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Definition of Autism
Ruth C. Sullivan, Ph. D.
Revised 1997

Autism is a severe disorder of communication and behavior and lifelong disability which typically appears during the first three years of life. It occurs in approximately 20 out of 10,000 births; roughly 10 percent are classically autistic, falling into the category first described by Kanner (1943) and later by Rimland (1964). Three out of four are male. It has been found throughout the world in families of all racial, ethnic, and social backgrounds. No known factors in the psychological environment of a child have been shown to cause autism. More than 60 etiologies, or causes, have been identified. There is no known cure, although early intervention and appropriate education and training have proven effective, with learning of social and adaptation skills often continuing throughout adulthood. The condition can best be behaviorally described by specific characteristics, which may exist in varying combinations and degrees of severity.

A neurological disorder, autism may occur by itself or in association with other disorders which affect the function of the brain, such as viral infections, metabolic disturbances, epilepsy, and other functionally retarding disorders of behavior and communication.

The two essential features of autism are:

• Extreme aloneness and unresponsiveness to other people. probably based on the profound inability to understand and use language in a normal way.
• Preservation of sameness, sometimes labeled obsessive, compulsive.

These characteristics remain to some extent throughout the individual's life, but often, especially with appropriate education and training become less severe, less disabling. Symptoms must be documented by history of be present on examination

A combination of some or all of the following characteristics are found in individuals with autism. These behaviors vary from person to person in severity and manner.

1. Extremely impaired relatedness to other people.
2. Severely impaired speech or lack of speech. Speech development may be normal, then suddenly stop at about 18 months. Echolalia is common in their early years. some individuals whisper for periods of their lives. Some have unusually fast speech. Some sing or talk backwards. Half never speak, though that may change with better programs. Tone is flat.
3. Repetitive behavior, sometimes seeming to get "stuck," which seriously impedes learning.
4. Extreme distress for no discernible reason, equally with major or even with minor changes in the environment.
5. Delayed development in certain areas, sometimes accompanied by normal or superior skills in others, such as arithmetic, music or memory (often referred to as "splinter skills" or in the case of extraordinary performance, "savant" skills.).
6. Inappropriate use of toys and objects, often in a highly repetitive and unusual manner.
7. Peculiar body motions, such as incessant rocking, flapping arms or hands, or flicking fingers.
8. Unusual reaction to perceptual stimuli, such as seeming to not hear certain sounds yet overreacting to other (e.g., holding hands or ears, extremely sensitive to touch.)
9. Gaze aversion, or "looking through," instead of at people. Seems aloof, unengaged, "spacey."
10. Many have good-to-superior fine and gross motor skills, but some walk with peculiar gait, "toe-walk," or have limpness in fingers and hands (e.g., seem unable to hold a pencil).
11. Many are extremely hyperactive, but a subgroup is extremely hypoactive.
12. Apparent insensitivity to pain (e.g., walking barefoot in snow, pulling out hair or fingernails).
13. A subgroup (generally thought to be approximately 25%) develops seizures, usually at puberty.
14. Some, probably fewer than 10%, become self-abusive, sometimes severely so.
15. Sixty-five percent are non-right-handed.

Autism is treatable - early diagnosis and interventions are vital to the future development of the child in that they can help ameliorate the deleterious effects of many autism characteristics.

The accompanying chart visually portrays the more important signs and symptoms of autism. If a child exhibits seven or more of the symptoms listed above and in the chart and if the bizarre behavior is constant and inappropriate for the child's age, further evaluation is recommended.

This working definition is a composite of personal and professional experience (36 years) and of the two officially published definitions of the Autism Society of America (ASA), which are closely followed by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM III and DSM IV).

© Autism Society of Pittsburgh