We don’t know what causes PDD/ASD.
	PDD/ASD are not the result of any parenting approach.
	There are many theories but none have been conclusively proven.  Scientifically supported findings and theories include:
	nFamily Heritability:  there is a 50 to 100 fold increase in the rate of autism among siblings (Simonoff, 1998); 60% of identical twins have Autism, 71% have broader Autistic spectrum disorder and 92% show an even broader clinical presentation (Baily et al, 1998).

	nAssociated Medical or Genetic Conditions: autistic symptoms appear in some other medical disorders (New York State Department of Health, 1999).
	nNeurocutaneous disorders (ie. tuberous sclerosis);
	nMetabolic disorders (ie. phenylketonuria);
	nIntrauterine infections (ie. rubella, cytomegalovirus);
	nGenetic disorders (ie. Williams syndrome, Fragile X).
	nPhysical Characteristics: a larger than average head circumference typically appears in early to middle childhood due to an increased rate of brain growth (Bailey et al., 1998).

Exercise: How my child experiences the world…

Pair up with another parent. Discuss how your child engages in the following:

	Communication;
	Emotional expression;
	Social interactions;
	Play;
	Sensory responses (reactions to movement or things seen, touched or heard).

What are typical difficulties with nonverbal communication?

Nonverbal communication (gaze, facial expression, sounds and gestures) is limited or absent:

	Use hand leading instead of pointing;
	Absent or impaired use of anticipatory reach (hands up with eye gaze to signal desire to be picked up);
	Smiles and eye gaze may be over stimulating so it is fleeting (usually only when something is wanted) or absent;
	Regulate the space between themselves and others differently (keep farther distances, remain in periphery of a group, keep back turned to others when concentrating, back into adults for hugs, preference for side to side contact instead of face to face, will circle or pace when wary or apprehensive).

What are typical difficulties with verbal communication?

	25 to 45% of children with autism remain nonverbal (never speak or only speak a few words or sounds).
	Most language is elicited rather than spontaneous.
	Language is instrumental (to provoke an action or obtain an object).
	Immediate or delayed echolalia (echoes back what has been heard in an attempt to process the information, communicate understanding, or as a way of communicating).
	Pronoun reversal (confusing "I" and "you").
	Those with conversational skills will talk about topics of interest to them with little or no encouragement yet are cursory in their responses about other topics.
	Poor understanding of language pragmatics (how to express what needs to be said, knowing that the listener is listening and interested, knowing when enough or not enough has been said).

What are typical difficulties with emotional expression?

	There is a diminished range of emotional expression.
	Emotional reactions tend to go from one extreme to another with few or no emotional expressions in between (positive excitement and displeasure).
	Often look solemn or serious as they pursue their activities (lack smiles to show their accomplishments).
	Tone of voice is often flat, high pitched and unmodulated, or sing-song like with the wrong words being accentuated.
	It is like learning two languages at the same time (1. Language of content, 2. Language of intonation and cadence, which expresses the emotional component). We say the same word differently each time thus making it difficult to decode.

What are typical difficulties with emotional interpretation?

	Difficulty interpreting the emotional states of others (intensity of the emotion is perceived but fail to notice whether it is positive or negative).
	Lack the understanding that others have thoughts and feelings too.
	Difficulty understanding emotions make it difficult to link the punishment to the misdeed; so punishment tends to be ineffective and make the child more anxious.

What are typical difficulties with social interactions?

	Relates for instrumental purposes (to gain something wanted) and not expressive (to provoke or show emotions).
	Social isolation:

	Wanders far from parents without concern;
	Leaves room when company arrives;
	Removes oneself from the centre of the group action.

Limited or absent social play:

	Play tends to be concrete rather than representational (imaginary);
	Most like movement stimulation (chasing, tickling, jumping, roughhouse play);
	Often play near children where few if any play is copied (therefore, it is not parallel play).

	Lack peer friendships as other children are not the most interesting things in the room.
	Rarely engages in socially reinforcing behaviours (seeking someone to share in your accomplishments).
	Tend to compensate by learning social rules; due to lack of flexibility in thinking and reasoning, the rules are sometimes applied to situations where they are no longer appropriate.
	Seek physical affection on their terms (when, how long and how they want it), which typically lacks eye gazing and talking/sounds.
	Atypical patterns of comfort seeking:

	Calming faster when left alone to cry;
	Seeking isolation when afraid;
	No glances at others while crying/screaming to see what effect they are having on others.

Difficulties in developing imitation (the more social it is, the harder it is to imitate because it may be difficult to pay attention to the human model).

What are typical difficulties with play and imagination?

	Interest in toys may be absent, limited or short in duration.
	Attachment to unusual objects due to enjoyment of the evoked sensation (i.e. Play with the empty bottle of fabric softener because of the smell).
	Remain at the sensory stage longer.
	Perseveration in certain activities that are difficult to interrupt (ie. Pulling the cord on the See & Say, lining up objects).
	Preoccupation with parts of the object and not seeing the object as a whole (i.e. Spinning the wheels on a toy car).
	Play lacks imagination (play shows the function but they do not add their own thoughts, feelings or interpretations).
	Need for sameness, insistence on routines and resistance to change (routine is reassuring and predictable).

Can unusual activities or interests be useful?

	Sometimes the perseveration of interests leads to adaptive behaviour (i.e. Teach themselves to read and count by lining up letters and numbers).
	Our challenge is to transform the "special interest" into a functional, useful activity or learning strategy (i.e. The keen interest in nuts and bolts led to a job at a hardware store).

What difficulties occur with the senses?

Reactions to things seen, touched, heard or movement can either be too much or too little:

	Auditory hypersensitivity results in tantrums or the covering of ears when certain sounds are heard;
	Auditory hyposensitivity seems like selective hearing and there is often concern of hearing loss;
	Visual detail scrutiny occurs when a specific object or group of objects, are chosen to be visually inspected repeatedly (i.e. Wiggling string);
	Tactile detail scrutiny occurs when there is a fixation on the tactile qualities of an object (ie. The smooth silk on the blanket);
	Taste sensory stimulation occurs when things are put in the mouth but not eaten (ie. Gravel, twigs, leaves);
	Smell fixations occur when objects are smelled as a way of exploring it;
	Movement over reactivity occurs when there is a strong like or dislike to experiencing movement (ie. Swinging, jumping).