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New technology to help children with Autism

Frequently Asked Questions

These FAQ was created making use of the contents available in the following web sites:

  •   www.autismspeaks.org
  •   www.nimh.nih.gov/
  •   www.parents.com
  •   www.autismeurope.org 

1. What is autism?

Autism is a generic term referring to a group of developmental brain disorders.

The “Diagnostic and Statistical Manual of Mental Disorders” of 1994 (DSM-IV) defined autism and related disorders as “pervasive developmental disorders – PDD” and listed five types of subtypes of autism:  

  • Autistic disorder or classic autism,
  • Asperger’s disorder or Asperger syndrome,
  • Rett syndrome,
  • Childhood disintegrative disorder (CDD),
  • Pervasive developmental disorder not otherwise specified (PDD-NOS).

In its last edition (DSM-5 published in 2013) the definition of “pervasive developmental disorders” is replaced by the term “Autism Spectrum Disorders” (ASD) including four of the above mentioned subtypes (the Rett syndrome is no longer included). Moreover rather than making a clear distinction between different subtypes, the DSM-5 prefers to specify three levels of symptoms severity.   

2. What are the most common symptoms of ASD?

As indicated by the term “spectrum”, ASD is characterized by a wide range of symptoms and levels (from mild to severe) of impairment and every child presents symptoms in their own unique way.

According to the DSM-5 there are two core symptom categories:  

  • Social and communication deficits,
  • Restricted / repetitive behaviours.

The first category combines social and communication problems that in the DSM-IV were considered as two distinct categories.  

More specifically the following diagnostic criteria are defined in the DSM-5:

A. Persistent deficits in social communication and social interaction across multiple contexts:

  1. Deficits in social-emotional reciprocity;
  2. Deficits in nonverbal communicative behaviours used for social interaction;
  3. Deficits in developing, maintaining and understanding relationships.   

NOTE: “language impairment / delay” – reported in the DSM IV – is no longer included in this symptom category in the DSM-5 since this deficit is not considered a distinctive feature of ASD. As an example dysphasia disorders lead to severe delays in language development and abnormal language features (such as echolalia, repetitive speech, etc. ) which are like those language features seen in autism. 

B. Restricted, repetitive patterns of behaviour, interests or activities as manifested by at least two of the following, currently or by history:

  1. Stereotyped or repetitive motor movements, use of objects or speech;
  2. Insistence on sameness, inflexible adherence to routines or ritualised patterns of verbal or nonverbal behaviour;
  3. Highly restricted, fixated interests that are abnormal in intensity or focus;
  4. Hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of the environment.

Moreover the DSM-5 specifies that:

  • Symptoms must be present in the early developmental period (even if in some cases they become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life);
  • Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning;
  • These disturbances are not better explained by intellectual disability (intellectual developmental disorder), or global developmental delay.

3. When are the first symptoms recognizable?

The most typical signs and symptoms of autism tend to emerge between 12 and 18 months of age.  In some cases, babies with ASD may seem different very early in their development (between 8 to 12 months). Even before their first birthday, some babies become overly focused on certain objects, rarely make eye contact and fail to engage in typical back-and-forth play and babbling with their parents. Other children may develop normally until the second or even third year of life and then have a “regression pattern” and develop autism; they start to lose interest in others and become silent, withdrawn or indifferent to social signals. 

4. How can I detect these symptoms? 

Indicators related to social interaction and to communication

Most children with ASD have trouble engaging in everyday social interactions; they may 

  • Make little eye contact; 
  • Tend to look and listen less to people in their environment or fail to respond to other people; 
  • Do not readily seek to share their enjoyment of toys or activities by pointing or showing things to others; 
  • Respond unusually when others show anger, distress or affection. 

Studies suggest that children with ASD may misread or not notice subtle social cues—a smile, a wink, or a grimace—that could help them understand social relationships and interactions (for example, one study found that children with ASD focus on the mouth of the person speaking to them instead of on the eyes which is where typically developing children tend to focus).  

Children with ASD also may have trouble understanding another person’s point of view. 

With regard to communication deficits some children with autism may: 

  • Fail or be slow to respond to their name or other verbal attempts to gain their attention; 
  • Fail or be slow to develop gestures, such as pointing and showing things to others; 
  • Coo and babble in the first year of life, but then stop doing so; 
  • Speak only in single words or repeat certain phrases over and over, seeming unable to combine words into meaningful sentences; 
  • Repeat words or phrases that they hear, a condition called echolalia; 
  • Use words that seem odd, out of place, or have a special meaning known only to those familiar with the child’s way of communicating. 

Even children with ASD who have relatively good language skills often could have difficulties with the back and forth of conversations. 

A related study showed that facial expressions, movements, and gestures of autistic children are often vague or do not match what they are saying. Their tone of voice may not reflect their actual feelings either. Many older children with ASD speak with an unusual tone of voice and may sound sing-song or flat and robot like. 

Repetitive and stereotyped behaviors 

Children with ASD often have repetitive motions or unusual behaviors. These behaviors may be extreme and very noticeable, or they can be mild and discreet. For example, some children may repeatedly flap their arms or walk in specific patterns, while others may subtly move their fingers by their eyes in what looks to be a gesture. 

Children with ASD also tend to have overly focused interests. Children with ASD may become             fascinated with moving objects or parts of objects, like the wheels on a moving car. They might spend a long time lining up toys in a certain way, rather than playing with them. They may also become very upset if someone accidentally moves one of the toys. 

While children with ASD often do best with routine in their daily activities and surroundings, inflexibility may often be extreme and cause serious difficulties. They may insist on eating the same exact meals every day or taking the same exact route to school. A slight change in a specific routine can be extremely upsetting.

5. How common is Autism? 

Studies on autism in USA indicate a prevalence ranging from 1 to 60 to 1 to 110 children; in Europe a prevalence of 1 to 160 is reported. Boys face about four to five times higher risk than girls.

Even if the value is different depending on the source all the analysts report a growth of the prevalence over the years but there is no agreement if there is a true increase in ASD or if it is due to a change in the diagnosis guidelines and to a better monitoring of the situation.

6. What causes ASD? 

Scientists don’t know the exact causes of autism spectrum disorder (ASD), but research suggests that both genes and environment play important roles.

There is no one cause of autism just as there is no one type of autism.

Over the last years, scientists have identified a number of rare gene changes or mutations, associated with autism. Research has identified more than a hundred autism risk genes. In around 15 percent of cases, a specific genetic cause of a person’s autism can be identified. However, most cases involve a complex and variable combination of genetic risk and environmental factors that influence early brain development. 

The clearest evidence of these environmental risk factors involves events before and during birth. They include advanced parental age at time of conception (both mom and dad), maternal illness during pregnancy, extreme prematurity and very low birth weight and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the baby’s brain. Mothers exposed to high levels of pesticides and air pollution may also be at higher risk of having a child with ASD. It is important to notice that these factors, by themselves, do not cause autism. Rather, in combination with genetic risk factors, they appear to modestly increase risk.

Increasingly, researchers are also looking at the role of the immune system in autism. 

It is important to highlight that many studies - conducted to determine if a link exists between immunization and increased prevalence of autism - have found no link between vaccines and autism.

7. How can I prevent it?

The only way to make prevention is to have an early diagnosis and an early treatment.

As already indicated some symptoms appear already during the first year of life; parents can notice these symptoms mainly in the comparison with other childrem of the same age.

The American Academy of Pediatrics suggests a screening at 18 and at 24 or 30 months.

Early diagnosis and treatment can avoid degenerative patterns or even allow regressive patterns.

13 to 17% of children who are accurately diagnosed with autism can “fall off the spectrum”.   

Many people—including paediatricians, family doctors, teachers, and parents—may minimize signs of ASD at first, believing that children will “catch up” with their peers. While you may be concerned about labelling your young child with ASD, the earlier the disorder is diagnosed, the sooner specific interventions may begin. Early intervention can reduce or prevent the more severe disabilities associated with ASD.

8. How to do screening and diagnosis?

The screening process is based on a mix of interviews to the parents and of doctor’s own observation of the child. 

There are two ‘gold-standard’ tools for diagnosis: 

  • the Autism Diagnostic Observation Schedule (ADOS) and 
  • the Autism Diagnostic Interview-Revised (ADI-R). 

The ADOS is an activity based assessment that involves interaction between the patient and the assessor. The ADI is an interview conducted with the parent. A diagnosis is often a multi-step process and based upon the unique needs of the child there may be other assessments that need to be conducted such as a brain imaging, hearing test, genetic testing and others such as n-depth memory, problem-solving, and language testing.  Typically the diagnostic  team  includes a physician, a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals experienced in diagnosing ASD. The evaluation may assess the child’s cognitive level (thinking skills), language level, and adaptive behavior (age¬ appropriate skills needed to complete daily activities independently, for example eating, dressing, and toileting).

9. How is ASD treated?

There is no single best treatment for all children with ASD. Treatment guidelines recommend early, intensive and comprehensive programs. Intervention should be individualized and multidimensional to maximize the individual’s potentialities and functioning in daily living routines and to provide the necessary support to the family.  It is suggested to use a curriculum that focuses on: 

  • Language and communication,
  • Social skills, such as joint attention (looking at other people to draw attention to something interesting and share in experiencing it),
  • Self-help and daily living skills, such as dressing and grooming,
  • Research-based methods to reduce challenging behaviors, such as aggression and tantrums,
  • Cognitive skills, such as pretend play or seeing someone else’s point of view,
  • Typical school-readiness skills, such as letter recognition and counting. 

Behavioural interventions such as Applied Behavioural Analysis (ABA) and integrated behavioural/developmental programs such as the Early Start Denver Model (ESDM) demonstrated so far a better evidence of efficacy compared to other intervention programs. They have two different theoretical frameworks - developmental for ESDM and behavioural for ABA - and although sharing some common strategies in treatment delivery, they use a different approach to teaching i.e. directive, structured in the ABA, while naturalistic, not structured and based on play routines and child initiation in the ESDM.

10. How can technology help in the diagnosis, assessment  and treatment of ASD?

ICT technology may have a beneficial impact in various fields related to autism:

  • ICT can support the doctors in the diagnosis and in the assessment of the autistic child thanks to advance in various areas such as:
    • Imaging processing techniques (e.g. advanced solutions for the analysis of Magnetic Resonance images), 
    • sophisticated algorithms for the interpretation of EEG (Electroencephalography) and physiological signals,
    • unobtrusive and wearable sensors for continuous monitoring of these signals,
    • video-based and eye-tracking solutions for the detection of the child’s behaviours and response to stimuli.
  • ICT-based therapeutic interventions including computer-based educational software, virtual environments, robotic platforms and interactive gaming solutions.
  • At the same time researchers are starting to develop prosthetic technologies able to help children with autism in their daily life by mitigating the consequences of their deficits and disabilities (e.g. language problems, emotion recognition). Advances in key technology areas such as affective computing and wearable computing offer a lot of potential for computer based prosthetic tools.
  • Different ICT-technologies combined in different ways can be used to identify variables (e.g. gaze behavior, brain activity or physiological measures) that can indicate a priori which treatment is most suitable to benefit individual children and set up individualized treatments.
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The Michelangelo Project is co-funded from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° #288241