Chapter 3 - Autism

Autism is a developmental disorder that affects more boys than girls. You have already heard my bit about how I call Charlie my egg roll, but here is my bit about how autism is like ordering Chinese food – two from column A, three from B and one from C, you will see what I mean in a minute. I need to throw into this story what forms the diagnosis for autism, but the reading of it is dry. For those already familiar with the criteria that delineates autism, you can all have my express permission to skip this part. This is for the person who is new to autism.

The actual diagnostic criterion for autism is as follows from the Diagnostic and Statistical Manual of Mental Disorders


(A) qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction

2. failure to develop peer relationships appropriate to developmental level

3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)


4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )

(B) qualitative impairments in communication as manifested by at least one of the following:

1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)

2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

3. stereotyped and repetitive use of language or idiosyncratic language

4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:

1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

2. apparently inflexible adherence to specific, nonfunctional routines or rituals

3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects

Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play

(III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder

So, as you can see, if you actually read all of that, is that the diagnosis of autism is made by finding six (or more) items in that list, but they can vary from mild to severe in any area and be so mixed and matched that when someone asks, “What is a child who has autism like?” there could be a hundred different answers. Or maybe a million. Each child with autism is so different. Researchers say that autism is a spectrum, that your child is somewhere on that spectrum and he or she will be completely different than any other child with autism. That just makes it harder to know exactly what to do to help your child. You have to learn what your child is like and what his needs are first and then determine what to do to bring that child to his potential. Now do all of that while the child is unable to tell you what is reaching him and what isn't. You must be very tuned into your child.

And don’t let anyone limit your child's potential, because these kids are SMART. It used to be believed that kids with autism were mentally retarded. Mental retardation used to be part of the diagnostic criteria. It no longer is. Many kids with autism are very intelligent. But in this world a person is judged to a large extent by what comes out of their mouth. My mother often said, “Better to be quiet and be thought a fool, then to open your mouth and remove all doubt.” Well, some of these kids are quiet and if, at some point they are able to become verbal, their speech is usually of a strange stilted variety (probably from years of speech therapy), but this does not reflect a lack of intellect. And mores the pity because these kids are locked inside themselves and have thoughts and feelings that they cannot express. Sure they scream. I would too.

The diagnostic criterion has haunted me. I was able to delude myself into thinking that Charlie would grow out of whatever was making him non-verbal and felt that if he gained language he would lose that (B) (1) criteria and then not be autistic anymore. Unfortunately when he did learn to speak his speech was typical of (B)(2) criteria, so here we are, still mired in autism. I can't kid myself. Charlie hits each of the criteria to differing degrees, but each category is well represented from what we can see.

There are differing forms of autism as well; Charlie has plain old regular autism. But some kids have Aspergers. Some kids have PDD. This is not a book written by a doctor about all of the facets of autism, I have to talk about what I know, and I know Charlie – so I am going to go back to talking about Charlie.