Too Much Information...

By: Meghana Reddy

I heard shrieks and found seven-year-old Jack screaming and thrashing on the floor. His mother was sitting next to him, “tactically ignoring” his autistic behavior, trying to discourage him from continuing his yelling and hoping that he would calm down.

Source: http://specialedpost.com/wp-content/uploads/2012/09/tantrum.jpg

But there was so much noise around Jack, he couldn't calm down. With all the conversations going on nearby, between parents and the specialists at the autism center, there was too much information for his brain to handle. Jack was overwhelmed by this sensory overload; but, he was unable to communicate what he was feeling because of his autism. So, he continued yelling, drowning out the other sounds in the only way he knew how.

His mother, unable to console him, started tearing up. Seeing her desperation, and Jack’s frustrated inability to communicate, I felt like crying as well. But crying wouldn't cure anything.

I rushed to find a therapist, so we could do something about Jack’s unrest. A physical therapist brought Jack into another room, set him down on a bed, and gave him a cranio-sacral massage. I watched, amazed that after just fifteen minutes, Jack’s screams died down and he fell asleep. His mother smiled, and thanked the therapist for her help. She then carefully scooped him up, and brought him into the car for a nice, quiet ride back home.

New Jersey has twice the national average of autism (1 in 49, as opposed to 1 in 88)*, which got me interested in volunteering at an autism center, which provides medical and psychosocial care for autistic children. With these therapy sessions, such as the massage therapy that worked so well for Jack, we can provide relief and care for the affected children, as well as emotional support for their families. Autism is an on-going, patience-testing disorder that requires a lot of effort from both the children, and their parents and caretaker. But it's amazing to see how just one therapy session can affect people in such a positive way, even if it's only for a day at a time.

[*] http://www.autismnj.org/prevalence-rates

"What, Ho! Apothecary!"

By: Sabiha Toni

When we think of illnesses, we think of medicine—rows upon rows of multicolored, multi-shaped pills with their individual ratios and concoctions of chemicals. We run to our nearest drug store for an upset stomach or strep throat. It is easy enough to administer medications, inject IV’s, or swallow capsules to treat the brief bouts of discomfort that we expect to end once the treatment takes effect. But what if this condition had a chronic and perpetual hold? And what if there was no cure?

Research has progressed concerning effective treatments for Autism Spectrum Disorders. Though there are not many effective pharmacological options to treat autism, behavior therapies are often recommended for autistic individuals (McPheeters et al., 2011). Autism takes continuous psychological treatment alongside any supplemental medications for proper management. ABA techniques, or applied behavioral analysis techniques, are often used to treat autism. The goal is to assist in problem areas such as unwanted behaviors, development, and learning by regulating every day activities (Myers, Johnson, 2007). The treatments tackle issues including: 

• Improvement of communication skills
• Development of social skills, such as imitation and reciprocation
• Adaptation and self-reliance
• Cognitive skills
• Intellectual/academic skills

Applied Behavior Analysis is used to target unwanted behaviors while retaining and increasing acceptable ones. It is also possible to introduce new behaviors as well as adapt them to different environments. Often, this requires monitoring the individual for at least 25 hours per week with methodically and appropriately designed sets of activities for the autistic person. The activities are structured and often based around predictable routines. Autistic individuals often interact with a social worker either one-on-one or in small groups, since a low student-to-teacher ratio is necessary for sufficient individual attention (Myers, Johnson, 2007).

Since autism can be detected at an early age, early intervention programs are highly recommended to children who display appropriate signs. If such behavior therapies are administered at earlier stages, it may lead to better management of the disorder later on in life (Rogers, Vismara, 2010). Parent figures play a large part in early intervention therapies. They are educated about techniques to improve and increase certain behaviors and discourage others. They are also taught to facilitate social and communication skills in their children. Multiple studies show the efficacy in these treatments, in which more children had a lower severity of autism, developed speech, and increased IQs (Rogers, Vismara, 2010).

It is important to keep in mind that Autism Spectrum Disorders have a range of signs and severities, so routines and behavioral programs should be tailored to the individual’s needs. Autism’s chronic and ongoing influence demands intensive and involved therapies. Though there is no single pill or overnight remedy to ASDs, studies show that treatment is far from a hopeless cause. Applied Behavior Analysis is simply one of these options.  

References:

McPheeterson, ML, Warren, Z, Sathe, N, Bruzek, JL, Krishnaswami, S, Jerome, RN, Veenstra-VanderWeele, J. A systematic review of medical treatments for children with Autism Spectrum Disorders. Pediatrics. 2011; 127(5): e1312-e1321.

Myers, SM, Johnson, CP. Management of children with Autism Spectrum Disorders. Pediatrics. 2007; 120(5): 1162-82.

Rogers, SJ, Vismara, LA. Evidence-based comprehensive treatments for early autism. J Clin Child Adolesc Psychol. 2010; 37(1): 8-38.

Image: http://media.whas11.com/images/352*264/Pills_Spilled.jpg

Moving Forward

By: Erin Thomas

Just tell me what I have to do to help my child and I will do it. –the heart- cry of every parent who hears that daunting autism diagnosis.

The bad news: It can sometimes be a grueling process to find what works.

The good news: There are a multitude of resources available today, that were not available just over a decade ago, to help you find your path.

The therapies for Autism Spectrum Disorders are plentiful and varied. It is crucial that parents work to craft a personalized therapy for their child. While the process of trial and error can certainly be disheartening, it is often the case that what is therapeutic for one child, for example pet therapy, may be too stimulating or ineffective for another child on the Spectrum. There is no elixir for ASDs, and that can be frustrating for parents who simply want their child to live to his or her full potential. It is important to remember that each small step of improvement along the way is integral for the journey and should be celebrated.

Generally, there are two models of early intervention behavioral treatments. One model is the Lovaas Model using Applied Behavior Analysis (ABA). ABA is widely used today as an early intervention method to improve cognitive skills, language, and behavior. As of yet, it is the therapy with the most scientific support (Geschwind, 2009). ABA aims to cultivate basic skills such as looking, listening, and imitating as well as language skills, sociability, motor development, and academic skills (Autism Speaks, 2013). It has also been shown to improve skills in teens and adults with autism, and is useful for those trying to live more independent lives or find employment. However, the use of ABA has been less studied in teens and adults than in children.

The other model of early intervention therapy is the Early Start Denver Model for children ages 12 months to 4 years. This approach incorporates the principles of the ABA method but is more relationship-centered. Parents play an integral role in the execution of this model, and it is play-based to increase social and communicative skills.

Here a few more early intervention behavioral therapies that some parents have found effective:

• Floortime, in which the parents engage their child for 20 to 30 minute sessions of playtime on the floor. Parents implement activities based on their child’s interests, and they are in effect meeting the child at his or her “level”. Parents allow their child to take the lead but challenge them to interact more or use language. For example, if a child is playing with a doll, a parent may use another doll to imitate what the child is doing and then add language to the game. Systematic studies regarding the efficacy of this approach have been very limited, but case studies have reported improvement in communication skills (Martinex-Pedraza, 2009).
• Pivotal Response Treatment (PRT) shares the core principles of ABA and the Early Start Denver Model, but it focuses on pivotal areas that may affect broad functioning. For example, PRT uses certain behavioral methods to target the “pivotal area” of motivation and fosters social motivation by using rewards (Steiner, 2013).
• Verbal Behavior Therapy is a method that aims to teach individuals with ASDs how to communicate effectively using language. Instead of regarding words as mere labels for objects, it trains people to think of language as a means to obtain things they want or to relay ideas (Autism Speaks, 2013). For example, it conditions children to realize that if they say ice cream then their parent or therapist will produce ice cream for them.

This is just a sampling of the multitude of treatments available for individuals with ASDs, and the focus here was on early intervention methods. In some cases medication may be used to treat certain auxiliary symptoms of autism, such as high energy levels, inability to focus, tantrums, and depression (CDC, 2013). Unfortunately, there is no cookie cutter approach that guarantees results in all individuals with ASDs. However, there is an abundance of resources and information relating to autism treatment available, and this blog hopes to keep you informed about the various options.

The next post will take a more in depth look into one of the popular treatment options, Applied Behavior Therapy. Stay tuned!

Autism Speaks. 2013. How is autism treated? Retrieved from http://www.autismspeaks.org/what-autism/treatment

Centers for Disease Control and Prevention. 2013. Treatment. Retrieved from http://www.cdc.gov/ncbddd/autism/treatment.html.

Geschwind. Advances in Autism. Annu Rev Med. 2009; 60: 367–380. [PubMed].

Martinez-Pedraza. Autism spectrum disorders in young children. Child Adolesc Psychiatr Clin N Am. 2009 July; 18(3): 645–663. [PubMed].

Steiner, A et al. Pivotal response treatment for infants at risk for autism spectrum disorders: A pilot study. J Autism Dev Disord. 2013 January; 43(1): 91–102. [PubMed].

A Trip to the Store

By: Meghana Reddy

According to the Center for Disease Control, the current rate of autism in the US is 1 in 88 children. This number is only set to increase, as diagnoses become more frequent and awareness is raised about the disorder.

Autism impairs a person's ability to communicate and relate to others, and is also associated with rigid routines, repetitive behaviors, and difficulty with change. As a result, the social, emotional, and sensory challenges an autistic person may face are unpredictable, and outbursts can occur at inopportune times. And unfortunately, because there are many people who are not educated about autistic behaviors and its challenges, children with autism are often considered "problem” children.

If an autistic child is taken to a grocery store, she may start throwing things, walking in circles, or screaming in the middle of the aisle. Parents receive stares and disapproving looks, as if they we were the ones who caused the behavior, by not keeping good discipline and allowing their child to run “wild”.

But what most people don’t realize is that this is normal behavior for autistic children; autism does not result from bad parenting. The public perception that there is something wrong with both parent and autistic child is not fully informed, nor properly aware of the circumstances behind the disorder. Parents of an autistic child, by going to the grocery store, may be actually trying to give their child exposure to real-world experiences, teaching them how to interact with other people in a more constructive way. They may have to pick up after the child in the process, paying for any dropped produce, cleaning up spills, or apologizing for their child standing in the way of another customer.

But in doing so, parents are attempting to work around the difficulty their child may have with social interaction, and instead, provide them with a sense of normalcy by doing activities that other families do. Rather than hiding or being ashamed of the fact that their child has autism, they take the child out to explore, and make small steps towards gaining new experience and adjusting to the environment around them.

However, no matter how good the intentions and how effective the work of the parents may be, they receive disapproval for their child’s autistic behavior. Something that shouldn’t be viewed as poor or unacceptable may make them feel embarrassed, or even ashamed to have even brought their child along with them. The negative public perception of the parents and their autistic child may discourage many from continuing with excursions outside of the house or daycare. As a result, they prevent the autistic child from having enriching experiences, out of fear for what others may think and say about their child, and about them.

But with a bit of perseverance, patience, and a better public understanding, this negative perception of autism and its behaviors can change. If we encourage more parents to accept the challenge of managing their children and being willing to go on excursions outside to the store, or to the zoo, or to museums, (anywhere!), and the public is willing to accept and tolerate these autistic behaviors, we can create a happy, safe, and more wholesome lifestyle for many autistic children.

References: 

Center for Disease Control. 2013. "Data and Statistics." Retrieved Sep 15, 2013, from http://www.cdc.gov/ncbddd/autism/data.html.

Seattle Children’s Hospital: The Autism Blog. 2013. “Autism and a Trip to the Grocery Store.” Retrieved Sep 24, 2013, from http://theautismblog.seattlechildrens.org/autism-and-a-trip-to-the-grocery-store/

Variations

By: Sabiha Toni

The bell rings, signaling the end of a long, drawling computer science class.

“Wait! I just have one more question!”

We groan. This was Adam, the technological enthusiast, the introductory programming genius. His hand was always in the air. His inquisitiveness was a nuisance, unless of course the knowledge he absorbed came into use at the end of the semester, when we all lined up for his help for our final projects. We greeted him in between classes, stopped for a small chat at times.

At the end of the semester as valedictorian of the Class of 2011, Adam described—to many of our surprises—his struggle with Asperger’s.

Reserved.

Socially inept.

Good with numbers.

There is a particular combination of characteristics that are expected of an autistic individual—a certain demeanor about them, a certain personality, and certain similarities to a certain famed autistic pop-culture character. What happens with situations such as Adam’s in which the signs don’t appear as blatant? The problem with such a rigid set of expectations is the fact that autism is not simply an assemblage of “red flags” but a variation of multiple signs and symptoms with different degrees of effect, which contributes to the difficulty in pinpointing the causes of the disorder.

To cover such a variety of combinations, the term ASDs, or “Autism Spectrum Disorders” was established (Johnson 2007). Because ASDs are neurodevelopmental disorders—meaning that they impair the development of the brain—it is common to find symptoms in three broad areas:

1. Social Interaction: People with autistic disorders tend to avoid social contact with others, or lack interest in interacting with the people around them. These signs can be picked up from a very early age, even in the first year of life. Many infants may not be responsive to others or avoid eye contact. As they grow, toddlers can show disinterest in intermingling with peers, taking turns with them, and playing with them (Volkmar, 2005). These social impairments often make it difficult for those with ASDs to create and maintain meaningful relationships.
2. Communication: Communicative limitations in individuals with autism are prominent and also tie-in to their social skills. For example, autistic people often do not have a desire to communicate. They are often quiet and do not attempt to compensate through gestures, signifying that there is no intent to communicate. About one fourth of autistic children begin to learn and say words but eventually stop speaking them (Johnson, 2007). Conversational language may be slow to develop in certain types of ASD and autistic individuals often babble incoherently or parrot words, sentences, jingles, etc. (Johnson, 2007).  
3. Behavior: Stereotyped behavior, which is characterized by repetitive or rhythmic actions with no purpose or function, are common among people with autism. For example, many will flap their hands, pace, or rock from side to side continuously (Rapin, 2008). Habits and compulsions are also key characteristics of most people with autistic disorders. They are often very averse to interruptions in an activity or changes in routine (Johnson, 2007).

Many of these signs can be seen in those with autistic disorders, but not all need to be present to diagnose an individual with an ASD. Because there is such a range in the combination of signs and symptoms, and because many of these tendencies are not unique to ASDs (for example, normally developing toddlers may also flap their hands), it is not appropriate to class every patient under one disorder. Different signs vary in the degree of severity in different types of ASDs. Thus, it is important to take into consideration impairments in the three general areas above, but not implement them universally as signs of all individuals with autism.

References:

Johnson, CP. Early clinical characteristics of children with autism. In: Gupta, V.B. ed: Autistic Spectrum Disorders in Children. New York: Marcel Dekker, Inc., 2004:85-123.

Rapin I, Tuchman RF. Autism: definition, neurobiology, screening, diagnosis. Pediatr Clin North Am. 2008;55(5):1129–46.

Volkmar F, Chawarska K, Klin A. Autism in infancy and early childhood, Annu Rev Psychol. 2005;56:315—36.

Dispelling the Myth

By: Erin Thomas

The question on everyone’s minds…

With an astounding incidence of autism in the U.S. today that only seems to be growing, it is even more astounding that a definite cause has yet to be found.  Autism has done a successful job of leaping into the public eye and vernacular; fifteen years ago, talk about having an autistic child likely would have been met with confused gazes. It is understandable that the lack of an explicit cause is a frustrating reality for so many individuals on the Autism Spectrum and their families. Without a cause, it becomes all the more difficult to target a treatment for an individual, and families are often left shooting in the dark for therapies.

One school of thought that has pervaded the media is the connection between the Measles-Mumps-Rubella (MMR) vaccine and autism. You may have heard public figures, most notably Jenny McCarthy, promoting the culpability of MMR as a cause of autism. Well, from a scientific standpoint, you may be surprised to hear that there has been NO scientific evidence to support this claim. Not one. So how did this idea gain fuel and become so embedded in the public perception of autism?

Quick history break- Well in 1998, a gastroenterologist named Andrew Wakefield published a paper in Britain describing 8 children who apparently experienced the onset of autism one month after receiving the MMR vaccine. Wakefield claimed that the MMR vaccine caused intestinal inflammation that allowed certain peptides (chains of two or more amino acids, similar to proteins but normally smaller) to enter the bloodstream and thus make their way to the brain where they affected development (Gerber, Offit, 2009). Wakefield was eventually prompted to take down his paper because of the

•  lack of experimental controls to confirm that MMR was responsible for causing the autism
• the unsystematic method in which data was collected
•  the lack of connection between measles, mumps, or rubella to intestinal inflammation, and
• the fact that gastrointestinal issues did not even precede autism onset in some children. (Click here to read more about the issues nullifying the Wakefield paper.)

Since then, research has been conducted to further rule out MMR’s role in causing autism. For one, research has not determined that children with ASDs contain more of the genetic information of the measles vaccine virus than those without ASDs (Hornig, 2008). Moreover, the harmful peptides Wakefield suspected to have been invading the brain from the intestine have not been identified (Gerber, Offit, 2009). In fact, the proteins now believed to contribute to ASDs are endogenous, or have no external origins, and affect neuron activity (Sutcliffe, 2008). 

Studies have further severed the link between the MMR vaccine and autism by showing that the incidence of autism has not increased since people started becoming vaccinated against MMR.  An extensive study on 498 autistic children born from 1979-1992 in the UK is just one source of evidence that rates of autism did not increase after the introduction of the MMR vaccine in 1987. Nor did children who received the MMR vaccine or a second dose of the vaccine have higher onsets of autism than unvaccinated children (Farrington, 2001). Click here for an outline of more studies that have refuted the connection between MMR and autism. 

So if there is no scientific evidence supporting the link between the MMR vaccine and autism, and no logical scientific mechanism for how MMR could even lead to autism, why is the idea still lingering in the minds of parents taking their newborns to the pediatrician’s office?   

The MMR vaccine is administered in babies at 18 months…right around the time when autism is typically first detected (although in some cases it can now be detected earlier). Scientists have coined the term “correlation vs. causation” to illustrate an important fallacy associated with the connection being made here. For example, if I notice that the number of sick people in the U.S. increases as the consumption of hot chocolate in the country increases, is it safe to say that drinking a sweet cup of Swiss Miss causes people to fall ill? Of course not! The two are simply correlated because people happen to consume more hot chocolate in the winter, which is when flu season is at its peak. Similarly, the correlation between the administration of MMR vaccines at 18 months and the subsequent diagnoses of autism around that time does not necessarily link the vaccine to the cause of autism. This correlation vs. causation issue is something we will keep in mind as we continue to assess ongoing autism research. 

Farrington CP, Miller E, Taylor B. MMR and autism: further evidence against a causal association. Vaccine. 2001;19:3632–5. [PubMed]

Gerber J, Offitt P. Vaccines and autism: a tale of shifting hypotheses. Clinical Infectious Diseases. 2009;48:456–461 [PubMed]

Hornig M, Briese T, Buie T, et al. Lack of association between measles virus vaccine and autism with enteropathy: a case-control study. PLoS ONE. 2008;3:e3140.

Sutcliffe JS. Genetics: insights into the pathogenesis of autism. Science. 2008;321:208–9. [PubMed]

Fact vs Fiction: Defining Autism

By: Koeun Choi

So let's talk Autism. Most recent Center for Disease Control stats tell us that 1 out of every 88 children has been diagnosed with autism, with boys being 5 times more likely to be afflicted than girls. It reaches across all race and socioeconomic groups, and tens of millions of people affected worldwide.The United States alone has over 2 million people who have been diagnosed. The rate of autism diagnosed has increased ten-fold in the past 40 years and in the recent years alone, statistics suggest that it has increased 10-17%.* For something that is so prevalent in society, Autism is unfortunately greatly misunderstood.

It probably doesn't help that the Autism Spectrum Disorder (ASD), more commonly called Autism, actually encompasses a wide range of complex disorders of brain development.** Autism affects each individual to different degrees. Think of the loveable TV show character Abed from Community who is able to live independently, appears to be incredibly proficient in the art of cinematography, and yet has difficulty interacting in the normal social situations. Others may have difficulty learning languages, makes awkward gestures such as flapping of the arms, and frequently throws tantrums in an attempt to vent out feelings they cannot communicate to others. Generally, all Autism disorders are characterized by difficulty in socializing, and tends toward repetitive behaviors.

The stigma associated with Autism is greatly detrimental to those afflicted and their families. And the stigma is worsened by the many misconceptions of the disease, which brings about greater consequences. Here are some common ones below:

Fiction: People can grow out of their Autistic condition.

Fact: Unfortunately, there is no cure for autism, nor does a child ever grow out of it.  It is important to realize that the longer parents wait for their children to get better without proper treatment, the worse their condition becomes. However, there are many behavioral and communication therapies that can help autistic children. Therefore, it is imperative that they receive treatment as early as possible!

Fiction: Autism must have resulted from some wrongdoing of the mother or of the parents during the pregnancy/early years of development.

Fact: The truth is that nobody is at fault. Although there is no definite cause of autism - scientific evidence points to genetics, possible chemical prenatal exposure, the parental age at conception, maternal nutrition, and infections during pregnancy and early development. Blaming parents damges relationships and takes the focus away from finding therapy for the loved ones affected by Autism.

Fiction: Vaccines, MMR Vaccines in particular, cause Autism.

Fact: The study that first sparked this claim was, if I may be frank, so not kosher on so many levels (there will be more said about this in the future).  There is no relationship between receiving vaccine shots and the occurrence of autism. This myth is actually really harmful because it dissuades many concerned parents away from getting their kids flu shots, leading to multiple incidents of preventable childhood deaths.

And lastly, on a happier note...

Fiction: Autism shortens life spans.

Fact: With the proper support and treatment, autistic children have the potential to lead long and healthy lives.

*Note that the great increase may be compounded by the fact that the methods of diagnosing autism has become more efficient

**For greater information on the different types of autism disorders, please check out our fellow blog: http://www.humanologyproject.org/autism-as-a-disorder/

References

Center for Disease Control. 2013. "Data and Statistics." Retrieved Sep 15, 2013, from http://www.cdc.gov/ncbddd/autism/data.html.

Autism Speaks. 2013. "What is Autism." Retrieved Sep 15, 2013, from http://www.autismspeaks.org/what-autism.

South Asian Autism Awareness Center. 2013. "Myths & Stigma." Retrieved Sep 10, 2013, from http://saaac.org/about-autism/myths-stigmas/.

So What's the Buzz About?

By: Erin Thomas     

Autism has increasingly been making headlines in recent years and has sometimes found itself in the center of hot debate. How can the mere mention of a disorder stir so much controversy? Well, it is reported that today one in 50 children, aged 6-17, has an Autism Spectrum Disorder (CDC, 2013)- that is an alarming rate, and the incidence seems to be increasing.

So with such a high prevalence, the next thing you are probably wondering is what the culprit is. And here lies the problem at the center of disputes- a single cause of autism has yet to be pinpointed. As of now, researchers believe a combination of genetic and environmental factors are at play. There is a plethora of ongoing  research into the causes and treatments of autism. It is the goal of this blog to keep you informed   as well as clear up common misconceptions as best as we can.

 To start, there is often a  misunderstanding in the public of what autism is and whom it affects. Autism  is actually a general term used to refer to a group of five Autism Spectrum  Disorders, or ASDs, which affect brain development. Individuals with ASDs   process sensory information differently than those with normal brain development. Autism spans all races, ethnicities, and social groups (Autism Science Foundation, 2013).

What are the different types of ASDs? Well a “spectrum  disorder” means that symptoms can range from mild to severe (American Autism   Association, 2013).

• “Classic autism” is known as autistic disorder, in which a child may have delays in the development of language, have problems communicating, lack social ability, have intellectual disabilities, or have unusual behaviors and interests.
• Asperger’s Syndrome presents itself with milder symptoms than autistic disorder and is characterized by unusual behaviors or interests as well as a lack of social skills. Those living with Asperger’s do not normally have intellectual deficits or communication issues.
• Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS)   is when an individual shows some but not all of the symptoms of autistic disorder or Asperger’s Syndrome (American Autism Association, 2013). People with PDD-NOS may only lack social and communication skills.
• Rett syndrome is a very rare and severe form of autism occurring only in girls. It is caused by a mutation on the X chromosome.
• Child disintegrative disorder is another very rare and severe condition in which a child regresses in development after at least two years of completely normal development (Mayo Clinic, 2013).

At the heart of the attention towards ASDs is, of course, the people who live with them and endure the symptoms each and every day- and we want to keep it that way. There is no cure for ASDs, but there is an array of therapies available to help treat the symptoms. Treatments play a large role in allowing individuals to overcome certain symptoms and thrive in society. This blog hopes to be a source of valuable information and resources in an effort to shed light on the ongoing research. We all have a lot to learn about Autism Spectrum Disorders, so let's use this space to learn together. 

References:

American Autism   Association. (2013). “What is autism?”[Handout]. New York, NY. Autism Science   Foundation. (2013). “What is autism?” Retrieved fromhttp://www.autismsciencefoundation.org/what-is-autism

Centers for Disease   Control and Prevention. (2013). “Autism spectrum disorders.”  Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr065.pdf.

Mayo Clinic staff.   (2013). “Childhood disintegrative disorder.” Retrieved from http://www.mayoclinic.com/health/childhood-disintegrative-disorder/DS00801