Defining and diagnosing Autism

Autism basics

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Basic overview

Autism is a pervasive developmental disorder (a servere impairment in several areas of development which starts early in childhood and becomes apparent as the child begins to develop.) it is approximately four times more likely to occur in boys than girls.

Population studies show there could be an increase in autism numbers, but this could be due to the hightened awareness of the disorder, and the children were most likely diagnosed as mentally retarded.

Autistic children appear to be healthy but are usually aloof and isolated and fail to interact with others normally. They also have an obsessive need for sameness and would be panicked if routine was altered.

Some children have islets of ability (a superior talent in a particular task) and these are known as savants, but the majority have an IQ of below 70, meaning they're interleculaly retarded.

Autism was first inspected by Kanner who noticed autistic aloneness, desire for sameness and islets of ability in many of these children.

The DSM-IV is used to diagnose autism

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o QUALITATIVE IMPAIRMENT IN RECIPROCOL SOCIAL INTERACTION- poor use of eye gaze, gestures and lack of personal relationships- at least TWO

o QUALITATIVE IMPAIRMENT IN VERBAL AND NON VERBAL COMMUNICATION- stereotyped and repetitive use of language, lack of speech - at least ONE

o RESTRICTED REPITOIRE OF ACTIVITIES AND INTRESTS- non functional routines or rituals, repetitive or stereotyped movements such as hand flapping - at least ONE

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Autism and joint attention

About 9-15months, an infant engages in behaviour that results in shared interaction between infant and another person. The infant draws attention to an interesting thing and draws the other persons attention to it also. This is usually done by gazing or pointing and is known as Joint Attention (this is where both infant and another person are attentive to the same object and to each other.)

The infant is interested not only in the care giver looking at the object, but also their attitude and feelings toward it.

This is an important prelinguistic stage as it is important for mutual understanding and sharing.

Critically this joint attention is absent in autistic children (sigman et al)

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Autism as a syndrome - the triad of impairments

The DSM-IV requires delays or abnormal functioning in at least three of the following areas for a diagnosis of autism to be given:

o Social interaction

o Language as used in social communication

o Symbolic or imaginative play

This has lead researchers to see if these three domains occur together by chance, or whether they form a triad of impairments and always occur together, and therefore constitute a syndrome (a set of symptoms that occur together and may have a common origin.)

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Traid of impairments - Wing and Gould 1970

AIM- to discover how many children in a population showed symptoms of autism and whether these symptoms could be interpreted as a syndrome.

METHOD- a longitudinal study was carried out in camberwell, London. A group of 914 handicapped children aged 0-14 were screened for autistic symptoms and 173 displayed at least 1 in 3 typical autistic behaviours. A follow up study was given when the children were 16-30 years.

RESULTS- when children were tested to Kanners main symptoms, 17 children were found to be autistic. However, an additional 62 children showed a severe social impairment before 7, a classic autistic symptom. The behaviours of these children, though, did not show elaborate routines or islets of ability and so didn't fall into Kanners autistic categorisation. The socially impaired group were divided into higher and lower ability groups. Only the higher ability was impaired communication and imagination clearly identifiable. Critically, all children in he higher ability group showed impairment of all three features.

CONLUSION- the triad don't occur together by chance but can be considered a syndrome

EVAL- longitudinal study, so suffered from drop outs and the final sample was quite small and specific to an area of London, making generalisations unreliable

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Evaluation of the triad of impairments

o Although too vague to be used reliably as a diagnostic tool, all three features do appear in diagnostic manuals and further research into autism as a syndrome is ongoing.

o The triad doesn't tell us anything of other recognised symptoms that some autistic people display, eg, islets of ability. It may be individuals who have the triad and another symptom such as this form further sub groups, such as Asbergers.

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