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Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Autism is a condition surrounded by myth and generalizations about people with autism that are rarely appropriate. The common beliefs that people with autism never express emotion, never smile or laugh, never make eye contact, never talk, and never display affection are simply that - myths. Just as every person is unique, with his or her own personality and characteristics, every person with autism manifests the disorder in his or her unique way.

The list of symptoms and behaviors associated with autism is long, and each affected person expresses his or her own combination of these behaviors. None of these clinical features is common to all people with autism, and many are occasionally exhibited by people who are not autistic.

That said, however, all people with autism have abnormal functioning in three core areas of development: social interaction, verbal and nonverbal communication, and the presence of repetitive and restricted patterns of behavior, interests, and activities. The diagnosis of autism is typically made when impairment is significant in all three areas.

Impaired reciprocal social interaction

Examples include the following:

• poor use of body language and nonverbal communication, such as eye contact, facial expressions, and gestures;
• lack of awareness of feelings of others and the expression of emotions, such as pleasure (laughing) or distress (crying), for reasons not apparent to others;
• remaining aloof, preferring to be alone;
• difficulty interacting with other people and failure to make peer friendships;
• may not want to cuddle or be cuddled;
• lack of or abnormal social play;
• not responding to verbal cues (acting as if deaf).

Impaired communication

Examples include the following:

• delay in, or the total lack of, the development of spoken language or speech;
• if speech is developed, it is abnormal in content and quality;
• difficulty expressing needs and wants, verbally and/or nonverbally;
• repeating words or phrases back when spoken to (known as echolalia);
• inability to initiate or sustain conversation;
• absent or poorly developed imaginary play.

Restricted repertoire of interests, behaviors, and activities

Examples include the following:

• insisting on following routines and sameness, resisting change;
• ritualistic or compulsive behaviors;
• sustained odd play;
• repetitive body movements (hand flapping, rocking) and/or abnormal posture (toe walking);
• preoccupation with parts of objects or a fascination with repetitive movement (spinning wheels, turning on and off lights);
• narrow, restricted interests (dates/calendars, numbers, weather, movie credits).

There are a number of associated features and behaviors that are seen in some people with autism, including the following:

Cognitive function: Autism occurs at all intelligence levels. Although about 75% of autistic individuals have an intelligence quotient (IQ) below average, the other 25% have an average or above average intelligence. The performance IQ is generally higher than the verbal IQ. A small percentage have high intelligence in a specific area such as mathematics.

Neurologic function

• Seizures may develop in 25% to 35% of children with autism and can be resistant to treatment. The onset of seizures peaks in early childhood and again in adolescence. There is an increased risk of seizures in children with autism who have mental retardation or a family history of autism.
• Uneven gross and/or fine motor skills (well developed in some areas, poorly developed in others)

Behavioral symptoms include:

• aggressive or self-injurious behavior;
• noticeable extreme underactivity or overactivity;
• throwing tantrums;
• short attention span;
• abnormal responses to sensory stimuli (for example, expressing over sensitivity or undersensitivity to pain);
• abnormalities in eating or sleeping;
• not responding to normal teaching methods;
• playing in odd or unusual ways;
• having inappropriate attachment to objects;
• having no apparent fear of dangerous situations.

Mood and affect

• Mood and affect vary considerably, and may include being unaware of the feelings of others, withdrawn, or emotionally labile. Some people with autism become outwardly anxious or they may become depressed in response to the realization of their problems.
• In some children with autism who express affection, the affection may be indiscriminate.

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