The varied behaviors of autism make the disorder extremely difficult to detect. While some children acquire language and can play appropriately, others can be mute and play in odd eccentric ways. As with many other parents, Catherine Maurice (1993) was puzzled by her daughter’s peculiar behaviors at 1 year of age. Maurice (1993), however, brushed off any of her daughter’s behaviors to, “the uniqueness of [Anne-Marie’s] personality,” since, “she was passing her regular pediatric checkups with flying colors” (p.5).
It is true, as in Maurice’s (1993) case, that in approximately 20% of children, development is normal in the first 2 years of life (DSM IV, 1994). Between the second and third year of life, however, parents report a regression of language and then finally an abrupt stop in development (DSM IV, 1994). According to the DSM IV (1994), there are core deficits and excesses in autism that must occur before the age of 3 for a proper diagnosis.
Main deficits in children with autism can affect communication, play and social interaction (DSM IV, 1994). Impairments in communication are primarily associated with expressive and receptive language. Language can be delayed (DSM IV, 1994), or non-existent in which other forms of communication such as Picture Exchange Communication (PEC) might be used (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Language can also be impaired in the form of a lack of spontaneity (i.e. “I see a car”) or reciprocal statements (i.e. “Tickle my tummy”), pronoun reversal (i.e. “This is your [instead of my] bedroom”), echolalia in which children repeat words said to them and in, “pitch intonation, rate, rhythm [and] stress” (DSM IV, 1994; Schopler, Riechler, DeVellis & Daly, 1980). When children do acquire some language, it can be extremely limited and can largely encompass an array of unique idiosyncrasies such as phrases from books, movies, songs or funny sounding words like “gasoline” which can be spoken during inappropriate times (DSM IV, 1994). Not only is expressive language affected, but so is receptive understanding of spoken language. An impairment of receptive understanding may cause enormous frustration for children trying to understand language and for parents who ask children to do simple commands such as, “go get your shoes and coat” (DSM IV, 1994). Parents often complain that the first sign of something wrong was that their child did not respond to their own name (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).
The areas of parallel, associative, cooperative, imaginary and interactive play can also be impaired in children with autism (DSM IV, 1994). Some children with autism unfortunately do not know how to play since they may lack imitation skills. When they do play they usually engage in perseverative play of doing the same actions over and over again. They can also form ritualistic patterns during play in which play sequences must be exactly the same each and every time (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).
As well, social interaction can be severely affected since autism means to be isolated from others (Maurice, 1993). Deficits in social interaction can take the form of a lack of sustained eye contact, asking questions, nonverbal cues such as tapping a person’s shoulder to get their attention and including other people in their play (DSM IV, 1994). Children with autism also may not recognize other people as sources of social enjoyment and might prefer to be isolated from others since it is more reinforcing to be alone and comfortable than to be forced to engage with other people (Bohdanna Popowycz Kvam, personal communication, November 1, 2002).
Autism can also be characterized by a series of marked excesses. Besides perseverative and ritualistic behaviors, self-stimulatory behaviors can also exist in children with autism (Bohdanna Popowycz Kvam, personal communication, November 1, 2002; Lovaas, 1987). These behaviors appear to look odd to others since they do not represent normal development in children. Examples of self “stims” include verbal (i.e. repeating a word), visual (i.e. using your peripheral vision to look at everything) or tactile (i.e. licking books) (Bohdanna Popowycz Kvam, personal communication, November 1, 2002). Children with autism can also exhibit self-injurious behaviors or severe aggression and tantrums (DSM IV, 1994). As well, some children can be hypersensitive or hyposensitive to any of our five senses (DSM IV, 1994).
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