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When you have to have your world in order

Abraham Eisenstein, M.D. |
Autism is a complex developmental disability: it affects how people perceive the world and interact with others. It is not a disease that can be cured, it's a condition that lasts for life.

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It is important to say that autism is a spectrum condition. That means there isn't a single symptom or way of behavior: Autistic people share certain difficulties but autism affects them in different ways. From learning disabilities to obsessive need for keeping things in certain places to mental health issues, different people are affected in different ways.

That in turn means they need different help to go through life and they can live a life that's different from ours but nevertheless it may be a fulfilling life.

Autism, or to be more precise Autism Spectrum Disorder, is the result of a disorder that has an effect on normal brain function. It is a wide-spectrum disorder which means that people with autism share some common symptoms but there are no two people that share exactly the same symptoms.

A wide-spectrum disorder also means that some people have mild symptoms, sometimes barely recognizable, while others have severe symptoms.

However, there are some common found characteristics that we can find among people with autism.

Autistic people have difficulties with social communication and social interaction. They have a problem with interpreting both verbal and non-verbal language. They don't understand - or have a hard time understanding - jokes, sarcasm, tone of voice, and facial expressions.

That means that many of them take spoken word in a very literal way: For them a spoken sentence means exactly what the words say. While "Oh, you're so clever" can have different meaning depending on the context, tone and body language, for autistic people it means exactly that: You are so clever.

Some autistic people understand what other people are saying but have a problem with abstract concepts or they have hard time trying to express themselves. That's why some of them use visual symbols or sign to be able to communicate.

On the other hand, it may be difficult for them to understand the way the conversation goes and they end up repeating what other people say or they just talk about something that's on their mind. That difficulty in understanding other people's emotions is the second group of common symptoms: social interaction.

Autistic people my appear to be insensitive or they just look strange but it's just hard for them to connect with other people on emotional level.

In the third group of symptoms there are repetitive behavior and routines. For people with autism - in which they can't understand other people's intentions - the world seems like a very confusing place. The answer to that are routines and repetitive behavior.

They repeat some task in a certain way, walk around using same routes, like to eat same food at the same time, or like to put things on their desk in a perfect order. Their "right way" of doing things is the way they keep the world in order.

Then, autistic people have intense and highly-focused interests, often from a fairly young age. They can be extremely interested in mathematics, art, music or anything else.

A research shows that a large number of them have great IQ and are extremely good in fields that demand a very focused thinking. There are even companies that target the autistic population to employ them as computer programmers.

It is interesting that many of them find happiness in some meaningful work which means that their brain - if we may say so - understands that they are different but that there are also some values common to all society.

Autistic people may experience over-sensitivity to sounds, touch, tastes, smells, light, colors, temperatures or pain - or under-sensitivity. Some background sound may drive them crazy although we can barely hear them because our brain filters data that are not necessary in a given situation.

Now, what causes autism? We don't know.

We may start with genes: Complex conditions, and autism is complex, do not have a clear mutational footprint and although we do know that the CX3CR1 gene mutation can be found in autistic people we still don't know exactly how it is connected with other gene mutations.

Fever during pregnancy increases the risk for autism by 40 percent - but that's far from 100 percent. Low vitamin D level during pregnancy increases likelihood of having a child with autistic traits.

We also know that nSR100 protein influence features of autism. Also, aerial spraying of against mosquitoes may increase the risk of autism spectrum disorder. That means that the environment has an influence too.

But, when we put all that together, that's still "might," "increase," "risk": For the majority of people with Autism Spectrum Disorder, the reasons behind their disorder remain unknown. We can only say, for now, that the cause is some combination of genetics and external conditions.

There is no cure for autism. So, what can we do?

It is important to work with autistic children: speech, occupational, and physical therapy are very important and should all be included in the child's treatment.

Behavioral training uses positive reinforcement and social skills training to improve behavior and communication in autistic people. Drugs are used only to treat related conditions - anxiety, for example - and not the core condition itself.

It is important to say that autistic people are very much like us: they feel, suffer, enjoy, work, and love like the rest of us. They just have their different ways of seeing the world and communicate with us.

When we truly understand how they function, we invariably come to the same conclusion: as much as their world seems different to us, our seems different to them.

We should try to narrow that gap in the same way we would try to narrow the gap trying to talk to a person from a different culture, speaking foreign language we don't understand well. Autism is not a disease, it's a state of mind.


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