What is autism?
The word Autism is derived from the Greek word Autós, which means self. The word was coined by Swiss psychiatrist Paul Eugen Bleuler in 1908 to signify the withdrawal into the self that he observed in one of his patients.
Today, autism spectrum disorder (ASD) is recognised as a complex neurodevelopmental condition. Its exact causes are not fully understood but research suggests that a combination of genetic and environmental factors likely contribute to its development.
WHO’s International Classification of Diseases (ICD) defines autism as:
“Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.” (ICD-11, chapter 6, section A02)
Autism was initially classified as a pervasive developmental disorder (PDD). There were five types of PDDs: autistic disorder, Asperger’s disorder, Rett syndrome, child disintegrative disorder, and pervasive developmental disorder—not otherwise specified [PDD-NOS]. After the updates in the DSM-5 (Diagnostic & Statistical Manual of Mental Disorders-5, published by the American Psychiatric Association (APA), 2013), all these were grouped into autism spectrum disorder, due to a significant overlap in their presentations.
Autism is a condition that affects the way a person’s brain works. It can make it harder for them to communicate, interact with others, and understand the world around them in the same way that most people do.
Autism can be defined as a disorder where the child finds it hard to bond and form relationships with others. The child has difficulty communicating, making eye contact, reading nonverbal cues, understanding verbal nuances, interpreting words non-concretely, dealing with people and social situations, coping with sensory stimulation, and being flexible with changing circumstances. The child may also have strong interests that they can engage in for long periods, often appearing oblivious to the world around them.
People with autism might have different strengths and challenges, and they may see, hear, and feel things differently. It’s important to remember that autism is just one part of who a person is, and they can still do many amazing things.
The primary areas that are affected by autism are social development, communication skills, cognitive development, and behavioural patterns.
So, what we primarily see is that an autistic child is unable to relate with others: it appears as if the autistic child is in his or her own world; it is as though, for the autistic child, the world outside does not exist.
The child is not taking any cues from their social environment and is not responding to the social cues given to it by the parents or caretakers.
The primary deficit area that the pediatrician and the teacher notice is that the child is not interacting with others. The child does not even interact with their own parents as they should.
Language development is usually delayed in these children.
So here is a child who is not communicating, is not responding to social cues, has poor eye contact, poor name response, is not showing any needs, is not developing language, seems to be lost in his or her own world, has sensory issues like noise-sensitivity and mouthing and, later on, the child develops behavioural patterns like spinning of objects, looking continually at rotating objects, switching buttons on and off, toe walking, hand flapping, and lining up different objects in a particular way. We will discuss these symptoms in greater detail in the next chapter.
But this is one extreme. Autism is a spectrum disorder and there will be other autistic children who are cognitively, behaviourally, and socially relatively normal.
Some children are born with other medical conditions, too. There are autistic children with intellectual disability, there are autistic children who suffer from epilepsy, there are autistic children who suffer from gastrointestinal disorders, etc.
There are no two autistic children who are alike. There are children with different symptoms and with different intensities of symptoms. However, there is a common denominator, and the denominator is that in the majority of cases, the ability to perceive social cues, to have a meaningful social life and social interaction with family, peers, friends, and society, is significantly lacking. At the same time, there are special behavioural patterns present in different degrees in most of these children. Also, language development is usually delayed and restricted.
