Autism is known as a complex developmental disability. Experts believe that Autism presents itself during the first three years of a person's life. The condition is the result of a neurological disorder that has an effect on normal brain function, affecting development of the person's communication and social interaction skills.

People with autism have issues with non-verbal communication, a wide range of social interactions, and activities that include an element of play and/or banter.

ASD stands for Autism Spectrum Disorder. In this text Autism and ASD mean the same. ASDs are any developmental disabilities that have been caused by a brain abnormality. A person with an ASD typically has difficulty with social and communication skills.

A person with ASD will typically also prefer to stick to a set of behaviors and will resist any major (and many minor) changes to daily activities. Several relatives and friends of people with ASDs have commented that if the person knows a change is coming in advance, and has time to prepare for it; the resistance to the change is either gone completely or is much lower.

Autism, a wide-spectrum disorder

Autism (or ASD) is a wide-spectrum disorder. This means that no two people with autism will have exactly the same symptoms. As well as experiencing varying combinations of symptoms, some people will have mild symptoms while others will have severe ones. Below is a list of the most commonly found characteristics identified among people with an ASD.

Social skills

The way in which a person with an ASD interacts with another individual is quite different compared to how the rest of the population behaves. If the symptoms are not severe, the person with ASD may seem socially clumsy, sometimes offensive in his/her comments, or out of synch with everyone else. If the symptoms are more severe, the person may seem not to be interested in other people at all.

It is common for relatives, friends and people who interact with someone with an ASD to comment that the ASD sufferer makes very little eye contact. However, as health care professionals, teachers and others are improving their ability to detect signs of autism at an earlier age than before, eye contact among people with autism is improving. In many cases, if the symptoms are not severe, the person can be taught that eye contact is important for most people and he/she will remember to look people in the eye.

A person with autism may often miss the cues we give each other when we want to catch somebody's attention. The person with ASD might not know that somebody is trying to talk to them. They may also be very interested in talking to a particular person or group of people, but does not have the same skills as others to become fully involved. To put it more simply, they lack the necessary playing and talking skills.

Empathy - Understanding and being aware of the feelings of others

A person with autism will find it much harder to understand the feelings of other people. His/her ability to instinctively empathize with others is much weaker than other people's. However, if they are frequently reminded of this, the ability to take other people's feelings into account improves tremendously. In some cases - as a result of frequent practice - empathy does improve, and some of it becomes natural rather than intellectual. Even so, empathy never comes as naturally for a person with autism as it does to others.

Having a conversation with a person with autism may feel very much like a one-way trip. The person with ASD might give the impression that he is talking at people, rather than with or to them. He may love a theme, and talk about it a lot. However, there will be much less exchanging of ideas, thoughts, and feelings than there might be in a conversation with a person who does not have autism.

Almost everybody on this planet prefers to talk about himself/herself more than other people; it is human nature. The person with autism will usually do so even more.

Physical contact

A number of children with an ASD do not like cuddling or being touched like other children do. It is wrong to say that all children with autism are like that. Many will hug a relative - usually the mother, father, grandmother, grandfather, teacher, and or sibling(s) - and enjoy it greatly. Often it is a question of practice and anticipating that physical contact is going to happen. For example, if a child suddenly tickles another child's feet, he will most likely giggle and become excited and happy. If that child were to tickle the feet of a child with autism, without that child anticipating the contact, the result might be completely different.

Loud noises, some smells, and lights

A person with autism usually finds sudden loud noises unpleasant and quite shocking. The same can happen with some smells and sudden changes in the intensity of lighting and ambient temperature. Many believe it is not so much the actual noise, smell or light, but rather the surprise, and not being able to prepare for it - similar to the response to surprising physical contact. If the person with autism knows something is going to happen, he can cope with it much better. Even knowing that something 'might' happen, and being reminded of it, helps a lot.

Speech

The higher the severity of the autism, the more affected are a person's speaking skills. Many children with an ASD do not speak at all. People with autism will often repeat words or phrases they hear - an event called echolalia.

The speech of a person with ASD may sound much more formal and woody, compared to other people's speech. Teenagers with Asperger's Syndrome can sometimes sound like young professors. Their intonation may sound flat.

Repetitive behaviors

A person with autism likes predictability. Routine is his/her best friend. Going through the motions again and again is very much part of his/her life. To others, these repetitive behaviors may seem like bizarre rites. The repetitive behavior could be a simple hop-skip-jump from one end of the room to the other, repeated again and again for one, five, or ten minutes - or even longer. Another could be drawing the same picture again and again, page after page.

People without autism are much more adaptable to changes in procedure. A child without autism may be quite happy to first have a bath, then brush his teeth, and then put on his pajamas before going to bed - even though he usually brushes his teeth first. For a child with autism this change, bath first and then teeth, could completely put him/her out, and they may become very upset. Some people believe that helping a child with autism learn how to cope better with change is a good thing, however, forcing them to accept change like others do could adversely affect their quality of life.

Development happens differently

While a child without autism will develop in many areas at a relatively harmonious rate, this may not be the case for a child with autism. His/her cognitive skills may develop fast, while their social and language skills trail behind. On the other hand, his/her language skills may develop rapidly while their motor skills don't. They may not be able to catch a ball as well as the other children, but could have a much larger vocabulary. Nonetheless, the social skills of a person with autism will not develop at the same pace as other people's.

Learning may be unpredictable

How quickly a child with autism learns things can be unpredictable. They may learn something much faster than other children, such as how to read long words, only to forget them completely later on. They may learn how to do something the hard way before they learn how to do it the easy way.

Physical ticks and stimming

It is not uncommon for people with autism to have ticks. These are usually physical movements that can be jerky. Some ticks can be quite complicated and can go on for a very long time. A number of people with autism are able to control when they happen, others are not. People with ASD who do have ticks often say that they have to be expressed, otherwise the urge does not stop. For many, going through the ticks is enjoyable, and they have a preferred spot where they do them - usually somewhere private and spacious. When parents first see these ticks, especially the convoluted ones, they may experience shock and worry.

Obsessions

People with autism often have obsessions.

Myth

A person with autism feels love, happiness, sadness and pain just like everyone else. Just because some of them may not express their feelings in the same way others do, does not mean at all that they do not have feelings - THEY DO!! It is crucial that the Myth - Autistic people have no feelings - is destroyed. The myth is a result of ignorance, not some conspiracy. Therefore, it is important that you educate people who carry this myth in a helpful and informative way.

Not all people with autism have an incredible gift or savantism for numbers or music. People with autism are ordinary people... with autism.

What is Autism? - Video

What is Autism - Hans Asperger. Discussion from Tony, the father of an 8 year old child with autism, about what Dr. Hans Asperger said in his sentinel paper. Note: this video was produced independently, and is not owned by Medical News Today.

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Further reading

• Autistic disorder (also known as Autism) (Yale Medical Group)
• Pervasive development disorder (Wikipedia)
• What is Asperger's Syndrome?
• Useful Autism Website Links

Autism news

Medical News Today is a leading resource for the latest headlines on autism. So, check out our autism news section. You can also sign up to daily autism news alerts or our weekly digest newsletters to ensure that you stay up-to-date with the latest news.

ADD AND THE FAMILY

THE LINK BETWEEN ADD/HD AND EATING DISORDERS

SELF-MEDICATING WITH FOOD

WHY FOOD?

SUGAR CRAVING AND HYPERACTIVITY

THE SEROTONIN CONNECTION

COMPULSIVE OVER EATING

BINGE EATING

BULIMIA

ANOREXIA

COMPREHENSIVE TREATMENT

The Link Between ADHD & Addiction

Putting Out Fires With Gasoline

Who Will Become Addicted?

Prevention and Early Intervention

Untreated ADHD and Addiction Relapse

Treating Both ADHD and Addictions

A COMPREHENSIVE TREATMENT PROGRAM CONSISTS OF:

Medication and Addiction

There is Hope

David Rabiner, Ph.D.
Durham, N.C— 2000

The information presented below is intended to provide a general overview of a behavioral approach to improving children's behavior. Designing and implementing an effective behavioral plan will vary from one child to the next, however, and consultation with an experienced child mental health professional is recommended. Despite the well documented benefits of stimulant medication for treating ADHD, medication is no panacea, and some children with ADHD should not receive it. There are several reasons for this.

First, although medication helps the majority of children with ADHD, as many as 20% derive no real benefit from medication. Second, some children experience side effects that prevent them from receiving medication on an extended basis. Third, many children who benefit from medication still have difficulties with primary ADHD symptoms or associated problems which must be targeted via other means. Fourth, some children with ADHD can have their symptoms managed effectively without medication (this is most likely to be true, however, when symptoms are relatively mild.)

In addition to these reasons, some children have extremely strong objections to taking medication—this may be more likely to occur with teenagers. In these circumstances, trying to force medication on a child can create more problems than it solves. For all these reasons, other treatments are often necessary—some would say always necessary—to effectively treat ADHD.

An important non-medical approach used in treating children with ADHD is known as behavior therapy or behavior management. Behavior therapy is based on several simple and sensible notions about what leads children to behave in socially appropriate ways. One reason is that children generally want to please their parents and feel good about themselves when their parent is proud of them. When the relationship between parent and child is basically positive, this is a very important source of motivation. A second reason that children behave appropriately is to obtain positive consequences for doing so (i.e. privileges or rewards). Finally, children will behave appropriately to avoid the negative consequences that follow inappropriate behavior.

The goal of behavior therapy, therefore, is to increase the frequency of desirable behavior by increasing the child's interest in pleasing parents and by providing positive consequences when the child behaves. Inappropriate behavior is reduced by consistently providing negative consequences when such behavior occurs. This is a simplified, but not unreasonable view, of what behavior therapy is all about.

"My child and I seem to be in conflict almost all the time and I don't think he cares about pleasing me at all. How can I change this?"

Fostering a Postive Parent-Child Relationship

Let's begin by focusing on children's desire to please their parents. Often times, relationships between parents and children become fraught with conflict and angry feelings in response to the frustration caused by ADHD symptoms. Good times between parent and child can dwindle to almost nothing, and the child's desire to please his or her parent can evaporate. After all, most of us are not interested in pleasing someone that we constantly argue with. Unfortunately, when this important positive source of motivation for good behavior disappears, parents have to rely more exclusively on the threat of punishment to induce compliance. This generally makes for ongoing conflict and struggle.

In many situations, therefore, the first step in behavioral treatment is to enhance the amount of positive feelings between parent and child. One helpful way to do this is to set aside a certain amount of time each day (30 minutes is certainly sufficient) that is designated as the child's "special time". During this time, the child gets to choose the activity (it must be within reason, of course), and the parent's sole focus is on trying to have a good time with his or her child.

During this time, it is important to avoid asking too many questions or giving commands, and, instead, to simply tune into what your child is doing in an interested and complimentary way. For example, if your child is building a tower with blocks, the comment "Don't you think it would be better if you used these bigger blocks first?", will be less helpful than a comment like "Boy, the tower your building is really getting tall!"

The goal of this time together is to build up good feelings between your child and you so that your child will become more invested in wanting to please you. When this occurs, discipline and limit setting generally go much more smoothly. When parents first begin to try this, they are often surprised to that chores, homework, or errands are getting done. The absence of this special time can be a real loss to both parent and child. Working to make it part of your daily routine can yield substantial benefits in the parents' relationship with their children.

Using Positive Reinforcement

The second focus of behavioral treatment involves providing your child with positive consequences for behaving in appropriate ways. The simple logic is that you can increase the frequency of desired behavior (e.g. putting away toys) by providing rewards when such behavior occurs. At the simplest level, this requires nothing more than noticing when your child is doing something you want to encourage (e.g. playing quietly) and making sure to comment on it ("Your doing such a nice job of playing quietly. I really appreciate that.").

Think about the kinds of behavior you want to encourage, make sure your child understands what you want him or her to do, and then be sure to praise your child whenever you happen to observe it occurring. This simple technique of noticing good behavior is easy to overlook but can be quite helpful. I often recommend to parents that they make a conscious effort to catch their child doing something good at least five times a day and to point it out. When children are convinced that their parents notice and appreciate their efforts at behaving well, it frequently increases their desire to do so.

In addition to these "social rewards", behavioral treatment also involves providing your child with concrete rewards and/or privileges for appropriate behavior. As an example, suppose your child has developed the problematic habit of talking back. You tell him to put away his toys and he tells you "not now, later". One way to increase your child's compliance is to make a tangible reward or privilege contingent on his following your request. For example, you could explain that each time he does what he is told, he will earn a point. These points can then be used to "purchase" a privilege such as access to TV, computer time, etc.

Designing a good behavior plan and implementing it effectively is not easy, and parents may often require professional assistance to do this successfully. Although the specifics of a good plan will vary from child to child and from parent to parent, there are several general principles that are important to keep in mind:

"Isn't this bribing my child? Why should he be rewarded for things he should do anyway?"

Parents are often concerned that providing their child with rewards for behaving appropriately is nothing more than bribery. The way I prefer to look at this, however, is that you are providing your child with the opportunity to earn extra privileges for behaving in a more mature and cooperative manner.

An analogy to the adult workplace may be useful here. If your boss promises a promotion and raise for a specified level of productivity are you being bribed, or are you being given the chance to earn a deserved reward for a job well done? If your child's behavior improves shouldn't he or she have access to more privileges than when they were behaving poorly? That is really all that is being talked about here—the main difference with what most parents already try to do is that the expectations and rewards for meeting those expectations are made more explicit.

Using Negative Consequences to Reduce Misbehavior

In addition to using positive reinforcement to encourage good behavior, behavioral treatment also relies on negative consequences or punishment to reduce undesirable behavior. Simply stated, when a particular behavior is consistently followed by negative consequences for a child, it should diminish in frequency and intensity.

For example, suppose you are trying to reduce your child's tendency to "talk back" and this is being targeted in your behavioral treatment plan. Here is a general approach one might take.

* First, your child would need to understand exactly what you mean by "talking back" so it is clear what should not be done.
* Second, you would want to teach your child an acceptable way to disagree with you - how he or she is allowed to express disagreement and how they can not.
* Third, as discussed above, you would review with your child the rewards they will earn for not talking back and for expressing disagreements in an acceptable way.
* Finally, you would discuss with your child what privileges they will lose each time they "talk back". For example, talking back could result in their having to take a "time out", losing TV time, having to go to bed early, ect. If you are using a token system where your child is accumulating tokens that can be used to purchase rewards, talking back can result in the loss of a pre-specified number of tokens.

By setting things up this way, what you are trying to do is to make sure your child understands that there is simply no pay-off for bad behavior. Instead, when he or she acts appropriately, it will always result in good things coming their way. In contrast, when behavioral expectations are not met, the consequences are always negative.

IMPORTANT—Try hard not to overdo the negative consequences. Children tend to get discouraged if they are used too frequently and can lose interest in the program as a result. If you find yourself having to resort to negative consequences too frequently, it's important to take a careful look at what may be going wrong with an eye towards redesigning the program.

Have a Game Plan!

Now it would be wonderful if the first time you used a negative consequence as discussed above, it effectively ended your child's misbehavior. As we all know, however, this is often not the case. Instead, you may take away TV time because of some misbehavior, and your child either ignores you or says he "doesn't care" and continues with the problematic behavior.

It is easy to become frustrated and angry in situations like this. At such times it is easy (I know from experience because this is a mistake I make myself) to blurt out a punishment that is born of frustration and will be difficult if not impossible to enforce:

* "Your grounded for the next 2 weeks!"
* "That's it! No more birthday party for you!"

I know that I've had the experience of shouting out something like this, and realizing right away that it wasnít something I would stick with. In fact, it wasn't even something I should stick with because it was excessive and unreasonable. You are then left with the uncomfortable choice of enforcing something unreasonable to show your child that you mean business or backing down. Choose the former and your child is justifiably upset and you wind up feeling guilty. Choose the latter and your child gets the idea that punishments don't matter because you don't stick with them anyway.

One helpful way to avoid this dilemma is to plan out, IN ADVANCE, a graded series of punishments for persistent misbehavior. For example, when your child initially fails to comply you could impose a five-minute time-out. If the non-compliance continues, you could say "If you don't do what you're told now, the time out will increase to ten minutes."

Continued non-compliance results in loss of TV, in addition to the time out. After that, an earlier bed time could be imposed. You have to decide what specifics make sense, of course, but the general point is to have an escalating series of consequences that you can calmly but firmly announce and calmly ,but firmly, enforce. (It is best that these consequences do not extend into the following day so the new day can get off to a fresh start.)

Having this plan in mind can help you to keep your cool and prevent you from blurting out a punishment that is not going to be helpful. If you can stick with game plan, your child should learn that there is something nothing to be gained by persistent disobedience.

Don't Teach Your Child to Misbehave

Here is a pattern that is easy to fall into and which is associated with increasing misbehavior and non-compliance. You ask or tell your child to do something—like pick up his toys. Your child ignores you and keeps on playing. You repeat your request and your child ignores you again. You get angry and intensify your demand; your child gets angry in response and starts to tantrum. After a few more cycles of this, you are both very angry. To keep things from exploding, you drop your demand, send your child away, and pick up the toys yourself because "it's not worth all the hassle and aggravation" trying to make your child do it.

Most parents have been through something like this. With children who have ADHD and are also oppositional, this is a distressingly frequent occurrence. Unfortunately, what a child learns from this type of exchange is that if they just hang in there and persist in being defiant, they will eventually get their way. What happens, therefore, is that your child's disobedience is actually being REWARDED. This can result in things going downhill because your child is being taught that defiance pays off.

It is important to chose your battles carefully. Once you demand something of your child, BE SURE TO FOLLOW THROUGH WITH IT. If your child persists in being defiant, try using the graded series of consequences as discussed above. Your child needs to see that you mean business, and that there is ABSOLUTELY NO PAYOFF for being disobedient.

"This type of behavioral approach sounds like something that would be useful with all children. Is there anything different about using this approach with a child who has ADHD?"

"What kinds of behaviors can be addressed with this type of approach?"

In theory, virtually any type of behavior can be targeted using a behavioral treatment approach. For example, primary ADHD symptoms such as not completing tasks can be targeted by providing rewards for task completion. Symptoms such as interrupting and talking out of turn can be targeted in similar ways. Associated difficulties such as deliberate non-compliance, aggression, ect. can also be targeted in a behavioral treatment plan. Regardless of what behavior is being targeted it is essential to be sure that:

* the child understands what is being expect of him or her
* the expectation is reasonable and something the child is capable of doing
* the child understands what rewards can be earned by meeting the expectation
* the child understands what the negative consequences will be for not meeting the expectation
* you follow through with what you say you are going to do

Remember, don't try to take on too many things at once. Try to set things up so the child has a good chance to experience some early success. Don't expect or require perfection. Even a small improvement is still an improvement.

"I don't think this will work because it's impossible to enforce consequences with my child. Trying to enforce a punishment just makes him angrier."

Unfortunately, things can get to this point. Even in these situations, however, sometimes one parent has more success than the other. For children with ADHD who are also oppositional, fathers often seem to have greater success than mothers.

If this is the case, one approach is for mom to calmly and firmly attempt to induce compliance from the child and to be clear about what the consequences for continued non-compliance will be. If the child refuses to comply, make it clear that when dad gets home the child will need to do what is being demanded and that the consequences will be enforced at that time. PLUS, an additional negative consequence will also be administered.

By refusing to listen to mom, therefore, they are not getting out of what they don't want to do, but only delaying the inevitable. In fact, by not listening to mom, they will actually be making things worse. The intent here is to keep mom from getting into an unsuccessful and escalating battle with the child while making it clear to the child that there is no pay off for not listening to mom. For this approach to work, cooperation between parents and support for each otherís efforts is essential.

"What if neither parent can get their child to comply?"

Neuroplasticity Research Offers Hope to People with Dyslexia

Carolyn Cosmos is a contributing writer for The Washington Diplomat.