the Autism Spectrum

I found this website the gives great info on the Autism Spectrum:
http://www.pediatricneurology.com/autism.htm

Here's a little from the site:

The Skills Involved in Communication

In order for us to effectively communicate, we need skill in multiple areas, including (A) verbal and  (B) non-verbal arenas.

(A) Verbal/Spoken Communication Skills (may or may not be affected in ASD)

Semantic language: The ability to use and understand words, phrases and sentences; including abstract concepts and idioms. Aspects of semantic language include: Receptive verbal language: The ability to understand spoken words and ideas. Central Auditory Processing (CAP): A mixed group of abilities needed to process and derive meaning from sounds and words; including the abilities to distinguish between similar sounds, and to pick out the main voice from background. In short,“what we do with what we hear.” Expressive verbal language: The ability to express our ideas with spoken words. Articulation: The ability to speak each word clearly.

(B) Non-Verbal/Non-Spoken Communication Skills (Problematic in ASD)

Urge to initiate shared social interaction and two-way communication: Theory of Mind.

The ability to socialize/relate/empathize requires a working “Theory of Mind.” Theory of mind refers to the relatively unique ability of humans to understand: (1)that I have a mind, (2) that you have a mind; and most importantly, (3) that our minds may not know or be feeling the same things.  Without a theory of mind, there is little point in communicating. After all, who would you be communicating to? There is limited ability to truly recognize that there is another human being in the room. It will be difficult to feel the need to communicate with anyone else. It may seem as if there is a plane of glass between the child and others. Eye contact will be poor.

With limited ability to “get inside your mind,” it will be frequently difficult for the child to demonstrate empathy for what you are feeling. For example, a child with theory of mind problems may assume that since he is happy, then you must be happy; or the child may not understand that someone else is deceptive when his own mind always attempts honesty. 

Thus, the ability to recognize that you have a mind, the ability to relate to that mind, and the ability to empathize with that mind are all parts of the same skill. It is felt that theory of mind problems underlie many of the difficulties seen in the Autistic Spectrum Disorders.

Closely related to the “interest” in social communication (that arises from a working theory of mind) are the following skills.  They are required to actually achieve the meaningful interaction.  Certainly, if you don’t have these skills, your ability to appear interested in social interaction may become blunted.

	Pragmatic language: The practical ability to use language in a social setting, such as knowing what is appropriate to say, where and when to say it; and the give and take nature of conversation. Effective pragmatics requires a working theory of mind:  the ability to figure out what the other person does or does not already know—or might or might not be interested in hearing about. Examples of pragmatic language/theory of mind problems would be: A new student moves into the school district and enters the classroom for the first time. The teacher asks him where he comes from. The Autistic Spectrum child responds: “From the hallway.” As an Asperger’s child walks into the office, the doctor notices that her pink shirt matches the color of her jacket. He jokes, “If you change into a green shirt, does the color of the jacket change, too?” The child responds: “My wardrobe includes a turquoise shirt, not a green one.” This child’s spoken language is precise, but she misses (1) the actual meaning of the question; and more importantly, (2) misses that the whole purpose of this conversation was just a little fun chit-chat to initiate an interaction.
	The skill to know what is—and what is not—important Ability to see the big picture rather than fixate on details. Ability to maintain a full range of interests.
	Symbolic play skills Give a child a yellow box on wheels, with thin long black strips on it. The ability to understand that this object actually represents a school bus is a type of communication—just like the ability to recognize that the letters “C-A-T” stand for a furry animal. Both involve the use of symbols rather than the actual object to communicate. By 18 months, most toddlers start to use objects as symbols for something else. For example, a cup is for drinking, but it also makes quite a handy telephone. By 3 years of age, most children are quite good at “let’s pretend” activities, such as “You be the cowboy!” The toy school bus is not fascinating because the cold metal box can move, but because little toy figures chat while getting on it as they go to school. Stuffed animals are not just warm rags of cloth to drag around, but living creatures that have feelings and needs. So, by 18-36 months of age, typical children make continuous progress in the skill of appreciating the representational meaning of a toy, rather than focusing on its straight forward visual attributes.  Failure to develop representational/symbolic/pretend play is a strong marker of the Autistic Spectrum Disorders. After all, if you cannot understand that a physical toy bus represents a real truck, how could you understand that the even more purely representational sound “bus” represents a real truck.
	Non-verbal (non-spoken) transmission of language. The simple sounds are not the only thing my body sends through space when it attempts to communicate with you. It also transmits: Facial expressions Body language Tone and prosidy of voice

·        Associated skills sometimes also involved with language problems:

o       Motor (muscle) coordination, including both gross and fine motor.

o       Spatial orientation.

o       Overall cognition.

Secondary Problems Resulting from Failure to Understand

If the child does not understand what is going on around her—especially if pragmatic/socialization cues are difficult—secondary problems usually occur in the Autistic Spectrum Disorders. The child will frequently appear:

·        Anxious, since she doesn’t know where the next blunder will come from.

·        Insistent on sameness and showing ritualistic behavior.  Change means that previously hard-learned strategies will not help in this situation.  These kids are barely hanging on. One new wrinkle can throw them over the edge. For example, Jill may know how to unpack her lunch from her backpack each day; but, what happens if the lunch is missing. Now what do she do?

·        Inattentive, since it’s hard to pay attention to something you don’t understand.

·        Rude-appearing, since she doesn’t understand rules of conversation such as waiting your turn.

·        Interested in objects rather than people. After all, objects are more predictable.

·        “Hanging back” from peers, for all of the above reasons, and from simply not knowing how to make conversation and relate.

·        “Out of it” and “odd” looking.

 

Categories of Communication Disorders

When a child has difficulties in these areas out of proportion to his/her general cognitive abilities, he/she can be considered to have a communication disorder.

Difficulties in the above skills can group together in varying combinations and severities, allowing for the naming of several communication disorder syndromes. As we shall see, these disorders overlap greatly. They may also co-exist as “co-morbid” conditions, may lead to each other, and some may even be duplicates of the same condition but approached by different specialties. Additionally, as children develop, their symptoms and most appropriate diagnostic classification might change. The human brain is not so simple that its disorders fit into neat, static categories. Nonetheless, we still attempt to find certain patterns.  Unless we know about the range of syndromes, we will fail to look for important symptoms that need to be addressed.  These disorders are (over) simplified in Table 1 below.

Disorders of the communication skills are grouped into two major types of “disorders.”

(A) Typical language-based learning disorders are due to problems in the purely spoken/written language communication skills. These include Expressive, Receptive, Processing, and Articulation Language Disorders. Most routine speech and language evaluations examine these areas.  Note that routine psychological testing (such as the WISC- “IQ”) examines areas of cognition (thinking), rather than language per se.

(B) Autistic Spectrum Disorders (ASD) are those that include non-spoken communication problems—in particular, problems with socialization/empathy. In other words, the Autistic Spectrum Disorders all share trouble with theory of mind, socialization, the pragmatics of language, and  representational play.   They may occur with or without additional verbal speech problems.

In turn, the Autistic Spectrum Disorders are written about in two groupings. These are summarized in the two charts below, and then are discussed in more detail.

(1) The Pervasive Developmental Disorders (PDD), defined in DSM-IV by the American Psychiatry Academy. These are a series of five diagnoses--of which autism is the most commonly discussed. “Pervasive” means that the problem cuts across multiple types of communication.  These five disorders are:

Autistic Disorder	Severely disordered verbal and non-verbal language; unusual behaviors.
Asperger’s Syndrome	Relatively good verbal language, with “milder” non-verbal language problems; restricted range of interests and relatedness.
PDD-NOS	Non-verbal language problems not meeting strict criteria for other PDD disorders.
Rett’s Disorder*	Rare neurodegenerative disorder of girls.
Childhood Disintegrative Disorder*	Neurologists are scratching their head on this one, and assume psychiatrists mean neurodegenerative disorders.

*In common practice, the diseases of Rett’s Disorder, and Childhood Disintegrative Disorder are considered medical disorders and are not usually considered part of the “Autistic Spectrum Disorders.”

(2) Other Autistic Spectrum Disorders

Meanwhile, the rest of the world has extended the spectrum beyond those conditions discussed in DSM-IV to include other “Autistic Spectrum Disorders.” These are:

Semantic Pragmatic Communication Disorder	Delay and trouble with the use of language (both semantic and pragmatic), but socialization relatively spared.
Non-Verbal Learning Disabilities	Trouble integrating information in 3 areas: non-verbal difficulties causing the child to miss the major gestalt in language; spatial perception problems; and motoric coordination problems.
High Functioning Autism	For some authors, synonymous with Asperger’s; for others, implies milder autism without retardation.
Hyperlexia	Most notable for incredible rote reading skills starting at an early age.
Some aspects of ADHD	Impulse and control difficulties in ADHD may lead to trouble showing their empathy.