Welcome to Charlie's Playroom
Charlie DiMichele's Journey with Autism through Son-Rise
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What is Autism?

AUTISM IN OUR OWN WORDS

There are countless resources: books, websites, magazines, doctors, therapists, physiologists, counselors and teachers whom may give you slightly different variations of what autism is. We've sited some information taken directly from some well known resources below but we would like to give you our own explanation of what autism is in general and also share some of the "symptoms" that Charlie has shown over the years

Social Disconnection
No matter if an autistic child is high functioning or non-verbal, the strongest notable trait is a social disconnection from other people, including family members, siblings, and even parents.  Charlie never played the same as other typically developing children even as a baby.  He didn't reach his arms up to be picked up or demand the constant interaction other babies do.  As he grew he did develop the interest in others children and adults but never the skills to interact socially.  He does not know how to "play" and often asks for attention or interaction from others with a pull of their hands, hit or even a bite.  He plays to rough and doesn't know how to play with someone else appropriately.


Communication
Many young children with autism do not speak, have limited speech, or speak inappropriately.  In other words, do not communicate as a typically developing child does.  Charlie did not speak his first word until he was over the age of 4.  Even when he did begin to speak it was, and still is, limited and basic.  Charlie also has Apraxia, which means although his brain may know what words it wants to say, it is unable to "tell" his mouth how to say it.  Therefore, Charlie's articulation is poor which makes the words he does say difficult to understand.

***We should mention that other children with high-functioning autism often have normal or advanced language development at an early age. It is very common for children with high functioning autism such as aspergers syndrome to not be diagnosed until 5 years old or even into their teens. This is often because they have enough language and cognitive skills to "pass" as typical until, eventually, their unusual social tendencies begin to separate them from other children.***

Repetitive Behaviors

Most children with autism do repetitive behaviors throughout the day. Most people refer to these as "behaviors" or "stims" (since they seem to be stimulating their senses), and Son-Rise parents call them "isms" (because they see it as truly a part of the child, just as a unique attitude or habit is part of certain people you know in your life).

These "isms" can range from hand-flapping, jumping, running back and forth, spinning objects, humming, squealing, fluttering fingers (often beside their eyes), rocking, ripping paper, playing with string, even talking in circles by repeating segments of movies, songs or books, to dangerous self-injury like head-banging, self-punching or self-biting. The defining characteristics of a “stim” or “ism” are that it is repetitive and exclusive. Tantruming or Crying are not "stimming", rather they are forms of communication from the child, often as a result of communication attempts by the child failing.

Charlie has several stims of isms.  They include hand flapping, chewing, making noises with his mouth, and rubbing rough surfaces with his hands and forarms.  Now we know that his "isms" are absolutely his own, and are possibly his own ways of coping with his heightened sensitivities to his environment and his own body. But none the less, he does his "isms" because he chooses to, not because his autism forces him to. Just like you could rub your tummy for a sore stomach, you are choosing to deal with it in that way. Your stomach hurts because it hurts. Your way of coping with it is your unique choice, based on your own personality and what feels good to you.


WHAT IS AUTISM?

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Dictionary and technical definitions of autism can be frustratingly vague and don’t really describe autism. The following is from Autism Speaks, and it describes autism in a way that is easy to understand:

Autism affects the way a child perceives the world and makes communication and social interaction difficult. The child may also have repetitive behaviors or intense interests. Symptoms, and their severity, are different for each of the affected areas - Communication, Social Interaction, and Repetitive Behaviors. A child may not have the same symptoms and may seem very different from another child with the same diagnosis. It is sometimes said, that if you know one person with autism; you know one person with autism.
The symptoms of autism typically last throughout a person's lifetime. A mildly affected person might seem merely quirky and lead a typical life. A severely affected person might be unable to speak or care for himself. Early intervention can make extraordinary differences in a child's development. How a child is functioning now may be very different from how he or she will function later on in life (autismspeaks.org).

SOCIAL SYMPTOMS

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The following information – about the social symptoms, communication disorders and repetitive behaviors associated with autism – is taken from the National Institute of Mental Health.

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile.

By contrast, most children with autism seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interactions. Even in the first year of life, many do not interact and avoid eye contact in a normal way. They may seem indifferent to other people, and prefer being alone. They may resist attention or passively accept hugs and cuddling. Later, they may fail to seek comfort or respond to parents' displays of anger or affection in a typical way. Research has suggested that although children with autism are attached to their parents, their expression of this attachment is unusual and difficult to “read”. To parents, it may seem as if their child is not connected at all. Parents who looked forward to the joys of cuddling, teaching and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.

Children with autism also are slower in learning to interpret what others are thinking and feeling. Subtle social cures such as a smile, a wave, or a grimace-may have little meaning to a child with autism. To a child who misses these cues, “Come here” may always mean the same thing, whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people with autism have difficulty seeing things from another person's perspective. Most five year olds understand that other people have different thoughts, feelings, and goals than they have. A child with autism may lack such understanding. This inability leaves them unable to predict or understand other people's actions.

Although not universal, it is common for people with autism to have difficulty regulating their emotions. This can take the form of “immature” behavior such as crying in class or verbal outbursts that seem inappropriate to those around them. Sometimes they may be disruptive and physically aggressive, making social relationships even more difficult. They have a tendency to “lose control”, particularly when they're in a strange or overwhelming environment, or when angry or frustrated. At times, they may break things, attack others or hurt themselves. In their frustration, some bang their heads, pull their hair or bite their arms (
nimh.nih.gov).
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Diagnositic and Statistical Manual IV-TR
DSM stands for “Diagnostic and Statistical Manual of Mental Disorders” and is published by the American Psychiatric Association, the professional organization representing United States psychiatrists. DSM contains a listing of psychiatric disorders and their corresponding diagnostic codes. Each disorder included in the manual is accompanied by a set of diagnostic criteria and text containing information about the disorder, such as associated features, prevalence, familial patterns, age-, culture- and gender-specific features, and differential diagnosis. No information about treatment is included. DSM is used by mental health professionals from a variety of disciplines and backgrounds in a wide range of settings, including clinical, research, administrative, and educational.

Diagnostic criteria provide a common language for clinical communication and their use has been shown to increase diagnostic agreement between clinicians. It is important to understand that the appropriate use of the diagnostic criteria requires clinical training and that they cannot be simply applied in a cookbook fashion.

Another important aspect of the DSM diagnostic system is that the diagnoses are described strictly in terms of patterns of symptoms that tend to cluster together. These symptoms can be observed by the clinician or reported by the patient or family members. Because it focuses on manifest symptoms clinicians from widely differing theoretical orientations can therefore use DSM. Since the causes of most mental disorders are subject to ongoing scientific inquiry, DSM avoids incorporating competing theories in its diagnostic definitions. This feature has been an important element in the widespread clinical acceptance of DSM, and has allowed a wide scope of research investigation.

This is also an important limitation of the DSM system. Patients sharing the same diagnostic label do not necessarily have disturbances that share the same etiology nor would they necessarily respond to the same treatment. It is therefore critical to understand that the diagnostic terms and categories in DSM represent only current knowledge about how symptoms cluster together. We fully expect that, over the coming decades, the DSM system will be radically reorganized as the etiologies of mental disorders become better understood.

DSM IV-TR Criteria for Diagnosing 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.



Proposed changes to the diagnosis criteria for Autism in the Diagnositic and Statistically Manual 5, which is due for publication in 2013.

Autism Spectrum Disorder

Must meet criteria A, B, C, and D:

 

A.    Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1.     Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,

2.     Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.

3.     Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and  in making friends  to an apparent absence of interest in people

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

1.     Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 

2.     Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

3.     Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).

4.     Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

C.    Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

D.         Symptoms together limit and impair everyday functioning.



1. Qualitative impairment in social interaction, as manifested by at least two of the following:
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