Cases like those of Anderson and Mitchell demonstrate the range of langug ms | characteristics of children on the autism spectrum. This disorder Seem, aan caayiora chars and the general public. Researchers are intrigued by this mat fascinate researchers an : find a cause and a treatment. The genera] at defies their best efforts to é disorder ta oe pen raised by numerous depictions of those with the cond f . What is it about autism and related disor interest in al i films, on television, and in media article: make them so elusive and fascinating? [Definition of Autism Spectrum Disorders Autism is a complex developmental disability that causes significant difficulties with soci interaction and communication. Symptoms usually start before age three and can cause. lays or difficulties in many different skills that develop from infancy to adulthood (Nicki, 2011). It is one of a group of disorders sometimes called pervasive developmental dis. orders (PDD) or autism spectrum disorders (ASD). These terms recognize that aut behavior lies on a continuum (or spectrum) of severity. Although the number and severity of symptoms may vary, the disorders have several characteristics in common. | During the last 20 years, considerable progress has been made in narrowing ani | sharpening the definition of autism. Even the name (Kanner’s syndrome, infantile aution, autistic disorder) has changed. One of the most widely used definitions is that contained in the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV-TR), published by the American Psychiatric Association (2000). In the DSM-IV-TR, autistic disorder is con sidered one of a group of disorders called pervasive developmental disorders. In order tobe diagnosed with autistic disorder, a child must exhibit at least six of the symptoms included in the definition. These symptoms are distributed among three general categories: ition ders 1. Qualitative impairment in social interaction 2. Qualitative impairment in communication 3. Restricted repetitive and stereotyped patterns of behavior, A child must have at least two symptoms from group 1, one from group 2, and ot from group 3 in order to be a candidate for the saline aera label. In maatsce the onset of the disorder must occur during infancy or childhood (before 36 months of age) : Recently, in the Individuals with Disabilities Education Act (IDEA), the federal 6°” Tnment recognized autism as a distinct disorder. ‘The federal definition states: Autism means a developmental ‘communication and social inter interests, and activities disability significantly affecting verbal and nonverbal ‘action, generally evident before age 3, that advers¢lY m, engagement in repetitive activities and stereo! Movements, resistance to enviror ital yeah lpr ery eps i ae atin ‘The definitions rane DSM-IV and the IDEA contain specific and easly recogni a ere in practice, even highly skilled ionals have difficulty diag", autism. Frequently, children with autistic characteristics act like children with otLanguage and Students with Autism hearing impairments, or psychiatric disorders acteristics with children with other disabilities, children with autism have more se Although children with autism share char there are distinct differences. For example, eee "vere cognitive and behavioral impairments than those found among children with pervasive language disorders. Unlike children with other die, abilities, children with autism do not respond to communicative attempts by others, and unlike children with severe hearing impairments, the sensory impairments of children with autism fluctuate from one extreme to the other, Researchers believe that autism is one of a group of related disorders that includes Asperger Disorder (or syndrome), Rett syndrome, and Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS). These other disorders share characteristics with au- tism but also differ in specific ways. For example, the onset of autism is prior to age 3, but PDD-NOS may occur after age 3 (Lord & Risi, 2000), There is an ongoing debate in the scientific literature about whether Asperger syndrome is part of the autism spectrum or a separate disorder. Although the current version of the Diagnostic and Statistical Manual in- cludes Asperger syndrome as a separate disorder on the autism spectrum, the group work- ing on the next revision of the manual has proposed that Asperger syndrome be subsumed within the autism definition, so it would not be recognized as a separate disorder. Like children with autism, those with Asperger syndrome usually have deficiencies in social in teraction but have much better language and cognitive skills than children with autism. For most of the remainder of this chapter our focus will be on language and communication disorders associated with autism. Until recently, most of the research has focused on this population. However, we will also examine the research on the language and communica- tive characteristics of individuals with Asperger syndrome because of growing interest in and identification of this population in schools. [Gharacterist s of Autism Spectrum Disorders The DMS-IV-TR definition of autism identifies three major characteristics: impai ments in social interaction; impairments in communication; and restricted repetitive and stereotyped patterns of behavior, interests, and activites. Let look at each of these in more detail. Impairments in Social Interaction Significant impairments in social interaction are the defining feature of avtism Hoge, 2000). Young children with ASD often are not responsive to parent cares They do not respond to the subtle social stimuli of facial expressions sod more that form the foundation of human social interaction (Dawson eta 2901), an, dren with autism have been found to engage in joint attention sree ee others ‘much less than typically developing children (Osterling, Dawson. 0 srt ey early defcts in social interaction do not go away. They persist through the schoo! into adulthood.er — ication Impairments in Language and — ; . i in language andy, i trum disorders have severe disorders HABE andre ae boat me “of children with autism (up to half, in some estima. aver develop speech (Tager-Fiusbergs Paul, & Lord, 2005). Language and commun, dit ties are evident in most young children with ASD and persist through adu} ifficul guage development (Howlin, 2003). There ae g ven in adults with reasonably good lan} nificant delays in language development, but, even more important, there are characters. differences in language development in most ind! viduals with autistic spectrum disorder Restricted Repertoire of Activities and Interests “The “restricted repertoire” of activities and interests category includes the following characteristics = interests that are narrow in focus, overly intense, or unusual m= “unreasonable” insistence on sameness and routines = repetitive motor mannerisms ® preoccupation with object Many children with autism spectrum disorders are described as engaged in stereotypic behaviors, such as spinning objects, twirling their fingers in front of their face, slapping tet heads, flapping their hands, and the like. These behaviors may increase or decrease in int sity based on the child’s age and social situations (Boutot & Myles, 2011). Children with ASD are not the only individuals with disabilities who engage in such behaviors, but the behav seem to be particularly characteristic of autism spectrum disorders. In addition, individwss a S often have a compelling desire for sameness and routine. They may become upset eocating their room is out of place or if their usual schedule is changed in any way. Thi 'ause problems in schools, where classroom schedules are subject to change. Causes of Autism disorder is imy Early theories of autism f Foti focus - a cause ofthe syndrome. Kanner (1943) aa ay and amily interaction 38 the tae ‘ss cased by parents who were unuaval ge etlbei (1967), suggested thlanguage and Students with Autism personality traits f parents of children with autism ou dren (Prior & Werry, 1986). Although autistic chil rather than to peychopathlegy een or be AU othe Behavior of the Ifparents do not cause autism, what den eae ical disorder underlying autism. Howeves to pinpoint. A recent review of research on umber of suspected causes, including. or in the way they relate to their chil- Des? More and more evidence points to a biolog- the specific biological problem has been difficalt the causes of autism (Hughes, 2008) identified a s intriguing evidence for a genetic and/ or chromosomal basis for autism. Studies of the incidence of autism within families have found that siblings, especially identical twins, are at much higher risk for autism (Folstein & Rutter, 1988). While a number of chromosomes and genetic structures have been implicated as possible causes of autism, no single chromosome or gene has yet been definitely linked with the disorder. Hughes (2008) suggests that this may be because autism has a complex genetic architecture and may be caused bya combination of genes and/or chromosomes, 7 7 = Central nervous system disorder: Many regions of the brain (including the frontal lobes, amygdala, hippocampus, and brainstem) have been identified as being either structurally or functionally different in autism. In addition, various neurochemicals (such as serotonin) have been implicated in the disorder. However, as with genetic and chromosomal disorders, no region of the brain or functional difference has been conclusively linked with autism. = Vaccinations: There has been a lot of controversy about the possible link between vaccinations and autism. Specifically, it has been claimed by some that thimerosal, a substance that was added to some vaccines prior to 2001, may be linked to autism. However, a comprehensive review conducted by the Centers for Disease Control (Price et al., 2010) has failed to find any evidence for such a link. What can we conclude about the etiology of autism? Unfortunately, not much. While there is significant evidence that autism is a neurobiological disorder that soy pave 8 ge- etic basis, scientists have not yet identified a single cause ora group of causes of autism. I is possible that what we call “autism” is really a group of disorders with — aa tcs (such as severe social dysfunction, specific language disorders et.) at may manilest ise diferent ways with diferent individuals As we lear more bout the ewig cal basis of autism, we may find that specific symptoms can be explaine a tors, even ifthe nature ofthe overall disorder remains a puzzle language and Communication pene)” Deficiencies in language and communication are an important itv mn Spectrum disorders—some would say the most Se eetderinnsl (McEachin, Cation skis have been found to be an excellent predictor ofan Cr ee Sait, & Lovas, 193). Cilden pie coarmind have better overall outcomes. As Successfully included in school ommunity—_————— develop spoken lan, in thi hildren with autism do not P el noted aie ee es language, there are nels delays in developmen oe ili i t deficits. cat ae of relatively preserved abilities and significant munication Development Eatty Language and Com {children with autism i y e development of children with autism becay, It is not easy to ee Pe peel age pe later. However, in two innovating the disorder is wsuil'Y Or abies who were later identified as autistic, Osterling and he Be Ga aes Demat, 1994; Osterling, Dawson, & Munson, 2002) found tha, ae ‘with autism were less likely to look at people, look at eee by people avant to their name, and use gestures than typically developing 1-year-olds. These resus suggest that, right from the start, language development is a problem for children with autism. You may recall from chapter five of this text that one of the earliest communica. tive developments takes place when infants and their parents receive attention from each other, This interaction sets the foundation for the development of communication and eventually language. But children with autism have been found to have significant defi- cits in joint attention (Kasari, Freeman, & Paparella, 2001). That is, they are less likely than typically developing children to share their attention with a caregiver over an ob ject or activity. Young children with autism initiate and respond to joint interactions less frequently even when compared with other children with developmental disabilities (Chiang, Soong, Lin, & Rogers, 2008.) It appears that these difficulties with joint atten tion do not improve over time. When Dawson et al. (2004) compared the joint attention skills of children with autism around four years of age to similar age children with pet vasive developmental disorder and to younger, typically developing children, they found that the autistic children made fewer attempts to initiate joint attention and were less ay to sane to the examiner's attempts to engage them in joint attention. oie ea eee eh attention, young children with autism use fewer ae ee than children with language disorders and is- Gl Rane aie ne Taeeesae ad Ghesmacilea pl ildren with autism at significant risk for deficits in ication. Even when children with autism develo, ken language: they do so at a later age and develop more slowly th ae ith Ialeslae dteorsierk ly than other children—even those i 2 gees Beane ance that many children with autism actually reste pI luring the early childhood years. F Landa and Garrett-Mayer (2006) found that children with autisn betwen'e and 2a ne : rienced a progressive slowing in rate of recent autism between 6 and 24 months hi For the children in their study who we eptive and expressive language developm=*; age, there were no significant gains in re initially identified as autistic at 14 months those identified aftr Ti nan as in Communication between 14 and 24 months ro over time. , there was a pattern of declining communication sk Children with “high-functioning” autis those with IQ scores higher than 80 followa pallens chan oe cul dnl