Autism

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This post is about the classic autistic disorder; some use the word autism, which is an umbrella term for a variety of disorders that delay children socially or intellectually, when referring to the range of ASDs (autism spectrum disorders) or to the various pervasive developmental disorders (PDDs).

Autism is a complex developmental disability characterized by, to a greater or lesser extent, impaired social interaction and communication skills, and by restricted and repetitive behavior. In its most severe form, autism may include extreme self-injurious, repetitive, highly unusual, and aggressive behaviors.  For a diagnosis to be made, symptoms must become apparent before a child is three years old.  Autism affects information processing in the brain by altering how nerve cells and their synapses connect and organize; how this occurs is not well understood.  It is one of three recognized disorders in the autism spectrum (ASDs), the other two being Asperger syndrome, which lacks delays in cognitive development and language, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), which is diagnosed when the full set of criteria for autism or Asperger syndrome are not met.

Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by rare mutations, or by rare combinations of common genetic variants.  In rare cases, autism is strongly associated with agents that cause birth defects.  Controversies surround other proposed environmental causes, such as heavy metals, pesticides or childhood vaccines; the vaccine hypotheses are biologically implausible and lack convincing scientific evidence.  The number of people diagnosed with autism has increased dramatically since the 1980s, partly due to changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved.

Parents usually notice signs in the first two years of their child's life.  The signs usually develop gradually, but some autistic children first develop more normally and then regress.  Early behavioral or cognitive intervention can help autistic children gain self-care, social, and communication skills.  Although there is no known cure, there have been reported cases of children who recovered.  Not many children with autism live independently after reaching adulthood, though some become successful.  An autistic culture has developed, with some individuals seeking a cure and others believing autism should be accepted as a difference and not treated as a disorder.

Characteristics

Autism is a highly variable neurodevelopmental disorder that first appears during infancy or childhood, and generally follows a steady course without remission.  Overt symptoms gradually begin after the age of six months, become established by age two or three years, and tend to continue through adulthood, although often in more muted form.  It is distinguished not by a single symptom, but by a characteristic triad of symptoms: impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.  Autism's individual symptoms occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.

Social Development

Social deficits distinguish autism and the related autism spectrum disorders from other developmental disorders.  People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic Dr. Temple Grandin described her inability to understand the social communication of neurotypicals, or people with normal neural development, as leaving her feeling "like an anthropologist on Mars".

Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers differ more strikingly from social norms; for example, they have less eye contact and turn taking, and do not have the ability to use simple movements to express themselves, such as the deficiency to point at things.  3 to 5 year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers.  Most autistic children display moderately less attachment security than non-autistic children, although this difference disappears in children with higher mental development or less severe ASD.  Older children and adults with ASD perform worse on tests of face and emotion recognition.

Children with high-functioning autism suffer from more intense and frequent loneliness compared to non-autistic peers, despite the common belief that children with autism prefer to be alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply.

There are very few studies of aggression in ASD. The limited data suggests that aggressive behaviors do seem to be common in those children with autism spectrum disorders.

A study by Simons Simplex Collection (SSC) evaluating aggressive behaviors in 1,380 children with ASD between the ages of 4 and 17 found that 56% were engaging in aggressive behaviors towards caregivers, while a smaller number (32%) engaged in these behaviors towards non-caregivers. Similarly, 68% of the children had previously behaved aggressively towards caregivers and 49% towards non-caregivers.

"Meltdowns and Aggression in Children with Autism" (webinar video).  This webinar video features Dr. Stephen Kanne of the Baylor College of Medicine, who used information provided by Simons Simplex Collection (SSC) families to better understand meltdowns and aggressive behaviors in children with autism spectrum disorders (ASD).  In addition to his research, Dr. Kanne is a clinician who has worked with hundreds of families with children on the autism spectrum and has many insights to share.

Communication

About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs.  Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver.  In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words (echolalia) or reverse pronouns.  Joint attention seems to be necessary for functional speech, and deficits in joint attention seem to distinguish infants with ASD, for example, they may look at a pointing hand instead of the pointed-at object, and they consistently fail to point at objects in order to comment on or share an experience.  Autistic children may have difficulty with imaginative play and with developing symbols into language.

In a pair of studies, high-functioning autistic children aged 8 to 15 performed equally well as, and adults better than, individually matched controls at basic language tasks involving vocabulary and spelling. Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends.



Our supporters share why they ROAR!  ROAR for Autism is a bike ride, nature walk, and family festival that is sure to be fun for every member of the family. Funds raised through the event support autism research at the Kennedy Krieger Institute.  Lets break the silence that surrounds autism and come together to ROAR for the millions of children who cant. To learn more, visit: www.ROAR.kennedykrieger.org


Repetitive Behavior

Autistic individuals display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) (pg.4) categorizes as follows:

• Stereotypy is repetitive movement, such as hand flapping, making sounds, head rolling, or body rocking.
• Compulsive behavior is intended and appears to follow rules, such as arranging objects in stacks or lines.
• Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.
• Rtualistic behavior involves an unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.
• Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program, toy or game.
• Self-injury includes movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging.  A 2007 study reported that self-injury at some point affected about 30% of children with ASD.

No single repetitive or self-injurious behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.



"Punding". Image© Garrondo. Punding is a psychiatric behavior occasionally associated with individuals with autism and OCD (obsessive compulsive disorder), and consists in the repetition of complex motor behaviors such as collecting or arranging objects.

Other symptoms

Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family.  An estimated 0.5% to 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.  Many individuals with ASD show superior skills in perception and attention, relative to the general population.  Sensory abnormalities are found in over 90% of those with autism, and are considered core features by some, although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.  Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements).  An estimated 60% to 80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking; deficits in motor coordination are pervasive across ASD and are greater in autism proper.

Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur; this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual; studies report conflicting results, and the relationship between GI problems and ASD is unclear.

Parents of children with ASD have higher levels of stress.  Siblings of children with ASD report greater admiration of and less conflict with the affected sibling than siblings of unaffected children or those with Down syndrome; siblings of individuals with ASD have greater risk of negative well-being and poorer sibling relationships as adults.

Classification

Autism is one of the five pervasive developmental disorders (PDD), which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests and highly repetitive behavior.  These symptoms do not imply sickness, fragility, or emotional disturbance.

Of the five PDD forms, Asperger syndrome is closest to autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with autism, but may have unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism) is diagnosed when the criteria are not met for a more specific disorder.  Unlike with autism, people with Asperger syndrome have no substantial delay in language development.  The terminology of autism can be bewildering, with autism, Asperger syndrome and PDD-NOS often called the autism spectrum disorders (ASD) or sometimes the autistic disorders, whereas autism itself is often called autistic disorder, childhood autism, or infantile autism. In this article, autism refers to the classic autistic disorder; in clinical practice, though, autism, ASD, and PDD are often used interchangeably.  ASD, in turn, is a subset of the broader autism phenotype, which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact.

The manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments, who may be silent, mentally disabled, and locked into hand flapping and rocking, to high functioning individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication.  Because the behavior spectrum is continuous, boundaries between diagnostic categories are necessarily somewhat arbitrary.  Sometimes the syndrome is divided into low-, medium- or high-functioning autism (LFA, MFA, and HFA), based on IQ thresholds, or on how much support the individual requires in daily life; these subdivisions are not standardized and are controversial. Autism can also be divided into syndromal and non-syndromal autism; the syndromal autism is associated with severe or profound mental retardation or a congenital syndrome with physical symptoms, such as tuberous sclerosis.  Although individuals with Asperger syndrome tend to perform better cognitively than those with autism, the extent of the overlap between Asperger syndrome, HFA, and non-syndromal autism is unclear.

Some studies have reported diagnoses of autism in children due to a loss of language or social skills, as opposed to a failure to make progress, typically from 15 to 30 months of age. The validity of this distinction remains controversial; it is possible that regressive autism is a specific subtype, or that there is a continuum of behaviors between autism with and without regression.

Research into causes has been hampered by the inability to identify biologically meaningful subpopulations and by the traditional boundaries between the disciplines of psychiatry, psychology, neurology and pediatrics.  Newer technologies such as fMRI and diffusion tensor imaging can help identify biologically relevant phenotypes (observable traits) that can be viewed on brain scans, to help further neurogenetic studies of autism; one example is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects. It has been proposed to classify autism using genetics as well as behavior.

Causes of Autism

It has long been presumed that there is a common cause at the genetic, cognitive, and neural levels for autism's characteristic triad of symptoms.  However, there is increasing suspicion that autism is instead a complex disorder whose core aspects have distinct causes that often co-occur.



"The three major single chromosome mutation; deletion, duplication and inversion". Image© Richard Wheeler.
Deletion (1), duplication (2) and inversion (3) are all chromosome abnormalities that have been implicated in autism.

Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by rare mutations with major effects, or by rare multigene interactions of common genetic variants.  Complexity arises due to interactions among multiple genes, the environment, and epigenetic factors which do not change DNA but are heritable and influence gene expression.  Studies of twins suggest that heritability is 0.7 for autism and as high as 0.9 for ASD, and siblings of those with autism are about 25 times more likely to be autistic than the general population.  However, most of the mutations that increase autism risk have not been identified. Typically, autism cannot be traced to a Mendelian (single-gene) mutation or to a single chromosome abnormality, and none of the genetic syndromes associated with ASDs have been shown to selectively cause ASD.  Numerous candidate genes have been located, with only small effects attributable to any particular gene.  The large number of autistic individuals with unaffected family members may result from copy number variations—spontaneous deletions or duplications in genetic material during meiosis.  Hence, a substantial fraction of autism cases may be traceable to genetic causes that are highly heritable but not inherited: that is, the mutation that causes the autism is not present in the parental genome.

Several lines of evidence point to synaptic dysfunction as a cause of autism.  Some rare mutations may lead to autism by disrupting some synaptic pathways, such as those involved with cell adhesion.  Gene replacement studies in mice suggest that autistic symptoms are closely related to later developmental steps that depend on activity in synapses and on activity-dependent changes.  All known teratogens (agents that cause birth defects) related to the risk of autism appear to act during the first eight weeks from conception, and though this does not exclude the possibility that autism can be initiated or affected later, it is strong evidence that autism arises very early in development.

Although evidence for other environmental causes is anecdotal and has not been confirmed by reliable studies, extensive searches are underway.  Environmental factors that have been claimed to contribute to or exacerbate autism, or may be important in future research, include certain foods, infectious disease, heavy metals, solvents, diesel exhaust, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illicit drugs, vaccines, and prenatal stress, although no links have been found, and some have been completely disproven.

Parents may first become aware of autistic symptoms in their child around the time of a routine vaccination. This has led to unsupported theories blaming vaccine "overload", a vaccine preservative, or the MMR vaccine for causing autism.  The latter theory was supported by a litigation-funded study that has since been shown to have been "an elaborate fraud".  Although these theories lack convincing scientific evidence and are biologically implausible, parental concern about a potential vaccine link with autism has led to lower rates of childhood immunizations, outbreaks of previously controlled childhood diseases in some countries, and the preventable deaths of several children.

Mechanism

Autism's symptoms result from maturation-related changes in various systems of the brain. How autism occurs is not well understood. Its mechanism can be divided into two areas: the pathophysiology of brain structures and processes associated with autism, and the neuropsychological linkages between brain structures and behaviors.  The behaviors appear to have multiple pathophysiologies.

Pathophysiology

Unlike many other brain disorders, such as Parkinson's, autism does not have a clear unifying mechanism at either the molecular, cellular, or systems level; it is not known whether autism is a few disorders caused by mutations converging on a few common molecular pathways, or is (like intellectual disability) a large set of disorders with diverse mechanisms.

  Autism affects the amygdala, cerebellum, and many other parts of the brain.

Autism appears to result from developmental factors that affect many or all functional brain systems, and to disturb the timing of brain development more than the final product.  Neuroanatomical studies and the associations with teratogens strongly suggest that autism's mechanism includes alteration of brain development soon after conception.  This anomaly appears to start a cascade of pathological events in the brain that are significantly influenced by environmental factors.  Just after birth, the brains of autistic children tend to grow faster than usual, followed by normal or relatively slower growth in childhood. It is not known whether early overgrowth occurs in all autistic children. It seems to be most prominent in brain areas underlying the development of higher cognitive specialization.  Hypotheses for the cellular and molecular bases of pathological early overgrowth include the following:

• An excess of neurons that causes local overconnectivity in key brain regions.
• Disturbed neuronal migration during early gestation.
• Unbalanced excitatory–inhibitory networks.

Abnormal formation of synapses and dendritic spines, for example, by modulation of the neurexin–neuroligin cell-adhesion system, or by poorly regulated synthesis of synaptic proteins.  Disrupted synaptic development may also contribute to epilepsy, which may explain why the two conditions are associated.

Interactions between the immune system and the nervous system begin early during the embryonic stage of life, and successful neurodevelopment depends on a balanced immune response. Aberrant immune activity during critical periods of neurodevelopment is possibly part of the mechanism of some forms of ASD.
Although some abnormalities in the immune system have been found in specific subgroups of autistic individuals, it is not known whether these abnormalities are relevant to or secondary to autism's disease processes.  As autoantibodies are found in conditions other than ASD, and are not always present in ASD, the relationship between immune disturbances and autism remains unclear and controversial.

The relationship of neurochemicals to autism is not well understood; several have been investigated, with the most evidence for the role of serotonin and of genetic differences in its transport.  The role of group I metabotropic glutamate receptors (mGluR) in the pathogenesis of fragile X syndrome, the most common identified genetic cause of autism, has led to interest in the possible implications for future autism research into this pathway.  Some data suggest an increase in several growth hormones; other data argue for diminished growth factors.  Also, some inborn errors of metabolism are associated with autism, but probably account for less than 5% of cases.

The mirror neuron system (MNS) theory of autism hypothesizes that distortion in the development of the MNS interferes with imitation and leads to autism's core features of social impairment and communication difficulties. The MNS operates when an animal performs an action or observes another animal perform the same action. The MNS may contribute to an individual's understanding of other people by enabling the modeling of their behavior via embodied simulation of their actions, intentions, and emotions.  Several studies have tested this hypothesis by demonstrating structural abnormalities in MNS regions of individuals with ASD, delay in the activation in the core circuit for imitation in individuals with Asperger syndrome, and a correlation between reduced MNS activity and severity of the syndrome in children with ASD.  However, individuals with autism also have abnormal brain activation in many circuits outside the MNS and the MNS theory does not explain the normal performance of autistic children on imitation tasks that involve a goal or object.


Autistic individuals tend to use different areas of the brain (yellow) for a movement task compared to a control group (blue). fMRI-derived image of difference between brains of autistic and control groups. Legend reads "Activation during visuomotor coordination: Autism Group [yellow], Control Group [Blue], Overlap (both groups) [green]". for Laurent Mottron*, "Even researchers who study autism can display a negative bias against people with the condition. For instance, researchers performing functional magnetic resonance imaging (fMRI) scans systematically report changes in the activation of some brain regions as deficits in the autistic group — rather than evidence simply of their alternative, yet sometimes successful, brain organization". Image© Ralph-Axel Müller. Source: Figure 1A of: Powell K (2004). "Opening a window to the autistic brain". PLoS Biol 2 (8): E267. DOI:10.1371/journal.pbio.0020267. PMID 15314667. PMC:509312.


ASD-related patterns of low function and aberrant activation in the brain differ depending on whether the brain is doing social or nonsocial tasks.  In autism there is evidence for reduced functional connectivity of the default network, a large-scale brain network involved in social and emotional processing, with intact connectivity of the task-positive network, used in sustained attention and goal-directed thinking. In people with autism the two networks are not negatively correlated in time, suggesting an imbalance in toggling between the two networks, possibly reflecting a disturbance of self-referential thought.

Recent studies have suggested that limitations of frontal–posterior brain connectivity in autism underlie the varied set of deficits associated with this disorder.  The underconnectivity theory of autism hypothesizes that autism is marked by underfunctioning high-level neural connections and synchronization, along with an excess of low-level processes.  Evidence for this theory has been found in functional neuroimaging studies on autistic individuals and by a brainwave study that suggested that adults with ASD have local overconnectivity in the cortex and weak functional connections between the frontal lobe and the rest of the cortex.  Other evidence suggests the underconnectivity is mainly within each hemisphere of the cortex and that autism is a disorder of the association cortex.

From studies based on event-related potentials, transient changes to the brain's electrical activity in response to stimuli, there is considerable evidence for differences in autistic individuals with respect to attention, orientiation to auditory and visual stimuli, novelty detection, language and face processing, and information storage; several studies have found a preference for nonsocial stimuli.  For example, magnetoencephalography (MEG) studies have found evidence in autistic children of delayed responses in the brain's processing of auditory signals.

In the genetic area, relations have been found between autism and schizophrenia based on duplications and deletions of chromosomes; research showed that schizophrenia and autism are significantly more common in combination with 1q21.1 deletion syndrome. Research on autism/schizophrenia relations for chromosome 15 (15q13.3), chromosome 16 (16p13.1) and chromosome 17 (17p12) are inconclusive.

Neuropsychology

Two major categories of cognitive theories have been proposed about the links between autistic brains and behavior.

• The first category focuses on deficits in social cognition. The empathizing–systemizing theory postulates that autistic individuals can systemize, that is, they can develop internal rules of operation to handle events inside the brain, but are less effective at empathizing by handling events generated by other agents. An extension, the extreme male brain theory, hypothesizes that autism is an extreme case of the male brain, defined psychometrically as individuals in whom systemizing is better than empathizing; this extension is controversial, as many studies contradict the idea that baby boys and girls respond differently to people and objects.

These theories are somewhat related to the earlier theory of mind approach, which hypothesizes that autistic behavior arises from an inability to ascribe mental states to oneself and others. The theory of mind hypothesis is supported by autistic children's atypical responses to the Sally–Anne test for reasoning about others' motivations, and the mirror neuron system theory of autism described in Pathophysiology maps well to the hypothesis.  However, most studies have found no evidence of impairment in autistic individuals' ability to understand other people's basic intentions or goals; instead, data suggests that impairments are found in understanding more complex social emotions or in considering others' viewpoints.

• The second category focuses on nonsocial or general processing. Executive dysfunction hypothesizes that autistic behavior results in part from deficits in working memory, planning, inhibition, and other forms of executive function.  Tests of core executive processes such as eye movement tasks indicate improvement from late childhood to adolescence, but performance never reaches typical adult levels.  A strength of the theory is predicting stereotyped behavior and narrow interests; two weaknesses are that executive function is hard to measure and that executive function deficits have not been found in young autistic children.

Weak central coherence theory hypothesizes that a limited ability to see the big picture underlies the central disturbance in autism. One strength of this theory is predicting special talents and peaks in performance in autistic people.  A related theory, enhanced perceptual functioning, focuses more on the superiority of locally oriented and perceptual operations in autistic individuals.  These theories map well from the underconnectivity theory of autism.

Neither category is satisfactory on its own; social cognition theories poorly address autism's rigid and repetitive behaviors, while the nonsocial theories have difficulty explaining social impairment and communication difficulties.  A combined theory based on multiple deficits may prove to be more useful.

Screening

About half of parents of children with ASD notice their child's unusual behaviors by age 18 months, and about four-fifths notice by age 24 months.  According to an article The Screening and Diagnosis of Autistic Spectrum Disorders in the Journal of Autism and Developmental Disorders (vol. 29, no. 6, 1999) failure to meet any of the following milestones is an absolute indication to proceed with further evaluations. Delay in referral for such testing may delay early diagnosis and treatment and affect the long-term outcome.

In the U.S. the American Acadamy of Pediatrics (AAP) recommends that "all children be screened for developmental delays and disabilities during regular well-child doctor visits at 9 months, 18 months, and 24 or 30 months".  Japan recommends screening all children for ASDs at 18 months using autism-specific formal screening tests.

Worldwide Prevalence of Autism - Prevalence and Services in Countries outside of Europe and North America.  CDC Data and Statistics Autism Spectrum Disorders (ASDs).

In contrast, The UK policy on screening for autism below the age of 5 is currently being reviewed as part of the UK NSC's regular review cycle of all policies.  The review process began in August 2011 and it is estimated to be completed by August 2012.  The consultation on the expert review has now finished but you can still download the document here Download the expert review for Autism (pdf).

ASD varies widely in severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Very early indicators that require evaluation by an expert include but are not limited to:

• no babbling or pointing by age 1.
• no single words by 16 months or two-word phrases by age 2.
• no response to name.
• loss of language or social skills.
• poor eye contact.
• "pending" - excessive lining up of toys or objects.
• no smiling or social responsiveness.

Later indicators include but are not limited to:

• impaired ability to make friends with peers.
• impaired ability to initiate or sustain a conversation with others.
• absence or impairment of imaginative and social play.
• stereotyped, repetitive, or unusual use of language.
• restricted patterns of interest that are abnormal in intensity or focus.
• preoccupation with certain objects or subjects.
• inflexible adherence to specific routines or rituals.

Several screening tools and rating scales have been developed for use in diagnosing ASDs.

Screening tools and rating scales designed for one culture's norms for behaviors like eye contact may be inappropriate for a different culture.  Although genetic screening for autism is generally still impractical, it can be considered in some cases, such as children with neurological symptoms and dysmorphic features.

A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs.  The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for an ASD, children with delayed speech development should also have their hearing tested.

Children with some symptoms of an ASD but not enough to be diagnosed with classical autism are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Much rarer are children who may be diagnosed with childhood disintegrative disorder, also known as Heller syndrome, in which they develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors.

Diagnosis

Diagnosis is based on behavior, not cause or mechanism.  The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) 1 provides diagnostic criteria for 299.00 autistic disorder, which is defined as exhibiting at least six symptoms total, including at least two symptoms of qualitative impairment in social interaction, at least one symptom of qualitative impairment in communication, and at least one symptom of restricted and repetitive behavior. Sample symptoms include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with parts of objects. Onset must be prior to age three years, with delays or abnormal functioning in either social interaction, language as used in social communication, or symbolic or imaginative play. The disturbance must not be better accounted for by Rett syndrome or childhood disintegrative disorder.  ICD-10 uses essentially the same definition.

Several diagnostic instruments are available. Two are commonly used in autism research:

• the Autism Diagnostic Interview-Revised (ADI-R) is a semistructured parent interview, and
• the Autism Diagnostic Observation Schedule (ADOS) uses observation and interaction with the child.

The Childhood Autism Rating Scale (CARS) is used widely in clinical environments to assess severity of autism based on observation of children.

A pediatrician commonly performs a preliminary investigation by taking developmental history and physically examining the child.  If warranted, diagnosis and evaluations are conducted with help from ASD specialists, observing and assessing cognitive, communication, family, and other factors using standardized tools, and taking into account any associated medical conditions.  A pediatric neuropsychologist is often asked to assess behavior and cognitive skills, both to aid diagnosis and to help recommend educational interventions.  A differential diagnosis for ASD at this stage might also consider mental retardation, hearing impairment, and a specific language impairment such as Landau–Kleffner syndrome.  The presence of autism can make it harder to diagnose coexisting psychiatric disorders such as depression.

Clinical genetics evaluations are often done once ASD is diagnosed, particularly when other symptoms already suggest a genetic cause.  Although genetic technology allows clinical geneticists to link an estimated 40% of cases to genetic causes, consensus guidelines in the US and UK are limited to high-resolution chromosome and fragile X testing.  A genotype-first model of diagnosis has been proposed, which would routinely assess the genome's copy number variations.  As new genetic tests are developed several ethical, legal, and social issues will emerge. Commercial availability of tests may precede adequate understanding of how to use test results, given the complexity of autism's genetics.  Metabolic and neuroimaging tests are sometimes helpful, but are not routine.

ASD can sometimes be diagnosed by age 14 months, although diagnosis becomes increasingly stable over the first three years of life: for example, a one-year-old who meets diagnostic criteria for ASD is less likely than a three-year-old to continue to do so a few years later.  A 2009 US study found the average age of formal ASD diagnosis was 5.7 years, far above recommendations, and that 27% of children remained undiagnosed at age 8 years.  Although the symptoms of ASDs begin early in childhood, they are sometimes missed; years later, adults may seek diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some locations to claim disability living allowances or other benefits.

Underdiagnosis and overdiagnosis are problems in marginal cases, and much of the recent increase in the number of reported ASD cases is likely due to changes in diagnostic practices. The increasing popularity of drug treatment options and the expansion of benefits has given providers incentives to diagnose ASD, resulting in some overdiagnosis of children with uncertain symptoms. Conversely, the cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis.  It is particularly hard to diagnose autism among the visually impaired, partly because some of its diagnostic criteria depend on vision, and partly because autistic symptoms overlap with those of common blindness syndromes or blindisms.

Management: Autism Therapies

The main goals when treating children with autism are to lessen associated deficits and family distress, and to increase quality of life and functional independence. No single treatment is best and treatment is typically tailored to the child's needs.  Families and the educational system are the main resources for treatment.  Studies of interventions have methodological problems that prevent definitive conclusions about efficacy.  Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic reviews of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options.  Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, social, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors; claims that intervention by around age three years is crucial are not substantiated.  Available approaches include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.

Educational interventions can be effective to varying degrees in most children: intensive ABA treatment has demonstrated effectiveness in enhancing global functioning in preschool children and is well-established for improving intellectual performance of young children.  Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided.  It is not known whether treatment programs for children lead to significant improvements after the children grow up, and the limited research on the effectiveness of adult residential programs shows mixed results.  The appropriateness of including children with varying severity of autism spectrum disorders in the general education population is a subject of current debate among educators and researchers.

Many medications are used to treat ASD symptoms that interfere with integrating a child into home or school when behavioral treatment fails.  More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics.  Aside from antipsychotics, there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.  A person with ASD may respond atypically to medications, the medications can have adverse effects, and medications for treating the three core characteristics of autism (communication difficulties, social challenges, and repetitive behavior) have yet to be approved.  Thanks to recent advances in our understanding of the biology that produces autism’s core symptoms, the range of medication options may soon change. This has made it possible for researchers to begin testing compounds that may help normalize crucial brain functions involved in ASDs.  Early experiments suggest that several compounds with different mechanisms of action have great potential for clinical use, and many are now in clinical trials.

Although many complementary and alternative medicine (CAM) therapies and interventions are available, few are supported by scientific studies.  Treatment approaches have little empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance.  Scientific evidence appears to matter less to service providers than program marketing, training availability, and parent requests.  Some alternative treatments may place the child at risk. A 2008 study found that compared to their peers, autistic boys have significantly thinner, less dense bones if on casein-free diets; in 2005, botched chelation therapy killed a five-year-old child with autism.

The Harvard study Autism has high costs to U.S. society estimates that it can cost over $3 million to take care of an autistic person over his or her lifespan.  Treatment is expensive; indirect costs are more so. Publicly supported programs are often inadequate or inappropriate for a given child, and unreimbursed out-of-pocket medical or therapy expenses are associated with likelihood of family financial problems; one 2008 U.S. study found a 14% average loss of annual income in families of children with ASD, and a related study found that ASD is associated with higher probability that child care problems will greatly affect parental employment.  U.S. states increasingly require private health insurance to cover autism services, shifting costs from publicly funded education programs to privately funded health insurance.  After childhood, key treatment issues include residential care, job training and placement, sexuality, social skills, and estate planning.

Prognosis

There is no known cure for ASDs. Children recover occasionally, so that they lose their diagnosis of ASD; this occurs sometimes after intensive treatment and sometimes not.  It is not known how often recovery happens; reported rates in unselected samples of children with ASD have ranged from 3% to 25%.  Most autistic children can acquire language by age 5 or younger, though a few have developed communication skills in later years.  Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination.  Although core difficulties tend to persist, symptoms often become less severe with age.  Few high-quality studies address long-term prognosis. Some adults show modest improvement in communication skills, but a few decline; no study has focused on autism after midlife.  Acquiring language before age six, having an IQ above 50, and having a marketable skill all predict better outcomes; independent living is unlikely with severe autism.

• A 2004 British study of 68 adults who were diagnosed before 1980 as autistic children with IQ above 50 found that 12% achieved a high level of independence as adults, 10% had some friends and were generally in work but required some support, 19% had some independence but were generally living at home and needed considerable support and supervision in daily living, 46% needed specialist residential provision from facilities specializing in ASD with a high level of support and very limited autonomy, and 12% needed high-level hospital care.
• A 2005 Swedish study of 78 adults that did not exclude low IQ found worse prognosis; for example, only 4% achieved independence.
• A 2008 Canadian study of 48 young adults diagnosed with ASD as preschoolers found outcomes ranging through poor (46%), fair (32%), good (17%), and very good (4%); 56% of these young adults had been employed at some point during their lives, mostly in volunteer, sheltered or part-time work.

The number of reported cases of autism increased dramatically in the 1990's and early 2000's. This increase is largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness, though unidentified environmental risk factors cannot be ruled out.  The available evidence does not rule out the possibility that autism's true prevalence has increased; the risk is greater with older fathers than with older mothers; two potential explanations are the known increase in mutation burden in older sperm, and the hypothesis that men marry later if they carry genetic liability and show some signs of autism.

Autism is associated with several other conditions:

• Genetic disorders. About 10 to 15% of autism cases have an identifiable Mendelian (single-gene) condition, chromosome abnormality, or other genetic syndrome, and ASD is associated with several genetic disorders.
• Mental retardation. The fraction of autistic individuals who also meet criteria for mental retardation has been reported as anywhere from 25% to 70%, a wide variation illustrating the difficulty of assessing autistic intelligence. For ASD other than autism, the association with mental retardation is much weaker.
• Anxiety disorders are common among children with ASD; there are no firm data, but studies have reported prevalences ranging from 11% to 84%. Many anxiety disorders have symptoms that are better explained by ASD itself, or are hard to distinguish from ASDs symptoms.
• Epilepsy, with variations in risk of epilepsy due to age, cognitive level, and type of language disorder.
• Several metabolic defects, such as phenylketonuria, are associated with autistic symptoms.
• Minor physical anomalies are significantly increased in the autistic population.
• Preempted diagnoses. Although the DSM-IV rules out concurrent diagnosis of many other conditions along with autism, the full criteria for ADHD, Tourette syndrome, and other of these conditions are often present and these comorbid diagnoses are increasingly accepted.
• Sleep problems affect about two-thirds of individuals with ASD at some point in childhood. These most commonly include symptoms of insomnia such as difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings. Sleep problems are associated with difficult behaviors and family stress, and are often a focus of clinical attention over and above the primary ASD diagnosis.

Epidemiology of Autism

Data released in 2012 from the Centers for Disease Control and Prevention (CDC) estimates that 11.3 per 1,000 (1 in 88) children has been identified with an autism spectrum disorder (ASD).  This marks a 23% increase since the CDC's last report in 2009, and, a 78% increase since their first report in 2007.  Also, the prevalence of ASDs are markedly higher among boys (1 in 54) as compared to girls (1 in 252).  The sex ratio averages 4.3:1 and is greatly modified by cognitive impairment: it may be close to 2:1 with mental retardation and more than 5.5:1 without.  Causes and Risk Factors of Autism.  Most professionals believe that race, ethnicity, and socioeconomic background do not affect the occurrence of autism.

History of Autism and other ASDs

The Latin word autismus (English translation autism) was coined by the Swiss psychiatrist Eugen Bleuler in 1910 as he was defining symptoms of schizophrenia. He derived it from the Greek word autós, meaning self, and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance".

The word autism first took its modern sense in 1938 when Hans Asperger, a Viennese child psychologist who published the first definition of Asperger syndrome in 1944, adopted Bleuler's terminology autistic psychopaths in a lecture in German about child psychology. Asperger was investigating an ASD now known as Asperger syndrome, though for various reasons it was not widely recognized as a separate diagnosis until 1981.  Chaskel Leib Kanner (Leo Kanner) of the Johns Hopkins Hospital first used autism in its modern sense in English when he introduced the label early infantile autism in a 1943 report of 11 children with striking behavioral similarities. Almost all the characteristics described in Kanner's first paper on the subject, notably "autistic aloneness" and "insistence on sameness", are still regarded as typical of the autistic spectrum of disorders (ASDs).  It is not known whether Kanner derived the term independently of Asperger.

Kanner's reuse of autism led to decades of confused terminology like infantile schizophrenia, and child psychiatry's focus on maternal deprivation led to misconceptions of autism as an infant's response to the "refrigerator mother" hypothesis. Starting in the late 1960s autism was established as a separate syndrome by demonstrating that it is lifelong, distinguishing it from mental retardation and schizophrenia and from other developmental disorders, and demonstrating the benefits of involving parents in active programs of therapy. As late as the mid-1970s there was little evidence of a genetic role in autism; now it is thought to be one of the most heritable of all psychiatric conditions. Although the rise of parent organizations and the destigmatization of childhood ASD have deeply affected how we view ASD, parents continue to feel social stigma in situations where their autistic children's behaviors are perceived negatively by others, and many primary care physicians and medical specialists still express some beliefs consistent with outdated autism research.

Possible Autism or other ASDs in Certain Famous or Notable Historical People

Journalists, academics and autism professionals have speculated that certain famous or notable historical people had autism or other autism spectrum disorders (ASDs) such as Asperger syndrome. Such speculation is controversial and little of it is undisputed. For example, several autism researchers speculate that Wolfgang Amadeus Mozart had autism or other conditions, while other researchers say there is not sufficient evidence to draw such conclusions.

Speculative claims that historical figures displayed behaviors associated with autism spectrum disorders include people who died before the work done by Hans Asperger and Leo Kanner in classifying autism spectrum conditions was completed. Autism has only been recognized since the 1940s, so many earlier cases may have gone undiagnosed.  Speculation about their diagnoses is based on reported behaviors rather than any clinical observation of the individual. Fred Volkmar, a psychiatrist and autism expert and director of the Yale Child Study Center says, "There is unfortunately a sort of cottage industry of finding that everyone has Asperger's".

Historical Figures Speculated to have an Autistic Spectrum Disorder (ASD):

• Hans Christian Andersen - Danish writer, author, and novelist.
• Béla Bartók - 20th century Hungarian composer.
• Hugh Blair of Borgue - The earliest well-documented case of autism - 18th century Scottish landowner thought mentally incompetent, now studied as case history of autism - as detailed in a 1747 court case in which his brother successfully petitioned to annul Blair's marriage to gain Blair's inheritance.
• Lewis Carroll - English church official, author, mathematician.
• Henry Cavendish - English physicist and chemist. He was unusually reclusive, literal minded, had trouble relating to people, had trouble adapting to people, difficulties looking straight at people, drawn to patterns, etc.
• Charles XII of Sweden – King of Sweden from 1697 to 1718, speculated to have had Asperger syndrome.
• Anne Claudine d'Arpajon, Countess of Noailles – French aristocrat and first lady of honour to Queens of France, Marie LeszczyÅ„ska and Marie Antoinette.
• Charles Darwin – English naturalist.  In The Origin of Species Charles Darwin outlined the theory of natural selection, or "survival of the fittest," as the explanation for the changing of living beings over time.
• Emily Dickinson – American poet and author.  One of the finest poets in the English language, Emily Dickinson was a keen observer of nature and a wise interpreter of human passion. 
• Éamon de Valera – Irish revolutionary, the head of Sinn Féin, and the third president of an independent Ireland.
• Paul Adrian Maurice Dirac – English mathematician and theoretical physicist.  The founder of quantum electrodynamics and the co-founder of quantum physics.  He shared the 1933 Nobel Prize for Physics with Erwin Schrdinger.
• Albert Einstein – German-born American physicist and scientist.  Albert Einstein revolutionized the science of physics. He is best known for his theory of relativity, which holds that measurements of space and time vary according to conditions such as the state of motion of the observer.  Albert Einstein's famous equation for the photoelectric effect won him the Nobel Prize in physics in 1921.
• Janet Paterson Frame – Author. One of New Zealand's most famous literary exports, Janet Frame searingly chronicled the sometimes-fluid border between mental illness and what society terms "normal" in her dozen novels. Her fiction was a byproduct of her own struggle.
• Glenn Gould – Canadian "classical" musician (pianist) and noted Bach interpreter. He liked routine to the point he used the same seat until it was worn through. He also disliked social functions to the point that in later life he relied on the telephone or letters for virtually all communication. He had an aversion to being touched, had a different sense of hot or cold than most, and would rock back and forth while playing music. He is speculated to have had Asperger syndrome.
• Adolf Hitler – Austrian-born German dictator and nationalist. Adolf Hitler led the extreme nationalist and racist Nazi party and served as chancellor-president of Germany from 1933 to 1945.   
• Thomas Jefferson – American president, philosopher, and statesman.  Thomas Jefferson was the first secretary of state, the second vice president, and the third president of the United States. 
• Keith Joseph – The father of Thatcherism.  The former Conservative education secretary, who was Mrs Thatcher's mentor in the 1970s and 1980s, had Asperger's syndrome. 
• James Joyce – Irish author.  In 1992 he published, what many consider to be Joyce's most mature work, Ulysses, which is patterned after Homer's Odyssey. Homer was a Greek poet who produced his works around 850 B.C.E.
• Stanley Kubrick - American film director, producer, screenwriter, cinematographer, editor.  Considered one of America's greatest filmmakers.  A perfectionist, Stanley Kubrick’s Filmmaking Technique “Social Surrealism” is the conscious manifestation of a subconscious form of forces taking place beneath the mind’s eye.   
• William McGonagall - One of Scotland’s best-known poets, McGonagall published only a single volume of poems in his lifetime, Poetic Gems (1890).  His poems have been criticized for their lack of imagery and lapses in rhythm and meter, and his style has been frequently parodied. 
• Michelangelo – Michelangelo Buonarroti was recognized as one of the most talented sculptors of central Italy, and one of its greatest painters and architects.  Michelangelo was apprenticed at the age of thirteen to Domenico Ghirlandaio (1449–1494), the most fashionable painter in Florence at the time.  Michelangelo's earliest sculpture, the Battle of the Centaurs, a stone work created when he was about seventeen, is regarded as remarkable.  In 1501 he was commissioned to carve the David for the Florence Cathedral.
• Wolfgang Amadeus Mozart – Austrian composer.  Mozart's mastery of the whole range of contemporary (modern) instrumental and vocal forms, including the symphony, concerto, chamber music, and especially the opera, was unchallenged in his own time and perhaps in any other.
• Isaac Newton - English scientist and mathematician. Newton made major contributions in mathematics and physics and advanced the work of previous scientists on the laws of motion, including the law of gravity.  Isaac Newton's greatest work, Philosophiae naturalis principia mathematica, was completed in eighteen months. First published in Latin in 1687, when Newton was forty-five, its appearance established him as the leading scientist of his time, not only in England but in the entire Western world. 
• Moe Norman – Canadian golfer.  Murray Irwin "Moe" Norman was a Canadian professional golfer. He was widely considered the best ball striker who ever lived among the best players in the world. His accuracy, his ability to hit shot after shot perfectly straight, gave him the nickname "pipeline moe".
  A legend and a man revered by golf professionals all over the world, Moe Norman was inducted into the Canadian Golf Hall of Fame in 1995.   
• George Orwell – India-born English writer, novelist, essayist.  George Orwell, born Eric Arthur Blair in Motihari, Bengal, India is best known for his satirical novels Animal Farm (published in 1945) and Nineteen Eighty-four (published in 1949).  Because he was earning his living as a teacher, he preferred to publish his initial and subsequent works under the pseudonym "George Orwell".
• Enoch Powell –  John Enoch Powell, MBE (Most Excellent Order of the British Empire), was a British politician, member of Parliament, classical scholar, poet, writer, linguist, and soldier. Powell served as a Conservative Party MP (1950–74), Ulster Unionist Party MP (1974–1987), and Minister of Health (1960–63).  He attained most prominence in 1968, when he made the controversial "Rivers of Blood" speech against immigration.
• Srinivasa Ramanujan – Mathematician and autodidact (a self-taught person).  Srinivasa Ramanujan who, with almost no formal training in pure mathematics, made substantial contributions to mathematical analysis, number theory, infinite series and continued fractions.  Born and raised in Erode, Tamil Nadu, India, Ramanujan first encountered formal mathematics at age 10.  Cambridge granted him a Bachelor of Science degree "by research" in 1916, and he was elected a Fellow of the Royal Society (the first Indian to be so honored) in 1918.  It is believed that Ramanujan actually worked out the problems on a slate in an attempt to save paper, using the sheets in his notebooks only to note down results. Ramanujan was said by the English mathematician G.H. Hardy to be in the same league as mathematicians like Euler and Gauss in terms of natural genius.
• Charles Francis Richter – American seismologist and physicist.  Richter is most famous as the creator of the Richter Magnitude Scale which, immediately became the standard measure of earthquake intensity.
• Erik Satie – French composer.  Born Erik-Alfred-Leslie Satie, his spare, unconventional, often witty style exerted a major influence on 20th-century music, particularly in France.  Preferring to live alone and cultivating an eccentric mode of life, Satie permitted no one to enter his apartment.  Satie was dismissed as a charlatan by musicians who misunderstood his irreverence and wit.
• Jonathan Swift – An Anglo-Irish journalist, political activist, and writer of novels, poetry and essays who also used the name Isaac Bickerstaff among other pseudonyms.  Swift is best known for his satirical novel Gulliver's Travels (published in 1726).  He wrote many public letters and political pieces with the purpose of rallying the people. One of his most famous essays, a satirical hyperbole, was "A Modest Proposal, for Preventing the Children of Poor People From Being a Burden on Their Parents or Country, and for Making Them Beneficial to the Publick".  In the essay, Swift suggests that impoverished Irish might ease their economic troubles by selling their children as food for rich gentlemen and ladies.  
• Nikola Tesla - Serbian-American inventor, researcher, mechanical and electrical engineer.  Tesla discovered the rotating magnetic field, the basis of most alternating-current machinery.  In 1894, he was given honorary doctoral degrees by Columbia and Yale University and the Elliot Cresson medal by the Franklin Institute. In 1934, the city of Philadelphia awarded him the John Scott medal for his polyphase power system. He was an honorary member of the National Electric Light Association and a fellow of the American Association for the Advancement of Science.  In 1915 Tesla and Thomas Edison were to share the Nobel Prize for physics. Oddly, neither man received the prize, the reason being unclear.  Tesla sold several patent rights, including those to his alternating-current machinery, to George Westinghouse, a prolific inventor, entrepreneur, and in 1886 Westinghouse founded the Westinghouse Electric Company.  An 1891 invention, the Tesla coil, is used in radio technology.
• Alan Turing – English mathematician, logician, cryptanalyst, and computer scientist. He was highly influential in the development of computer science, providing a formalisation of the concepts of "algorithm" and "computation" with the Turing machine, which played a significant role in the creation of the modern computer.  Turing is widely considered to be the father of computer science and artificial intelligence.   
• Michael Ventris – English architect and classical scholar who, along with John Chadwick, was responsible for the decipherment of Linear B.  Ventris was awarded an OBE and an annual award in his honour, the Michael Ventris Award, was established in 1957. These awards, given to young Linear B scholars and architects, continue to the present day, under the auspices of the London Institute of Classical Studies and the Architectural Association, where Ventris took his degree.
• Andy Warhol – American artist and filmmaker. Warhol is the figure head of the Pop art movement of the 1960s.  Motion pictures of his such as The Chelsea Girls (1966), Eat (1963), My Hustler (1965), and Blue Movie (1969) were classed as "underground films" due to their inventive eroticism, lack of plot which resulted in boredom, and inordinate length (up to 25 hours).   
• Blind Tom Wiggins – Autistic savant.  Thomas "Blind Tom" Wiggins was an African American Pianist and Composer.  Wiggins was one of the nineteenth century's most famous and perplexing pianists. Born a slave in Georgia, "Blind Tom" died an international celebrity in 1908. He had an encyclopedic memory, all-consuming passion for music and mind boggling capacity to imitate - both verbally and musically - any sound he heard. These extraordinary savant powers rocketed him to fame and made his name a household word.
• Ludwig Wittgenstein – Austrian-British philosopher who worked primarily in logic, the philosophy of mathematics, the philosophy of mind, and the philosophy of language.  Ludwig Josef Johann Wittgenstein was professor in philosophy at the University of Cambridge from 1939 until 1947. 
• William Butler Yeats – Irish poet, playright, and prose writer.  His poetry and writings were a display of his passion for mysticism and the Occult Sciences.  In 1923, Yeats was awarded the Nobel Prize for Literature and, as one of the foremost figures of 20th century literature, he confounded expectations by producing his greatest work between the ages of 50 and 75. 

The advent of the Internet has helped autistic individuals bypass nonverbal cues and emotional sharing that they find so hard to deal with, and has given them a way to form online communities and work remotely.  Sociological and cultural aspects of autism have developed: some in the community seek a cure, while others believe that autism is simply another way of being.


External Links

CDC estimates 1 in 88 children in United States has been identified as having an autism spectrum disorder - Centers for Disease Control and Prevention (CDC).
Autism in Arapahoe County (Colorado) higher than nation's: 1 in 85 - The Denver Post.
Autism Spectrum Disorders (ASDs) - Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
Autism fact sheet - National Institute of Neurological Disorders and Stroke.
Autism and Diet - Academy of Nutrition and Dietetics.
Autism Treatment: Can Special Diets Help? - Mayo Foundation for Medical Education and Research.
Autism: Caregiver Support - National Alliance for Mental Illness (NAMI).
How Much Do You Know about Austism Spectrum Disorders (ASDs)? Test Your Knowledge - Centers for Disease Control and Prevention (CDC).
Interactive Tools to Track Child Development - Centers for Disease Control and Prevention (CDC).
People with Autism May Be Better at Processing Information - (03/26/2012, HealthDay) MedlinePlus.
Study Might Explain Brain Overgrowth Seen in Autism - (03/23/2012, HealthDay) MedlinePlus.
Mothers of Kids with Autism Earn Less - (03/19/2012, HealthDay) MedlinePlus.
Autism Concerns (video) - (02/22/2012, HealthDay) MedlinePlus.
Variation in Brain Development Seen in Infants with Autism - Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
Autism Speaks - It's Time to Listen.
Autism Society of America: Improving the Lives of All Affected by Autism.
The Global and Regional Asperger Syndrome Partnership.
Children Born to Obese Moms May Face Higher Autism Risk: Study - (04/09/2012) HealthDay News.
Scott James - Through My Eyes - Autism Awareness.  Scott James was diagnosed at age 13 with a form of autism called Asperger's Syndrome.  "Scott James Stuns audience on X Factor 2009 in final auditions"

Clinical Trials

ClinicalTrials.gov: Autistic Disorder, Child Development Disorders, Pervasive, Autism - National Institutes of Health (NIH).

Genetics

Genetics Home Reference: 16p11.2 deletion syndrome - U.S. National Library of Medicine.
Genetics Home Reference: 2q37 deletion syndrome - U.S. National Library of Medicine.
Learning about Autism - National Human Genome Research Institute.
Autism Linked to Inherited Gene Mutations, Particularly from Dad - (4/4/2012) ABC News.

Research

Autism Research at the NICHD - National Institute of Child Health and Human Development.
Autism Research - Centers for Disease Control and Prevention (CDC).
Autism Risk in Younger Siblings May Be Higher Than Previously Thought - National Institute of Mental Health (NIMH).
Prenatal and Infant Exposure to Thimerosal from Vaccines and Immunoglobins and Risk of Autism - Centers for Disease Control and Prevention (CDC).
Recovery Act-Funded Jobs Program Helps High School Grads Who Have ASD - National Institute of Mental Health (NIMH).
Treatments Show Promise in Reducing Autism-Related Behaviors, But Some Have Significant Side Effects - U.S. Department of Health and Human Services: Agency for Healthcare Research and Quality.
Study to Explore Early Development (SEED) - Centers for Disease Control and Prevention (CDC).
CHARGE (Childhood Autism Risks from Genetics and the Environment) Uncovering Environmental Causes of Autism.
EARLI Study - Reasearch Into Early Causes of Autism.

Complementary and Alternative Medicine (CAM) Therapies

Autism Treatment Options: Related Approaches - Autism Society.

Videos

National Database for Autism Research - National Institute of Mental Health (NIMH).
Stem Cell Possibilities in Autism Research - National Institute of Mental Health (NIMH).
What Is Autism? - Centers for Disease Control and Prevention (CDC).
Autism Concerns - (02/22/2012, HealthDay) MedlinePlus.



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Validity of ASD subtypes:

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Mirror neuron system (MNS) and autism:

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Lack of research on drug treatments:

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Lack of support for interventions:

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