Term Papers About Autism

In this term paper, I will be discussing the disorder of Autism, a sever disorder that affects the function of the brain. It causes problems in such areas as social contact, intelligence, language and speech impediments, along with ritualistic or compulsive behaviors, as well as different responses to the environment that an autistic individual may have different than individuals not having autism would exhibit. I will be talking generally about the history and description of autism, the cause, affected age group, signs and symptoms that mark a autistic individual, the people who an autistic individual may go to for medical help and treatment, the actual treatment that a autistic person may receive, risk factors that a autistic person may encounter, how you would asses someone with autism, activities that a individual who has autism may take part in, and also the long term affects and treatment goals for someone who has autism should be trying to accomplish. I feel that by doing all of this that I will gain a greater sense of understanding for individuals with autism so as to better help them if I should ever have the privilege to work with an autistic person. I will be giving this information to you by going through each topic that I have outlined in the introduction and explaining what each means and how they affect an individual with autism.

Definition of Autism
Before anything else, I feel that I should give a scientific definition of Autism. Autism is a sever disorder of brain function marked by problems with social contact, intelligence and language, together with ritualistic or compulsive behavior and bizarre responses to the environment.

Autism is a disorder that, as of right now, you have for a lifetime. It interferes with the individual’s ability to understand what is seen, heard, and touched. This can cause tremendous problems in personal behavior and in the ability to relate and communicate with others. A person with autism has to be taught to communicate normally and how to have relationships with people, objects and events in their lives. However, not all individuals suffer to the same degree of impairment. There is a whole area of different symptoms that individuals can suffer from, which can range from mild symptoms to severe. Autism occurs in as many as one or two per 1,000 children. It is four times more often in boys (usually more often than not, the first born) and it does not discriminate (occurs around the world in all races and social backgrounds). While a individual can have symptoms ranging from the very mild to sever, around %10 have an extraordinary ability in one area of the 9 multiple intelligences, such as mathematics, music, memory, or art. Such individuals were once referred to as “idiot savants”, but now that the world has expanded and realized their ignorance, they are now called “autistic savants”.

Affected Age Group
Autism is usually found in a individual within the first three years of life, but can be not seen for very long after that. It can be very hard to tell sometimes when the problem develops in some children, sometimes the condition isn’t found until the child enters into school and it is spotted by someone who is around children and can see the symptoms because of experience.

Signs and Symptoms
Autism is a brain disorder that affects the way the brain uses the information sent to it or the way that it transmits the information it receives. Some studies have found that abnormalities in many parts of the brain have almost always occurred during the time of fetal development. The problem may be centered in the parts of the brain responsible for processing language and information from your senses.

Autism appears to have a strong genetic base. Twins that are identical are more likely to be both affected by autism then twins of a fraternal nature. In a family who has one autistic child, the chances of having another child that has autism is about one in twenty, much more greater then the population of families who do not have a autistic child. In some cases, there are relatives of an autistic child who my display the mild behaviors that are very similar to the autistic individual in the family, such as repetitive behaviors and social or communication problems. Problems of an emotional nature (such as manic depression) occur most often in families of an individual with autism.

There is a link between one abnormal gene and autism. The gene may be just one of at least three of 5 genes that interact in some way to cause the condition. Scientist suspect that a faulty gene or genes may make a person vulnerable to develop autism in the presence of other factors, such as chemical imbalance, viruses or chemicals, or a lack or oxygen at birth.

=Rubella in the pregnant mother
=Tuberous Sclerosis
=Fragile X Syndrome
=Untreated Pneylketonuria

The severity of the condition is different from case to case, ranging from the most sever (extremely unusual, repetitive, self-injuring, aggressive behaviors) to very mild, such as a simple learning challenge. Problems with social interactions are the most common symptoms related to autism. Babies with the disorder will not be as cuddly as usual. They want very little human contact with anyone. They may not even smile or lift their arms in the situation of being picked up by a parent like a baby without autism would. They may not form a bond with the parents and also may not show any or little anxiety toward people that they do not know. Individuals with autism may not learn childhood games such as peak-a-boo or other such games of that nature.

Speech Problems

A child with autism may not speak at all. And if he/she does, it is often single words. They may endlessly say words over and over that are the reverse of what they mean, such as “you got to sleep” instead of “I want to go to sleep”.

Sensory Problems
A child with autism may ignore objects or become obsessively attached to them. Many of these individuals may react to sounds differently, doing things such as banging their head or waving fingers in the air.

Intellectual Problems
Most autistic children appear to be moderately mentally challenged. They may giggle or cry for no reason, have no fear of real, impending danger, but exhibit terror of harmless objects.

Interdisciplinary Professional
There are many places a person with autism should go, depending on the severity of their case and what symptoms they are being affected by. If they have speech problems then a speech therapist would be a start. Therapeutic Recreational Specialists can help develop programs that will help them create co-ordination and hopefully some social skills, but it all depends on the individual and the symptoms that are dominant in them.

Unfortunately, there is no current cure for autism. Treatments are aimed at minimizing specific symptoms. Because the symptoms that someone may have very a lot from case to case, there is no single approach to a treatment that is universal. Individuals may be trained in music, listening, vision, speech, and language, and senses. Special diets and medications may also be prescribed. With proper treatment, people with autism can improve significantly in their lives. A child with autism can learn best with special teachers in a special setting to meet the individual’s need. The two most often studied types of treatment are:

Educational or Behavioral Treatment
Behavioral related treatments are used to help the child respond to decreased symptoms. This may include positive reinforcement to boost language and social skills. The training may include structured, skills-oriented instruction made to boost social and language skills. Training needs to begin in the early stages of life, since early intervention appears to influence brain development.

Most experts in the area of autism believe that modern treatment is most effective if it is carried out in the home of the individual, although the treatment, although treatment may also take place in a psychiatric hospital, specialized school, or day care program.

There is no single treatment that has yet proved effective for the major features of autism However, a variety of drugs can control self-injurious, aggressive, and other of the more hard to control behaviors. Drugs also can control epilepsy, which afflicts up to 20% of individuals with autism.

Alternative Treatments
Many parents of autistic children may also consider the Megavitamin Therapy. Some studies have shown that vitamin B6 improves eye contact and speech and this vitamin also treats tantrum behaviors. It causes less side effects than other medications and is considered safe when used appropriately by the individual. However, not many health practitioners advocate its use in the treatment of autism, citing that the studies showing its benefits were flawed.

DMG (Dimethylglycine)
This compound, found in many health food stores, is legally classified as a food, not a vitamin or a drug. Some researches say that it improves speech in autistic children. Those who respond to the treatment will usually do so within a week of starting the treatment. Again, many of the doctors do not feel that the studies are adequate to advocate for this treatment.

Vigorous exercises (20 minutes or longer, three or four days a week) seem to decrees hyperactivity, aggression, self-injury, and other autistic symptoms.

Risk Factors
There are many risk factors associated with autism. People who have had a traumatic birth, due to complications of a natural or maybe environmental factors, such as rough doctors, may cause a child to be autistic. When there is a history of allergies in the family, there is a better chance of someone having an autistic child. Fibromyalgia, chronic fatigue, or low thyroid in the mother may also cause a autistic child to be born to the mother of the child. When there is a history of chronic problems, including constipation, chronic diarrhea, or reflux in the family, the children of people in this family are at a greater risk of being born with autism then if there was no history of it at all. History of an extended immunization reaction in the family also is a risk factor for a child being born with autism.

There are many risk factors that can contribute to the chances that a child will be born to a family and be autistic, but there is no way to prevent some of them. That’s the saddest part about it. If we could only lessen the factors that are related to someone having an autistic child, then we could really cut back on the number of autistic births worldwide. But for now, all we can do is educate people on what the risk factors are and hopefully decrease the number of children that are born with the disorder.

The assessment of a child suspected to have autism consists of many parts. Observations of the individual at school or day-care, depending on where the child is at their stage of growing, and also a number of different settings at these places. EX: play, class work, recess, morning and meal times and snack times.

Discussions with staff in the above settings will help you to find what the child was like in the past before your presence at the facility, letting you know if they have changed since you have be brought there or if they are still the same.

Formal assessments either in the above places or in the home of the child to determine how they react to you on a personal level as a stranger, and to see if the parents have any input to behaviors that they may have noticed in the past of lately that can be attributed to autistic behavior.

An extensive interview with the parents or caregiver of the individual expected to have autism. This should not take any longer than 2-3 hours and should be done in the home of the people involved. This gives the assessor a chance to find out the Childs current behavior and also what the child’s progress has been like from birth to present.

Remedial Activities
There are many activities tailored to the special needs that an autistic individual may have. But it depends on the individual’s strengths and weaknesses. For example, if a child is extremely intelligent in math, but may lack social skills, then maybe a program tailored to meet the needs of this individual could have a bit of math involved, because they enjoy math, but also try and incorporate social interaction into the activity, slowly at first, but as time goes on, add more and more people to the program and it should be easier for the individual to adjust to a big group once they have had enough experience with a smaller one.

Some children may have a difficulty in recognizing facial expressions in the people around them. A way to help a child with this is to sit face to face and for you to make different facial expressions and try to get the child to guess what expression it is that you are showing. This will probably be enjoyable to the child, and also teach him the expressions that he can show and that that’s what the people around him are feeling.

Some autistic children may like arts and crafts. This is great because by having them make different things with these materials could help them learn many different things. Get the child to make different shapes and to learn the different names to the shapes. You could get them to learn about an endless array of different things, just by having them make crafts in the images that you provide them.

If the child is highly intelligent in music, then you can do many different things to help the child have fun and learn at the same time. There are many education songs that the child may enjoy and that would help him to learn about different things that maybe they would have had a hard time to learn it they had to do it a different way.

If an autistic child is gifted in the area of reading, then this would be good because they can read on anything. There is a whole world open to the individual if they can read. And you can make games out of reading. See if they may like to have a race to see who can read the fastest or the most material in a set amount of time. There is so many different opportunities to an autistic child that can read.

Long-term Affects and Treatment Goals
While there is no cure for autism, with the right treatment, the negative behaviors that the individual may have will improve. The goals of the treatments vary, depending on the case. The main objectives of the treatments are to increase the underdeveloped traits of the individual and sustain the developed traits at the same time. Maybe not an easy goal, but with time and training, it can be done.

This assignment has taught me a lot about autism and the different aspects of the disorder. I don’t think that I would have been able to understand how hard life would be like if I was to have autism, and I don’t think that I still yet fully understand, no one can, unless they have autism. But I feel a new understanding and respect for these individuals and in time I feel that I will learn more about them and hopefully understand them better.


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Stephen M. Edelson, Ph.D.

It has been over 50 years since Dr. Leo Kanner, a psychiatrist at Johns Hopkins University, wrote the first paper applying the term 'autism' to a group of children who were self-absorbed and who had severe social, communication, and behavioral problems. This paper provides a general overview of the complexity of this developmental disability by summarizing many of the major topics in autism.


For many years, the most cited statistic is that autism occurs in 4.5 out of 10,000 live births. This was based on large-scale surveys conducted in the United States and England. More recently, estimates on the prevalence of autism have ranged been as high as 1/4% to 1/2% of the population. These estimates typically include those with autism, Asperger syndrome, and PDD.

Autism is three times more likely to affect males than females. This gender difference is not unique to autism since many developmental disabilities have a greater male to female ratio.

Major characteristics

Many autistic infants are different from birth. Two common characteristics they may exhibit include arching their back away from their caregiver to avoid physical contact and failing to anticipate being picked up (i.e., becoming limp). As infants, they are often described as either passive or overly agitated babies. A passive baby refers to one who is quiet most of the time making little, if any, demands on his/her parents. An overly agitated baby refers to an infant who cries a great deal, sometimes non-stop, during his/her waking hours. During infancy, many begin to rock and/or bang their head against the crib; but this is not always the case.

In the first few years of life, some autistic toddlers reach developmental milestones, such as talking, crawling, and walking, much earlier than the average child; whereas others are considerably delayed. Approximately one-half of autistic children develop normally until somewhere between 1 1/2 to 3 years of age; then autistic symptoms begin to emerge. These individuals are often referred to as having 'regressive' autism. Some people in the field believe that candida albicans, vaccinations, exposure to a virus, or the onset of seizures may be responsible for this regression. It is also thought that some children with 'regressive' autism may have Landau-Kleffner Syndrome (see next section).

During childhood, autistic children may fall behind their same-aged peers in the areas of communication, social skills, and cognition. In addition, dysfunctional behaviors may start to appear, such as self-stimulatory behaviors (i.e., repetitive, non-goal directed behavior, such as rocking, hand-flapping), self-injury (e.g., hand-biting, headbanging), sleeping and eating problems, poor eye contact, insensitivity to pain, hyper-/hypo-activity, and attention deficits.

One characteristic which is quite common in autism is the individual's ‘insistence on sameness’ or 'perseverative' behavior. Many children become overly insistent on routines; if one is changed, even slightly, the child may become upset and tantrum. Some common examples are: drinking and/or eating the same food items at every meal, wearing certain clothing or insisting that others wear the same clothes, and going to school using the same route. One possible reason for ‘insistence on sameness’ may be the person's inability to understand and cope with novel situations.

Autistic individuals sometimes have difficulty with the transition to puberty. Approximately 25% have seizures for the first time during puberty which may be due to hormonal changes. In addition, many behavior problems can become more frequent and more severe during this period. However, others experience puberty with relative ease.

In contrast to 20 years ago when many autistic individuals were institutionalized, there are now many flexible living arrangements. Usually, only the most severe individuals live in institutions. In adulthood, some people with autism live at home with their parents; some live in residential facilities; some live semi-independently (such as in a group home); and others live independently. There are autistic adults who graduate from college and receive graduate degrees; and some develop adult relationships and may marry. In the work environment, many autistic adults can be reliable and conscientious workers. Unfortunately, these individuals may have difficulty getting a job. Since many of them are socially awkward and may appear to be 'eccentric' or 'different,' they often have difficulty with the job interview.

Subgroups and Related Disorders

There is no adjective which can be used to describe every type of person with autism because there are many forms of this disorder. For example, some individuals are anti-social, some are asocial, and others are social. Some are aggressive toward themselves and/or aggressive toward others. Approximately half have little or no language, some repeat (or echo) words and/or phrases, and others may have normal language skills. Since there are no physiological tests at this time to determine whether a person has autism, the diagnosis of autism is given when an individual displays a number of characteristic behaviors.

In the last five years, research has shown that many people who engage in autistic behaviors have related but distinct disorders. These include: Asperger Syndrome, Fragile X Syndrome, Landau-Kleffner Syndrome, Rett Syndrome, and Williams Syndrome. Asperger Syndrome is characterized by concrete and literal thinking, obsession with certain topics, excellent memories, and being 'eccentric.' These individuals are considered high-functioning and are capable of holding a job and of living independently.

Fragile X Syndrome is a form of mental retardation in which the long arm on the X chromosome is constricted. Approximately 15% of people with Fragile X Syndrome exhibit autistic behaviors. These behaviors include: delay in speech/language, hyperactivity, poor eye contact, and hand-flapping. The majority of these individuals function at a mild to moderate level. As they grow older, their unique physical facial features may become more prominent (e.g., elongated face and ears), and they may develop heart problems.

People with Landau-Kleffner Syndrome also exhibit many autistic behaviors, such as social withdrawal, insistence on sameness, and language problems. These individuals are often thought of as having 'regressive' autism because they appear to be normal until sometime between ages 3 and 7. They often have good language skills in early childhood but gradually lose their ability to talk. They also have abnormal brain wave patterns which can be diagnosed by analyzing their EEG pattern during an extended sleep period.

Rett Syndrome is a degenerative disorder which affects mostly females and usually develops between 1/2 to 1 1/2 years of age. Some of their characteristic behaviors include: loss of speech, repetitive hand-wringing, body rocking, and social withdrawal. Those individuals suffering from this disorder may be severely to profoundly mentally retarded.

Williams Syndrome is characterized by several autistic behaviors including: developmental and language delays, sound sensitivity, attention deficits, and social problems. In contrast to many autistic individuals, those with Williams Syndrome are quite sociable and have heart problems.


Although there is no known unique cause of autism, there is growing evidence that autism can be caused by a variety of problems. There is some indication of a genetic influence in autism. For example, there is a greater likelihood that two monozygotic twins (i.e., identical twins) will have autism than two dizygotic twins (i.e., fraternal twins). In the case of monozygotic twins, there is a 100% overlap in genes; whereas in dizygotic twins, there is a 50% overlap in genes, the same overlap as in non-twin siblings. Currently, a great deal of research has focused on locating the 'autism gene;' however, many researchers speculate that three to five genes will likely be associated with autism. There is also evidence that the genetic link to autism may be a weakened or compromised immune system. Other research has shown that depression and/or dyslexia are quite common in one or both sides of the family when autism is present.

There is also evidence that a virus can cause autism. There is an increased risk in having an autistic child after exposure to rubella during the first trimester of the pregnancy. Cytolomegalo virus has also been associated with autism. Additionally, there is also a growing concern that viruses associated with vaccinations, such as the measles component of the MMR vaccine and the pertussis component of the DPT shot, may cause autism.

There is growing concern that toxins and pollution in the environment can also lead to autism. There is a high prevalence of autism in the small town of Leomenster, Massachusetts, where a factory manufacturing sunglasses was once located. Interestingly, the highest proportion of autism cases were found in the homes down-wind from the factory smokestacks. Recently, a large proportion of autistic children were identified in Brick Township, New Jersey. Several agencies are now attempting to uncover the reason(s) for the high proportion of autism in this community.

Physical abnormalities

Researchers have located several brain abnormalities in individuals with autism; however, the reasons for these abnormalities is not known nor is the influence they have on behavior. These abnormalities can be classified into two types--dysfunctions in the neural structure of the brain and abnormal biochemistry of the brain. It will be important for future researchers to examine the relationship between these two types of abnormalities.

With respect to brain structure, Drs. Bauman and Kemper examined post-mortem brains of several autistic individuals and have located two areas in the limbic system which are underdeveloped--the amygdala and the hippocampus. These two areas are responsible for emotions, aggression, sensory input, and learning. These researchers also found a deficiency of Purkinje cells in the cerebellum. Using Magnetic Resonance Imaging, Dr. Courchesne has found two areas in the cerebellum, vermal lobules VI and VII, which are significantly smaller than normal in autistic individuals. Interestingly, there are a some autistic individuals whose vermal lobules VI and VII are larger than normal. One or both of these areas of the cerebellum are believed to be responsible for attention.

With respect to biochemistry, many autistic individuals have elevated levels of serotonin in their blood and cerebral spinal fluid, whereas others have relatively low levels of serotonin. It should be mentioned that other disorders, such as Down Syndrome, attention deficit/hyperactivity disorder, and unipolar depression are also associated with abnormal levels of serotonin. There is also evidence that some autistic individuals have elevated levels of beta-endorphins, an endogenous opiate-like substance in the body. It is felt that those individuals who have an increased pain tolerance may likely be due to elevated levels of beta-endorphins.

A dysfunctional immune system has also been associated with autism. It is thought that a viral infection or an environmental toxin may be responsible for damaging the immune system. As mentioned above, there is also evidence of a genetic association to a compromised immune system. Researchers have found that many autistic individuals have a decreased number of helper t-cells which help the immune system fight infection.

There is growing evidence that the gut or intestinal tract of autism children is impaired. Researchers have documented yeast overgrowths (candida albicans), low levels of phenyl sulfur transferase, and measles virus in their intestinal tract.

Sensory impairments

Many autistic individuals seem to have an impairment in one or more of their senses. This impairment can involve the auditory, visual, tactile, taste, vestibular, olfactory (smell), and proprioceptive senses. These senses may be hypersensitive, hyposensitive, or may result in the person experiencing interference such as in the case of tinnitus, (a persistent ringing or buzzing in the ears). As a result, it may be difficult for individuals with autism to process incoming sensory information properly.

Sensory impairments may also make it difficult for the individual to withstand normal stimulation. For example, some autistic individuals are tactilely defensive and avoid all forms of body contact. Others, in contrast, have little or no tactile or pain sensitivity. Furthermore, some people with autism seem to 'crave' deep pressure. Another example of sensory abnormalities is hypersensitive hearing. Approximately 40% of autistic individuals experience discomfort when exposed to certain sounds or frequencies. These individuals often cover their ears and/or tantrum after hearing sounds such as a baby's cry or the sound of a motor. In contrast, some parents suspect their children of being deaf because they appear unresponsive to sounds.


"Theory of mind" refers to one's inability to realize that other people have their own unique point of view about the world. Many autistic individuals do not realize that others may have different thoughts, plans, and perspectives than their own. For example, a child may be asked to show a photograph of an animal to another child. Rather than turning the picture around to face the other child, the autistic child may, instead, show the back of the photograph. In this example, the autistic child can view the picture but does not realize that the other child has a different perspective or point of view.

About 10% of autistic individuals have savant skills. This refers to an ability which is considered remarkable by most standards. These skills are often spatial in nature, such as special talents in music and art. Another common savant skill is mathematical ability in which some autistic individuals can multiply large numbers in their head within a short period of time; others can determine the day of the week when given a specific date in history or memorize complete airline schedules.

Many autistic individuals also have a narrow or focused attention span; this has been termed 'stimulus overselectivity.' Basically, their attention is focused on only one, often irrelevant, aspect of an object. For example, they may focus on the color of a utensil, and ignore other aspects such as the shape. In this case, it may be difficult for a child to discriminate between a fork and a spoon if he/she attends only to the color. Since attention is the first stage in processing information, failure to attend to the relevant aspects of an object or person may limit one's ability to learn about objects and people in one's environment.


Over the years, families have tried various types of traditional and non-traditional treatments to reduce autistic behaviors and to increase appropriate behaviors. Although some individuals are given medications to improve general well-being, there is no primary drug which has been shown to be consistently effective in treating symptoms of autism. The most widely prescribed medication for autistic children is Ritalin, (a stimulant used to treat Attention Deficit/Hyperactivity Disorder). However, there are no double-blind controlled studies to demonstrate its effectiveness for those with autism.

The two treatments which have received the most empirical support are Applied Behavior Analysis (ABA; behavior modification) and the use of vitamin B6 with magnesium supplements. Behavior modification involves a variety of strategies, (e.g., positive reinforcement, time-out), to increase appropriate behaviors, such as communication and social behavior, and to decrease inappropriate behaviors, such as self-stimulatory and self-injurious behavior.

Vitamin B6 taken with magnesium has been shown to increase general well-being, awareness, and attention in approximately 45% of autistic children. There are also a number of recent reports about the benefits of another nutritional supplement, Di-methylglycine (DMG). DMG also seems to help the person's general well-being, and there are many anecdotal reports of it enhancing communication skills.

Some people with autism have excessive amounts of a type of yeast called 'candida albicans' in their intestinal tract. It is thought that high levels of candida albicans may be a contributing factor to many of their behavioral problems. One scenario is that when a child develops a middle ear infection, the antibiotics that help fight the infection may destroy microbes that regulate the amount of yeast in the intestinal tract. As a result, the yeast grows rapidly and releases toxins in the blood; and these toxins may influence the functioning of the brain. Excessive candida albicans can be treated with rather mild medications such as Nystatin.

Food intolerances and food sensitivities are beginning to receive much attention as possible contributors to autistic behaviors. Many families have observed rather dramatic changes after removing certain food items from their children's diet. Researchers have recently detected the presence of abnormal peptides in the urine of autistic individuals. It is thought that these peptides may be due to the body's inability to breakdown certain proteins into amino acids; these proteins are gluten (e.g., wheat, barley, oats) and casein (found in human and cow's milk). Many parents have removed these substances from their children's diets and have, in many cases, observed dramatic, positive changes in health and behavior.

As mentioned earlier, many autistic individuals have sensory impairments. Sensory integration techniques are often used to treat dysfunctional tactile, vestibular, and proprioceptive senses. Some of the techniques involve swinging a child on a swing in various ways to help normalize the vestibular sense and rubbing different textures on the skin to normalize the tactile sense. In addition, an autistic woman, Dr. Temple Grandin, developed a hug machine which provides the individuals with deep pressure which appears to have a calming effect on the person.

Many autistic individuals are also sensitive to sounds in their environment. They may hear sounds beyond the normal range and/or certain sounds may be perceived as painful. Auditory integration training, (listening to processed music for ten hours), is an intervention which is often used to reduce these sensitivities. Visual training is another sensory intervention designed to normalize one's vision. There are several different methods of visual training. One popular program, developed by Dr. Melvin Kaplan, involves wearing ambient (prism) lenses and performing movement exercises which appear to reorganize and normalize the visual system.


Autism is a very complex disorder; and the needs of these individuals vary greatly. After 50 years of research, traditional and contemporary approaches are enabling us to understand and treat these individuals. It is also important to mention that parents and professionals are beginning to realize that the symptoms of autism are treatable--there are many interventions that can make a significant difference.

The logo for the national parent support group, the Autism Society of America, is a picture of a child embedded in a puzzle. Most of the pieces of the puzzle are on the table, but we are still trying to figure out how they fit together. We must also keep in mind that these pieces may fit several different puzzles.

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