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in slow motion, even after the extra prodding necessary to the environment, and is more socially withdrawn.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? Rett's disorder, childhood disintegrative disorder, Asperg-
er's syndrome, and PDD-NOS (not otherwise specified)
Autism is a disability that significantly impairs a child's are included under the umbrella of PDD. Of these condi-
ability to interact and communicate with others. Autism tions, autism is the most prevalent (APA, 2000). Students
interferes with normal brain development, causing defi- with any of the PDD diagnoses benefit from the same
cits in verbal and non-verbal communication, social inter- array of educational opportunities.
action, and play. These deficits make it hard for children Autism appears before the age of three. The child may
with autism to relate to the world around them. They may not be responsive to sounds, may not want to cuddle, may
exhibit odd behaviors, such as repeated body movements, cling tightly to just one parent, may avoid eye contact,
flapping their hands in the air, or rocking back and forth. may seem distant and withdrawn, or may make no effort
They may also develop unusual attachments to objects to speak. In some cases parents may suspect something is
and resist changes in routine. Other than their unique wrong with the child soon after birth. In other cases par-
behaviors and lack of normal language development, they ents report that their child actually developed normally
do not look different from a typically developing child (including normal language development and interaction
(Holmes, 1997; Powers, 1989; see Table 1 for the diag- with parents and siblings) until he/she reached the age
nostic criteria for autism). Boys are 5 times more likely of 1 or 2 years. Then, suddenly, the child seemed to lose
to have autism than girls are, but girls with autism tend the skills he/she had acquired, became withdrawn and
to exhibit more severe characteristics (APA, 2000). unresponsive, and began to show unique behaviors and
interests (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- What Are the Causes
ized by severe (major impact) and pervasive (all aspects of Autism?
of a child's life) deficits in several areas of development,
including social interactions and communication skills as No one knows for sure what causes autism. Hov;^ever, it is
well as the presence of unique behaviors. These deficits becoming clear that autism is a neurological impairment
and unique behaviors are not normal for the child's devel- (something wrong with the brain) and not something
opmental level. Most closely related disorders, such as that can be caused by parental child rearing practices or

Table 1—Diagnostic Criteria for Autistic Disorder*

A total of 6 (or more) items from 1. 2, and 3. with at make-believe play or social imitative play appropriate
least two from 1, and one each from 2 and 3: to developmental level.
3. Restricted repetitive and stereotyped patterns of
1. Qualitative impairment in social interactions, as
behavior, interests, and activities, as manifested
manifested by at least two of the following: (a)
by at least one of the following: (a) encompassing
marked impairment in the use of multiple nonverbal
preoccupation with one or more stereotyped and
behaviors such as eye-to-eye gaze, facial expres-
restricted patterns of interest that is abnormal either
sions, body postures, and gestures to regulate social
in intensity or focus; (b) apparently Inflexible adher-
interactions; (b) failure to develop peer relationships
ence to specific, nonfunctional routines or rituals;
appropriate to developmental level; (c) lack of spon-
(c) stereotyped and repetitive motor mannerisms
taneous seeking to share enjoyment, interests, or
(e.g.. hand or finger flapping or twisting, or complex
achievements with other people (e.g.. by a lack of
whole-body movements); (d) persistent preoccupa-
showing, bringing, or pointing out objects of interest);
tion with parts of objects.
(d) lack of social or emotional reciprocity.
2. Qualitative impairment in communication as mani- Delays or abnormal functioning in at least one of the
fested by at least one of the following; (a) delay in, following areas, with onset prior to age 3 years: social
or total lack of, the development of spoken language interaction, language as used in social communication,
(not accompanied by an attempt to compensate or symbolic or imaginative play.
through alternative modes of communication The disturbance is not better accounted for by Rett's
such as gestures or mime); (b) in individuals with Disorder or Childhood Disintegrative Disorder.
adequate speech, marked impairment in the ability
to initiate or sustain a conversation with others; (c) *from American Psychiatric Association (2000). Diag-
stereotyped and repetitive use of language or idio- nostics and statistical manual of mental disorders (4th
language; (d) lack of varied, spontaneous ed. - Text revision). Washington, DC: Author.

Teaching Elementary Physical Education I November 2006

maternal stress (Powers, 1989; Strock, 2004), as was pro- attention via eye gaze—looking at an object, then at a
posed in the 1960s [Bettelheim, 1967). Recent evidence person with whom to share, and then back at the object
suggests a genetic link to autism, as noted in twins' stud- again). In contrast, the child with autism does not seem
ies as well as extensive family histories. Research has to seek mother's interest or praise. This does not mean
shown that 70-90% of identical twins [those with virtu- that children with autism always want to be alone and/
ally identical genetic make-up) both have autism while or avoid sharing with or seeking the comfort of others.
only 3% of fraternal twins both have autism. Another Many children with autism love to cuddle with mother
link to genetics is that a family having one child with or father, squeal with delight when they are tickled, or
autism is 50-100 times more likely to have a second child enjoy watching others play. For example, a child with
with autism when compared to families that do not have autism might enjoy watching others run around and play
a child with autism. It has also been shown that families tag. He may even enjoy having peers run up and tag him,
that have a child with autism often have a relative who but it's likely he won't look at them or even smile. People
has autism or has some features of autism (e.g., language with autism just have a very difficult time understand-
delay, rigid temperament, unique behaviors). It is impor- ing how to seek and accept social contact.
tant to note that genetics alone cannot fully explain the
cause of autism, so there is speculation of some unknown Communication impairment. The second most noticeable
environmental influence. While possible environmental deficit in children with autism is significant problems
factors such as immunizations, infections, or food aller- with communication. In the most severe cases, a child
gies have been discussed and studied, to date there has with autism might have no speech whatsoever, to the
been no support for these claims (Holmes, 1997; Strock, extent of appearing to be mute. Children with this level
2004; Towbin, 2001). 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
What Are Common abnormal tone, loudness, or vocal quality. In addition,
Characteristics of Children they are likely to speak in one or two word sentences
(APA, 2000; Powers, 1989; Towbin, 2001). For example,
With Autism? a child with autism might
There are three main characteristics of autism: lack of • whisper "I thirsty" to signal that she wants a drink;
social relatedness, communication impairments, and • calmly state, with no emotion or hint of pain, that he
unique stereotypic and repetitive behaviors. In addition, fell and cut his hand;
many children with autism have intellectual impairments
(mental retardation) and motor delays. The following list • enjoy the sound or feeling of certain words or phrases
highlights these major characteristics. and repeat them over and over, for example, perse-
verating on "Deal or No Deal" after watching the TV
Lack of social relatedness. Perhaps the most distinctive show where those words are stated repetitively by
characteristic of autism is the child's inability to interact the host;
appropriately with others. Making and maintaining eye • exhibit "echolalia," a parrot-like pattern of repeating
contact is very difficult for many children with autism. back what is said to them, for example, if you greet
Some use peripheral vision to complete tasks or look at the child by saying, "Hi Billy, ready for PE today?"
people and objects. Some children with autism want to Billy replies back, "Hi Billy, ready for PE today."
interact with others but just do not have the language or
social skills to do so. Others make no effort to seek inter- Children with autism also have receptive language
actions. This reciprocal nature of social interactions—an impairments. They have a difficult time understanding
interest in being with, interacting with, and enjoying what others are saying and sometimes do not react at all
others—seems to he underdeveloped or missing (APA, when others attempt to communicate with them. In fact,
2000; Powers, 1989; Towbin, 2001). in some of the most severe cases, parents have reported
For example, a typically developing three-year-old that they first thought their child was deaf due to a com-
stops what he is doing to see what mother is excited plete unresponsiveness to sounds and speech. In more
about (e.g., she might have dropped a plate or got excited mild cases, a child with autism who exhibits receptive
at a TV show). In contrast, the child with autism is less language problems might simply not understand abstrac-
likely to look at mother, or looks in her direction but not tions or words with two meanings. Encouraging the child
directly at her. Similarly, the typically developing three- to 'knock it over the fence" (when practicing striking
year-old is excited to share what she is doing with mother skills) leads to frustration because he truly thinks he
(e.g., asking her to look at a picture she is drawing, or to should hit the ball over the fence. He doesn't realize he
see her jump down from a chair). Children with autism cannot, and that it is not your real intention. Likewise,
tend not to display shared attention (Mundy & Sigman, idioms ("I'm hungry enough to eat a horse") could cause
1989; a typically developing child invites others to share real concern to a literal minded child with autism.

Teaching Elementary Physical Education I November 2006

 Unique behaviors. The final hallmark characteristic earplugs or headphones to muffle sounds in the envi-
of autism is unique behaviors and interests. Behavioral ronment.
differences are the most obvious signal that a child has Fascinating and contradictory about sensory reactions
autism. Behavioral signals can range from mild stereotypic in children with autism is that at one moment they seem
mannerisms to prolonged periods of disruption of prop- to react very strongly to seemingly innocuous sounds
erty, self-injury, tantrumming, or aggression. Children (e.g., a child screams and holds her ears at the sound
with autism, who are frustrated by very limited commu- of announcements over the loudspeaker) but then seem
nication skills in many cases communicate their wants to not even hear other sounds (e.g., an adult trying to
and needs through these challenging behaviors. Some chil- get his attention or a police siren going by). Within that
dren with autism seem to enjoy repetitive activities such spectrum, some children are fascinated by the sensation
as rocking or pacing back and forth, watching spinning provided by certain stimuli. For example, a child may
objects, shaking their hands or head, or tapping objects. enjoy turning lights on and off, looking through her fin-
Another common behavior of children with autism is gers at a bright light, swinging or running in a circle, or
lining up objects in a particular way. They do not seem running his hand over a surface to feel a certain soft or
to understand appropriate ways to play with toys and rough texture.
objects. Or, they simply prefer playing with objects in
their own unique way, Perseveration, previously men- Other characteristics. Two other characteristics asso-
tioned as an excessive repetition of a word or phrase, ciated with autism are intellectual and motor delays.
also refers to the repetition of a behavior or fixation on Approximately 2/3 to 3/4 of children with autism have
an idea to the extent that a student is perceived as odd intellectual disabilities (mental retardation). As a general
by his peers. The exact reason for these unique behaviors rule, the more severe the autism the more likely the child
and rituals is not known. These children rarely initiate will display intellectual disabilities (APA, 2000; Towbin,
appropriate play or pretend play. 2001). It is unclear whether intellectual disabilities are
A related characteristic is an insistence on sameness a functional label or a true indication of the child's cog-
in the way they play, objects they use, and routines they nitive skills. In other words, children with autism are
prefer. When play, objects, or routines change, the child extremely difficult to test due to their severe communica-
with autism is likely to get anxious and even upset (APA, tion disorder, lack of interest in others, and lack of interest
2000; Powers, 1989; Towbin, 2001): in using objects appropriately. And, unfortunately, most
tests of cognitive function require communication, atten-
• A child with autism likes to hold a favorite object tion to others, and a specific use of objects. Thus, children
when he comes to physical education. Trying to take with autism often test at a level similar to children with
the object away so he can participate in physical intellectual disabilities. However, people working closely
education activities generates stress within this with these children often argue "there is more there."
child. To further complicate the issue, some children with
• A child with autism has learned a routine for walking autism display extraordinary cognitive skills in very spe-
down to physical education and participating in cific areas (APA, 2000). For example, there are reports
physical education every TYiesday and Thursday of children with autism who play classical music on
from 9:30-10:00. OneTliesday, the gym is being used the piano, recall dates and names, or create wonderful
for a science fair, so physical education has to take artwork. While true savant skills, popularized in such
place outside. The child does not understand why movies as Rain Man and Shine, are rare (Scott et al., 2000),
her routine has been changed and insists on going unusual visual strengths are common.
to the gymnasium for physical education. Motor delays are another area that can be difficult to
measure in children with autism. Some suggest that chil-
A primary strength of people with autism is interpret- dren with autism do not have any motor delays and, in
ing things that are seen rather than heard. Presenting fact, demonstrate unique mastery of motor skills (Sigman
information in a visual format can be beneficial when & Capps, 1997); however, when formally tested, most
changes in routine occur (Quill, 1997). research shows that children with autism do have motor
Another unique behavior seen in many children with delays. For example, Slavoff (1997) found that 13 children
autism is hypersensitivity to sights, sounds, smells, and she tested (all labeled as autistic) scored significantly
the feel of things. For some unknown reason, many below age level on the Peabody Developmental Motor
people with autism find certain sensory stimuli uncom- Scales (a measure of overall motor development that
fortable and even painful. For example, some children examines balance, coordination, speed, and strength).
with autism do not like being touched by others or only Similarly, Berkeley, Zittel, Pitney, and Nichols (2001)
like being touched in a certain way, such as with deep found that 3/4 of their sample (children ages 6-8 with
pressure rather than light touches, and are comfortable high functioning autism) scored "poor" to "very poor"
only in loose-fitting clothes. Others prefer food with cer- on the Test of Gross Motor Development (a measure of
tain textures. Accommodating such idiosyncrasies is a qualitative patterns in gross motor skills such as throw-
challenge, but often manageable, such as Ryan wearing ing, catching, kicking, running, jumping, and hopping).

Teaching Elementary Physical Education I November 2006

Manjivionaand Prior {1995(found that 2/3 of their sample Powers, M.D. |1989). What is autism? In M.D. Powers (Ed.|, Children
[high functioning children with autism, ages 7-17 years) with autism: A parent's guide (pp. 1-29). Bethesda, MD: Woodbine
House.
performed at a delayed level on the Test of Motor Impair- Quill, K.A. (1997). Instrumental considerations for young children with
ment-Henderson Revi.sion [a test of motor abilities such autism: The rationale for visually cued instruction. The Journal of
as speed, coordination, and balance). As with intellectual Autism and Developmental disorders. 27(6), 697-714.
disabilities, it is unclear whether the motor delays are a Scott, J., Clark, C , & Brady, M.B. (2000). Students with Autism:
true reflection of deficits in motor development and coor- Characteristics and instructional programming for special educators.
Belmont, CA: Thomson Wadsworth.
dination or, rather, due to these children's difficulty in
Sigman, M,, & Capps, L. (1997). Children with autism: A developmental
understanding or simply not being interested in specific perspective. Cambridge, MA: Harvard University Press.
motor tasks required by the tests. Regardless, physical Slavoff, G. {1997). Motor development in children with autism. Unpublished
educators should expect mild to severe motor delays in doctoral dissertation. University of Virginia, Charlottesville.
their students with autism. Strock, M. [2004-]. Autism Spectrum Disorders (Pervasive Developmental
Disorders). NIH Publication No. NTH-04-5S11, Bethesda, MD:
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Manjiviona, J., & Prior, M. (1995). Comparison of Asperger syndrome Martin E. Block, TEPE's Adapted Physical Education Board
and high-functioning autistic children on a test of motor impairment. Member, is with the Kinesiology Program at the University of
Journal of Autism and Developmental Disorders, 25, 23-39. Virginia in Charlottesville. Vickie E. Block is a Special Education
Mundy, P., & Sigman, M. |1989), Specifying the social impairment in Teacher at Charlottesville (VA} High School Peggy Halliday is
autism. In G. Dawson |Ed.). Autism: Nature, diagnosis, a?id treatment with the Virginia Institute of Autism in Charlottesville. (^
Ipp. 34-21). New York: Guilford Press.

Sport Stacking with SpeeHStacks

A track meet fer your hands at warp speed!

Teaching Elementary Physical Education I November 2006