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Don Castellano-Hoyt
Historical and Diagnostic Issues


Autism is the least understood of the major categories of developmental disabilities. While research on this condition has been conducted for over 50 years, much has yet to be learned. Persons with autism are subject to behavioral changes, and these behavioral changes are frequently factors when police are called to deal with these persons. Persons with autism have experienced countless injustices by the criminal justice system, and many of these incidents have raised the level of awareness on the part of society for the need for police training on all the categories of developmental disabilities.


The vast majority of research on persons with this condition has been conducted on or with children. Until recently, children with autism never grew up to be called adults with autism. Instead, they were called schizophrenic or mentally retarded, and were usually institutionalized. Why were adults with autism not identified as such? Until recently, there were no residential, training, or employment opportunities for adults with autism, so the only way they could receive services was to be labeled as something else. Once labeled, the easiest thing to do was to shut them away in institutions.


Now more services are available for adults with autism, and as a result, more people are beginning to see adults with autism for who they are. They are people who usually require intensive, continuous training in order to lead fulfilling lives. The more they are capable of satisfying their own needs and wants, the happier they will be. Children with autism usually carry with them into adulthood the same behavior, preferences, and demands they have had throughout life. This can be both good and bad, as undesirable behavior does not end with adulthood. The good news is that adults with autism do not usually acquire new behavior problems, nor do they lose the progress they have made in controlling their behavior and in meeting their own needs (Holmes, 1989).


Although the diagnostic criteria for autism have become increasingly refined, accurate diagnosis can be complicated by several factors. First, there are no medical tests or biological markers for the condition; the sole determination is behavior-based. Since no physiological tests to diagnose autism currently exist, the diagnosis is given when an individual displays a number of characteristic behaviors. Because of the condition's low prevalence, few professionals receive exposure to persons with autism in the course of their training and are unfamiliar with its behavioral expression. The second problem arises from the fact that characteristics and behavioral manifestations often vary as functions of age or developmental level. Diagnostic features which are prominent during the preschool years may not be the same as those seen in middle childhood. A third factor is that of overlapping conditions between autism and other forms of developmental disability. Lastly, the body of knowledge about autism continues to expand and therefore many "facts" quickly become outdated.


Many infants with autism are noticeably different from birth. Two common characteristics they may exhibit include arching their back away from their caregiver to avoid physical contact and falling 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 and who makes few, if any, demands on his/her parents. An overly agitated baby refers to an infant who cries a great deal, sometimes nonstop, during his or her waking hours. During infancy, many begin to rock and/or bang their head against the crib; this is not always the case. In the first few years of life, some toddlers with autism reach developmental milestones, such as talking, crawling, and walking, much earlier than the average child does, whereas others are considerably delayed. Approximately 1/3 of children with autism develop normally until between I 1/2 to 3 years of age, when autistic symptoms begin to emerge. These individuals have what is often called regressive autism. Some people in the field believe that exposure to a virus during vaccination or the onset of seizures may be responsible for this regression.


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


One characteristic which is quite common in autism is the individual's "insistence on sameness" or "perseveration" behavior. Many persons become overly insistent on routines; if one is changed, even slightly, the person may become upset and have a tantrum. Common examples include 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 places away from the home using the same route. One possible reason for "insistence on sameness" may be the person's inability to understand and cope with novel situations.


Individuals with autism sometimes have difficulty with making the transition to puberty. Approximately 20% 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. Others, though, experience puberty with relative ease.


No single adjective can describe every type of person with autism because there are many forms of this disorder. For example, some individuals are antisocial, some are asocial, and others are social. Some are aggressive toward themselves and/or aggressive toward others. Although half have little or no language skills, some repeat (or echo) words and/or phrases, and others may have normal language skills.


In contrast to 20 years ago when many individuals with autism were institutionalized, many flexible living arrangements now exist for them. Usually, only the most severely impaired individuals live in institutions. As adults, 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 adults with autism who graduate from college and receive graduate degrees, and some who develop adult relationships and marry. In the work environment, many adults with autism 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 job interviews.