Autism is a pervasive developmental disorder. The term ‘pervasive’ is used because early developmental processes are often so seriously impaired that a child usually requires a special educational setting. This type of disorder is seen in the DSM-VI as the most devastating and perplexing. Autism involves noticeable abnormalities in a child’s social adjustment. Problems also occur in many domains of functioning, language, attention, social responsiveness, perception and motor development.
The symptoms of autism are first observed very early in life, usually in infancy. The essential feature of the disorder is the child’s lack of ability to respond to others within the first three years of its life. Even at this young age, the child’s social deficits are quite noticeable, along with the bizarre responses that these children make to their environment. They lack response and interest in people, and fail to develop normal relationships to the adults that care for them.
These traits are reflected in infancy due to their failure to cuddle, lack of eye contact or an aversion to physical affection. These children may also entirely fail to develop language, and any that is acquired is usually abnormal, such as echolalia (the tendency to repeat or echo precisely what they’ve just heard), echopraxia (to repeat the actions of others) or pronominal reversal (the tendency to use ‘I’ where ‘you’ is meant and vice versa) Autistic children also respond very negatively to any changes in their routines or environments.
This severe disorder of childhood is rare, Rivito in 1989 and Fombonne in 1998 discovered that autism only occurs in approximately four in ten thousand children, and that boys out number girls by about three to one. They also found no relation to socio-economic status or race. The prevalence of autism is similar across different countries, income levels and ethnic groups. The central feature of autism was stated by Leo Kanner in 1943, “It is the inability to relate…in the ordinary way to people and situations…an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from outside.”
This striking idea of ‘aloneness’ can take a variety of forms in areas such as language, behaviour, cognitive development, and social relationships. One of the prominent features of children with autism is their poor use and understanding of the spoken language. In 1998, Eisenmajer saw their obvious language delay as the most powerful predictor of their clinical outcome. Most parents of autistic children have reported that their child’s development of language was unusual from the beginning. They show no attempts at ‘enthusiastic babbling’ popular with normal infants. But even when they do begin to vocalise they fail to show the usual pattern of language development.
By the age of one, a child can use some simple, one-syllable words, but about half of the children with autism do not. When these children do begin to communicate, they use noticeably peculiar sounds and words. In the early stages, the child often uses a high-pitched, bird-like squeaking. When comprehensible sentences do finally start to emerge, autistic children display many of the grammatical errors of a normal child, but they are long lasting and peculiar.
Language development doesn’t proceed very far for some autistic children, and communication skills remain noticeably deficient. There is a lack of colloquialism, as conversation is stilted. Emotional tone is lost on them, and they fail to imitate gestures or initiate imaginative play. This was discovered by Smith and Bryson in 1998, who see these traits as crucial in the early stages of language development. Autistic children also fail to use non-verbal strategies to make their needs known. It is believed that the key to understanding communication deficits in children with autism lies in their lack of understanding of social interactions.
Usually the first symptoms that are observed in children with autism involve some aspects of their social behaviour. One striking characteristic is their obvious air of aloofness; it is a physical and emotional barrier from others that can be especially hurtful for parents. This type of behaviour reflects a fundamental failure to develop social attachments. In 1970, Hermelin and O’Conner found that an autistic child would rather spend time near a non-reacting adult than an empty chair. They do begin to gradually improve their social relationships, but not entirely. These children continue to show a lack of enthusiasm for cooperative group activities, they fail to make personal friendships, and have difficulty in responding appropriately to other people’s feelings.
In 1998 Charmin found evidence that suggests that children with autism have fundamental problems in understanding other people’s expressions of emotion, and also in communicating their own emotions by using their own faces, voices and gestures. Baron-Cohen suggested in 1995, that autistic children suffer from ‘mindblindness’, as they don’t understand that other people exist as separate individuals with their own ideas and feelings, and lack the ability to imagine what other people are experiencing. They can’t make sense of other people’s actions, and have trouble in decoding non-verbal cues of the human face and eyes.