Remember Charlie (Tom Cruise) and his brother, Raymond, (Dustin Hoffman) in the award winning film "Rain Man"? It offered an inspiring, up-front view of autism and the special bond that developed between brothers from opposite worlds. Raymond, who had autism, could compile baseball statistics, memorize dinner menus and calculate square roots in a flash. He also repeated favorite topics in conversation and was easily upset by changes in routine.

Autism Spectrum Disorders (ASDs) are fascinating and more common than you might think. They rank as the third most prevalent developmental disability, affecting 1 in every 165 births. Four times more frequent in boys than girls, the cause(s) of ASD are still unknown. We no longer believe that poor parenting and psychological imbalance are responsible. Brain- related factors, including biochemical imbalance and atypical neurological development, are the focus of current research.

This article will provide an overview of ASD, associated cognitive-communication impairments, the role of the speech-language pathologist in rehabilitation, and strategies for helping children with ASD at home and school.

Autism Spectrum Disorders (ASDs) refer to a range of developmental disabilities that share features of impaired communication, social and/or behaviour development:

1. Communication difficulties: problems understanding and using language and nonverbal communication
2. Social Interaction difficulties: difficulty in relating to people, objects, and events;
3. Behaviour difficulties: unusual play with toys and other objects; difficulty with changes in routine or familiar surroundings, and/ or repetitive body movements or behavior patterns.

In the diagnostic manual used to classify disabilities, "autistic disorder" is listed under the heading of "Pervasive Developmental Disorders". Autism is diagnosed when a child displays a least half of twelve communication, social and/or behaviour symptoms. When some, but not all of these symptoms are present, a diagnosis of Pervasive Developmental Disorder-NOS (PDD not otherwise specified) is assigned. Although the variable use of the terms "autism" and "PDD" can be confusing for parents, children with ASD usually have similar treatment and educational needs.

Children with ASD can vary widely in intelligence and abilities. About 80% have problems with motor planning for speech (i.e. "verbal apraxia"). Some cannot speak at all; while others use spoken sentences that contain repeated subjects and phrases. Individuals with more advanced language skills may have more subtle difficulties with social interaction, e.g. starting conversations, or understanding abstract concepts like emotions. Unusual responses to sensory stimulation (e.g. loud noises, lights, certain textures of food or fabrics) and delayed educational development are also common.

Speech-Language Pathologists assess and treat problems with thinking, communicating, socializing and learning. Untreated, cognitive-communication problems can lead to social isolation, academic failure and long- term dependency on others.

When communication skills are limited, inappropriate behaviour (e.g. angry outbursts) can occur. Improvements in communication skills often translate into improvements in behaviour, as well as better social and emotional adjustment.

Speech-language pathologists play a pivotal role in helping individuals with ASD to achieve their full potential in life. Intensive therapy, early in life, can have a significant impact on skill development, long- term prognosis and adjustment at home, school and in the community. Early speech-language pathology testing and treatment is critical.

Parents can also learn to establish daily routines and use visual materials to aid language learning, and help their child transition between activities with reduced frustration. They can learn to use multi-modal stimulation (e.g. picture exchange systems, sign language and other visual and tactile stimulation approaches) to teach their child how to communicate and learn.

Interaction with average developing peers provides important exposure to good language, social, and behavior modeling. But exposure is not enough. Children with ASD benefit from explicit teaching approaches using a hierarchy of training situations, e.g. one-on-one interactions, small groups and, later, busier social situations.

Difficulty using newly learned cognitive-communication skills in different situations (i.e. "generalization" of skills) is another common challenge. It is important that parents and other family members become active participants in treatment so that they can use the same therapy techniques at home and in the community to enhance their child’s learning.