Leo Kanner, who was the first to identify autism in 1943, offered a psychodynamic explanation for it. According to his speculation, the reasons for children to be driven into their own worlds were cold and ungiving family environments during their infancy. Their parents (the mothers, in particular), were described as 'refrigerator parents', who had thawed out just long enough to conceive a child.
These were purely theoretical statements, with no evidence of the existence of such family patterns. But generations of parents who were exposed to this hypothesis suffered from the thought that they were the cause of their children's autistic condition. While scientists can't pinpoint the exact causes of Autism Spectrum Disorder (ASD), it is believed that genes, as well as environmental factors, may act together in affecting the ways in which ASD develops. However, scientists are still trying to understand the reason for which some individuals develop ASD while others do not. One in 68 children in the USA are diagnosed with Autism.
Biological factors
According to Kabot, today, it is widely-accepted that Autism has a biological basis, but these factors remain undetermined. However, there have been widespread abnormalities found in the structures and functioning of the brains in autistic children. For example, brain imaging studies show autistic children's brains to be larger than average, reflecting abnormal brain growth during the first year of life. These children also reveal abnormal development in their cerebellum, which coordinates movement and is also involved in the shifting of attention (Courchesne).
Genetic factors have been linked to autism with siblings of autistic children being 200 times more likely to have the disorder than those in the general population. According to Piven, the concordance rate is highest in identical twins. No single gene seems to be involved; instead, there may be multiple interacting genes. According to a notable finding by Rutter, many relatives of autistic children with no manifestation of the disorder themselves, tend to have unusual personality characteristics that parallel autism, including aloofness and very narrow and specialised interests.
Theory of Mind
Another line of research is the examination of autism from the Theory of Mind perspective. According to Ritblatt, the Theory of Mind refers to awareness of what others are thinking, as well as their 'internal reactions'. Normal children tend to be aware of other people's characteristics by the time they reach the age of 3 or 4. Autistic children, however, seem to have poorly-developed skills in this area, which makes it difficult for them to communicate with others or understand the internal reactions of other people towards them (Heerey).
Autistic children also show poor comprehension of other people's emotional responses, such as expressions of distress. The deficits mentioned in the Theory of Mind could severely impair their language and social development—which makes them a strong focus of current research on autism.
- Having a sibling with ASD
- Being born to older parents
- Having certain genetic conditions (Down/Rett/Fragile X Syndromes)
- Very low birth rate
Diagnosis
ASD is diagnosed by looking at such a person's behaviour and development. By the time a child is 2 years old, ASD can be reliably diagnosed. It is important for concerned parties to seek out an assessment as soon as possible in order for a diagnosis to be made and treatment to begin as soon as possible for better treatment. Diagnosis in young children is often a two-stage process.
Stage I:General development screening during well-child checkups
Every child should have a well-child checkup by a paediatrician or an early childhood healthcare provider. The American Academy of Paediatrics recommends all children to be screened for development delays at their 9, 18, 24 or 30-month well-child visits and, specifically, for autism at their 18 and 24-month well-child visits. Additional screening may be needed in the case of a child being of high risk for Autism or development issues such as having a family member with ASD, having certain autistic behaviours or genetic conditions, having older parents, or low birth rates.
Parents’ experiences and concerns are of utmost importance in the screening process of young children. Doctors may ask parents questions about their child's behaviour in order to combine the answers with information from ASD screening tools, as well as his or her observations. Children who exhibit developmental problems during this screening process will be referred to a second stage evaluation.
Stage II:Additional evaluation
The second stage evaluation would be conducted by a team of doctors and healthcare professionals experienced in diagnosing ASD. This team may include a developmental pediatrician, such as a doctor who is specially trained in child development; a child psychologist and or psychiatrist (a doctor with specialised training in brain development and behaviour); a neuropsychologist (a doctor focusing in the evaluation, diagnosis, as well as and treatment of neurological, neurodevelopmental, and medical conditions); and a speech-language pathologist, a health professional with special training in communication difficulties.
The evaluation may cover, on a cognitive level, thinking skills, language abilities, as well as age-appropriate skills needed for completing daily activities independently (eating, dressing, and toileting). As ASD is a complex disorder sometimes occurring with other disorders, a comprehensive evaluation may include blood tests as well as hearing tests.
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