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OVERVIEW OF AUTISM
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Autism, or Autistic Disorder, is usually recognized by the time a child is 30 months old and is almost always recognized by three years of age. The child's development is atypical in the sense that: (1) there has been language delay or regression in language skills ("regression" means that the child's speech was developing normally, and then the child started "losing ground" or losing the speech skills they had), (2) the child doesn't cuddle or interact normally with family or others and (3) the child generally appears unresponsive or nonresponsive to the environment. The precise diagnostic criteria are contained in the DSM-IV and in the European alternative, ICD-10 (both pages open in windows).
The autistic child may engage in unusual or ritualistic behaviors like rocking, hand waving, or an obsessive need to maintain order. Many children with autism do not speak at all, and those who do speak may speak in rhyme, exhibit echolalia (repeating a person’s words like an echo), refer to themselves as a "he" or "she," or use othewise atypical language. Imagination is also impaired and many autistic children will have abnormal responses to sensory events, being either under- or over-reactive.
Although autism is about 3 to 4 times more common in boys, girls with the disorder tend to have more severe symptoms and greater cognitive impairment.(Fombonne, 1998). A recent study based on data collected in 1996 indicates that the M:F ratio declines as the severity of cognitive impairment increases, such that the M:F ratio is 4.4 for children with mild cognitive impairment and 1.3 for those with severe cogntive impairment.
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HOW COMMON IS AUTISM?
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The estimates of incidence in the general population have increased significantly over the last decade from estimates of 5 - 10 cases per 10,000 births up to about 60 cases per 10,000, while a later study yielded a somewhat more conservative rate of 3.4 cases per 1000.
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WHERE ARE CHILDREN WITH AUTISM EDUCATED?
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Autism represents a significant predictor for referral to special education, although whether the special education program is provided in a mainstream school or a segregated special education school may be more of a function of what country you are in:
In the U.S., for the 1998 - 1999 school year, over one half of all children classified under I.D.E.A.'s "autism" classification spent more than 60% of their school day outside of a regular classroom:
Percent of Autistic Students x Educational Placement, 1998 - 1999*
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Placement
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Percentage
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Regular classroom (outside of regular classroom for less than 21% of the day)
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20.3
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Resource room (outside of regular classroom more than 21% of the day but less than 60% of the day)
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13.1
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Separate class (outside of the regular classroom for more than 60% of the day)
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51.1
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Public separate school facility
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7.8
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Private separate school facility
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5.7
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Public residential facility
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.2
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Private residential facility
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1.2
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Homebound/hospital placement
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0.4
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In the UK, data collected on 5- to 11- year-old children by Fiona, Baron-Cohen, Bolton, and Brayne (2002) during the same time period indicated a prevalence rate of .33% in mainstream schools in Cambridgeshire (33 in 10,000 cases) and a prevalence rate of 12.5% in special education schools. These figures cannot be directly compared to the U.S. data, however, as the U.S. percentages are based on percent of children with autism while the UK data are based on percent of children in a particular school. A subsequent study in a single health district in the UK (Keen & Ward, 2004) on students diagnosed with Autism Spectrum Disorder compared placements in 1997 and 2001:
Educational Provision: 1997, 2001
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Placement
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Percentage in 1997
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Percentage in 2001
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Mainstream:
- with statement of special educational needs
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54.2
87
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69.9
89
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Severe learning difficulty:
- main school
- autistic unit
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3.1
15.6
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4.1
11.7
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Moderate learning difficulty:
- main school
- autistic unit
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4.1
14.5
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6.1
6.1
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Language unit, mainstream school
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--
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1.5
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Non-LEA autistic school
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6.3
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1.5
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Specialist residential placement
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1
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1
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Out of school
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0
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.5
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EBD school
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--
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.5
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ARE OTHER CONDITIONS ASSOCIATED WITH AUTISM?
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Individuals with autism often have symptoms of various co-occurring mental disorders, including Attention Deficit Hyperactivity Disorder (ADHD), psychoses, depressive disorders, obsessive-compulsive disorder, and other anxiety disorders (Volkmar, Cook, Pomeroy, et al., 1999). About one-third of children and adolescents with autism develop seizures (Giovanardi, Posar, & Parmeggiani, 2000). The relationship between autism and ADHD has recently received greater attention, as it appears that up to 60% of children with autism may also meet diagnostic criteria for the combined or inattentive subtypes of ADHD, and recognizing and addressing any comorbid ADHD may be an important piece of planning and treatment.
As with other conditions, autism is a spectrum disorder and the severity of the symptoms and presence of other conditions varies quite a bit. Some autistic individuals are very bright and may do very well in many domains but have significant social impairment, while others may be profoundly retarded and unable to live independently.
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NOTE
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SOURCE: U.S. Department of Education, Office of Special Education and Rehabilitative Services, Annual Report to Congress on the Implementation of The Individuals with Disabilities Education Act. Table 53, reproduced on the NCES site.
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