One of the hardest issues for parents of an autistic child is finding out if their child actually has autism. Though the current diagnostic standards require that children show some deficits before the age of three, many parents have suspicions much earlier in their child’s development (check out current DSM criteria). In fact, early detection of autistic symptoms is so prevalent that current revisions of the DSM have removed the use of a specific age, replacing it with this statement: Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) (check out the proposed revisions for the new DSM). The reason for this change is important. Many of the stereotypical deficits seen in autism can be hard to notice, or even nonexistent in young children. For example, many children with autism exhibit some difficulty with communication and language production. By three years old, little to no use of language is a serious sign of autism. And yet, there is nothing peculiar about a one year old with limited to no speech. So how do we know what to look for and when to start looking if we suspect there may be a problem?

The truth is, the earlier we can intervene with a child with autism, the better. Early interventions have proved quite influential in creating a better prognosis in the long run. In fact, some intervention programs have been shown to provide preschoolers with a 20 point increase in IQ score when enforced 30-40 hours a week for 1-4 years. (Read more about these interventions and more in the Landa article) Other intervention programs have found successful ways to facilitate communication in children with little speech. The Picture Exchange Communication System teaches children how to use cards of pictures to communicate what they want. The benefits of intervention are obvious, but the question still remains, how do we know when it’s time to start using them?

As the Landa article explains, many parents who suspect that something might be wrong with their child are told by their physicians to initiate the famous “wait and see” technique. This can be a serious problem because it puts parents in an especially difficult situation. No parent wants to diagnose their typically developing child with autism, and yet delaying early intervention to a child that ends up receiving a diagnosis can be just as painful. Landa discusses some “red flags” that parents can keep an eye out for when suspecting autism. These include things like lack of response to name, repetitive body movements, and lack of showing. Many of these signs can be helpful, but they can also just induce worry in parents, as many kids grow out of these behaviors.

So long story short, there is no answer. Basically all we can really say is that the earlier a child enters intervention, the better. As for deciding if a child even needs intervention, well that’s left to the parents to decide. Many parents may err towards safety and get their child help, even if they are not sure it’s necessary. Others, with less education about autism or without the money to pay for such extensive (and, let’s be honest, expensive) interventions, may decide to wait until they are sure. Current research is trying its hardest to establish some early diagnostic criteria, but this proves to be a difficult and tedious task. As for now, we have to depend on parents to know where to draw the line of what’s typical development and what isn’t. There is no right answer, and there is definitely no easy answer.

Just call me Rara

The best part of being a psychology major is the amazing amount of random facts you can crack out at parties. You just drop a bomb like, did you know vaccines don’t cause autism, and you are officially the life of the party. Since the birth of my niece I have really been able to up my game. I am the magician and she is my beautifully dressed side kick. We started our act right after her birth when we performed a pulmar grasp in front of a crowd. Within a year we were really turning heads with some fun displays of object permanence. Now, at 16 months, I have decided that Isabela is a trained professional and it is time for us to move on to more sophisticated tricks.

Last weekend I went home with the intention of teaching her an extraordinary amount of new words. Babies saying new words are always a show stopper. Before we started training, Isabela showed me what she could already do. I yawned condescendingly when she said mama and dada. I was unimpressed with her “more, more” and “alllllll done.” But like the true magician she is, Isabela was saving the best for last. First you must understand that we have two Labradors who are sisters. To the untrained eye they are one in the same, but not to Isabela.When prompted, where is Roxy? Where is Daisy? Isabela can point to the correct dog. What a champ.

Now understanding that Isabela is obviously a genius, I decided we were ready for her to learn my name. We practiced day in and day out with absolutely no results. I chanted: Sara, Sara, Sara. Nothing. I said “Isabela, say Sara, say Sara.” Nothing. And then one day something amazing happened. She said Rara. I’ll take it! I came back to Charlottesville feeling like a winner. Isabela knows who I am.

My excitement was short lived when the next day my sister called me to say Isabela’s been going around calling her dog (Roxy) Rara. I was so disappointed. I can’t believe I rewarded her with a popsicle.

Fortunately for me, the next day I read the article by Baron-Cohen (1997) and learned a little something about the Speaker’s Direction of Gaze strategy. Baron-Cohen and his colleagues surmise that infants utilize this strategy to learn the meaning of new words. The SDG strategy says that children look to what the speaker is gazing at (instead of what the child is gazing at) to see what the new word is referring to. I say shoe, Isabela will follow my gaze to see what object I’m talking about. What a remarkably simple and yet complicated finding. One could easily assume that infants use the Listener’s Direction of Gaze strategy. This would mean that every time we want to teach a new word, we would have to wait until the infant spontaneously gazed at the shoe before yelling SHOE SHOE SHOE! To be honest, this blew my mind. Because of the SDG strategy, Isabela was able to name the correct dog. Obviously when we say "Where is Roxy," we all look at Roxy.

This also explains why Isabela doesn’t understand why I am Rara. When teaching her my name, we lacked any sense of joint attention. We were not connected on one object. We did not share a beautiful moment where our eyes met. In fact, after I would say Sara she would look up at me inquisitively, perhaps searching for my gaze. Where was I looking? At her.

It seems clear that any disruption in using this method can inhibit its effects. Obviously this seems to be a lasting problem for children with autism. With an aversion to eye gaze, many autistic children are lacking a crucial step in understanding language. They are making up for this issue by utilizing the LDG strategy. But, as mentioned before, the LDG has its faults. Language acquisition now becomes temperamental and confusing. Baron-Cohen (1997) explains that even when autistic children learn new words, they might not understand what these words are referring to. If language learning can be so specific that Isabela can’t understand that I am referring to myself, then we must appreciate how difficult it is to teach language to a child averse to gaze. Perhaps language delays in children in autism are the cause of many different factors. They may have the ability to communicate, but have extreme difficulty in learning the words. It is definitely something to think about.

As for me, I suppose I owe Isabela another chance at learning my name. This time I will have my sister yell SARA every time Isabela looks at me. I will keep you updated.

It is clear to most that autism entails at least some form of social dysfunction at every level on the spectrum. Be it a debilitating response to touch or a subtle aversion to eye gaze, social impairments are an obvious problem for people with autism. It only makes sense then that if we can find out what mechanisms are malfunctioning then we can make our best efforts to correct them.

So what’s the cause of this dysfunction? Well we are not that sure yet, but Pelphrey and Morris have an idea.

As discussed in their article, the STS region of the brain seems to have significant importance in a person’s ability to interpret social interactions. To test this idea, Pelphrey and Morris monitored the STS region of the brain in response to goal directed behavior. In the study an attention grabber flashed on the screen, eliciting the animated person’s attention. The animation then had two choices; look at the attention grabber or don’t. When the animated figure attended to the checker board, the STS region in the observer responded with increased brain activity. But interestingly enough, even higher levels were elicited when the animated figure looked away from the attention grabber. Simply put, the STS was surprised!

So what does this mean? The STS region of the brain has expectations when participating in social interactions. The human brain has the ability to perceive the actions of others before they happen.

When it comes to studying autism this seems to be an important component. When people diagnosed with autism participated in the same experiment, their STS region did not discriminate between a congruent response and an incongruent response. This seems to imply that people with autism are deficient in social interaction at the neural level.

After reading this article, I thought to myself one thing: let’s retrain the STS region in order to help facilitate social interactions in people with autism.

The idea is not completely absurd as many other studies have shown that even infants can be trained to produce brain functions more advanced than expected for their age. For example, the famous “sticky mittens” experiment enabled children who were too young to grasp on their own, the ability to reach for things. When the infants received this new found ability to “grasp,” they were suddenly able to better perceive the goals and actions of other people in similar grasping situations. More amazingly, these results were able to generalize to other goal directed situations. Similar results are revealed in Sommerville’s study where they gave children canes to reach distant objects.

If infants with lower brain functioning can be taught to perceive and interpret the goal’s and actions of other people, why can’t we use similar techniques to alter the brain functioning of people with autism? Obviously much more research is necessary, but based on the infant studies, we already know that social interactions can be fostered and encouraged using early training. If comparable manipulations can be devised to fit their specific dysfunctions, perhaps these training devises can be added to early intervention programs for autistic children. If we can train autistic children have to read differences in eye gaze and facial expressions perhaps the STS region of the brain will start to respond in similar ways to typically developing children. Even though many parts of social interactions seem not to come naturally to autistic people, why shouldn’t we be able to teach them?

Why am I always on the bad guy's team?

Two years ago I started volunteering in a local kindergarten class. The class consisted of seven rambunctious boys who tested my youth with their high energy and extreme enthusiasm for Star Wars. It was there that I was first introduced to a young man, let’s call him Billy, who had recently been diagnosed with Aspergers syndrome. Knowing what little I knew about autism at the time, I was amazed at Billy’s high verbal skills and keen interest in socializing with the other boys.

The more time I spent with Billy, however, the more problems I realized he was having. Even today, after reading Temple Grandin’s accounts of her childhood and the Rogers and Ozonof (2005) article on sensory dysfunction, I think there was more to Billy’s situation than I understood at the time.

When it came to speaking, Billy was a master. One day I sneezed and he sat me down and gave me an extensive overview of the body’s immune system. I was impressed, to say the least. He knew more about white blood cells then I did. And yet as I read Temple’s autobiography I can’t help but recall things that I thought very little of at the time. To begin with, Billy and I had this ten minute discussion without our eyes ever meeting. He used hand gestures to help describe the flow of blood and stood up excited when he told me about bacteria, but never once did he look at me or make note that I was still there. In fact, I think I could have left and he wouldn’t have noticed. As Temple describes it, I think he was in his “inner world,” blocking out much of his surroundings. Additionally, in reading Temple’s autobiography I made another interesting realization. As I said earlier, Billy had no trouble talking, but there was something a bit bizarre about his speech. I must thank Temple for now, two years later, explaining to me what it was. Billy was exhibiting little to no change in his intonation. His voice was flat and steady as he spoke in an almost robotic sort of way. Now let me explain to you how our conversation ended. Right around the white blood cells attacking the invader germs, Billy noticed a piece of lint falling from the ceiling. For the next three minutes he followed it around the room. When it finally hit the floor he went and played Legos, as if nothing had ever happened.

As for social interactions, Billy had a fondness for being around his peers. The other boys seemed to notice little to nothing of Billy’s condition and included him in everything they did. When they played Lego Star Wars, they would pass him a car and yell “YOU’RE ON THE GOOD GUY’S TEAM.” Let’s note that I was always on the bad guy’s team. Billy had fun participating, but when the boys got too rambunctious you could find him sitting in the corner, rocking back and forth, spinning the wheel of his car over and over again. Quite often when the class got too loud you would find Billy standing in place rocking himself or spinning the wheel of his car. Call it under arousal or over arousal, but it seems pretty clear to me that there was a threshold for how much stimulation Billy could handle. I can’t help but think of the boy from Autism: The Musical who was playing outside with the girls at school. He ran around the carelessly with them, but soon he stopped. He covered his ears and stood alone, presumably to block out some of his world as the kids continued to play around him.

The article by Rogers and Ozonof seems inconclusive in determining if children with Autism are experiencing under arousal or over arousal. Was Billy spinning rocking back and forth to calm himself or was he needing some more arousal? There seems to be a lot of contradicting information out there. To start with, Metz (1967) claims that autistic children have a preference for higher volume sounds than normally developing children. Presumably this means that autistic children are experiencing under arousal. Perhaps things such as flapping and rocking are means to provide more stimulation. In contrast, Hutt, Hutt, Lee, and Ounsted (1964) concluded in their study that children with autism experienced high levels of activation in their brain stem during and EEG. Unlike Metz, they concluded that stereotyped behavior, was a means of suppressing some of the over arousal they were experiencing.

So where do we go from here? It seems obvious to most that there is some sense of sensory dysfunction in children with autism. Temple, Billy, and Wyatt all exhibited such problems. But with such varying (and quite dated) information, I think it is important for us to go further, conducting more studies on the topic, in order to better understand what children with autism are really experiencing.