Autism is a neurological condition in which a child is unable to relate to people and situations. It first emerges in early childhood, when the child is first developing social and interpersonal skills. It is a rare condition affecting approximately five people out of every 10,000. Seventy per cent of people with autism are male. Physically there is nothing wrong with people who have autism, and this can make diagnosis difficult. However, most autistic children will have been diagnosed by the age of three.

The condition continues throughout life, and can seriously affect how autistic people view and interact with the world around them. People with autism often find the world a confusing place, and can become trapped in behaviour patterns that may seem strange or obsessive while attempting to find the meaning in it.

Autistic people can find it extremely difficult to develop and sustain friendships since the feelings of other people make little sense to them. In an attempt to create a sense of meaning, autistic people may often fall into repetitive patterns of behaviour.

There are three main areas in which autistic people can experience difficulties. These are often known as the triad of impairments:

• Communication — Autistic people have difficulty in interpreting gestures, body language, tone of voice and facial expressions. People with autism may talk "at" others, and if they use gestures, they are often odd or inappropriate. Around half of all autistic people have little verbal ability. Certainly delay in speaking is very common.
• Relationships — Because of the communication difficulties, people with autism find it hard to develop and sustain social relationships. They are often described as seeming "aloof" or "indifferent" to those around them. Some people with severe autism may respond badly to any kind of social interaction.
• Imagination — Children with autism often show a lack of imagination when they play. They may repeat the same activity endlessly, or become fascinated by an apparently irrelevant aspect of play, such as focusing on a doll’s hair rather than playing with the doll.

Autistic people tend to be resistant to change and develop rituals of behaviour. They may display evidence of disturbance if any attempts are made to change their familiar routine. This resistance to change makes it difficult to teach the autistic child new skills.

There are a number of related disorders that were confused with autism in the past. Recent research has begun to distinguish between the different types of disorders that can cause autistic types of behaviour:

• People with Asperger’s Syndrome often display a high-functioning form of autism. The character of Raymond in the film Rain Man, for which Dustin Hoffman won an Oscar, displayed typical behaviour patterns of someone with Asperger’s Syndrome. Able to communicate and possessing an excellent memory, Raymond’s thinking was extremely literal and he showed signs of obsessive behaviour, such as insisting on flying with a particular airline.
• Fragile X syndrome is a genetically caused mental disorder caused by the constriction of the long arm on the X chromosome. Around 15% of people with Fragile X syndrome reveal autistic behaviours, such as hyperactivity, hand flapping and speech delays. People with Fragile X syndrome are characterised by having elongated faces and ears, and can develop heart difficulties as they get older.
• Rett Syndrome is a degenerative disorder that primarily affects girls. Their behaviour typically involves a loss of speech, wringing their hands, rocking, and social withdrawal. People with Rett syndrome are often very severely mentally retarded.
• Landau-Kleffner Syndrome is often misdiagnosed as regressive autism, as children can appear normal until up to the age of seven. While they may be able to speak well in early childhood, this ability is gradually lost. People who have Landau-Kleffner syndrome also develop many autistic types of behaving, such as withdrawing from company and resisting change
• People with Williams Syndrome demonstrate several autistic types of behaviour, including a delay in developing any language or social skills. They may also be sensitive to sound and find it difficult to pay attention. Unlike many people with autism, those with Williams syndrome can be quite sociable, though they may develop heart problems.

There does not seem to be a single cause of autism, but increasingly genetic influence is coming to be seen as important. It is more likely that identical twins will both be autistic than non-identical twins, for example. Autism is thought to be related to how the brain develops during pregnancy and shortly after birth. There is growing speculation in America about the influence of viruses and pollution on the development of autism. Having a bout of Rubella while pregnant may increase the chances of having an autistic child.

Autism is a lifelong condition, and there is no "cure". With early diagnosis and special education, children with autism will be able to improve their social and communication skills. Unfortunately, such specialist care can be difficult to obtain in Ireland.

Some people with autism respond well to a hormone treatment of Secretin. This is not yet readily available in Ireland, and careful medical advice should be sought by anyone thinking about embarking on such a treatment.

Associated medical problems such as epilepsy will require treatment with anti-epileptic medications.

In the Republic, people with autism and their families and friends can get information and support from the Irish Society for Autism, which was founded in 1963. They can be contacted at:

The Irish Society for Autism,

Unity Building,

16/17 Lower O'Connell Street,

Dublin 1.

Tel: (01) 8744684

Fax: (01) 8744224

In Northern Ireland and Donegal, the PAPA organisation provides support for those with autism and their families. They have branches throughout the North of Ireland, and can be contacted at:

PAPA Resource Centre,

Graham House,

Knockbracken Healthcare Park,

Saintfield Road,

Belfast BT8 8BH.

Tel: (01232) 401729

Fax: (01232) 403467