their life that somehow made them autistic. There just isn’t any evidence of that. Instead, there is plenty of evidence that the problem is with the child’s brain development itself and with their genetic makeup rather than anything that happens to them later on.

For example, you may have heard that immunizations in children are the cause of autism in some cases. This idea was based on one small research study done about 20 years ago that was later found to be so flawed that it was withdrawn from the public domain. No other research since has ever shown any connection between childhood immunizations and the development of autism. There is a great deal of evidence to suggest that there is a genetic basis for autism or at least a genetic basis behind which children might be at risk for this problem. As you will learn in this audiobook, the genetic factors that determine whether or not a child will have autism is actively being researched all over the world. You will see how we already have the evidence that genetics is big part of why a child gets autism, but so far, no single gene or even a set of genes has yet been found to explain exactly how genetics by itself plays a role in autism. Autism is not also strictly an environmental disease. By using the term “environmental”, we can mean a lot of things. The environment, for medical purposes, is anything definitely not related to genetics or to the genes a person is born with. The environment could be something in the womb a fetus is exposed to in its earliest developmental stages. It could be related to the birth process itself or to things that change a child’s genes after he or she is born. Finally, it could also be related to things everyone is exposed to in the physical environment or things a child is exposed to in the parentchild interaction. After we talk about how the normal human brain develops and what seems to be wrong with the brains of those who have autism, we will talk about the symptoms of autism and about how it is diagnosed in children. Autism itself used to be thought of as several different related disorders of the brain. There were even different diagnoses given to describe the various presentations seen in autism, such as Asperger syndrome. Now, we recognize that autism is more likely to be instead a spectrum of different presentations of essentially the same disease. This is why we now call autism by the name “autism spectrum disorder” or ASD rather than by any separate disease names. Yet, no two autistic children are the same. There is a great deal of variability in what you can expect if you have a child with autism. Some children with autism have mental

retardation and a great deal of disability. Others are what some call “autistic savants” because, while they have a lot of deficits in the way they relate to the world around them, they have significant gifts and amazing talents not often seen in other children. What accounts for these differences in children who essentially have the same disease? We’ll look at the possibilities as we talk about this some more. Autism can be said to be a specific developmental disorder of the brain that affects the way a child behaves and how he or she relates to the world. In the case of autism, the developmental issue relates to the child’s ability to communicate and to have social skills, which is very impaired in these children compared to other children. It is seen in their inability to seek out the help of their parents, to communicate their needs, or to tolerate or even recognize when comfort is given to them. Such things seem so innate in what it means to be a human child that it is hard to imagine what it would be like for these children to grow up and to develop into functional adults. Yet, the truth is that some children with autism can become functional as they grow up, even with their very specific developmental disability. Some of the child’s success later in life just happens because he or she has other neurological gifts to draw upon and some happens likely by virtue of having understanding and patient parents who are able to nurture their child’s strengths despite their disability. Toward the end of the audiobook, we will talk about how autism is treated. To date, there are no known cures for autism, partly because we simply don’t know yet what causes it. There are several approaches to treatment in use today and even more being looked at with the future in mind. Many treatments involve the whole family and how they can collectively develop and grow together when one of their members has what can be a severe disability. Because the entire family is affected, they are often a big part of the treatment. How the autistic child is managed in his or her growing years seems to make a difference in their overall outcome. Finally, we will talk about what research is out there that could potentially influence the future of the diagnosis, treatment, and outcomes of children born with autism. Because we know some of the big picture but not all of it, research is very important and will

someday unlock the keys we need to have in order to have significant breakthroughs in autism outcomes for these children. The more you look at this type of research and the direction the different research projects are going, the more hopeful you might feel about your own situation. It may be that we cannot help children who already have autism today, no matter how old they are now. Even so, we can’t discount the possibility that a cure might be out there nor can we discount the greater probability that there is more that can be done to help these children live fulfilling lives despite their developmental disability, even if there is no cure. If you are the parent or loved one of someone who has autism, you should see after listening to this audiobook that, while nothing we know of yet could have prevented the disorder in those who already have it, perhaps you can do something even now to make a difference in an autistic child’s life. Keep listening to this audiobook and hopefully you will find out more than you expected to know about this unusual neurodevelopmental disorder.

BACKGROUND AND STATISTICS ON AUTISM In this section, we will talk about what autism looks like from a basic standpoint. Later on, we will delve further into the different symptoms and manifestations you might see in a child or adult who has autism so you can get an even bigger picture of the disease process. We will also talk more about what we know about the developmental and neurological issues related to autism; in other words, what’s wrong with the autistic child’s brain? We will also talk about the statistics on the prevalence of autism being followed on a regular basis by the Centers for Disease Control and Prevention in the US and by other agencies, such as the World Health Organization. You should know that there is a difference between the concepts of incidence and prevalence of any disease. The incidence refers to the number of patients with a certain disease identified every year, while the prevalence is the number of people in the community as a whole who have the

disease at any given point in time. Because you generally don’t die from autism, the prevalence of the disorder will be much higher than the incidence. Is autism actually becoming more common and why do some parts of the world seem to have more cases than others? These types of questions are easy to answer with some diseases and harder with others. The problem with autism that makes it hard is that there is no blood test or x-ray to identify it so there will be differences across the world in how many cases seen because not all parts of the world will have the same criteria they use to decide who has it and who doesn’t. This will lead to regional differences in the number of cases seen. The other thing that makes it hard to determine if the incidence of autism is increasing or not is that it was not that long ago that it wasn’t even recognized as a real disorder. You could say then that it didn’t exist at all but, if it wasn’t even recognized, who could possibly have been diagnosed with it? It’s only when a disease is easy to identify, has clear identifying criteria, and is recognized as a real disease can doctors really say if the incidence of the problem is increasing or decreasing. This just isn’t true for autism. We will also talk a bit about how the whole diagnosis of autism came to be in the first place. What did people think was happening before autism was formally recognized as a distinct disease? How has our concept of autism changed over time? Are we right now about what we think autism is all about or will that potentially change in the future? As you look at this history of autism, you’ll see how things have evolved over time as doctors gradually came to understand what we now call autism spectrum disorder today.

WHAT IS AUTISM? As you will learn later, the word “autism” can mean something different to you, depending on your own experience of it. As we already discussed, autism is actually a spectrum of disorders no longer identified separately, although we will talk about these separations later so you understand why they once existed. The basic problem leading to autism is a neurological and biological dysfunction in the brain that causes deficiencies in a child’s ability to have normal social interactions, normal communication skills and abilities, and behavioral issues. Children with autism can be very low-functioning, either because these necessary brain functions are very damaged or because the child has some other cognitive impairment, such as mental retardation. In the same way, some children with autism either have minor communication, social, or behavior problems leading to higher functioning or have a much higher IQ scores so they can make up for severe deficits in other areas. What does autism look like when these crucial areas of development are impaired in the affected child? If communication is impaired, it can show up early in a lack of social smiling commonly seen in babies as an early way of communicating. As a parent, you can elicit this social smile by smiling at the baby first to see his or her natural social response. Other ways of communicating or having social skills in the older child shows up in their ability and desire to have eye contact with their caregivers. Babies are receptive to the eye contact of their parents and will return their gaze as a way of maintaining connection but, in the child with autism, this just doesn’t happen. Eye contact is either avoided or just not attended to at all among these children. Verbal communication is often also impaired in autism. While each child develops the ability to have meaningful speech at different rates, you will sometimes notice a lack of babbling or a lack of desire to imitate sounds in the autistic child. After babbling, basic words are picked up that become two-word sentences by the age of two years. This should be combined with some sense of the understanding of what you say to them. In

autism, the problem is more related to the production of speech than it is to the understanding of speech. The autistic child will play differently from other children. Normal toddlers will not necessarily play with each other but will play alongside one another. This is called parallel play. The point is that the child still likes to be near other children, even if the play itself is not interactive. Over time, play will be more interactive in the healthy child but not at all in the autistic child. Many autistic children prefer to be alone rather than having any type of proximity to another person or other child. For the autistic child, this type of closeness is uncomfortable, sometimes because it is just too stimulating to deal with the sensory input gotten when the child is around others. Look for evidence of this type of selfisolation in the child at risk for autism. The autistic child is often very resistant to any type of change in their routine, particularly with young children who tend to thrive best on routine anyway because they feel more emotionally regulated by consistency in their life. The autistic child often has severe and negative reactions to routine changes, even if they don’t seem much different to anyone else. Older children with autism have difficulty with being too sensitive to their environment. Things like unusual or unexpected tastes, different textures, odors, loud sounds, or excessive light exposures often trigger a negative, violent, or rejecting response. Exactly which things the child becomes sensitized to depends on the child and on his or her experiences. Autism by itself is not necessarily considered a sensory disorder and other children without autism can have similar symptoms but these types of things should be considered another possible manifestation of autism. Another common feature of autism, particularly in older children, is repetitive actions. Others will develop an extremely focused interest in just a few things that interest them. Babies sometimes normally flap their hands or spin in circles as ways to cope with stress. When these kinds of things are seen in older children, however, you need to expect that autism may play a role in the behaviors. The echoing of the words of others

and a variety of repetitive behaviors are commonly seen as part of the autistic child’s coping strategies. Not every autistic child will have the commonly associated habit of memorizing extraneous things, hyper-focusing on specific areas of interest, or needing to have things in a specific order. While some of these things seem like the child is just very interested in a certain topic, the problem is more of the need to memorize something rather than any type of genuine interest. There are a few that demonstrate amazing talents in music, for example, which seems all the more amazing when you realize just how disabled they are in their everyday life.

AUTISM STATISTICS In the United States, autism and its incidence is studied and tracked by the Developmental Disabilities Monitoring Network or ADDM. It involves a large number of connected organizations in the US that track autism spectrum disorder in communities across the country. By tracking these individuals, it is hoped that this process can help further research and public policy directed at helping the affected children and their families. As of this year, about one out of 54 children in the US have some form of autism spectrum disorder. The way this is assessed is important in understand what it means. Only eleven communities in the US are looked at as part of the tracking process and only children aged 8 years are included so it is basically a prevalence of autism among 8year-olds only. There is no ethnic group, race, or socioeconomic class that is immune to having autism. There are no differences in prevalence among blacks and Caucasians but there is a slightly lower prevalence rate in Hispanic children. More than four times as many autistic children are boys compared to girls. More children than ever are being screened for autism early in life, with most children getting evaluated by the age of three years. Intelligence or lack of intelligence does not appear to be an issue with autistic children as was once thought. About half of these kids have average intelligence or even above average intelligence.

The incidence of autism has increased dramatically since the year 2000, when the incidence was just one out of 150 children. It has become the fastest growing type of developmental disability in the US, increasing by between six and fifteen percent each year. The costs of this disorder are staggering, costing Americans about $250 billion dollars per year. Most of the costs involve the care of adults with the disorder. Remember that, since autism doesn’t shorten one’s lifespan, those with the disorder will need lifelong care and medical management. Early diagnosis in life seems to decrease the lifelong costs associated with the disorder. More than a third of all young adults living with autism have never had a job nor have they received any type of education past graduation from high school. Those who are educated in the public school system cost the system more than $8600 dollars per year to do the necessary adaptations to educate them. Even after graduation, few of these children are able to joint the work force in their lifetime. It is especially difficult to track the rates of autism throughout the world. Most nations simply do not track these kinds of things and, as we’ve discussed, there is no simple way of quickly identifying who has the disorder in a given population. The resources to do the necessary testing for autism isn’t there in many countries of the year. Most of the data we do have on autism comes from developed countries where the resources are available to test kids for the disorder. Hong Kon tops the list with one out of 27 children being diagnosed with some type of autism. Other countries with a high prevalence of autism are South Korea and the United States. The prevalence of autism in Canada is about one in 94. Most of the European countries have lower rates of autism, in the range of one out of 145 to one out of 196. There is no data on these things for nearly every other country. Again, because autism does not have clear criteria throughout the world and because it is difficult to detect the mildest cases, it is very hard to know if there are truly parts of the world where there are very few cases of autism. Most likely, the prevalence of autism is much higher than the public health organizations of the world know about.

HISTORY OF AUTISM Autism was first conceived of in 1911 by a German psychiatrist named Eugen Bleuler. He was trying to describe certain cases of what he thought was severe schizophrenia in children. He himself was the first in the mental health world to identify the existence of schizophrenia as well. He thought that autism was a psychological disease where children had an infantile wish to stay away from reality they couldn’t tolerate and to instead live in a world of hallucinations and fantasies. The term autism meant “inner life”, describing people who essentially lived within themselves. This description of autism was used in Europe among psychologists and psychoanalysts up until the 1950s. By the 1960s, child psychologists in England challenged this notion and decided to study autism from a more scientific perspective. Autism was labeled as a diagnosis by itself as doctors completely reformulated the idea of what it meant to have this disorder. In fact, the change in ideas about autism meant that, rather than having a lot of fantasies and hallucinations, it was felt by 1970 that instead these children had a complete lack of ability to have any kind of symbolism or fantasies in their life. There was a distinct lack of fantasy rather than too much fantasy. The first genetic studies on autism were begun in 1972 and have continued ever since. In the 1920s and 1930s, there was essentially no difference between autistic children and those who were thought to be psychotic or schizophrenic. Many were institutionalized and doctors tried to teach parents better skills so they could avoid causing these problems in their children. Psychiatrists who specialized in psychoanalysis looked for psychological themes in the thoughts of these children to explain what they were seeing. It was believed that autistic children had weak nervous systems that caused them to be unable to have a normal sense of reality. In the 1920s, one of the most well-respected child psychologists at the time was Jean Piaget. He said that children who lived their lives before they became able speak or to understand words existed with symbols and were essentially all autistic. As the child took in his or her environment, there was a gain in their sense of reality. Autistic

children did not gain a sense of reality and were felt to have a lack of logical reasoning skills as a result. Other child psychologists into the 1930s continued to be focused on the idea that autistic children were stuck in some kind of preverbal stage of development, where they suffered from illogical thinking, hallucinations, symbolic thinking, and fantasy. This was not unlike what they thought was going on in schizophrenic children and some thought that autism was just a very severe type of schizophrenia. During and after World War II, researchers in England had the opportunity to study many children at once, mainly because more than a million of them had been taken from their homes in the war in order to be evacuated to more rural areas. It was then that it was decided that some children with autism suffered from maternal deprivation by their experiences during the war. They thought that, because the mothers were not around, these children couldn’t form normal relationships, which also affected their intelligence and thought processes. Rather than attaching to their parents, the children just retreated into an inner world of their own. In the 1940s, doctors from Johns Hopkins University Hospital in Baltimore said they had discovered a new psychological disorder in children. These children were obsessive in their thinking, had extreme autism, stereotypical behaviors, and echolalia. Echolalia is the tendency to repeat the same words or syllables that the child hears from others. They felt this problem was inborn in the child and did not necessarily think that the affected child had problems with excessive symbolism and illogical thought processes. They noted, though, that many of these kids were attached to certain objects but not as much to people. These were kids who didn’t relate physically to others and who used language very literally and concretely. This was a far cry from the earlier autistic children, who were thought to have too much fantasy in their thinking. In that sense, these children were called autistic, mainly because they lived more inside themselves and were less engaged in the environment around them. This better fits with how we understand autism today but most doctors didn’t pay attention to the research in favor of the idea that the real problem was better explained by the ideas proposed by

doctors still focused on symbolic thinking and infantile thought processes they thought were going on in affected children. As late as the 1950s, the psychiatric diagnoses of autism, psychosis, and schizophrenia were thought to be essentially the same. Some believed that these supposed child schizophrenics were stuck in the stage of development seen in infancy, where internal symbolism was thought to be prominent before the environment around them and relationships in their lives changed the ways babies thought and responded to the world. They recognized that autism developed at different times in a child’s development and said that the different manifestations of the disorder they saw could be explained by when the child first became sick. They drew on the idea that all babies start out being autistic but that they grow to reach a barrier they first get from their mother that allows them to focus on the important things in their environment, ignoring all of the extraneous and unnecessary things. Early autism came from a very thick barrier so that they were forced to block out all forms of external environmental stimuli, essentially living inside themselves. Late autism instead came from a barrier that was too thin so that the child was bombarded by too much external stimuli they could not filter out. When this happens, the child learns to block all of this stimulation out. Others used ideas on child development that were based on their ability to receive different sensations. They said that children first relied on visceral and internal sensations, then on touch and movement, and finally on vision and hearing. They felt that autistic children were stuck in primitive patterns of sensations so they could not take in or understand sensations they felt that were based on certain things, preferring touch and vision to other sensations. In that sense, the problem wasn’t because of a lack of intelligence. There were child psychologists who wanted to study just the behaviors seen in autism rather than the fact that many could not form relationships as part of their problem. They developed checklists of behaviors to look at for doctors to identify autistic children. All of this happened in about the late 1950s. By using behaviors, doctors could more easily screen children at risk for being autistic without thinking too hard about what these children were thinking or feeling. The behavior checklists included things like

echolalia, lack of speech, social avoidance, visual avoidance, looking through people, being solitary, having noise distress, being insistent on sameness, and having strange and repetitive movements. The shift in thinking about autism was similar to the shift seen in how all mental disorders have been classified since the 1950s. They used to think about certain cases or individuals with a disease as being unique by themselves and started to use scientific data and epidemiology to cluster similar cases together. The Diagnostic and Statistical Manual of Mental Disorders or DSM first described autism in 1980. It reclassified the disorder as a spectrum of disorders in 1987. While autism is listed in a manual on mental disorders, it is not a mental illness in the traditional sense. In fact, many of the diseases we see as being mainly mental have a great deal of biology and genetics behind them. It is only in this manual because the symptoms are mostly related to thoughts, feelings, and behaviors. You would think that the incidence of autism has been hugely increased since the 1960s but, considering no one really looked at the disorder from an epidemiological perspective as is true of other diseases, it is not surprising at all. The first study on the incidence of autism showed that only 4.5 out of 10,000 children in the UK had the disease. By 2006, this same figure had risen to more than 116 out of 10,000 in the same geographical area. You should know too that, prior to 1960, nearly all autistic children with severe impairments were institutionalized and were not in the school system or community. This effectively rendered them invisible so they couldn’t be studied or evaluated as to just how many of them there were in society. In addition, most parts of the world later included the idea that these children were mostly profoundly mentally retarded so that some mentally retarded children in the 1980s were classified as being autistic. Parts of the world that didn’t do this, such as France, didn’t see any major increase in the rates of autism. As children with autism were released in large numbers from psychiatric institutions and kept at home, more and more parents started to campaign for their children. They wanted more recognition of the problem, better diagnostic strategies for identifying

affected children, and more resources for treating them. Everything that had been thought of regarding the treatment of autism through psychoanalysis, the type of treatment proposed by Sigmund Freud, was thrown out of the window as being useless, in favor of new treatment strategies for managing autistic children and their symptoms. After autistic children were effectively liberated from psychiatric institutions in the 1960s, there was a need to educate them. More educational psychologists got involved and it was felt by these doctors that all autistic children had the potential to be educated. Children were integrated into classrooms in some cases, while special schools for autistic kids were also created for other children. As mentioned, parents of these children wanted answers. They wanted their children to be recognized and treated as humanely as possible in search of better outcomes. This all came at around the same time, which was in the early 1970s, that doctors decided that hallucinations had nothing to do with autism. As thoughts and fantasies become less of the picture of autism, this as replaced by the idea that perhaps autism is a communication-related disorder. Psychology had shifted from psychoanalysis to behavior and finally to thinking. This led to autism being thought of as a problem of severe language delays, ritualistic or compulsive movements, and difficulties with relationship formation. They studied the language of children with autism and determined completely that emotional disturbances were not a part of what makes a child autistic. The researchers who studied this in autistic children and developed a checklist of mainly language issues seen in autism. Once they decided that autism was a language-related disorder, they came to recognize the problem as being developmental in origin. They developed the term “pervasive developmental disorder” to describe some of the affected children and decided there were four different categories of this, called infantile autism, childhood pervasive developmental disorder, atypical autism, and residual autism. The idea that autism was at all related to schizophrenia was quickly abandoned. It was also separated from adult schizophrenia. By the time that the DSM-III was written, doctors and researchers had developed a checklist or set of criteria used to define autism from an observable standpoint. All

mental diagnoses are labeled this way so as to be very objective, easy to diagnose, but very difficult to look specifically at what might be the underlying cause. A second model was made up by the World Health Organization that looked at three separate parts of the disease, which are the psychiatric findings, the intellectual delays sometimes seen, and possible causes of the disorder. By 1979, autism started to be thought of as a neurodevelopmental disorder with cognitive or thought-related features. The researchers who studied this felt that the underlying problem was one of severe impairments in social interactions, which led to the other findings seen in autism. They then developed their own three key features seen in autism, such as absence or impairment in normal language skills, impairment or loss of social interaction skills, and any type of repetitive or stereotypical movement or activity. The compared the similarities and differences between autistic children and those who were mentally retarded. All of this research led to similar conclusions we have today about autism. They believed that there were certain area of the brain that were specifically related to social interaction and symbolic imagination. These dysfunctional areas led to the primary problem of social impairment that leads to the other symptoms seen in these children. The prevalence of children who fell into this category was about 21 children out of 10,000. A continuum of impairment was suggested rather than separate autistic diseases. Instead of treating these children with psychanalysis, the decided to develop social behavior management programs. The concept of Asperger syndrome or mild autism was determined to be part of the autism spectrum and was listed as a separate disease in the DSM-IV in 1994. Autism itself became linked to other developmental disorders that are not strictly considered to be autism. As you can see, the definition of what was autism and what it meant was completely different from what it first started out to be in 1911 and in much of the early years of the understanding of the disorder. Autism was felt to be related specifically to social interaction itself rather than to emotional relationships with those in the child’s life. It meant that more children fell into the category of being autistic and that it appeared as though the incidence of autism had increased during this time.

As you have learned from this brief history of autism is that the ideas about what was going on inside the minds of autistic children have changed dramatically. What you might not know is that this fits with how doctors have come to see almost all disorders related to mental symptoms. There was once a big push to identify everything as being psychoanalytical and based on primitive wishes in the baby and child. Then came the idea that certain developmental stages just didn’t get achieved in these children. By the 1950s, psychiatrists looked only at behaviors to classify groups of mental disorders without thinking much at all about the causes. Finally, ideas related to aspects of development were mixed into the fold, so that the concept of autism as being neurological or biological was paramount rather than any type of psychological weakness. As you will hear later in this audiobook, there are brand new ideas we now have on the causes of autism but that even these are based only on what doctors know about neurodevelopment, genetics, and early life exposures but that this is how almost all other mental disorders are now being studied. You can decide for yourself just how right we are about what the real problem is in autistic children. We are probably more right now than doctors were in 1911 but, until an answer becomes clear, we will always have pieces of what we know about autism rather than a whole picture of the disorder, which is the key to how best to treat it.

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