(to read my personal journey with Language Disorders, please click HERE)
Autism Definition
One should start with Kanner’s original definition, with a hallmark of antisocial behavior underlying the condition beyond what would be explained by mental retardation or a language disorder. Children with Autism have very low rates of social interaction (both verbally and nonverbally) and often actively resist social contact. Many of them will pinch or bite or throw very, very intense tantrums when nonverbal social contact is initiated. Most late talkers are quite social in many situations which do not require talking, and so they do not meet the basic definition of autism.
From there one should use the DSM-IV definition which includes self stimulation and other compulsive repetitive (and bizarre) routines. I must say here that all children engage in routines and that these are important for learning and in no way clinically significant. Look at Mr Rogers, he opened the show the same way for decades, is he autistic or “on the spectrum?” Any parent who is asked about routines will have many examples for all their children. The key in autism is compulsivity and difficulty in redirecting the child.
A subset of children with autism engage in self injury and many use echolalia (not unprompted imitation, which is actually a good thing and no a clinical sign), which is defined as the meaningless repetition of adult utterances. Children using echolalia almost seem to be indicating that they know they are supposed to say something, so they pick something out that they heard recently and say it to terminate the interaction.
Anyway, a diagnosis of autism requires SEVERE (and the DSM-IV does say severe) disruption in the following areas: language (all late talkers meet this criteria) and behavior (severe rigidity in adhering to routines) and use of self stimulation (and I don’t mean spinning when listening to the soundtrack from the latest Disney cartoon and I definitely don’t mean lining up toys unless the child will refuse to move the location, lines up all kinds of things in addition to toys, and refuses to play with toys in other ways). And, as mentioned above, antisocial in a way that transcends what would be expected from the language deficits. To receive a diagnosis of autism, a child must display SEVERE clinically significant behavior in ALL THREE areas. Children with autism also do not engage in pretend or symbolic play (this is also a key feature of autism that is easily observed in nonautistic late talkers).
Also, and this is a very key point, autism will not disappear when the child learns to talk. So many late talkers are initially labeled autistic, only to have all signs of autism go away when they learn to talk. This is not autism, and folks who claim to cure autism should not be including these children in their reports.
PDD-NOS is accurately applied when a child only meets two of the three areas. For example, a social child who uses echolalia and hand flapping. I do not use “on the autism spectrum” because it is too imprecise. Because late talking is one characteristic of autism (all children with autism talk late) some label all late talkers as “on the autism spectrum.” As you have probably gathered by now, I strongly disagree with this characterization.
Just because all children with autism talk late, does this mean that all late talkers have autism? This is absurd, rather like saying that because all humans are mammals, all mammals are on “the human spectrum.”
A final word. When a clinician has seen and worked with children who meet the full definition of autism, it is unmistakable. The problem is that this condition is quite rare (thank goodness), so that I wonder whether all these questionable labels are being generated by folks with no experience with Kanner’s type of child or those meeting the full DSM-IV description.
Stephen M. Camarata, PhD
John F. Kennedy Center for Research on Human Development
Vanderbilt University School of Medicine
Nashville, Tennessee 37232
| Original content here is published under these license terms: |
X |
|
| License Type: |
Attribution, No derivative work |
|
|
| License Summary: |
You may copy this content and re-publish it in unmodified form, provided you include an overt attribution to the author(s). You are not permitted to create derivative works. |
|
| License URL: |
http://creativecommons.org/licenses/by-nd/3.0/ |
Incoming search terms:
Pingback: OneMom Speaks « One Mom
Pingback: Does Autism Impact 1 in 150? Details Behind the Numbers | Kristie McNealy, MD
Pingback: Glenn Beck Autism Story « One Mom
I have to say moms need to avoid Internet. Mamas here are crazy. They constantly throw out autism to worried moms making moms worry more and they not doctors! My son was very late talker, two language house but we mostly spoke one language to him. He didn’t really speak till three. He also didn’t have great eye contact. Otherwise he seemed normal, liked to play and run around and he was affectionate always. He had tantrums which normal kids have, maybe 3 a week, nothing major, usually we knew why. Now he is five, completely like other kids and I can tell you other people looked at him sometimes like he was autistic because he wasn’t so responsive to them and he didn’t talk. He was always more responsive to us parents and relatives. I shudder to think at all parents suffering from this insanity.
Recently have been worried about my son’s behavior, really active but gives hugs and kisses especially kisses after he hurts himself, he does flap his arms in protest but is learning to use “no” instead. He has about 60 words and always looks for Momma at the playground and calls our dog by slapping his hand on his knee, his eye contact isn’t great but I think it is because of his need to explore. I agree the Internet is making me scared. I think my son is just a typical boy who is very active. Thanks for sharing. I agree some Mommas can be crazy posting youtube videos and what not.
Hi Kelly – How old is your son? Have you had him evaluated? You might want to stop by my other blog “A Time to Talk” to read about our journey and the evaluation we had at Vanderbilt University with the Camaratas.
I think what Lina said is right. My son too has some behavioural problems but I think it is due to lack of affection, care. When he is in good mood, he does all the things we tell him. He is a late talker. Does not like to look at others except me and his grandma. May be he is not comfortable with others. He is also a very active boy who has to be kept engaged always creatively. I also agree that internet is scary. Children do throw tantrums. There is nothing abnormal about it. We can’t expect them to behave like adults always. We ourselves don’t behave well at times. One concern is my son keeps jumping and running in a specific pattern. He says he is playing. It sometimes look like a gymnastic game!!
While autism affects language, it is not a language disorder. Plenty of children in the spectrum talk and still have difficulty relating to people for other reasons. My daughter, who probably has normal intelligence, did not make steady progress in language until we treated it with speech therapy developed for children with aphasia (the association method). Teach Me Language and approaches geared toward autistic children did not help my daughter, who is now 19 and still learning English as a first language, but making awesome gains right now.
Hi Tammy – I certainly did not mean to insinuate that autism is a language disorder. Actually, that’s my concern with the new diagnosing going on, kids with language disorders are being put in the autism category and then declared cured when speech therapy (and time) correct the language difficulties.
my son is 33 months and he just had his 2nd evaluation with an early intervention program the psycologist has had concerns since 18 months for autism he was a late talker he talks now he has a great imagination loves pretend play is very affectionate has great eye contact his only problem is he does have some anxiety about being around big groups of adults he doesnt know i have not socialized him alot though it just frustrates me i dont believe he is austic and this dr who did his eval today told me 1 reason she thinks he is is because he likes cars!! he is an almost 3 year old boy!!! he does have some behavioral issues but not anymore than any other child his age i dont plan on having him eval for autism what really bothers me is that alot of my friends children have same issues as my son but were not late talkers so its normal for them to act that way but not for my son cause he didnt start to talk until he was a little over 2!
For the new folks that have dropped by this post, I’d encourage you to go to my other blog A Time to Talk and read our story and what we did for evaluation, etc.
I wanted to respond to the confusedmom comment. Your doctor suspects autism because he likes to play with cars? See that worries me about doctors because boys love cars dont they. I have 4 kids, when my 18 year old was little he loved cars so much he had to fill his pockets up with them at night and sleep with them, he had thousands of them. Then as he grew he started loving action figures, all kids go through phases of things they love to play with I think. Now hes 18 and hes a completely normal teenager out constantly with his friends, he has tons of friends a great social life. Turned out fine despite loving cars when he was a kid, lol. Dont all kids have those particular things they love, then they grow out of it and move onto something else? Its normal.
My son is 33 months as well and has made little gains in language. Met the milestones at around 6-12 months saying Mum, Dad and car but then nothing! Yet babbles to himself and it’s always seemed like language is just waiting to come out! I’ve noticed in the last six months alot more eye contact and maybe up to 20 words like bu for bus and bir for bird! I have seen a paediatrician who has recommended speech therapy doesn’t think it’s autism. I feel like I have a very inmature little boy instead that is probably more like a 18 month old. What I’m wondering is he seems so cheeky and when you go through flashcards with him and try to teach words like dog etc he smiles at you! I have heard on occassions probably about 3 times in the past year him say his sisters name but when you ask him to say it again he smiles at you instead! He’s just started attending preschool and of course they have started on the road of wanting evaluations, observations etc and although haven’t said it are thinking he is autistic! Because of the language and not handling transitions! Pretty much because he wants to play outside and not go inside and for example read a story etc I guess I’m wondering do children who have autism have cheeky personalities and laugh hysterically when watching Funniest Home Video shows and movies like Beverly Hills Chiwauha (where animals etc have voices). But what I can’t get over is that all children who are late talkers are going to show autistic signs and they are not going to talk to other children because they are unable to why are people so quick to just lump it into autism.
Pingback: New Autism Numbers: Proceed with EXTREME CAUTION « One Mom
I think the parents should be ashamed. they WANT the autism diagnosis. I think its bunk! its the new ADD. kids who arent social enough or are language delayed. they are not autistic or even on the spectrum! woe onto us when we have an ugliness spectrum for ugly kids!
I have a 3 year old who is in speech therapy and the therapist suggested that he have occupational therapy also. Because, she said, he sits in a chair floppy and would rather wander around than learn the lesson at hand. I agreed to have him evaluated. The occupational therapist did say that he had a sensory problem, but otherwise he could sit in a chair perfectly and complete a task (such as coloring). She also said that it appears as though it’s not that he can’t do certain things, it’s just that he won’t do them at the time you ask him to do it. I have been saying that forever and just now someone has pointed it out.
I knew my son didn’t like speech therapy when the therapist told me what was going on. He will only sit when it’s something he’s interested in.
@ lisa, You are right. Autism is the new ADD. I bet that when these ‘diagnosed,’ children grow up, they will be fully functioning adults worrying about the next ‘trendy’ diagnosis for their children.