Autism

A mental disorder that is characterized by repetitive behavior and a seriously impaired ability to communicate and interact with others.

Childhood autism (sometimes called pervasive developmental disorder) is characterized by a profound difficulty in social relationships. A disorder that appears in early childhood—generally by age three—autism is not completely understood by researchers but is likely to be due to abnormal brain development. The disorder differs from child to child, but autism may be first suspected when an infant or toddler fails to develop normal social interactions, such as eye contact with parents. When in the company of others, autistic children may display repetitive movements such as rocking, head banging, or hand twisting. These children also exhibit markedly delayed language or unusual language use, avoidance of eye contact, an obsessional concern for order and sameness, and an aversion to or lack of interest in other persons.

Autism is a rare disorder, occurring in perhaps one in 10,000 births. It can be confused with a form of mental retardation caused by a genetic disorder, fragile X syndrome, because many symptoms overlap. Research has attempted to characterize the central disorder of autism: is it a cognitive, social, or linguistic deficit? Compounding the picture is the fact that many autistic children are also retarded, though some show normal intelligence on non-verbal tests.

Approximately 50% of autistic children never learn to talk, or they talk in only the most rudimentary way. Six is the crucial age in this regard, after which the prognosis for dramatic language progress looks bleak. Rigorous behavioral intervention at an early age can often provide such children with a form of communication. Educational programs are willing to try any medium that the child can succeed with: speech, gesture, "communication boards" on which the child may point to pictures or symbols, signed languages, and so forth. In the 1990s, there was interest in reaching autistic children via "facilitated communication" in which the child is "helped" by a facilitator's touch to type on a keyboard. This method raised the hopes of many parents and teachers who work with autistic children. However, careful evaluation of the outcomes suggests that the dramatic successes are mostly illusory, and that the child's elaborate, seemingly spontaneous productions were in fact guided unknowingly by the facilitator.

"High-functioning" autistic children can learn to talk, but several features of their language have been highlighted as aberrant. A marked feature of autistic speech is echolalia, which an immediate or delayed repetition of the content and form of another person's speech. The function of echolalia has recently been reevaluated, with new evidence suggesting that it may be a way for the child to enter or maintain a conversation, in the face of poor spontaneous language skills. The autistic child is also prone to make pronoun substitutions, such as you for I. The autistic child will say such things as:

when he is clearly making a personal request.

Normal two-year-old children speak this way as well, but only fleetingly. In terms of lexical (vocabulary) development, substantial differences do not seem apparent in the type or variety of vocabulary in normal IQ autistic children. An exception is the autistic child's vocabulary referring to emotions or mental states, such as think, believe, know, which is generally impoverished or underdeveloped. Grammar and morphology (inflection and word formation) seem to be developed in an essentially normal way. However, in the area of conversational development, the peculiarities of autism are revealed.

Autistic children seem to have a poor grasp of the social functions of language: knowing what is an appropriate topic, or when they should respond. They might initiate inappropriate topics, saying, for example, "I had a shower this morning," as a conversational opener to a visitor to the school.

The child who is autistic may fail to keep up her end of the conversation, or give inappropriate replies to questions. In some cases, it is as if the child does not comprehend the purpose of language as a social skill. In fact, several studies conducted in the 1990s point to the possibility that the autistic child does not develop, or is seriously delayed in developing, an adequate "theory of mind" about other persons. Over the first few years of life—usually by about age four—the normally developing child forms a set of beliefs that help him to understand others around him. He comes to understand that people have ideas and beliefs, desires and fears that may differ from his own, and that allow him to predict what they will do. Autistic children lack these skills to a degree far beyond what their other mental impairments would suggest. This may be a central deficit of autism, and it may then explain the odd features of autistic language: the failure to understand social interaction, the in-attention to language, and the marked lack of reference to emotional or mental states in conversation.

In the late 1990s, a number of sites on the worldwide web offered autistics the opportunity to communicate with each other. One participant offered this explanation of why e-mail communication and online forums work where face-to-face conversation is impossible: "Imagine you are surrounded by ten people rapidly talking to you at the same time, and this goes on for several hours. I'm sure you would want to run into a small room and lock the door....Well, this is how I feel when I'm talking to two people (or one person, sometimes)."

People with autism cannot interpret facial expressions, body gestures, or voice inflection. These intuitive aspects of conversation represent powerful distractions to conversation—which explains the success of electronic communication, where distractions can be minimized or controlled.

Bettelheim, Bruno. The Empty Fortress: Infantile Autism and the Birth of the Self. New York: Free Press, 1972.

Frith, Uta. Autism: Explaining the Enigma. Cambridge, Mass.: Basil Blackwell, 1989 (1990 printing).

Gerdtz, John, and Joel Bregman. Autism: A Practical Guide for Those Who Help Others. New York: Continuum, 1990.

Grandin, Temple, and Margaret M. Scariano. Emergence: Labeled Autistic. New York: Warner Books, 1996.

——.Thinking in Pictures and Other Reports from My Life with Autism. New York: Doubleday, 1995.

Hobson, R. Peter. Autism and the Development of Mind. Hillsdale, NJ: L. Erlbaum Associates, 1993.

National Institutes of Health, Public Health Service. Fact Sheet: Autism. Washington, D.C.: U.S. Dept. of Health, Education, and Welfare, 1989.

Sacks, Oliver W. An Anthropologist on Mars: Seven Paradoxical Tales. New York: Knopf, 1995.

Wing, Lorna. Autistic Children: A Guide for Parents and Professionals. New York: Brunner/Mazel Inc., 1985.

Blume, Harvey. "Technology: Autistics, Freed from Face-to-Face Encounters, Are Communicating in Cyberspace." New York Times 147, June 30, 1997, p. C6.

Prisoners of Silence. PBS Video, 1993. Autism, Reaching the Child Within. Produced by WHA-TV, Distributed by PBS Video, 1988.

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