What is Autism?
Posted on December 29, 2018 by All In
It is stressful for any parent to find out that their child is suffering from a lifelong condition like autism. Although the journey can be challenging, know that you are not alone. There are like-minded parents, communities, helplines and organisations out there you can rely on for help. Instead of giving you prognosis, diagnosis and medical advice, this guide seeks to help you understand what autism is, the different streams of help available, and how you can cope with having a child with autism in the family.
What is Autism?
Autism is a lifelong developmental condition that impacts a person’s ability to relate to his or her environment, and interaction with people. People with autism are acutely sensitive with their senses that may result in them facing difficulties in social communication and interaction, repetitive behaviours and restricted interests. They also face challenges that include unusual sensory interests (such as sniffing objects), sensory sensitivities (sounds and textures may overly affect them), and intellectual or learning difficulties.
The cause of autism is still unclear, although there are many theories. Autism is usually developed during infancy and its symptoms are noticeable in the first two to three years of a child’s life.
Autism is a genetic disorder and is not defined by factors such as family background, race, religion or other external factors. A number of different circumstances, including environmental, biological, and genetic factors may cause autism.
How to Identify Autism (Symptoms)
A child with autism will show some signs and symptoms in the early years of childhood. These symptoms may vary depending on the spectrum of autism your child falls under. The symptoms differ for children of different ages and it can also be progressive, depending on the therapies or environment the child is in.
For a young child, the list below could alert you to the early warning signs of autism:
● No smiling or other warm, joyful expressions directed at people.
● Limited or no eye contact.
● Unusually silent. No smiling or other non-verbal communication.
● No babbling.
● No use of gestures to communicate (e.g. pointing, reaching, waving etc.).
● No reaction to name when called.
● No words from child.
● No meaningful two-word phrases.
● Any loss of any previously acquired speech, babbling or social skills.
For more information on early warning signs of autism, WebMD has a helpful slideshow.
Take our child development assessment for a more detailed questionnaire to find out whether your child is hitting the expected developmental milestones.
The list of symptoms can be classified as social impairment, communication impairment and impairment in the flexibility of thinking.
- Social impairment refers to the difficulty in interaction between a child with autism and other people.
- Communication impairment refers to difficulty in speech, in being understood, and in understanding others.
- Impairment in flexible thinking refers to the child’s imagination such as the ability to “make-believe”. There may be repetitive patterns in behaviour, interests and activities.
The aforementioned symptoms may occur simultaneously, and in some kids, these symptoms may be absent. The complexity in diagnosis lies in how every child with autism has varying symptoms of differing severity, making it hard to standardise diagnosis and classification. This study by The Iris Center gives a more comprehensive comparison between diagnosis manuals.
Analysis shows that as the child grows older, the symptoms get stronger. Their way of thinking also becomes more rigid. It is still unclear whether this is due to the effects of ageing or a worsening of symptoms. Depression and anxiety rates are also much higher for adults with autism as compared to normal adults.
If you suspect that your child has autism, we recommend consulting your local paediatrician or these certified healthcare experts for a clear affirmation of the condition.
Understanding the Autistic Spectrum
There are different types of autism which we explain in more detail below:
- Autistic Disorder
- Asperger’s Syndrome
- Pervasive Disintegrative Disorder, Not Otherwise Specified (PDD-NOS)
- Childhood Disintegrative Disorder
Kids diagnosed with Autistic Disorder have limited interest and functional skills such as playing, cooking or fixing. The key feature of this autistic disorder is the impairment of social and communication skills, which means to say that the child might have difficulty interacting with other people and/or difficulty in speech, in being understood, and in understanding others. This disorder can be further categorised into developmental stages and ages of the individual.
As they have difficulties communicating with others, children with autistic disorder are often isolated from their surroundings and prefer to immerse themselves in their own world.
They are also unable to relate to people, as they have difficulty understanding facial expressions and are not always able to make sense of situations. Those in this autism spectrum have delayed or even no development in the spoken language. For those without speech impairment, they may use repetitive and unusual choices of words, due to the lack of understanding nuance. They may also suffer from speech apraxia, a condition whereby the tongue, jaw and lips are unable to coordinate to form coherent words and sounds. The same word may sound different every time.
Behaviour-wise, children of this spectrum often have more acute reactions to sensory stimulations thus exhibiting behaviours that will isolate them. They can then immerse themselves in their own universe. Certain sounds, circumstances or breaking of routine can cause a sensory overload, which can be painful to them.
To escape, kids with autism will feel the need to quickly withdraw from their environment. They will either ignore the object completely, or be immensely focused on a single part of the object. Other ways these children cope with the pain of being sensory overloaded is by rocking, flapping or performing other repetitive motions to keep them distracted from the painful stimulation.
Taste is another sensory experience which children with autism find challenging. Children in this spectrum find foreign tastes or textures particularly difficult and will react strongly to it. For example, they may consume only smooth foods and avoid anything lumpy.
Because of this disorder, kids with autistic disorder may avoid physical contact such as hugs or handshakes and will have significant difficulty in maintaining eye contact, body gestures and other non-verbal communication signals. Due to their lack of facial expressions, a child with autism may seem detached and not show many or any emotions. They will lack reciprocity in sharing emotions and interests or achievements with others.
With regard to intelligence, autism is commonly associated with general intellectual disabilities. Some studies have shown that the majority of those suffering from autistic disorder will have below average non-verbal intelligence quotient (IQ). This does not mean that a person with fully functioning cognitive abilities may not have autism, as it can occur in conjunction with a wide spectrum of intellectual abilities.
Autistic disorder may present other conditions as well, such as epilepsy, anxiety disorder, attention deficit hyperactivity disorder (ADHD) and fragile X syndrome. For a detailed list of other conditions that may co-occur with autism, click here.
In a social setting, it may be difficult for kids with autistic disorder to even step out of their comfort zones to go on about their day-to-day living. This is especially so in an urban city setting like Singapore where sensory overload and epilepsy (or escapism) episodes can easily be triggered. They may display aggressive trigger behaviours such as head-banging and screaming, which makes it difficult for them to interact and socialise.
Asperger’s syndrome is also sometimes referred to as high-functioning autism. This is because a child with Asperger’s syndrome is able to understand what is happening in the environment and are often able to relate to others to a certain degree. They also have no clinically significant delays in cognitive development, which includes curiosity in his environment, self-help skills or adaptive behaviour. However, it is still considered a form of autism as a child with Asperger’s may still have the following struggles: trouble communicating with other people, interacting in social relationships, and having a rigid imagination with limited social play.
Kids with Asperger’s are often more fluent in speech than the other kids on the autistic spectrum. However, because they cannot comprehend linguistic nuances, their word choices may be on the formal side and not sound ‘normal’.
Those who have Asperger’s syndrome come across as very intense because they do not have the ability to think flexibly, nor do they have the ability to understand social cues and atmosphere. These kids show dogged preoccupation with certain objects or parts of an object. Oftentimes, they have repetitive patterns, such as being intensely focusing on one or more of their topics of interest which can seem abnormal or unusual to the rest of us.
Asperger kids are obsessed with routines or rituals which they adhere strictly to. Disturbances in these routines may impair their social and communicative functioning, or cause them extreme stress and anxiety. In such cases, they may also repeat certain physical actions such as flapping, twisting or some bodily gestures to cope emotionally .
Children with Asperger’s are known for their intelligence. Because of their focused fascination in a particular subject, they will learn everything they can on that subject and hence attain mastery in that subject. Unlike other forms of autism, these children display expertise, advanced vocabulary and the retention of their early language skills,
These children are most likely able to make friends and adapt into their own social circles, albeit with some hurdles, as they can communicate and understand feelings and emotions, although not as well. With patience and guidance, those with Asperger’s may have an easier time assimilating into society than those affected by more severe cases of autism.
Pervasive Disintegrative Disorder, Not Otherwise Specified (PDD-NOS)
PDD-NOS is also known as “atypical autism”. As with other forms of autism, children diagnosed on this spectrum generally exhibit difficulty in reciprocating social interaction and verbal or non-verbal communication. They may also display stereotypical or repetitive autistic behavior. What sets children with PDD-NOS symptoms apart is that the children may be missing certain key symptoms that would have otherwise placed them in a definite category (Asperger’s or Autism Disorder).
Like other forms of autism, PDD-NOS can occur in individuals with any level of intelligence, although its defining features are the impairment of social and communicative skills. However, as PDD-NOS is a relatively new category, there is no definite way of diagnosis. Different clinics may vary in their diagnosis.
There are studies that have suggested that persons with PDD-NOS can be placed in one of three different subgroups:
- The first group is a high-functioning one (around 25 percent) in which symptoms largely overlap with that of Asperger ‘s, but differ in terms of having a lag in language development and mild cognitive impairment. (Kids with Asperger’s do not generally have speech delays or cognitive impairments).
- The second group (around 25 percent) comprises of kids with autism who have symptoms that closely resemble those of autistic disorder, but do not fully meet all its diagnostic signs and symptoms.
- The third group (around 50 percent) of kids are those in which all the diagnostic criteria for autistic disorder are met, but the stereotypical and repetitive behaviors are noticeably mild.
Childhood Disintegrative Disorder (CDD)
The key feature of Childhood Disintegrative Disorder (CDD) is the loss of areas of functioning typically after two years of normal development. The skills previously learned will be lost. These skills can be language, social skills or adaptivity, bowel or bladder control, play and motor skills. There is also significant impairment in their social and communicative skills. CDD has also been referred to as Heller’s syndrome, disintegrative psychosis and “regressive autism”.
This section is mentioned in brief as Childhood Disintegrative Disorder is no longer included in the autism spectrum disorder diagnosis in DSM-5. Even prior to that, there was no true consensus as to whether CDD was considered an autism spectrum disorder.
Gina’s story about CDD may help you understand the disorder better, on a more everyday level.
If you suspect that your child may have symptoms that point to autism, it is beneficial to seek diagnosis. This is especially so if these symptoms are affecting his/her day-to-day life, such as basic motor skills (e.g using the toilet or getting to places), communication (e.g making friends), or during education (e.g learning disabilities).
While autism has no known cure, early intervention can alleviate symptoms. Receiving a proper diagnosis can make life smoother and more comfortable for you and your child. Children who have higher functioning autism can enroll in special schools or schools that provide support for children with autism. Even for severe autism cases, there are special centres that can cater to your child’s needs more effectively.
For healthcare services for autism in Singapore, click here. You can find the various treatments and therapies, nutrition tips, and a list of public and private support available.
For relevant educational services and resources for autism in Singapore, click here.
Raising A Child with Autism
It can be a lot to process when you find out that your child has autism. Kids with different abilities coupled with the degree of their autism require different methods of care for their needs.
Autism is not an uncommon disorder. Parents can be assured that they are not alone in the struggle. Online guides, help desks and various associations are available.
These websites are helpful in knowing more about the various aspects of autism, but should not be used as medical advice. Make a visit to the doctor for a professional opinion.
DSM-5 on Autism
Diagnostic and Statistical Manual of Mental Disorders
Autism Resource Centre (Singapore)
A local non-profit organisation dedicated to helping individuals with autism maximise their potential in life through advocacy and provision of services in education, employment and empowering of family caregivers or professionals.
One of the top online medical forums.
Wiley Online Library: Autism Research
A library with a medical database of published studies by researchers.
An american organisation that aims to improve lives of those suffering from autism. The page serves as an information guide.
A website hoping to bring people suffering from autism and their families together by spreading awareness and information about autism.
Autism Resource Centre (Singapore), accessed 30 January 2018
Centres for Disease Control and Prevention (US), articles written in 2016
The Straits Times “ 1 in 150 Children in Singapore has autism”, published 24 December 2016
Focus for Health, published 28 August 2017
Autism Speaks, accessed 31 January 2018
DSM-5 , accessed 31 January 2018
The Iris Centre, accessed 30 January 2018
The Free Dictionary (medical), accessed 30 January 2018
eMedTV, accessed 31 January 2018
Raising Children (Australia), accessed 31 January 2018
University of Hertfordshire, Intellectual Disability and Health, accessed 30 January 2018
The Conversation “ what happens when people with autism grows old?”, extracted 2 February 2018
All content found on the All In website, has been created for informational purposes only. The content is not intended to be a substitute for professional advice, diagnosis, or treatment.