Today we had a chat with John’s teacher on how autism can be treated. She is experienced and said that whether a child will grow out of autism or not depends also on how severely autistic he/she is. We witnessed John as he was having social skills lesson, which is one area where he is weak in.

How can Autism be treated?

There is no cure for autism at the moment, but doctors, therapists, and special teachers can help kids with autism overcome or adjust to many difficulties.

Autism itself is not treated with surgery or medicine, although some people with autism may take medicine to improve certain symptoms.

The best results are usually seen with children who begin treatment when they are very young, as soon as they are diagnosed.

Treatments

Autistic children often have problems which centre around social and language skills.

The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication.

· Teaching the child to communicate: Pointing or using pictures or sign language and to interact with others, eventually, many kids with autism learn to talk.

· Basic living skills: Crossing a street safely or ask for directions, greeting people, waiting for a turn, and following directions etc.

Autistic children are also prone to behavioral problems such as emotional outbursts, aggressive behavior or attention problems.

• Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child.
• Medications: Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity.

Possible outcomes

As they mature, some children with autism become more engaged with others and show less marked disturbances in behavior. They still require teachers trained to understand the problems they have with communicating and learning.

Some, usually those with the least severe impairments, may eventually lead normal or near-normal lives. They may be taking regular classes or attending special classes at the secondary school level.

Others, however, continue to have severe impairments in language or social skills, and the adolescent years can mean a worsening of behavior problems. They may be attending a special school because of ongoing behavioral problems.

Today we shall discuss the characteristics of autistic people. What all individuals diagnosed on the autism spectrum have in common are delays or disabilities when it comes to social skills such as ordinary conversation, eye contact and emotional understanding of others. These issues are likely to lead to impaired social interaction, problems with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests. Most people with autism also share delays in fine and gross motor skills. It’s important to note, too, that “symptoms” of autism can also be strengths. For example, a child on the autism spectrum may have better observational abilities a typical child of the same age.

Social impairments
Social impairments become apparent early in childhood and continue through adulthood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers have more striking social deviance; for example, they have less eye contact and anticipatory postures and are less likely to use another person's hand or body as a tool. Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers. Contrary to common belief, autistic children do not prefer to be alone.

We interviewed the parents of 67 children with ASD and it was reported that about two-thirds of the children had periods of severe tantrums and about one-third had a history of aggression, with tantrums significantly more common than in children with a history of language impairment.

Communication
About a third to a half of individuals with autism does not develop enough natural speech to meet their daily communication needs. Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and the desynchronization of vocal patterns with the caregiver. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words. Autistic children may have difficulty with imaginative play and with developing symbols into language. They are more likely to have problems understanding pointing; for example, they may look at a pointing hand instead of the pointed-at object. As people are often sized up initially from their basic language skills, people speaking to autistic individuals are more likely to overestimate what their audience comprehends.
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John tells us this today:
I do not like to be touched. I also do not like loud noises like people shouting. It makes my brain hurt and I end up groaning on the floor. My parents understand this and do not shout at me nor hug me. Instead, my parents and I hold hands with our fingers together, spreading out like a sun. This is how my parents tell me they love me.
I like dogs. I feel that they are easier to understand than other humans. Dogs only feel three emotions: happy, sad or cross. I can understand them easily. Sometimes I cannot understand what people are saying to me, so I keep quiet. They wait awhile, but in the end they always leave, leaving me all alone.
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Repetitive behavior
Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.
Stereotypy is apparently purposeless movement, such as hand flapping, head rolling, or body rocking.

Compulsive behavior is intended and appears to follow rules, such as arranging objects in a certain way.

Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.

Ritualistic behavior involves the performance of daily activities the same way each time, such as an unvarying menu or dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.

Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program.

Self-injury includes movements that injure or can injure the person, such as biting oneself. It was reported that self-injury at some point affected about 30% of children with ASD.

No single repetitive behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.

Other symptoms
Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family. A small fraction of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.

Thus concludes our research on the characteristics of autistic people.

Si Chun

John writes today:

I find people confusing. The first main reason is that people do a lot of talking without using any words. My teacher says that if you raise one eyebrow it can mean lots of different things. It can mean ‘I want to do sex with you’ and it can also mean ‘I think that what you just said very stupid.’

Today we investigate the social impacts of autism, both on the autistic people and the rest of us.

Social Implications

There are an estimated six in 1000 people with varying forms of autism. As such, it is unpreventable that they have an impact of on society.

Society has often ostracized many autistic individuals; perhaps because they are unaware they have a condition and perceive them to be unsociable and abnormal.

Curing autism

Curing autism is a controversial and politicized issue. Some seek a cure for autism, while others view autism as a way of life rather than as a disease, and as such consider a cure unnecessary and resist efforts to find one.

We believe there are benefits in trying to help people with autism-spectrum conditions with areas of difficulty such as emotion recognition. Nobody would dispute the place for interventions that alleviate areas of difficulty, while leaving the areas of strength untouched. What campaigners against cures for autism are afraid of is that autistic people lose their specialized ability - such as the remarkable attention to detail, and the ability to concentrate for long periods on a small topic in depth. Autism is both a disability and a difference. We need to find ways of alleviating the disability while respecting and valuing the difference.

Internet

In our world of technology, many autistics find it easier to communicate online than in person, resulting in a large number of online resources on the internet. The Internet helps bypass non-verbal cues and emotional sharing that autistics find so hard to interact with. It gives autistic individuals a way to communicate and form online communities.

A New York Times article said "the impact of the Internet on autistics may one day be compared in magnitude to the spread of sign language among the deaf" because it opens new opportunities for communication by filtering out "sensory overload that impedes communication among autistics".

Social impacts

Autism may lead to problems in social interaction with peers. These problems can be severe or mild depending on the individual. Children with Asperger’s syndrome (a milder form in autism-spectrum disorders) for example are often the target of bullying at school due to their idiosyncratic behavior, precise language, unusual interests, and impaired ability to perceive and respond in socially expected ways to nonverbal cues. Children with autism may be overly literal, and may have difficulty interpreting and responding to sarcasm, banter, or metaphorical speech. Difficulties with social interaction may also be manifest in a lack of play with other children.

Family – Parents or siblings unaware of autism or prejudiced towards autism often mistreat the autistic child.

Certain problems can even arise in the family; given an unfavorable family environment, the child may be subject to emotional abuse. A child or teen with autism is often puzzled by this mistreatment, unaware of what has been done incorrectly. Most children with autism want to be social, but fail to socialize successfully, which can lead to later withdrawal and asocial behavior, especially in adolescence. At this stage of life especially, they risk being drawn into unsuitable and inappropriate friendships and social groups.

Schoolwork

Children with autism often display advanced abilities for their age in language, reading, mathematics, spatial skills, and/or music—sometimes into the "gifted" range—but this may be counterbalanced by considerable delays in other developmental areas. This combination of traits can lead to problems with teachers and other authority figures. The child’s extremely low tolerance for what they perceive to be ordinary and mediocre tasks, such as typical homework assignments, can easily become frustrating; a teacher may well consider the child arrogant, spiteful, and insubordinate. Lack of support and understanding, in combination with the child's anxieties, can result in problematic behavior (such as severe tantrums, violent and angry outbursts, and withdrawal).

Adults

Although adults with autism may have similar problems, they are not as likely to be given treatment as a child would. Adult individuals diagnosed with autism may find it difficult finding employment or entering undergraduate or graduate schools because of poor interview skills .

Two traits sometimes found in autistic individuals are mind-blindness (the inability to predict the beliefs and intentions of others) and alexithymia (the inability to identify and interpret emotional signals in oneself or others), which reduce the ability to be empathetically attuned to others.

A second issue related to alexithymia involves the inability to identify and modulate strong emotions such as sadness or anger, which leaves the individual prone to "sudden affective outbursts such as crying or rage. People around them may choose not to accept this behaviour and exclude them from their social circle.

Marriage

A much smaller proportion of adult autistics marry than the general population. Individuals with autism will need support if they desire to make connections on a personal level. The complexity and inconsistency of the social world can pose an extreme challenge for individuals with autism, since it is often illogical.

Girls

The ratio of autistic boys to girls is estimated to be 4.3: 1. Autism may express differently in girls than boys; girls may be more concerned with how they are viewed by peers, and the failure to connect with people outside of their immediate family could lead to severe anxiety or clinical depression. Girls with autism who have normal intelligence may be more disadvantaged than boys socially because of the rising level of social interaction that comes in middle school, when girls' friendships often hinge on attention to feelings and lots of rapid and nuanced communication.

Parenting

Parenting a child with autism endures more stress than parenting a child with any other disability & heightens negative outcomes on health.

• Insistence on sameness; resistance to change
• Difficulty in expressing needs; uses gestures or pointing instead of words
• Laughing, crying, showing distress for reasons not apparent to others
• Prefers to be alone; aloof manner
• Tantrums
• Difficulty in mixing with others
• May not want to cuddle or be cuddled
• Little or no eye contact
• Unresponsive to normal teaching methods
• Inappropriate attachments to objects
• Apparent over-sensitivity or under-sensitivity to pain
• No real fears of danger
• Noticeable physical over-activity or extreme under-activity
• Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

Crime offending

There is no evidence of an association between autism and criminal offending. In fact, due to the rigid way many people with autism keep to rules and regulations, they are usually more law abiding than the general population. People with autism are more at risk as victims of crime rather than as offenders.

The following are examples of the main types of offences people with autism may commit:

• The desire to have friends has led some people with autism to be befriended by, and become unwitting accomplices of criminals.
• Offences of an aggressive nature, which are often related to an unexpected change in routine or to the environment, which may cause great anxiety and distress.
• Offences relating to a misunderstanding of social cues. For example many people with autism have difficulties with eye contact. Often eye contact will be avoided or may be fleeting. In some cases eye contact may be prolonged or inappropriate and on occasion this has been interpreted as making unwanted sexual advances.

In addition, the methods used by the police may exacerbate a situation for someone with autism. The use of handcuffs and restraint by the police may be extremely frightening for someone with autism who does not understand what is happening, and may not be able to communicate their fears in an appropriate way. In extreme circumstances they may hit out at people including the police.

Criminal acts by people with autism may be due to a variety of factors, but it seems that there is rarely a deliberate intention to hurt others.

We end our investigation of the social impacts of autism.

Timothy