Temple Grandin

Cheat Sheet / Updated 03-23-2022

As you're learning more about autism, this Cheat Sheet can serve as a handy reference to the related acronyms and helpful websites. It also provides tips on how to communicate with a person who has autism, make sure they get the most from their education, and ensure they are properly prepared for emergencies.

Article / Updated 07-01-2021

Because doctors can’t definitively, precisely diagnose autism, they encounter several other conditions and symptoms that tend to enter the diagnostic mix. This mixture makes awareness of conditions with related or similar symptoms important. Read on to see a rundown of conditions and symptoms and appear to be like autism. If a doctor diagnoses a child with some variant of autism spectrum disorder, the need for immediate intervention is the same. Such a diagnosis means that the child doesn’t fit the clinical criteria for an autism diagnosis, and it doesn’t address the severity of the symptoms that are present. You know whether or not your child needs help. And don't worry too much about the diagnosis, itself; instead, do what your child needs and find out what help is available to him or her. Childhood disintegrative disorder Although not much is known about childhood disintegrative disorder (CDD), children with this condition develop normally until they reach 3 to 4 years of age (rarely do children show change later than this, although some children develop this disorder as late as 10 years). At that point, they undergo a quick regression (faster than children with regressive-onset autism), usually losing all language ability and in some cases losing bowel and bladder control. In a show of other symptoms, the children can have epileptic seizures, for which anticonvulsive drugs are often helpful, and motor disorders, probably caused by acute sensory processing problems. The National Institutes of Health considers CDD part of the grouping of pervasive developmental disorders, but the Centers for Disease Control and Prevention disagrees. At any rate, CDD is quite rare, and because children experience such a late onset of symptoms, they require a very thorough medical workup. The individual treatment for these kids can be almost identical to the treatment of autism. Attention-deficit/hyperactivity disorder Many children who exhibit more severe cases of attention-deficit/hyperactivity disorder, or AD/HD, often share many of the characteristics and features with children at the high-functioning/Asperger syndrome end of the autism spectrum. This is true particularly in the areas of communication, social integration, and behavior. Some children get diagnosed with one of the disorders and then receive the other diagnosis at a later time. Symptoms for both autism and AD/HD include problems with organization, sensory issues, attention, and social skills. However, the delay in acquiring language that occurs with more severe autism isn’t consistent with AD/HD. What you (and your doctors) should keep in mind is that the two disorders are frequently confused because of their overlapping behavioral symptoms. Also, hyperactivity doesn’t always equal AD/HD. It can be part of many other childhood developmental problems. The implication for parents is to know their child well and to make sure they get a second opinion on their child’s diagnosis. In schools, AD/HD is treated differently than autism. Although the disorder is considered a disability under the Americans with Disabilities Act, schools usually offer a different set of accommodations than they do for children on the autism spectrum. Other possible diagnoses Science has come a long way from the time when autism was confused with deafness or mental retardation, but not that far. Don’t misunderstand: Some of the alternative diagnoses may be correct; that is, they may be present in addition to autism. However, a diagnosis of autism may better explain a person’s symptoms than any of the psychological categories he or she can fall into when autism isn’t a suspect. Sometimes people who are aggressive or seem resistant to authority are given a psychological diagnosis such as oppositional defiant disorder, conduct disorder, or borderline personality disorder. Bipolar disorder and depression are other diagnoses sometimes given to people who should be diagnosed with autism, which does lend itself to mood disorders. Obsessive-compulsive disorder is also easily diagnosed in autistic children. A child may have any of these disorders in addition to autism, but autism should be considered the primary problem. You should press your doctors to investigate further if you aren’t satisfied with the diagnosis or if your child doesn’t improve after some rounds of medication. Other syndromes that may look a bit like autism, but definitely aren’t autism, include the following (Note: Some of these syndromes may occur with autism or be mistaken for autism; people can have more than one disorder at a time): Cornelia DeLange syndrome Tourette’s syndrome Fragile X syndrome William’s syndrome Down’s syndrome Landau-Kleffner syndrome

Article / Updated 06-22-2021

Professionals diagnose autism based upon symptoms shown in the categories of social interaction, communication, and behavior. Early diagnosis and intervention, with characteristics present before the age of 3, are very important, because research shows that many features of autism respond better when you deal with them early. Sadly, some children don’t receive an official diagnosis until years after their parents first suspect that something is wrong, which means they lose valuable time. Even some doctors don’t have the necessary facts to provide an accurate diagnosis. You know your child better than any doctor, so if you disagree with a doctor’s assessment, get a second opinion. Trust your instinct if you think your child isn’t developing normally. Social development People with autism — partly because of the problems they have with communication — have difficulty developing friendships and playing cooperatively with others. Often, kids with autism don’t imitate others’ behaviors, as children usually do, and they don’t share their thoughts and observations. They also don’t spontaneously try to connect with others, as other children will. Despite the challenges children with autism face regarding social interaction, they still have the desire to interact. Children with autism may just need direct instruction to learn what others pick up by mere observation. Even mildly autistic children who have normal language development (a diagnosis known as Asperger Syndrome) find it difficult to form peer relationships because of their problems in understanding social protocols and others’ motivations. This social awkwardness can happen even if a child’s IQ is off the charts. Children on this end of the autism spectrum display little understanding of appropriate behaviors, and they may be criticized for being “brutally honest,” but many people note that they commonly lack pretension, dishonesty, flattery, and guile. However, they can also be quite hurt by their inability to connect socially, although they may not be able to express these emotions. Most people on this part of the spectrum lack the emotional vocabulary. Communication Autistic individuals have trouble with language development, sometimes losing speech at 18-24 months (known as regressive autism), talking only late in development, or not talking at all. Children may repeat words and phrases like television commercials (a condition known as echolalia), having no apparent understanding of their meaning. The children may hear words but not be able to make sense of what they mean. Non-verbal communication is also impaired in children with autism. Commonly, autistic individuals may not understand what gestures mean. They won’t point to objects. They may not make eye contact or smile when smiled at. Their responses or lack of responses can be isolating, resulting in communication barriers rising between them and other people. Behavior (activities and interests) Autistic children often have obsessions or preoccupations with objects or with fantasy worlds (they may have trouble distinguishing fantasy from reality) that go beyond the normal interests of a developing child. For example, an autistic child may play exclusively with string or believe she’s an animal. She may have trouble transitioning from one activity to the next and insist on sticking to a ritual or routine — even one that seems to have no meaning. Some children with autism display repeated mannerisms, such as hand flapping, rocking, or walking on one’s toes, which are often considered as self-stimulatory behavior or “stims." Doctors are certain that autism affects the way the brain functions (and autopsies of autistic brains show abnormalities in different areas), causing a sometimes distinctive set of behavioral symptoms. Each behavioral symptom can range from mild to severe. To complicate things further, not all children diagnosed as autistic display all of the behavioral symptoms. The behavioral symptoms govern the diagnosis, making treatment problematic. Coexisting issues Other conditions often coexist with autism, further complicating the diagnostic and treatment processes (and researchers are still debating whether the conditions are causes of autism). Some of the more common coexisting conditions include the following: Mental retardation Hyperlexia Obsessive compulsive disorder (OCD) Attention Deficit/Hyperactivity Disorder (AD/HD) Dyslexia Conditions are considered comorbid if they occur at the same time as the autistic symptoms and are deemed to have roughly equal “weight” by the diagnostician. Other associative conditions, such as depression, are often secondary to the autism — in other words, a person’s difficulties in interacting with the environment and connecting with others result in a depressive disorder.

Article / Updated 06-18-2021

You can help most autistic children think conceptually by guiding them to put details together to form ideas — preferably with visual symbols. You can demonstrate abstract concepts like “more” or “less” with objects instead of explaining them in words. To teach an autistic child fractions, for example, you can use a piece of paper or a piece of fruit that you can cut up to show quarters, thirds, and halves. And to teach the word “fraction,” you show the word with the pictorial example so that the child can form an association between the two. Say that you want to teach an autistic child the categories of dogs. Whenever you go for a ride or a walk, point out the different types of dogs when you see them. Identify the dog as a dog and mention what kind of dog it is (bulldog, Dalmatian, and so on). State what makes it a dog and not a cat or a bird. Picture books that show many kinds of dogs may be helpful. A person with autism functions best with literal, concrete terms, not abstractly. Explaining a concept with detailed descriptions isn’t as effective as showing a picture or the object itself. “A picture is worth a thousand words” is quite true for a person with autism. And to complicate matters, an autistic person will take idiomatic expressions like the previous quote so literally that they may ask, “What are the thousand words?” Severely autistic children (or children with classic autism) may need to use touch as their most reliable learning method. You can walk a child with severe autistic symptoms through a new task by taking their hand and prompting them to touch the objects involved, because they may not understand the shape by sight if their visual processing is impaired. A child with autism may also have trouble transferring a freshly learned skill, such as tying shoelaces, to a new task if you alter the situation at all. For example, if you teach a child how to tie their shoes and then give them a new pair of shoes that have brightly colored laces made of a different material, they may not be able to use the skills they recently learned to tie them. Although the two situations may seem identical to you, the autistic child doesn’t realize that the laces are still shoelaces and that they can tie them in the same way, because the laces look different than the ones they're used to. You should also maintain touch consistency when teaching tasks such as lacing shoes to a severely autistic child. If you introduce new touches, you must take time to acclimate the severely autistic child to the change. When introducing an autistic child to a new situation, even if only one or two details have changed, you must take care to familiarize them with new aspects that may cause confusion. If they're going to a new school, for instance, you can help by taking them there before the first day to do a walkthrough, where you explain what will happen and show them where different items are located and how to use them. Perhaps you can even arrange for them to meet their new teachers. And always remember to be understanding and compassionate. The normal anxieties a child faces in a new situation, like the first day of school, are increased by their difficulties in transferring behaviors to new settings — settings that seem conceptually similar but appear to them to be different.

Article / Updated 06-18-2019

Researchers are able to identify symptoms of autism at younger ages than ever before, as young as 18 months. This development leads toward more emphasis on early treatment, simply because that time frame is where children can usually make the greatest gains. Pediatricians are now looking for potential markers, such as a larger head during exams, and they are encouraging parents to look for other early symptoms, such as unusual eye contact and inability to follow a point. Also, autism experts are pressing pediatricians to use more direct observation to detect possible social clues, such as atypical vocalizations, including echolalia (the repetition of sounds and words from the environment). Other differences pediatricians may look for include A lack of joint attention A resistance to being held An appearance of deafness to words The best thing you can do for your child — whether you think she's autistic or not — is to start an educational/behavioral program early to help with her communication and social challenges. And make sure your child gets medical help for any physical symptoms, such as digestive problems, she may experience. That's the bottom line. According to Peter Mundy, a professor of psychology at the University of Miami, a social marker known as joint attention or gaze following, which neurotypical babies begin doing in the first 15 months of life, is impaired in autistic babies. Autistic babies don't follow or initiate eye contact in order to share an experience with a caregiver; they initiate eye contact for "instrumental purposes," which means to get something they need, such as food. Impaired joint attention can be a lifelong trait in autistic people, but if doctors and parents to notice the trait earlier, caregivers may be able to identify and help children at risk as early as infancy. Many professionals share a widespread agreement that social disengagement is what separates autism from other disorders. Children diagnosed with developmental disabilities share a common problem: They need help in communicating and developing social skills. Parents and other caregivers can teach these skills, and the sooner the better, because children's brains develop rapidly. So, whether your child is autistic or not, he or she still needs help, and you can focus on that. This doesn't imply that a diagnosis is unimportant, because it influences treatment, but in many cases where children are diagnosed as being on the autism spectrum, treatment is similar. And treatments that work for some children won't have any effect with others who have identical medical diagnoses. Diagnoses and prognoses based on behavioral symptoms can and do change. Many people with autism have been misdiagnosed as having mental retardation, schizophrenia, AD/HD, and other conditions.

Article / Updated 03-26-2016

Your child with autism can thrive in school. You may need to be more involved in the educational process of your autistic child than with an unaffected child, but the rewards of that extra investment can really pay off for you and your child. The following tips can guide you and your child’s teachers to a good educational experience: Insist on specific and measurable goals for your child’s IEP (Individualized Education Program). Involve your child in the process. Develop strong relationships with educational professionals. Keep it friendly, not adversarial. Stay informed about educational laws, your district’s policies, and your child’s progress. Know your options. Visit your child’s classroom to confirm that it’s an effective learning environment. It should have distinct areas for different subjects, comfortable lighting, good ventilation, appropriate noise level, and right-sized furniture, and the teacher should be approachable and fair. Support your child at home by reinforcing what educators are teaching at school. Develop your child’s strengths; don’t just remediate. If possible, get at least 25 hours a week of early intervention before age 3.

Article / Updated 03-26-2016

If you have autism or are caring for someone with autism, you can find resources, information, and legal support through the Internet. The links in the following list can help open new vistas of aid and support: Autism Resources Autism Society Wrightslaw

Article / Updated 03-26-2016

For many people with autism any disruption of their routine is overwhelming, and a real emergency situation is enough to throw anyone off-balance. So, if you have a loved one with autism, it pays to prepare as best you can before an emergency arises. Use the following tips to prepare your autistic loved one and your whole family: Consider attaching an identification sticker to the door or window of an autistic person’s home to prepare a person coming in to help. Create or purchase a medical alert tag, bracelet, or other notification that identifies a person with autism. Network with relatives, friends, and others to establish a web of contacts for assistance if needed. Register the person on the autism spectrum with the community 911 service as a person with a disability. Have an evacuation plan, and review and practice it frequently with the person on the autism spectrum. Project a sense of calm. People with autism often sense and reflect your emotion. View more on disaster preparedness at the following locations: FEMA American Red Cross

Article / Updated 03-26-2016

If you have autism or you care for a person with autism, making an emergency ID card is a good idea. If you make a card for someone else, educate the person with autism to keep it on hand to share with people in confusing situations, such as when they’re approached by a uniformed person or when they have difficulty interacting with others they don’t know. The front side of wallet-size card should give the name of the person with autism and two or three contact name and numbers. The next paragraph would be a good one to copy: My name is ___________________ and I have autism, which causes me to behave in unexpected ways. Please contact one of the people listed here: (List names and phone numbers for two or three people.) On the back of the card, you can include information on autism and offer tips with dealing with the person with autism, such as that in the following table: Autism Information I may: Please help by: Not understand what you say Not shouting Appear deaf Speaking slowly and softly Suddenly dart away Using concrete terms Have difficulty speaking Giving me time to respond Flap my hands or rock Explaining before doing Not understand legal issues Employing visual aids for communication when possible Be overly sensitive to shiny objects, sounds, touch, or smells Making no sudden movements and Warning me first if you must touch me Feel free to print out this page and use it to design your own emergency card.

Article / Updated 03-26-2016

Many “entrepreneurs” are only too happy to accept your money for their “miracle cures” or interventions for your loved one with autism. Keep your eyes open, and ask these questions about all those sellers and their interventions: What evidence supports the intervention’s effectiveness? Is the evidence independent research or just case studies? What’s the success rate of the intervention? Are there side effects or interactions? Who else is offering the intervention, and how is yours better? What other interventions are available? Can they be combined? What’s the total cost? Will my health insurance or a government program cover the cost, or is it tax deductible? Can I speak with other people who have tried this already? How will the treatment help, specifically? How can I measure progress? What timeframe does the treatment call for?