Causes psychological and family factors. Although Henry Maudsley, in the late 1800s, was the first psychiatrist to focus on very young children with mental disorders, it was the psychiatrist Leo Kanner who coined the phrase "early infantile autism" in 1943. Kanner believed that the parents of children with autistic behaviors were emotionally cold and intellectually distant. He coined the term "refrigerator parents" to describe them. His belief that parental personality and behavior played a powerful role in the development of autistic behaviors left a devastating legacy of guilt and self-blame among parents of autistic children that continues to this day. Recent studies are unequivocal, however, in demonstrating that parents of autistic children are no different from parents of healthy children in their personalities or parenting behaviors. In fact, many families with an autistic child also have one or more perfectly healthy children.
Because autistic children can be extremely sensitive to change, any change within the family situation can be potentially traumatic to the autistic child. A move, divorce, birth of a sibling or other stressors that occur in the lives of most families may evoke a more extreme reaction from an autistic child.
neurological and biological factors. While there is no single neurological abnormality found in children with autistic disorders, some research using non-invasive brain imaging techniques such as magnetic resonance imaging (MRI) suggests that certain areas of the brain may be involved. Several of the brain areas being researched are known to control emotion and the expression of emotion. These areas include the temporal lobe (large lobe of each side of the brain that contains a sensory area associated with hearing), the limbic system, the cerebellum, the frontal lobe, the amygdala, and the brain stem, which regulates homeostasis (body temperature and heart rate). Recent research has focused particularly on the temporal lobe because of the finding that previously healthy people who sustain temporal lobe damage may develop autistic-like symptoms. In animal research, when the temporal lobe is damaged, social behavior declines, and restless, repetitive motor behaviors are common. When measured by MRI, total brain volume appears to be greater for those with autistic disorders.
Other neurological factors include lesions to the brain, congenital rubella, undiagnosed and untreated phenylketonuria (PKU), tuberous sclerosis, and Rett's disorder (a related condition in which the baby develops in an apparently normal manner through age five months, and then begins to lose communicative and social interaction skills). There is also evidence of a higher proportion of perinatal complications (complications arising around the time of giving birth) among children with autistic symptoms. These complications include maternal bleeding after the first trimester and meconium in the amniotic fluid. (Meconium is a substance that accumulates in the bowel of the developing fetus and is discharged shortly after birth.) Some evidence suggests that the use of medications during pregnancy may be related to the development of autistic symptoms. As newborns, children with autistic behaviors show a higher rate of respiratory illness and anemia than healthy children.
allergies, infections, and immunizations.
Some professionals believe that autistic disorders may be caused by allergies to particular fungi, viral infections, and various foods. No controlled studies have supported these beliefs, but some parents and professionals report improvement when allergens and/or certain foods are eliminated from the diet.
Viral infections of the mother, such as rubella, or of the young child, such as encephalitis, mumps, and measles, occasionally appear to cause autistic disorders. The common childhood immunization series known as MMR (measles, mumps, rubella) has recently come under scrutiny as a possible cause of some autistic conditions.
DSM-IV-TR specifies three diagnostic categories, each with four components, that are used to make a diagnosis of autistic disorder. These diagnostic categories include impairments in social interaction, communication, and particular patterns of behavior. More information about the individual diagnostic categories and components follows.
social interaction. Qualitative impairment in social interaction, as demonstrated by at least two of the following:
• impairment in the use of nonverbal behaviors such as eye contact, facial expression, body posture, and gestures used for social interaction
• failure to develop age-appropriate peer relationships
• lack of attempts to share pleasure, activities, interests, or achievements with other people (by failing to bring items of interest to a parent, or pointing out animals or objects, for example)
• inability to respond to social situations or other people's emotions with empathy or a concerned attitude communication. Qualitative impairments in communicating in at least one of the following four areas:
• lack of, or delay in development of spoken language, without attempts to communicate through alternative means such as gestures or mime
• in individuals who do speak, severe impairment in the ability to initiate or sustain a conversation with others
• repetitive and stereotyped use of language, or use of words in unusual, idiosyncratic ways
• failure to show imaginative play, such as make-believe or social imitative play appropriate to developmental level behavior. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as demonstrated by at least one of the following:
• unusual and overly absorbing preoccupation with one or more interests or activities
• a need for rigid adherence to specific routines or rituals in daily life
• stereotyped and repetitive motor behaviors using parts of the body such as fingers or hands, or the whole body
• persistent preoccupation with parts of objects
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