The current Diagnosis and Statistical Manual of Mental Disorders-Fourth Edition, Treatment Revision (DSM-IV-TR) identifies three features that are associated with autism:
- Impairment in social interaction.
Impairment in social interaction
Patients with autism fail to develop normal personal interactions in virtually every setting. This means that affected persons fail to form the normal social contacts that are such an important part of human development. It is important to note that, contrary to popular belief, many, if not most, persons with this disorder are capable of showing affection, demonstrating affection bonding with their mothers or other caregivers. However, the ways in which individuals with autism demonstrate affection and bonding may differ greatly from the ways in which others do so.
As the child develops, interaction with others continues to be abnormal. Affected behaviors can include eye contact, facial expressions, and body postures. There is usually an inability to develop normal peer and sibling relationships and the child often seems isolated. There may be little or no joy or interest in normal age-appropriate activities. Affected children or adults do not seek out peers for play or other social interactions. In severe cases, they may not even be aware of the presence of other individuals.
Communication is usually severely impaired in persons with autism. What the individual understands (receptive language) as well as what is actually spoken by the individual (expressive language) are significantly delayed or nonexistent. Deficits in language comprehension include the inability to understand simple directions, questions, or commands. There may be an absence of dramatic or pretend play and these children may not be able to engage in simple age-appropriate childhood games such as Simon Says or Hide-and-Go-Seek. Teens and adults with autism may continue to engage in playing with games that are for young children.
Individuals with autism who do speak may be unable to initiate or participate in a two-way conversation (reciprocal). Frequently the way in which a person with this disorder speaks is perceived as unusual. Their speech may seem to lack the normal emotion and sound flat or monotonous. The sentences are often very immature: "want water" instead of "I want some water please." Those with autism often repeat words or phrases that are spoken to them. For example, you might say "look at the airplane!" and the child or adult may respond "at airplane," without any knowledge of what was said. This repetition is known as echolalia.
Persons with autism often exhibit a variety of repetitive, abnormal behaviors. There may also be a hypersensitivity to sensory input through vision, hearing, or touch (tactile). As a result, there may be an extreme intolerance to loud noises or crowds, visual stimulation, or things that are felt. On the other hand, there may be an underdeveloped (hyposensitivity) response to the same type of stimulation. This individual may use abnormal means to experience visual, auditory, or tactile (touch) input.
Children and adults who have autism are often tied to routine and many everyday tasks may be ritualistic. Any break in the routine can provoke a severe reaction in the individual and place a tremendous strain on the adult trying to work with him or her.
There may also be non-purposeful repetition of actions or behaviors. Persistent rocking, teeth grinding, hair or finger twirling, hand flapping and walking on tiptoe are not uncommon. Frequently, there is a preoccupation with a very limited interest or a specific plaything. Some individuals can also have an inappropriate bonding to specific objects and become hysterical without that piece of string, paper clip, or wad of paper.
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