When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was released in May of 2013, “autism” was relegated from a separate disorder to fall under the umbrella of Autism Spectrum Disorders (ASD) which, in and of itself is vague but includes the following subcategories of autism: Childhood Disintegrative Disorder, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Asperger’s Syndrome, and Autistic Disorder. Only recently has Rett Syndrome been included under the umbrella of ASD.

According to the Centers for Disease Control, autism is five times more likely to affect boys (1 out of 42) than girls (1 out of 189). Autism does not discriminate against color or race – it affects people world-wide. Autism is the fastest growing developmental disability, it is estimated that 1 out of 68 newborn babies in the USA has autism. In 2000 the number was 1 in 150 births.

There is a sweeping wide misconception that autism develops around the age of three. In truth, signs of autism begin to present themselves around the age of three.

What’s the difference?

If autism develops around the age of three then one might argue that a trigger exists that caused it. In the late 1990s the patsy was childhood vaccinations. The general public became so frightened by the growing autism epidemic they laid blame anywhere they could. It is important to note that this has been debunked and disproven through studies conducted around the world, but sadly not before cases of measles, mumps, rubella, and polio made a comeback because of this dangerous myth.

The age of three seems to be the magic number for most, but rather than “developing” autism, the symptoms actually begin to present themselves. Prior to the “symptomatic age” children are home with familiar surroundings: house, room, parents, relatives, sights, sounds, etc. Between the age of three and four the child is placed in social situations: play dates and pre-school. They are inundated with new sounds, people, situations, and locations. “Suddenly” the parent of the autistic child realizes that their baby is different.

Like the spectrum, autism is very hard to pinpoint because everyone is unique in their level of disability or giftedness – and any combination thereof.

Sensory overload often causes tantrums or lashing out, general misbehavior, symptomatic ADHD, excessive rocking or fiddling of the hands.

It is best to remember that people are born on the autism spectrum. They do not go out of their way to be a problem but they do lack social, behavioral, and coping skills. Depending on where they are on the scale, people with autism range from severely challenged to highly gifted. Many people would be surprised to know that some people with autism have very high IQs but often thought of as slow because of their lack of social etiquette or “street smarts”. On the other hand, there are cases of autism that are debilitating enough where they need lifelong care.

The Symptomatology

The symptoms of a person with autism are fairly universal in varying degrees. Some easy to spot behaviors may include:

• Repetitive movement
• Head movement (rocking or swaying)
• Rocking back and forth
• Flapping hands (or twirling fingers, drumming pens, swirling marbles, etc.)
• Echolalia or Non-verbal
• Inability to sit still

Some behaviors may be noticed but not always attributed to autism:

• Staring/Daydreaming
• Strong resistance to change (food, clothes, environment, plans)
• Lack of social skills
• Little to no eye contact
• Fixations on specific parts of objects
• Lack of facial expression or body language recognition

The great divide

Communication is often the great divide for people with autism. The communication problems in people with autism can be attributed to many factors. Comprehension is the key. Oftentimes the speed of normal conversation goes by too fast for a person with autism. This doesn’t mean they are slow but combined with the inability to read body language and understand conversational cues, they are like fish out of water.

You’ve heard the phrase, “Let me sleep on that.” It means I need time to think about that. Being inundated with information, a person with autism needs time to sort out all the sights, sounds, and experiences. It isn’t always lost on them but they need time to “sleep on it.”

Reading and writing is a matter or learning patterns. To someone on the scale it could be artwork and subject to interpretation. We learn how to read and write through repetition and eventually comprehend that C-A-T spells cat, and a cat is a furry animal that purrs. But perhaps a person with autism only sees C-A-T as one curvy letter followed by a roof and a see-saw. How do you get a furry animal that purrs from that perspective?

Some common communication disabilities:

Hyperlexia: Often considered skill beyond their years. It’s an amazing site to see a two-year old reading the New York Times without tripping over large words. It is reading savant with no comprehension.

Echolalia: Notice the word echo in there? A person on the scale may tend to mimic or repeat words they’ve heard before. For a baby we accept they are learning the language but for an autistic person they might repeat the words but never really know what it means or how to use it in context.

APD or Auditory Processing Disorder: When a human brain misinterprets what the person is hearing. For instance, they say soldier but really mean shoulder. There is auditory discrimination where S and SH are comingled, or CH/SH sounds. Perhaps even rhyming confuses them where language becomes a jumbled mess. There are times when they simply don’t retain audible information – literally in one ear and out the other.

Now, this isn’t necessarily a “disability” but people who speak in a monotone often have communication problems because they do not understand inflection, tone, or the importance of pausing during speech. Yet, another autistic person might speak in a sing-song voice – perhaps because there is a pattern in their head, or maybe they are musically inclined and the strange speak is natural to them.

Tantrums do not fall within disability either but it is a clear indication when there is a complete breakdown of communication and they have gone through system overload.

It is important to note that there is no cure for autism but there is hope. Depending on the severity of the symptoms and because this is more of a social and communication disorder, it is important to note that coping skills can be learned. Of course, early intervention is best to help a child strengthen their motor skills and coping behavior. High functioning autism, like Asperger’s might be interpreted as quirky or eccentric behavior. They have the ability to venture into the world – but don’t necessarily like to. They may possess coping skills to go to social events, interact with strangers – even carry jobs in retail where they have to interact with people daily. Don’t be fooled though! Just because they are assimilating into their surroundings doesn’t mean they are cured. It simply means they are probably more self-aware and have the ability to stretch their limitations. That being said, even a well-assimilated person with autism has tantrums or breakdowns.

In the United States, the annual cost of caring for people with autism is $90 billion. According to Autism Society estimates, this number is expected to grow to $200-400 billion in 10 years.  These figures include research, insurance, educational spending, employment, and therapy among other things. A person with high-functioning autism is often misdiagnosed because the range and scale of severity is so broad. Bipolar Disorder, Depression or Anxiety, ADD or ADHD are a few.

So the big question still remains: What is autism? We can say without hesitation that it is a communication and social disorder. There are still debates and more research being done to find out why autism exists – is it hereditary or genetic mutation? Did something happen during childbirth or in their formative years? No one really knows HOW or WHY. There are no clear markers for the severity of autism because each person on the scale is so unique. They might be brilliant heart surgeons but never look both ways before they cross the street. Autism might very well be defined as dichotomic – or polar opposites within one being. Like a switch, there is off and on, and anything in between is noise.

Image: flickr.com/photos/kaitlynnicolephotography/4315494994