What is Autism?

Martin E. Block, Vickie E. Block, and Peggy HalUday

erena is a 10-year-old 4th grader with

S big brown eyes and black hair that
is always in a perfect little pigtail. One
of Serena's favorite classes is physical
education. She particularly likes it when
the teacher puts on music. She will run,
jump, skip, or even dance whenever
she hears music. She also sings to the
music (very loudly!) and often asks the
teacher (over and over again) to play her
favorite Hillary Duff CD. The problem
is that she often is not supposed to run
around or dance when the teacher puts
the music on (and certainly not sing).
Unfortunately, Serena does not under-
stand when it is appropriate to run
around or dance versus when to sit and
listen. Neither does Serena stop moving
when the general physical educator tells
her to stop. And, perhaps most discon-
certing, she occasionally gets upset and
even throws a tantrum when someone
tries to get her to sit down.
Ryan is a 14-year-old, 8th grade boy. Unlike Serena, criteria are specific and based upon observable behav-
Ryan does not seem to enjoy physical education. Ryan iors, there is a wide range of variability in the severity
enters the gym very slowly, often dragging his hand of those behaviors (Scott, Clark, & Brady, 2000). That is
across the gym wall. He commonly stares at the ceil- why autism is known as a "spectrum disorder" because
ing lights or ihe back of his hands. He has learned to sit children with autism display characteristics across ihe
in his squad, but does not interact with anyone sitting spectrum. For example, Serena can talk and move quite
near him. During class activities, Ryan seems to move well, while Ryan does not speak, is highly sensitive
in slow motion, even after the extra prodding necessary to the environment, and is more socially withdrawn.
to get him to move at all. Music and loud noises annoy Recent reports suggest as many as 3-4 out of every 1,000
Ryan, but the echoes of the gym really bother him. in children have it (Yeargin-AUsopp et al., 2003). It is the
fact, he usually conies to physical education wearing fastest growing developmental disability in the United
headphones to muffle the sounds in the gym. Ryan States, which means school districts are scrambling to
does not respond to any verbal directions, so a teacher find qualified teachers who know how to accommodate
assistant who accompanies him to physical education the learning needs of these unique children.
has to point to pictures on a clipboard to communicate The purpose of this article is to introduce the reader
with him. to autism. The article begins with a definition of autism.
Both children described above have autism. One of This will be followed by a discussion of possible causes
the oddities of autism is that it does not seem to affect of autism as well as common characteristics associated
any two children the same way. Although diagnostic with the disorder-

Teaching Elementary Physical Education I November 2006

 What is Autism?
Autism is a disability that significantly impairs a child's
ability to interact and communicate with others. Autism
interferes with normal brain development, causing defi-
cits in verbal and non-verbal communication, social inter-
action, and play. These deficits make it hard for children
with autism to relate to the world around them. They may
exhibit odd behaviors, such as repeated body movements,
flapping their hands in the air, or rocking back and forth.
They may also develop unusual attachments to objects
and resist changes in routine. Other than their unique
behaviors and lack of normal language development, they
do not look different from a typically developing child
(Holmes, 1997; Powers, 1989; see Table 1 for the diag-
nostic criteria for autism). Boys are 5 times more likely
to have autism than girls are, but girls with autism tend
to exhibit more severe characteristics (APA, 2000).
Autism is considered a "pervasive developmental
disorder" (PDD) by the American Psychiatric Associa-
tion (APA, 2000). A PDD is an umbrella term used to
describe a spectrum of disorders that are all character-
ized by severe (major impact) and pervasive (all aspects
of a child's life) deficits in several areas of development,
including social interactions and communication skills as
well as the presence of unique behaviors. These deficits
and unique behaviors are not normal for the child's devel-
opmental level. Most closely related disorders, such as
Table 1—Diagnostic Criteria for Autistic Disorder*
A total of 6 (or more) items from 1. 2, and 3. with at
least two from 1, and one each from 2 and 3:
1. Qualitative impairment in social interactions, as
manifested by at least two of the following: (a)
marked impairment in the use of multiple nonverbal
behaviors such as eye-to-eye gaze, facial expres-
sions, body postures, and gestures to regulate social
interactions; (b) failure to develop peer relationships
appropriate to developmental level; (c) lack of spon-
taneous seeking to share enjoyment, interests, or
achievements with other people (e.g.. by a lack of
showing, bringing, or pointing out objects of interest);
(d) lack of social or emotional reciprocity.
2. Qualitative impairment in communication as mani-
fested by at least one of the following; (a) delay in,
or total lack of, the development of spoken language
(not accompanied by an attempt to compensate
through alternative modes of communication
such as gestures or mime); (b) in individuals with
adequate speech, marked impairment in the ability
to initiate or sustain a conversation with others; (c)
stereotyped and repetitive use of language or idio-
language; (d) lack of varied, spontaneous
Teaching Elementary Physical Education
Rett's disorder, childhood disintegrative disorder, Asperg-
er's syndrome, and PDD-NOS (not otherwise specified)
are included under the umbrella of PDD. Of these condi-
tions, autism is the most prevalent (APA, 2000). Students
with any of the PDD diagnoses benefit from the same
array of educational opportunities.
Autism appears before the age of three. The child may
not be responsive to sounds, may not want to cuddle, may
cling tightly to just one parent, may avoid eye contact,
may seem distant and withdrawn, or may make no effort
to speak. In some cases parents may suspect something is
wrong with the child soon after birth. In other cases par-
ents report that their child actually developed normally
(including normal language development and interaction
with parents and siblings) until he/she reached the age
of 1 or 2 years. Then, suddenly, the child seemed to lose
the skills he/she had acquired, became withdrawn and
unresponsive, and began to show unique behaviors and
interests (APA, 2000).
What Are the Causes
of Autism?
No one knows for sure what causes autism. Hov;^ever, it is
becoming clear that autism is a neurological impairment
(something wrong with the brain) and not something
that can be caused by parental child rearing practices or
make-believe play or social imitative play appropriate
to developmental level.
3. Restricted repetitive and stereotyped patterns of
behavior, interests, and activities, as manifested
by at least one of the following: (a) encompassing
preoccupation with one or more stereotyped and
restricted patterns of interest that is abnormal either
in intensity or focus; (b) apparently Inflexible adher-
ence to specific, nonfunctional routines or rituals;
(c) stereotyped and repetitive motor mannerisms
(e.g.. hand or finger flapping or twisting, or complex
whole-body movements); (d) persistent preoccupa-
tion with parts of objects.
Delays or abnormal functioning in at least one of the
following areas, with onset prior to age 3 years: social
interaction, language as used in social communication,
or symbolic or imaginative play.
The disturbance is not better accounted for by Rett's
Disorder or Childhood Disintegrative Disorder.
*from American Psychiatric Association (2000). Diag-
nostics and statistical manual of mental disorders (4th
ed. - Text revision). Washington, DC: Author.
I November 2006
maternal stress (Powers, 1989; Strock, 2004), as was pro-
posed in the 1960s [Bettelheim, 1967). Recent evidence
suggests a genetic link to autism, as noted in twins' stud-
ies as well as extensive family histories. Research has
shown that 70-90% of identical twins [those with virtu-
ally identical genetic make-up) both have autism while
only 3% of fraternal twins both have autism. Another
link to genetics is that a family having one child with
autism is 50-100 times more likely to have a second child
with autism when compared to families that do not have
a child with autism. It has also been shown that families
that have a child with autism often have a relative who
has autism or has some features of autism (e.g., language
delay, rigid temperament, unique behaviors). It is impor-
tant to note that genetics alone cannot fully explain the
cause of autism, so there is speculation of some unknown
environmental influence. While possible environmental
factors such as immunizations, infections, or food aller-
gies have been discussed and studied, to date there has
been no support for these claims (Holmes, 1997; Strock,
2004; Towbin, 2001).
What Are Common
Characteristics of Children
With Autism?
There are three main characteristics of autism: lack of
social relatedness, communication impairments, and
unique stereotypic and repetitive behaviors. In addition,
many children with autism have intellectual impairments
(mental retardation) and motor delays. The following list
highlights these major characteristics.
Lack of social relatedness. Perhaps the most distinctive
characteristic of autism is the child's inability to interact
appropriately with others. Making and maintaining eye
contact is very difficult for many children with autism.
Some use peripheral vision to complete tasks or look at
people and objects. Some children with autism want to
interact with others but just do not have the language or
social skills to do so. Others make no effort to seek inter-
actions. This reciprocal nature of social interactions—an
interest in being with, interacting with, and enjoying
others—seems to he underdeveloped or missing (APA,
2000; Powers, 1989; Towbin, 2001).
For example, a typically developing three-year-old
stops what he is doing to see what mother is excited
about (e.g., she might have dropped a plate or got excited
at a TV show). In contrast, the child with autism is less
likely to look at mother, or looks in her direction but not
directly at her. Similarly, the typically developing three-
year-old is excited to share what she is doing with mother
(e.g., asking her to look at a picture she is drawing, or to
see her jump down from a chair). Children with autism
tend not to display shared attention (Mundy & Sigman,
1989; a typically developing child invites others to share
Teaching Elementary Physical Education
attention via eye gaze—looking at an object, then at a
person with whom to share, and then back at the object
again). In contrast, the child with autism does not seem
to seek mother's interest or praise. This does not mean
that children with autism always want to be alone and/
or avoid sharing with or seeking the comfort of others.
Many children with autism love to cuddle with mother
or father, squeal with delight when they are tickled, or
enjoy watching others play. For example, a child with
autism might enjoy watching others run around and play
tag. He may even enjoy having peers run up and tag him,
but it's likely he won't look at them or even smile. People
with autism just have a very difficult time understand-
ing how to seek and accept social contact.
Communication impairment. The second most noticeable
deficit in children with autism is significant problems
with communication. In the most severe cases, a child
with autism might have no speech whatsoever, to the
extent of appearing to be mute. Children with this level
of expressive communication impairment often learn to
point to things they want, take a parent by the hand and
lead them to what they want, or point to pictures. Chil-
dren with autism who are able to speak do so with an
abnormal tone, loudness, or vocal quality. In addition,
they are likely to speak in one or two word sentences
(APA, 2000; Powers, 1989; Towbin, 2001). For example,
a child with autism might
• whisper "I thirsty" to signal that she wants a drink;
• calmly state, with no emotion or hint of pain, that he
fell and cut his hand;
• enjoy the sound or feeling of certain words or phrases
and repeat them over and over, for example, perse-
verating on "Deal or No Deal" after watching the TV
show where those words are stated repetitively by
the host;
• exhibit "echolalia," a parrot-like pattern of repeating
back what is said to them, for example, if you greet
the child by saying, "Hi Billy, ready for PE today?"
Billy replies back, "Hi Billy, ready for PE today."
Children with autism also have receptive language
impairments. They have a difficult time understanding
what others are saying and sometimes do not react at all
when others attempt to communicate with them. In fact,
in some of the most severe cases, parents have reported
that they first thought their child was deaf due to a com-
plete unresponsiveness to sounds and speech. In more
mild cases, a child with autism who exhibits receptive
language problems might simply not understand abstrac-
tions or words with two meanings. Encouraging the child
to 'knock it over the fence" (when practicing striking
skills) leads to frustration because he truly thinks he
should hit the ball over the fence. He doesn't realize he
cannot, and that it is not your real intention. Likewise,
idioms ("I'm hungry enough to eat a horse") could cause
real concern to a literal minded child with autism.
I November 2006
 Unique behaviors. The final hallmark characteristic
of autism is unique behaviors and interests. Behavioral
differences are the most obvious signal that a child has
autism. Behavioral signals can range from mild stereotypic
mannerisms to prolonged periods of disruption of prop-
erty, self-injury, tantrumming, or aggression. Children
with autism, who are frustrated by very limited commu-
nication skills in many cases communicate their wants
and needs through these challenging behaviors. Some chil-
dren with autism seem to enjoy repetitive activities such
as rocking or pacing back and forth, watching spinning
objects, shaking their hands or head, or tapping objects.
Another common behavior of children with autism is
lining up objects in a particular way. They do not seem
to understand appropriate ways to play with toys and
objects. Or, they simply prefer playing with objects in
their own unique way, Perseveration, previously men-
tioned as an excessive repetition of a word or phrase,
also refers to the repetition of a behavior or fixation on
an idea to the extent that a student is perceived as odd
by his peers. The exact reason for these unique behaviors
and rituals is not known. These children rarely initiate
appropriate play or pretend play.
A related characteristic is an insistence on sameness
in the way they play, objects they use, and routines they
prefer. When play, objects, or routines change, the child
with autism is likely to get anxious and even upset (APA,
2000; Powers, 1989; Towbin, 2001):
• A child with autism likes to hold a favorite object
when he comes to physical education. Trying to take
the object away so he can participate in physical
education activities generates stress within this
child.
• A child with autism has learned a routine for walking
down to physical education and participating in
physical education every TYiesday and Thursday
from 9:30-10:00. OneTliesday, the gym is being used
for a science fair, so physical education has to take
place outside. The child does not understand why
her routine has been changed and insists on going
to the gymnasium for physical education.
A primary strength of people with autism is interpret-
ing things that are seen rather than heard. Presenting
information in a visual format can be beneficial when
changes in routine occur (Quill, 1997).
Another unique behavior seen in many children with
autism is hypersensitivity to sights, sounds, smells, and
the feel of things. For some unknown reason, many
people with autism find certain sensory stimuli uncom-
fortable and even painful. For example, some children
with autism do not like being touched by others or only
like being touched in a certain way, such as with deep
pressure rather than light touches, and are comfortable
only in loose-fitting clothes. Others prefer food with cer-
tain textures. Accommodating such idiosyncrasies is a
challenge, but often manageable, such as Ryan wearing
Teaching Elementary Physical Education
earplugs or headphones to muffle sounds in the envi-
ronment.
Fascinating and contradictory about sensory reactions
in children with autism is that at one moment they seem
to react very strongly to seemingly innocuous sounds
(e.g., a child screams and holds her ears at the sound
of announcements over the loudspeaker) but then seem
to not even hear other sounds (e.g., an adult trying to
get his attention or a police siren going by). Within that
spectrum, some children are fascinated by the sensation
provided by certain stimuli. For example, a child may
enjoy turning lights on and off, looking through her fin-
gers at a bright light, swinging or running in a circle, or
running his hand over a surface to feel a certain soft or
rough texture.
Other characteristics. Two other characteristics asso-
ciated with autism are intellectual and motor delays.
Approximately 2/3 to 3/4 of children with autism have
intellectual disabilities (mental retardation). As a general
rule, the more severe the autism the more likely the child
will display intellectual disabilities (APA, 2000; Towbin,
2001). It is unclear whether intellectual disabilities are
a functional label or a true indication of the child's cog-
nitive skills. In other words, children with autism are
extremely difficult to test due to their severe communica-
tion disorder, lack of interest in others, and lack of interest
in using objects appropriately. And, unfortunately, most
tests of cognitive function require communication, atten-
tion to others, and a specific use of objects. Thus, children
with autism often test at a level similar to children with
intellectual disabilities. However, people working closely
with these children often argue "there is more there."
To further complicate the issue, some children with
autism display extraordinary cognitive skills in very spe-
cific areas (APA, 2000). For example, there are reports
of children with autism who play classical music on
the piano, recall dates and names, or create wonderful
artwork. While true savant skills, popularized in such
movies as Rain Man and Shine, are rare (Scott et al., 2000),
unusual visual strengths are common.
Motor delays are another area that can be difficult to
measure in children with autism. Some suggest that chil-
dren with autism do not have any motor delays and, in
fact, demonstrate unique mastery of motor skills (Sigman
& Capps, 1997); however, when formally tested, most
research shows that children with autism do have motor
delays. For example, Slavoff (1997) found that 13 children
she tested (all labeled as autistic) scored significantly
below age level on the Peabody Developmental Motor
Scales (a measure of overall motor development that
examines balance, coordination, speed, and strength).
Similarly, Berkeley, Zittel, Pitney, and Nichols (2001)
found that 3/4 of their sample (children ages 6-8 with
high functioning autism) scored "poor" to "very poor"
on the Test of Gross Motor Development (a measure of
qualitative patterns in gross motor skills such as throw-
ing, catching, kicking, running, jumping, and hopping).
I November 2006
Manjivionaand Prior {1995(found that 2/3 of their sample
[high functioning children with autism, ages 7-17 years)
performed at a delayed level on the Test of Motor Impair-
ment-Henderson Revi.sion [a test of motor abilities such
as speed, coordination, and balance). As with intellectual
disabilities, it is unclear whether the motor delays are a
true reflection of deficits in motor development and coor-
dination or, rather, due to these children's difficulty in
understanding or simply not being interested in specific
motor tasks required by the tests. Regardless, physical
educators should expect mild to severe motor delays in
their students with autism.
References
American Psychiatric Association (2000). Diagnostics and statisticat
manual of mental disorders [4th ed. - text revision), Washington,
DC; Author.
Berkeley, S.L.. Zittel, L,L., Pitney, L.V., & Nichols. S.E. (2001).
Locomotor and object control .skills of children diagnosed with
aulism. Adapted Physical Activity Quarterly, 18, 405-416.
Bettelheim, B. (1967). The empty fortress. New York: Free Press.
Holmes, D.L. (1997). Aulism through ihe lifespan: The Eden Model.
Bethesda, MD: Woodbine House.
Manjiviona, J., & Prior, M. (1995). Comparison of Asperger syndrome
and high-functioning autistic children on a test of motor impairment.
Journal of Autism and Developmental Disorders, 25, 23-39.
Mundy, P., & Sigman, M. |1989), Specifying the social impairment in
autism. In G. Dawson |Ed.). Autism: Nature, diagnosis, a?id treatment
Ipp. 34-21). New York: Guilford Press.
Sport Stacking with SpeeHStacks
A track meet fer your hands at warp speed!
Teaching Elementary Physical Education
Powers, M.D. |1989). What is autism? In M.D. Powers (Ed.|, Children
with autism: A parent's guide (pp. 1-29). Bethesda, MD: Woodbine
House.
Quill, K.A. (1997). Instrumental considerations for young children with
autism: The rationale for visually cued instruction. The Journal of
Autism and Developmental disorders. 27(6), 697-714.
Scott, J., Clark, C , & Brady, M.B. (2000). Students with Autism:
Characteristics and instructional programming for special educators.
Belmont, CA: Thomson Wadsworth.
Sigman, M,, & Capps, L. (1997). Children with autism: A developmental
perspective. Cambridge, MA: Harvard University Press.
Slavoff, G. {1997). Motor development in children with autism. Unpublished
doctoral dissertation. University of Virginia, Charlottesville.
Strock, M. [2004-]. Autism Spectrum Disorders (Pervasive Developmental
Disorders). NIH Publication No. NTH-04-5S11, Bethesda, MD:
National Institute of Mental Health, National Institutes of Health,
U.S. Department of Health and Human Services. Retrieved from
http://www.niaih.nih.gov/piiblicat/autism.cfm
Towbin. K,E. (2001), Autism spectrum disorders. In MX. Batshaw
(Ed.), When your child has a disability (revised ed., pp 341-353).
Baltimore: Paul H. Brookes.
Yeargin Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C,
Murphy C. (2003). Prevalence of autism in a US metropolitan area.
The Journal of the American Medical Association, 289(1), 49-55.
Martin E. Block, TEPE's Adapted Physical Education Board
Member, is with the Kinesiology Program at the University of
Virginia in Charlottesville. Vickie E. Block is a Special Education
Teacher at Charlottesville (VA} High School Peggy Halliday is
with the Virginia Institute of Autism in Charlottesville. (^
I November 2006