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ANSWERS TO QUESTIONS MOST COMMONLY ASKED ABOUT
AUTISM
By: Mark H. Yeager, Ph.D., FAAIDD

1. What is Autism?
It is important to realize that Autism is defined behaviorally and I.Q. tests are an ineffective means of diagnosis. The Autism Society of America has recently defined autism as follows:
AUTISM is a severely incapacitating, lifelong developmental disability that typically appears during the first three years of life. The results of a neurological disorder that affects functioning of the brain, Autism and its behavioral symptoms occur in approximately one to six out of every 1,000 births. Autism is four times more common in boys than girls. It has been found throughout the world in families of all racial, ethnic and social backgrounds. No known factors in the psychological environment of a child have been shown to cause Autism.
Some behavioral symptoms of Autism include:
(1) Disturbances in the rate of appearance of physical, social and language skills.
(2) Abnormal responses to sensations. Any one or a combination of senses or responses are affected: sight, hearing, touch, balance, smell, taste, reaction to pain, and the way a child holds his or her body.
(3) Speech and language are absent or delayed, while specific thinking capabilities may be present.
(4) Abnormal ways of relating to people, objects and events.
Autism occurs by itself or in association with other disorders, which affect the function of the brain such as viral infections, metabolic disturbances, and epilepsy. It is important to distinguish autism from retardation or mental disorders since diagnostic confusion may result in referral to inappropriate and ineffective treatment techniques. The severe form of the syndrome may include extreme self-injurious, repetitive, highly unusual and aggressive behavior. Special education programs using behavioral methods have proved to be the most helpful treatment for persons with Autism.
AUTISM IS TREATABLE---Early diagnosis and intervention is vital to the future development of the child.
(Reference: The Advocate, Vol.24, No.2, Summer 1992)

1B. What are the "classic" signs or symptoms of Autism and how do you recognize them?
1. Resist Normal Teaching Methods - Does child self-teach or resist hand-over-hand attempts? Does child not attend?
2. Inappropriate Laughing & Giggling - Does child laugh or giggle for no discernable reason or out of context of situation and conversations?
3. Echolalic, No or Limited Speech - Does child repeat what is heard? Does child seem to avoid speaking?
4. Acts as if Deaf or Painful Hearing - Does child not listen to instructions or cover ear and/or grimace at certain sounds?
5. Sustained Odd Play - Does child seem preoccupied with certain motions and insist on performing these motions repetitively? Does child play with toys in a way the toy is not intended?
6. Uneven Gross/Fine Motor Skills (Apraxic) - Does child appear to have difficulty maintaining a grip or appears uncoordinated in running or other physical activities?
7. No Fear of Real Danger - Does child disregard dangerous situations or places such as highways, oncoming vehicles, hot ovens, heights, etc.?
8. No or Poor Eye Contact, Blank Stare - Does child appear to deliberately avoid eye contact or act upset when attempts are made to make eye contact? Does child blankly stare into space or "through people"?
9. Difficulty in Mixing with other Children - Does child avoid relating to other children or use inappropriate approaches or speech when around others? Does child appear to be "rude" to social amenities?
10. Standoffish Manner, Withdrawn - Does child seek refuge from other people or environmental sounds? Does child seek isolation into small spaces?
11. Spins Self or Objects - Does child enjoy spinning or spinning wheels on a play car or spinning objects of any type?
12. Crying Tantrums - Does child display crying tantrums for no discernable reason?
13. Inappropriate Attachment to Objects - Does child fixate on unusual objects such as cans, pictures, or items that are age inappropriate?
14. Extreme Distress for no Discernable Reason - Does child display active outburst or peaks in hyperactivity for no reason or scream, cry, or grimace accompanied with aggressive behavior?
15. Not Cuddly or Tactilely Defensive - Does child push away when being held or touched?
16. Apparent Insensitivity to Pain - Does child not react to events that obviously would inflict pain?
17. Resist Change in Routine, Likes Sameness - Does child display inappropriate behavior when typical travel routes or schedules are changed or disrupted?
18. Indicates Need by Gestures - Does child point or bring things to you to express a need instead of verbalizing need?
19. Marked Hyperactivity - Is child extremely active such as running, not sleeping, or unable to sit?
20. Marked Hypoactivity - Does child appear lethargic and without motivation.
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2. What causes Autism?
It is not known what causes Autism but recent studies have disclosed some interesting theories. 1. It is suspected that the administration of antibiotics to children for such things as ear infections is responsible for the onset of Autism. 2. Exposure to toxic waste is another suspected culprit. Research indicates that this may even be a factor if the exposure occurred as much as three generations before the birth of the child with Autism. 3. An imbalance of Serotonin (brain enzyme) has an adverse effect of beta and alpha-receptors, thereby creating the behaviors that are prevalent in the population with Autism. 4. An over induction of mercury into the body via immunization injections is suspected to be a leading cause of the most recent almost epidemic level of occurrences of autism. There are other suspected causes but, these are the ones that are gaining the most attention at this time.
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3. Can Autism be cured?
No. Treated? Yes. The most successful treatment is early intervention and behavior modification that addresses the behavior problems. Other treatments are gaining acceptance as their success rate increases. 1. Auditory Integration Training (Therapy). 2. Dimethylglycine (DMG) 3. Vitamin B6 and Magnesium. 4. Mercury Chelation 5. Gluten Free/ Casein Free Diets 6. Other Vitamin and Nutritional Supplements
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4. What methods are most effective?
At this time the most effective methods showing the most profound positive results is Behavior Modification often paired with some of the treatments listed in number 3.
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5. Are all individuals with Autism also Mentally Retarded?
No. Some studies suggest that as few as 40% of the population with Autism are also Mentally Retarded. It should be pointed out that any attempt at clarifying this issue is ambiguous due to the fact that there is no effective assessment process that accurately rules out Mental Retardation. It is also important for professionals to realize that programs for the individual with Mental Retardation will not work for those individuals with Autism.
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6. Why are individuals with Autism often tactilely defensive?
(not cuddly) To put it simply, it is sometimes painful or uncomfortable for them to be touched. This is a response to gain control and comfort over their environment. In time individuals do learn to cope with their tactile difficulties. All children however are not tactiley defensive.
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7. Why do individuals with Autism spin and/or spin things?
Self-spinning is a self-stimulation activity that stimulates the vestibular system in the body; a feeling that for some reason is appealing. Object spinning is again a stimulating activity that seems to visually pacify a need. The problem arises with these behaviors because the individual tends to fixate on the behavior and it can become impossible to shift his attention to anything else.
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8. Should individuals with Autism take medication?
Maybe. There are many drugs that can be effective and many that are not. There is no "miracle drug" or even any one that consistently works the same on all individuals. A physician that is knowledgeable about Autism should be consulted to address this type of treatment, however, there is no abundance of knowledgeable physicians. Documentation of behaviors before and after onset of medical intervention is important to the success of medical strategies. The physician alone should not have the only input into the decision for treatment strategies. Input should be sought from parents, teachers, counselors, psychologists and anyone else who observes behaviors and has the individual’s best interest in mind. What are the most effective medications? The drugs that show the most promise are Nystatin, Beta Blockers (Propranolol, Corgard), Tegretol, Fenfluramine (Pondimin), Naltrexone, Prozac, Mellaril, Tofronil (Imipramine), Zyprexa, Aderal, and Geodon. Contrary to popular belief Ritalin is not a drug of choice for persons with ASD.
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9. Why do individuals with Autism reject certain foods?
Again, quite simply, they are unappealing to them. In many cases even repulsive. It is important to try to introduce these and other new items to their diet. Diet peculiarities are common among this group.
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10. Why do some individuals with Autism smell of everything?
To establish a preference. Those that smell good many times become fixations, those that smell bad become antecedents to behavior problems. Remember, just because we think something smells good or bad does not have any bearing on the person with Autism's interpretation. They often are delighted by smells that are offensive to us. (i.e. feces, urine, ammonia, etc.)
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11. Why do individuals with Autism demonstrate ritualistic or even compulsive behaviors?
This too is an expression of preference. Sameness is an important part of their attempt to gain control over their environment. Once a successful routine is established the person with Autism will follow it to a tee. It is most important to warn the person with Autism of upcoming changes in their schedules or staff changes. Many times, this will head off behavior problems. Structured programming and your ability to be consistent will help ensure success for a person with Autism.
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12. Why do individuals with Autism refuse to hold or grab things?
There are two possibilities for this behavior. 1. The object may be tactilely offensive and the response is to refuse to hold the object. 2. The individual may have apraxia, which effects their ability to motor plan and maintain a grasp.
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13. Why do individuals with Autism crawl under and between things or hug up to certain things?
The most common belief is that this serves as a sensory deprivation or calming method that many individuals have learned. This theory is advocated by Temple Grandin, Ph.D., a recovering person with Autism, who is in the business of creating machines that induce the same effect on animals. This is also an effort to establish control over environmental changes.
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14. Why do individuals with Autism have sudden behavioral outbursts for no discernible reason?
This is typically a response to some environmental factor that the individual found disturbing. Many times, we can't even perceive the problem. Why? Due to the hyper-sensory characteristic that most individuals with Autism possess, they can actually smell, hear, see, and feel things that we cannot, because of our inferior sensory system.
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15. Why do individuals with Autism have a blank stare and disregard social amenities?
The truth of this issue is that these behaviors actually serve no purpose except to make our relationships with others more pleasant. For some reason, which remains a mystery, the individual with Autism does not conform to the conventional need to interact with others. This is often displayed as such” rude" behaviors as staring, walking through conversations, walking over people and disregard of other social expectations of society. This is often the most confining aspect of Autism. "Typical People" just will not accept them as they are, but demand conformance to social amenities thereby leaving no place in our society for this group of people.
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16. Why do many individuals with Autism have no speech?
This is secondary to apraxia in many cases. It is also believed, in some cases, that the inability to organize language and communication thoughts attribute to minimal speech. It is further believed that some individuals even choose not to speak.
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17. Why do many individuals with Autism speak in a monotone?
The most common belief for this behavior is that the sound of their own voice actually hurts their hypersensitive auditory system. Once they find a tone that is not painful, they stick to it, which results in monotone speech. This could also be a cause for no speech, in that an individual may not be able to find a tone that is not painful.
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18. Why are many individuals with Autism echolalic?
Due to their inability to plan and organize communication thoughts and phrases and their desire to speak, many individuals simply echo what they hear and circumvent the planning process. The problem with this is that it typically serves only as nonfunctional speech and is frustrating to parents and programmers. It should be viewed as a starting point for functional speech and they should be encouraged not to echo. This is one behavior that Auditory Integration Training has proven effective in extinguishing.
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19. How does an Autopsy determine Autism?
Autopsies of known individuals with Autism have shown basically three things. 1. Unusual but inconsistent brain structure. 2. Unusually small brain stems. 3. Unusually high number of neurons (brain cells)
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20. What is the incidence of occurrence of Autism?
One to six out of every 1,000 births and 4 to 1 male to female. An interesting note is that most individuals with Autism that establish handedness are 60% more likely to be left-handed.
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21. Why do individuals with Autism seem to be insensitive to pain?
This is probably one of the biggest mysteries of Autism. Little study has been done in the area and what has been done indicates almost no answers. The most likely reason appears to have something to do with their sensory interpretations of all stimuli being "mixed up" so that pain is actually being felt but not recognized and responded to in a traditional manner.
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22. Why do individuals with Autism disregard danger?
Due to their insensitivity to pain, most individuals with Autism do not concern themselves with the trivial aspect of possible danger. Recognition of danger is a social amenity that requires motor planning in response to situational interpretation, a skill that for some reason is either absent or inhibited in individuals with Autism.
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23. Why do some individuals with Autism self-injure?
For the same reason that other developmentally disabled individuals do. It serves as either an attention seeking behavior or it is pleasing to that individual. Another possibility is that individuals with Autism lack self-identity. This, combined with a nontypical response to pain, can actually present the internal interpretation that they are not self-injuring but being aggressive toward someone else.
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24. Why do individuals with Autism not mix with other people?
This again is a social amenity that serves no purpose for the person with Autism. In most cases this mixing is only frustrating and intrusive.
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25. Why are many individuals with Autism hyperactive?
This can be explained by a couple of possibilities. 1. They produce more than usual levels of epinephrine and serotonin, which will cause the body to become agitated. The person with Autism reacts to this by demonstrating sudden bursts of energy such as running, jumping and hand flapping. Their lack of motor planning and self-restraint makes it impossible for them to control these outbursts. 2. The need to remove themselves from areas where there may be offensive sounds and odors cause them to appear to continuously be seeking refuge. Because refuge from these sounds and odors are almost impossible to find in our environment the search is without end. Result....a never-ending hunt for solitude.
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26. Why do individuals with Autism act as if they are deaf?
Many individuals with Autism have learned to "tune-out" painful or undesirable sounds. Because of their inability to shift attention from one thing to another, they appear deaf because their preoccupation of "tuning-out" consumes all incoming sounds and they do not react to sudden sounds or instructions. It is important when addressing an individual with Autism to try to place yourself in their line of vision in order to enhance their ability to shift attention.
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27. Why do many individuals with Autism sustain odd play?
This can be explained by several reasons. 1. Again the sameness of repetitive, compulsive, and obsessive movement is appealing. 2. Many activities of play are again dictated by social amenities, a need that most individuals with Autism do not possess. 3. Some odd play is actually a fixation on an item in a non-conventional manner as interpreted by society.
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28. Why do individuals with Autism display inappropriate laughing or crying?
This most probably is a somewhat appropriate response to something we do not hear or witness. Many individuals laugh or cry out loud to thoughts that cross their mind. Since it did not occur in a conventional sequence we interpret it as inappropriate. The inappropriateness of this is actually in the poor timing and interpretation of the behavior.
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29. Why do individuals with Autism have an inappropriate attachment to objects?
This again is a fixation on something appealing to the individual. Most everyone has an attachment to some type of object. We are just more discreet about our behavior. An individual with Autism, lacks the ability to interpret the social inappropriateness of this behavior.
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30. Why do individuals with Autism isolate themselves?
This again is a defense mechanism to seek refuge from distressing sounds and odors.
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31. What is it called when an individual with Autism has a refined talent despite the inability to do simple tasks?
Autistic Savant.
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32. What other disabilities are most often seen in individuals with Autism?
Mental Retardation, Obsessive-Compulsive Disorder, Fragile-X Syndrome, Asperger Syndrome, Bi-Polar Disorder and Manic Depressive, just to name a few.
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33. What is meant by Autistic-Like?
This is often used as a diagnostic term to describe an individual that exhibits some behaviors that are identified as Autistic but not enough to constitute a diagnosis of Autism. It is at best an attempt to describe confusing behaviors in a person with developmental disabilities.
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34. What is Pervasive Developmental Disorder?
This is the general category that Autism falls under. It is used most often with children. The Autism Society of America disagrees with its use and is encouraging the American Psychological Association to separate Autism into a category of its own in the DSM-IV upon its publication.
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35. Do immunizations cause Autism?
The vote is still out. It appears that the research is pointing to evidence that there is some connection. It seems that the preservative in many vaccines contains enough mercury to be dangerous to children with a pre-disposition and possibly even those that do not. The puzzle lies in the child’s inability to eliminate heavy metals from their body.
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The field of Autism and the strategies to help this population change daily. It is most important that we keep in contact and get organized so that these individuals can be better served. Your input and help is desperately needed. If you have any other questions, ideas, or need assistance, please feel free to contact me by phone or mail. We are attempting to establish a network of parents and professionals to better serve individuals with autism.
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For more information contact:

Mark H. Yeager, Ph.D. , FAAIDD
Director
Division of Autism Spectrum Disorders
Mississippi Department of Mental Health
mark.yeager@dmh.state.ms.us

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