Childhood Autism

Autism is a congenital disorder of certain functions of the brain. Its symptoms become manifest prior to the third year of the child’s life. The disorder results in a child who does not understand what they see, hear and experience. In autistic children, the ability to communicate, and react adequately in ordinary social situations is diminished or totally absent. As early on as the infant period, some children may for instance lack interest in human faces and voices, and lack the so-called social smile.

The clinical image of autism may be generalized using the characteristics of abnormal functioning in the following areas:

1) Social interaction and communication

2) Imagination

The following are typical traits of autism:

• Difficulty establishing eye contact (as if the child was looking through the other person),

• Stereotypical play or activity with objects (the child does not play with a toy in the usual manner),

• Fascination with the details of objects or of the human body (e.g. holding a toy car, the child only seems interested in its wheels, which it keeps rolling and observing),

• Lack of manifestations of emotional reactions to the presence and absence of a parent (the child does not manifest any joy in the presence of a parent, nor manifest sadness when the parent departs),

• Lack of interest in, and even aversion to emotional physical contact (e.g. cuddling),

• Delayed development of speech (at the age of two, the child cannot speak and often communicates by screaming),

• Repetition of others’ words or whole statements word-for-word without a clear communication intention (the content of the child’s statement is a mere echo of the statements of others),

• Problems with food intake (the child only eats certain types of foods, eats too little or overeats),

• Intolerance of certain sounds or smells, and strong affective reactions to them,

• Lack of interest in bonding with peers (as if the child did not perceive the presence of others or they actively avoid company),

• Problems focusing attention on things that another person is trying to point out; in particular, if these objects at a greater distance,

• In communication, the child uses the 3rd person singular instead of the 1st person (Peter wants….),

• Diminished ability, or even inability to come to terms with changes in daily routine or spatial arrangement (e.g. changes in the arrangement of the furniture in the child’s bedroom etc.).

Distorted contacts with close persons become more obvious after the second year of age. Some children do not react when spoken to by their parents, which often leads to the incorrect conclusion that they have an undiagnosed hearing disorder. Children suffering from autism also tend to react differently if a person unknown to them makes an appearance – in some cases they start screaming or crying, whereas in other cases they manifest anxiety and tension. They do not play with other children, and they do not spontaneously involve themselves in common activities – sometimes it seems as if they were unaware of the presence of other children.

Compared to children without the disorder, play activity of children with autism typically lacks imagination and symbolism. Their play lacks typical social elements (e.g. playing characters – princesses, knights, the doctor etc.). Play as an activity is stereotypical, as is the use of toys, which are used differently by the child from what their intended purpose is.

In the area of communication, the child may manifest a total absence of speech, whereas premature speech development is less frequent. Children suffering from autism often do not use speech as a means of communication, and information exchange. Speech is chaotic, nonsensical, purposeless in terms of communication; however, sometimes, speech reflects a very good mechanical, fragmentary memory (the child may quote word-for-word statements of various length that they have heard before). Children, as well as adults suffering from autism have difficulties understanding the context of the utterances of other people, they do not understand hyperbole or simile, they interpret utterances literally.

Emotional manifestations of persons with autism are ambivalent and polar. They have problems recognizing true danger; however, on the other hand, they often panic in completely safe situations. Their behavior is characterized by a number of rituals and obsessions, which usually accompany their activities in the area of hygiene, food, the journey to the kindergarten, etc.

Autism is further classified into three categories according to the level of development of skills in the area of social interaction, expression and understanding, the degree of problematic behavior, degree of intellectual development, and the ability to spend free time functionally:

• Low-functioning autism: Persons with this degree of the disorder manifest a minimally-developed, or even undeveloped ability to form and maintain social relationships. Lack of speech development is frequent. If speech does develop, it is present in the form of repeating what the child hears (echolalia). There is characteristic interest in simple, stereotypical activities. Their behavior often contains self-harm and aggression. Intellectual abilities of persons with low-functioning autism fall within the range of mental retardation (in most cases, it is severe mental retardation).

• Medium-functioning autism: What is characteristic for this degree of the disorder is the diminished ability to engage in social contact. In the area of social communication, there is passiveness, and a lack of spontaneity. The communication of persons with medium-functioning autism is partly functional. Noticeable features typically appear in speech production (e.g. switching between 1st and 3rd person, echolalia, newly coined words – neologisms). Stereotypical movements are often present (e.g. swinging or shaking of limbs). Play involves functional, relationship-based and construction games. Intellectual abilities are usually in the range of light to medium mental retardation.

• Highly-functioning autism: Basic social and communication functions are usually preserved in people with this degree of the disorder. However, they do have problems understanding the norms of behavior expected by society. Their behavior may be regarded by others as eccentric or inappropriate. Their speech is not significantly different from their peers, but they tend to not understand the roles of partners in communication (other children or adults). In conversation they often focus on their own favorite topics, without taking into account the interest or lack of interest of others. They have difficulties cooperating with other children. Their involvement in cooperative activities is not functional, which is why the role that the child will assume within a group activity must be given ample consideration to, or a suitable alternative must be created in the form of independent work. The intellectual abilities of children with highly-functioning autism are generally within the range of below average to above average.