Autism Musashino Higashi Gakuen
3-25-3 Nishikubo 
Musashino, Tokyo  180-0013
Japan
0422-54-8611 (Tel. Country Code 81)
0422-51-0267 (Fax.)
gakuen@musashino-higashi.org

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Dr. Kiyo Kitahara Autism

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bulletDefinitions of Autism

Definitions and descriptions of autism abound, many of them overlapping in parts or emphasis depending on the purposes for which they are promulgated. It is useful and instructive to compare the definitions from the medical/diagnostic perspective, from the etiological and neurobiological perspective, and from the point of view of advocacy and societal issues.@ Together these complementary viewpoints increase our understanding and hence inform our practices.

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Definition from the Diagnostic and Statistic Manual - fourth edition (DSM-IV)

The DSM-IV, the Diagnostic and Statistical Manual of the American Psychiatric Association, published in 1996, defines autism as a set of behavioral characteristics for the purpose of defining diagnostic criteria to differentiate this disorder from others. Under the broad heading of Pervasive Developmental Disorders (not in itself a diagnostic category), criteria are established to diagnose Autistic Disorder, Rettfs Disorder, Aspergers' Disorder, Childhood Disintegrative Disorder, and PDD-NOS (Pervasive Developmental Disorder- Not Otherwise Specified). These disorders are diagnosed as "syndromes", meaning that diagnosis is based on the presence of certain types of behaviors occurring together without any assumptions being made about etiological or causal agents. (The specific genetic defect responsible for Rett's Disorder has recently been identified.)@ The diagnostic criteria in DSM-IV for Autistic Disorder and for Aspergersf Disorder follow.

Diagnostic criteria for 299.00 Autistic Disorder

A.   A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
(1)
@  qualitative impairment in social interaction, as manifested by at least two of the following:
@@@ (a)@marked impairment in the use of multiple nonverbal behaviors         such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
@@@ (b)@failure to develop peer relationships appropriate to developmental level
@@@ (c)@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)
@@@ (d)@@lack of social or emotional reciprocity
(2)
@@qualitative impairments in communication as manifested by at least one of the following:
@@@ (a)@@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)
@@@ (b)@@in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
@@@ (c)@@stereotyped and repetitive use of language or idiosyncratic language
@@@ (d)@@lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
(3)
@@restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the @following:
@@@ (a)@@encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
@@@ (b)@@apparently inflexible adherence to specific, nonfunctional routines or rituals
@@@ (c)@@stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
@@@ (d)@@persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:@ (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

Diagnostic criteria for 299.80 Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1)
@marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, 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)
@a lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one 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 flopping or twisting, or complex whole-body movements)
(4)
@persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

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Definition & Description from Neurobiology of Autism by Isabelle Rapin, MD & Rober Katzman, MD (1998)

Researchers have now established that autism is a biological disorder but much more investigation is needed for the specific underlying bases and mechanisms to be unraveled. In their book, Neurobiology of Autism (1998), Rapin and Katzman state, "Autism is a lifelong condition, manifest from very early childhood. It denotes deviant brain development with genetic implications and represents a major public health problem because it often requires lifelong societal support."

Rapin and Katzman define the clinical features of autism in a way consistent with that of DSM-IV but also note deficits in cognition in a high proportion of cases. They further suggest that autism has a wide range of severity, hypothesizing, as have others, that Aspergersf Disorder may represent the mild end of the autism spectrum. Their clinical description emphasizes several important features. They particularly note the "young childrenfs reduced ability to focus attention with another person on a common target or activity (and) play (which) is grossly defective, unimaginative, manipulative, and solitary." Despite hyper focus in idiosyncratic ways, these children also may be severely hyperactive and disorganized, especially in unstructured situations.

These authors emphasize that the evidence so far is suggestive but non-specific regarding the neurobiology underling autism. "Autism is a behaviorally defined syndrome with a complex etiology and little is known about its pathological basis. c In a minority of cases, autism may be associated with readily diagnosable genetic and nongenetic conditions. c Epidemiological evidence indicates that environmental factors such as perinatal insults play a minor etiological role. Genetics or genetic vulnerability to some environmental factors may be prepotent in most cases of unknown cause. c Coherent chemical understanding and rational pharmacology is only now beginning to emerge. " Similarly the neurological basis for the characteristic motor manifestations as well as for autismfs many sensory aberrations is unknown at this time. However, despite these reservations, the authors make clear that current research into the brain from anatomical, chemical, pathological and developmental perspectives are suggestive and promising.

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Definition by Autism Society of America (1999)

The Autism Society of America has recently published their new description of autism as a way to clarify and summarize current opinion. Their concise statement covers diagnostic, behavioral, epidemiological, and neurological aspects in an easily accessible format. Their statement follows:

Autism is a complex developmental disability that typically appears during the first three years of life.@ The result of a neurological disorder that affects the functioning of the brain, autism, and its associated behaviors have been estimated to occur in as many as 1 in 500 individuals (Centers for Disease Control and Prevention 1997).@ Autism is four times more prevalent in boys than girls and knows no racial, ethnic, or social boundaries.@ Family income, lifestyle, and educational levels do not affect the chance of autism's occurrence.

Autism impacts the normal development of the brain in the areas of social interaction and communication skills.@ Children and adults with autism typically have difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities.@ The disorder makes it hard for them to communicate with others and relate to the outside world.@ In some cases, aggressive and/or self-injurious behavior may be present.@ Persons with autism may exhibit repeated body movements (hand flapping, rocking), unusual responses to people or attachments to objects and resistance to changes in routines.@ Individuals may also experience sensitivities in the five senses of sight, hearing, touch, smell, and taste.

Over one half million people in the U.S. today have autism or some form of pervasive developmental disorder.@ Its prevalence rate makes autism one of the most common developmental disabilities.@ Yet most of the public, including many professionals in the medical, educational, and vocational fields, are still unaware of how autism affects people and who they can effectively work with individuals with autism.

Several related disorders are grouped under the broad heading "Pervasive Developmental Disorder" or PDD-a general category of disorders which are characterized by severe and pervasive impairment in several areas of development (American Psychiatric Association 1994).@ A standard reference is the Diagnostic and Statistical Manual (DSM), a diagnostic handbook now in its fourth edition.@ The DSM-IV lists criteria to be met for a specific diagnosis under the category of Pervasive Developmental Disorder.@ Diagnosis is made when a specified number of characteristics listed in the DSM-IV are present.@ Diagnostic evaluations are based on the presence of specific behaviors indicated by observation and through parent consultation, and should be made by an experienced, highly trained team.@ Thus, when professionals or parents are referring to different types of autism, often they are distinguishing autism from one of the other pervasive developmental disorders.@ (Autism Society of America 1999)

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This is a useful statement but the limitation of this format is that controversy and contradictory evidence is insufficiently explicated. In particular, the areas of the brain controlling "social interaction and communication skills" have not yet been clearly and unambiguously established and the evidence to support these hypotheses is still being developed.

Implications for Education

These three approaches (diagnosis, research, advocacy) together can provide a useful working definition of autism for educational purposes. Autism is the result of as yet unspecified impairments to normal brain development from potentially multiple and variably overlapping causes. The syndrome that results has certain general features, categorized into three groups for diagnostic purposes, but also many other regularly associated features which impact functioning and must be addressed educationally. In broad terms, the most striking of these characteristics are in the domains of cognitive functioning, including intellectual attainment as well as the capacity for imagination and play, sensory sensitivity, hyperactivity, the regulation of anxiety, attentional focus, and the expression of motivation, initiative, and persistence.

The implication of such multiple and variable difficulties for the educational process is that the childfs total environment must be educationally sound and supportive in order to create conditions under which the child can learn. It must also be remembered, and be incorporated into the educational philosophy, that the "autism" does not define the child and is only a part of the child. All of the childfs needs c, to be nurtured, to be stimulated intellectually and aesthetically, to feel safe and secure and self-confident in having success and mastery, to have the health created by having an appropriate rhythm of daily life and the development of physical stamina, strength and coordination, to relate to others and be a part of and contribute to their communities, to communicate their needs and wants, to have independence and dignity and to respect others and be treated with respect c must be addressed in a broad and age-appropriate curriculum as is the case for any typical as well as any autistic child.

@(This page is quoted from the Home Page of Boston Higashi School.)

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