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A [SEP] A (named , plural "As", "A's", "a"s, "a's" or "aes") is the first letter and the first vowel of the modern English alphabet and the ISO basic Latin alphabet. It is similar to the Ancient Greek letter alpha, from which it derives. The uppercase version consists of the two slanting sides of a triangle, crossed in the middle by a horizontal bar.
A [SEP] The lowercase version can be written in two forms: the double-storey a and single-storey ɑ. The latter is commonly used in handwriting and fonts based on it, especially fonts intended to be read by children, and is also found in italic type. In the English grammar, "a", and its variant "an", is an indefinite article.
A [SEP] The earliest certain ancestor of "A" is aleph (also written 'aleph), the first letter of the Phoenician alphabet, which consisted entirely of consonants (for that reason, it is also called an abjad to distinguish it from a true alphabet). In turn, the ancestor of aleph may have been a pictogram of an ox head in proto-Sinaitic script influenced by Egyptian hieroglyphs, styled as a triangular head with two horns extended.
A [SEP] By 1600 BC, the Phoenician alphabet letter had a linear form that served as the base for some later forms. Its name is thought to have corresponded closely to the Paleo-Hebrew or Arabic aleph.
A [SEP] When the ancient Greeks adopted the alphabet, they had no use for a letter to represent the glottal stop—the consonant sound that the letter denoted in Phoenician and other Semitic languages, and that was the first phoneme of the Phoenician pronunciation of the letter—so they used their version of the sign to represent the vowel , and called it by the similar name of alpha.
A [SEP] In the earliest Greek inscriptions after the Greek Dark Ages, dating to the 8th century BC, the letter rests upon its side, but in the Greek alphabet of later times it generally resembles the modern capital letter, although many local varieties can be distinguished by the shortening of one leg, or by the angle at which the cross line is set. The Etruscans brought the Greek alphabet to their civilization in the Italian Peninsula and left the letter unchanged.
A [SEP] The Romans later adopted the Etruscan alphabet to write the Latin language, and the resulting letter was preserved in the Latin alphabet that would come to be used to write many languages, including English. During Roman times, there were many variant forms of the letter "A". First was the monumental or lapidary style, which was used when inscribing on stone or other "permanent" media. There was also a cursive style used for everyday or utilitarian writing, which was done on more perishable surfaces.
A [SEP] Due to the "perishable" nature of these surfaces, there are not as many examples of this style as there are of the monumental, but there are still many surviving examples of different types of cursive, such as majuscule cursive, minuscule cursive, and semicursive minuscule. Variants also existed that were intermediate between the monumental and cursive styles. The known variants include the early semi-uncial, the uncial, and the later semi-uncial.
A [SEP] At the end of the Roman Empire (5th century AD), several variants of the cursive minuscule developed through Western Europe. Among these were the semicursive minuscule of Italy, the Merovingian script in France, the Visigothic script in Spain, and the Insular or Anglo-Irish semi-uncial or Anglo-Saxon majuscule of Great Britain.
A [SEP] By the 9th century, the Caroline script, which was very similar to the present-day form, was the principal form used in book-making, before the advent of the printing press. This form was derived through a combining of prior forms. 15th-century Italy saw the formation of the two main variants that are known today. These variants, the "Italic" and "Roman" forms, were derived from the Caroline Script version.
A [SEP] The Italic form, also called "script a," is used in most current handwriting and consists of a circle and vertical stroke. This slowly developed from the fifth-century form resembling the Greek letter tau in the hands of medieval Irish and English writers. The Roman form is used in most printed material; it consists of a small loop with an arc over it ("a"). Both derive from the majuscule (capital) form.
A [SEP] In Greek handwriting, it was common to join the left leg and horizontal stroke into a single loop, as demonstrated by the uncial version shown. Many fonts then made the right leg vertical. In some of these, the serif that began the right leg stroke developed into an arc, resulting in the printed form, while in others it was dropped, resulting in the modern handwritten form.
A [SEP] Italic type is commonly used to mark emphasis or more generally to distinguish one part of a text from the rest (set in Roman type). There are some other cases aside from italic type where "script a" ("ɑ"), also called Latin alpha, is used in contrast with Latin "a" (such as in the International Phonetic Alphabet).
A [SEP] In modern English orthography, the letter represents at least seven different vowel sounds: The double sequence does not occur in native English words, but is found in some words derived from foreign languages such as "Aaron" and "aardvark". However, occurs in many common digraphs, all with their own sound or sounds, particularly , , , , and . In most languages that use the Latin alphabet, denotes an open unrounded vowel, such as , , or .
A [SEP] An exception is Saanich, in which (and the glyph Á) stands for a close-mid front unrounded vowel . In phonetic and phonemic notation: In algebra, the letter "a" along with other letters at the beginning of the alphabet is used to represent known quantities, whereas the letters at the end of the alphabet ("x", "y", "z") are used to denote unknown quantities. In geometry, capital A, B, C etc.
A [SEP] are used to denote segments, lines, rays, etc. A capital A is also typically used as one of the letters to represent an angle in a triangle, the lowercase a representing the side opposite angle A. "A" is often used to denote something or someone of a better or more prestigious quality or status: A-, A or A+, the best grade that can be assigned by teachers for students' schoolwork; "A grade" for clean restaurants; A-list celebrities, etc.
A [SEP] Such associations can have a motivating effect, as exposure to the letter A has been found to improve performance, when compared with other letters. "A" is used as a prefix on some words, such as asymmetry, to mean "not" or "without" (from Greek). In English grammar, "a", and its variant "an", is an indefinite article.
A [SEP] Finally, the letter A is used to denote size, as in a narrow size shoe, or a small cup size in a brassiere.
Alain Connes [SEP] Alain Connes (; born 1 April 1947) is a French mathematician, currently Professor at the Collège de France, IHÉS, Ohio State University and Vanderbilt University. He was an Invited Professor at the Conservatoire national des arts et métiers (2000). Alain Connes studies operator algebras. In his early work on von Neumann algebras in the 1970s, he succeeded in obtaining the almost complete classification of injective factors. He also formulated the Connes embedding problem.
Alain Connes [SEP] Following this, he made contributions in operator K-theory and index theory, which culminated in the Baum–Connes conjecture. He also introduced cyclic cohomology in the early 1980s as a first step in the study of noncommutative differential geometry. He was a member of Bourbaki. Connes has applied his work in areas of mathematics and theoretical physics, including number theory, differential geometry and particle physics. Connes was awarded the Fields Medal in 1982, the Crafoord Prize in 2001
Allan Dwan [SEP] Allan Dwan (3 April 1885 – 28 December 1981) was a pioneering Canadian-born American motion picture director, producer, and screenwriter. Born Joseph Aloysius Dwan in Toronto, Ontario, Canada, Dwan, was the younger son of commercial traveler of woolen clothing Joseph Michael Dwan (1857–1917) and his wife Mary Jane Dwan, née Hunt. The family moved to the United States when he was seven years old on 4 December 1892 by ferry from Windsor to Detroit, according to his naturalization petition of August 1939.
Allan Dwan [SEP] His elder brother, Leo Garnet Dwan (1883–1964), became a physician. Allan Dwan studied engineering at the University of Notre Dame and then worked for a lighting company in Chicago. He had a strong interest in the fledgling motion picture industry, and when Essanay Studios offered him the opportunity to become a scriptwriter, he took the job. At that time, some of the East Coast movie makers began to spend winters in California where the climate allowed them to continue productions requiring warm weather.
Allan Dwan [SEP] Soon, a number of movie companies worked there year-round, and in 1911, Dwan began working part-time in Hollywood. While still in New York, in 1917 he was the founding president of the East Coast chapter of the Motion Picture Directors Association. Dwan operated Flying A Studios in La Mesa, California from August 1911 to July 1912. Flying A was one of the first motion pictures studios in California history.
Allan Dwan [SEP] On 12 August 2011, a plaque was unveiled on the Wolff building at Third Avenue and La Mesa Boulevard commemorating Dwan and the Flying A Studios origins in La Mesa, California. After making a series of westerns and comedies, Dwan directed fellow Canadian-American Mary Pickford in several very successful movies as well as her husband, Douglas Fairbanks, notably in the acclaimed 1922 "Robin Hood".
Allan Dwan [SEP] Dwan directed Gloria Swanson in eight feature films, and one short film made in the short-lived sound-on-film process Phonofilm. This short, also featuring Thomas Meighan and Henri de la Falaise, was produced as a joke, for the 26 April 1925 "Lambs' Gambol" for The Lambs, with the film showing Swanson crashing the all-male club.
Allan Dwan [SEP] Following the introduction of the talkies, Dwan directed child-star Shirley Temple in "Heidi" (1937) and "Rebecca of Sunnybrook Farm" (1938). Dwan helped launch the career of two other successful Hollywood directors, Victor Fleming, who went on to direct "The Wizard of Oz" and "Gone With the Wind", and Marshall Neilan, who became an actor, director, writer and producer.
Allan Dwan [SEP] Over a long career spanning almost 50 years, Dwan directed 125 motion pictures, some of which were highly acclaimed, such as the 1949 box office hit, "Sands of Iwo Jima". He directed his last movie in 1961. He died in Los Angeles at the age of ninety-six, and is interred in the San Fernando Mission Cemetery, Mission Hills, California. Dwan has a star on the Hollywood Walk of Fame at 6263 Hollywood Boulevard.
Allan Dwan [SEP] Daniel Eagan of "Film Journal International" described Dwan as one of the early pioneers of cinema, stating that his style "is so basic as to seem invisible, but he treats his characters with uncommon sympathy and compassion." Print E-book
Autism [SEP] Autism is a developmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. Parents usually notice signs during the first three years of their child's life. These signs often develop gradually, though some children with autism reach their developmental milestones at a normal pace before worsening. Autism is associated with a combination of genetic and environmental factors.
Autism [SEP] Risk factors during pregnancy include certain infections, such as rubella, toxins including valproic acid, alcohol, cocaine, pesticides and air pollution, fetal growth restriction, and autoimmune diseases. Controversies surround other proposed environmental causes; for example, the vaccine hypothesis, which has been disproven. Autism affects information processing in the brain by altering connections and organization of nerve cells and their synapses. How this occurs is not well understood.
Autism [SEP] In the DSM-5, autism and less severe forms of the condition, including Asperger syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS), have been combined into the diagnosis of autism spectrum disorder (ASD). Early behavioral interventions or speech therapy can help children with autism gain self-care, social, and communication skills. Although there is no known cure, there have been cases of children who recovered. Not many children with autism live independently after reaching adulthood, though some are successful.
Autism [SEP] An autistic culture has developed, with some individuals seeking a cure and others believing autism should be accepted as a difference and not treated as a disorder. Globally, autism is estimated to affect 24.8 million people . In the 2000s, the number of people affected was estimated at 1–2 per 1,000 people worldwide. In the developed countries, about 1.5% of children are diagnosed with ASD , from 0.7% in 2000 in the United States. It occurs four-to-five times more often in males than females.
Autism [SEP] The number of people diagnosed has increased dramatically since the 1960s, which may be partly due to changes in diagnostic practice. The question of whether actual rates have increased is unresolved. Autism is a highly variable, neurodevelopmental disorder whose symptoms first appears during infancy or childhood, and generally follows a steady course without remission. People with autism may be severely impaired in some respects but normal, or even superior, in others.
Autism [SEP] Overt symptoms gradually begin after the age of six months, become established by age two or three years and tend to continue through adulthood, although often in more muted form. It is distinguished not by a single symptom but by a characteristic triad of symptoms: impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis.
Autism [SEP] Individual symptoms of autism occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits. Social deficits distinguish autism and the related autism spectrum disorders (ASD; see Classification) from other developmental disorders. People with autism have social impairments and often lack the intuition about others that many people take for granted.
Autism [SEP] Noted autistic Temple Grandin described her inability to understand the social communication of neurotypicals, or people with normal neural development, as leaving her feeling "like an anthropologist on Mars". Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name.
Autism [SEP] Autistic toddlers differ more strikingly from social norms; for example, they have less eye contact and turn-taking, and do not have the ability to use simple movements to express themselves, such as pointing at things. Three- to five-year-old children with autism are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers.
Autism [SEP] Most children with autism display moderately less attachment security than neurotypical children, although this difference disappears in children with higher mental development or less severe ASD. Older children and adults with ASD perform worse on tests of face and emotion recognition although this may be partly due to a lower ability to define a person's own emotions. Children with high-functioning autism suffer from more intense and frequent loneliness compared to non-autistic peers, despite the common belief that children with autism prefer to be alone.
Autism [SEP] Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they feel. Functional friendships, such as those resulting in invitations to parties, may affect the quality of life more deeply. There are many anecdotal reports, but few systematic studies, of aggression and violence in individuals with ASD.
Autism [SEP] The limited data suggest that, in children with intellectual disability, autism is associated with aggression, destruction of property, and meltdowns. About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs. Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver.
Autism [SEP] In the second and third years, children with autism have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Children with autism are less likely to make requests or share experiences, and are more likely to simply repeat others' words (echolalia) or reverse pronouns. Joint attention seems to be necessary for functional speech, and deficits in joint attention seem to distinguish infants with ASD.
Autism [SEP] For example, they may look at a pointing hand instead of the pointed-at object, and they consistently fail to point at objects in order to comment on or share an experience. Children with autism may have difficulty with imaginative play and with developing symbols into language. In a pair of studies, high-functioning children with autism aged 8–15 performed equally well as, and as adults better than, individually matched controls at basic language tasks involving vocabulary and spelling.
Autism [SEP] Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends. Autistic individuals can display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised (RBS-R) categorizes as follows.
Autism [SEP] No single repetitive or self-injurious behavior seems to be specific to autism, but autism appears to have an elevated pattern of occurrence and severity of these behaviors. Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family. An estimated 0.5% to 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.
Autism [SEP] Many individuals with ASD show superior skills in perception and attention, relative to the general population. Sensory abnormalities are found in over 90% of those with autism, and are considered core features by some, although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders. Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements).
Autism [SEP] An estimated 60–80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking; deficits in motor coordination are pervasive across ASD and are greater in autism proper. Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur. Parents of children with ASD have higher levels of stress.
Autism [SEP] Siblings of children with ASD report greater admiration of and less conflict with the affected sibling than siblings of unaffected children and were similar to siblings of children with Down syndrome in these aspects of the sibling relationship. However, they reported lower levels of closeness and intimacy than siblings of children with Down syndrome; siblings of individuals with ASD have greater risk of negative well-being and poorer sibling relationships as adults. There is tentative evidence that autism occurs more frequently in people with gender dysphoria.
Autism [SEP] Gastrointestinal problems are one of the most commonly associated medical disorders in people with autism. These are linked to greater social impairment, irritability, behavior and sleep problems, language impairments and mood changes. It has long been presumed that there is a common cause at the genetic, cognitive, and neural levels for autism's characteristic triad of symptoms. However, there is increasing suspicion that autism is instead a complex disorder whose core aspects have distinct causes that often co-occur.
Autism [SEP] Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by rare mutations with major effects, or by rare multigene interactions of common genetic variants. Complexity arises due to interactions among multiple genes, the environment, and epigenetic factors which do not change DNA sequencing but are heritable and influence gene expression. Many genes have been associated with autism through sequencing the genomes of affected individuals and their parents.
Autism [SEP] Studies of twins suggest that heritability is 0.7 for autism and as high as 0.9 for ASD, and siblings of those with autism are about 25 times more likely to be autistic than the general population. However, most of the mutations that increase autism risk have not been identified. Typically, autism cannot be traced to a Mendelian (single-gene) mutation or to a single chromosome abnormality, and none of the genetic syndromes associated with ASDs have been shown to selectively cause ASD.
Autism [SEP] Numerous candidate genes have been located, with only small effects attributable to any particular gene. Most loci individually explain less than 1% of cases of autism. The large number of autistic individuals with unaffected family members may result from spontaneous structural variation — such as deletions, duplications or inversions in genetic material during meiosis. Hence, a substantial fraction of autism cases may be traceable to genetic causes that are highly heritable but not inherited: that is, the mutation that causes the autism is not present in the parental genome.
Autism [SEP] Autism may be underdiagnosed in women and girls due to an assumption that it is primarily a male condition. Maternal nutrition and inflammation during preconception and pregnancy influences fetal neurodevelopment. Intrauterine growth restriction is associated with ASD, in both term and preterm infants. Maternal inflammatory and autoimmune diseases may damage fetal tissues, aggravating a genetic problem or damaging the nervous system. Exposure to air pollution during pregnancy, especially heavy metals and particulates, may increase the risk of autism.
Autism [SEP] Environmental factors that have been claimed without evidence to contribute to or exacerbate autism include certain foods, infectious diseases, solvents, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illicit drugs, vaccines, and prenatal stress. Some, such as the MMR vaccine, have been completely disproven. Parents may first become aware of autistic symptoms in their child around the time of a routine vaccination.
Autism [SEP] This has led to unsupported theories blaming vaccine "overload", a vaccine preservative, or the MMR vaccine for causing autism. The latter theory was supported by a litigation-funded study that has since been shown to have been "an elaborate fraud". Although these theories lack convincing scientific evidence and are biologically implausible, parental concern about a potential vaccine link with autism has led to lower rates of childhood immunizations, outbreaks of previously controlled childhood diseases in some countries, and the preventable deaths of several children.
Autism [SEP] Autism's symptoms result from maturation-related changes in various systems of the brain. How autism occurs is not well understood. Its mechanism can be divided into two areas: the pathophysiology of brain structures and processes associated with autism, and the neuropsychological linkages between brain structures and behaviors. The behaviors appear to have multiple pathophysiologies. There is evidence that gut–brain axis abnormalities may be involved.
Autism [SEP] A 2015 review proposed that immune dysregulation, gastrointestinal inflammation, malfunction of the autonomic nervous system, gut flora alterations, and food metabolites may cause brain neuroinflammation and dysfunction. A 2016 review concludes that enteric nervous system abnormalities might play a role in neurological disorders such as autism. Neural connections and the immune system are a pathway that may allow diseases originated in the intestine to spread to the brain. Several lines of evidence point to synaptic dysfunction as a cause of autism.
Autism [SEP] Some rare mutations may lead to autism by disrupting some synaptic pathways, such as those involved with cell adhesion. Gene replacement studies in mice suggest that autistic symptoms are closely related to later developmental steps that depend on activity in synapses and on activity-dependent changes.
Autism [SEP] All known teratogens (agents that cause birth defects) related to the risk of autism appear to act during the first eight weeks from conception, and though this does not exclude the possibility that autism can be initiated or affected later, there is strong evidence that autism arises very early in development. Diagnosis is based on behavior, not cause or mechanism.
Autism [SEP] Under the DSM-5, autism is characterized by persistent deficits in social communication and interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. These deficits are present in early childhood, typically before age three, and lead to clinically significant functional impairment. Sample symptoms include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with unusual objects.
Autism [SEP] The disturbance must not be better accounted for by Rett syndrome, intellectual disability or global developmental delay. ICD-10 uses essentially the same definition. Several diagnostic instruments are available. Two are commonly used in autism research: the Autism Diagnostic Interview-Revised (ADI-R) is a semistructured parent interview, and the Autism Diagnostic Observation Schedule (ADOS) uses observation and interaction with the child. The Childhood Autism Rating Scale (CARS) is used widely in clinical environments to assess severity of autism based on observation of children.
Autism [SEP] The Diagnostic interview for social and communication disorders (DISCO) may also be used. A pediatrician commonly performs a preliminary investigation by taking developmental history and physically examining the child. If warranted, diagnosis and evaluations are conducted with help from ASD specialists, observing and assessing cognitive, communication, family, and other factors using standardized tools, and taking into account any associated medical conditions. A pediatric neuropsychologist is often asked to assess behavior and cognitive skills, both to aid diagnosis and to help recommend educational interventions.
Autism [SEP] A differential diagnosis for ASD at this stage might also consider intellectual disability, hearing impairment, and a specific language impairment such as Landau–Kleffner syndrome. The presence of autism can make it harder to diagnose coexisting psychiatric disorders such as depression. Clinical genetics evaluations are often done once ASD is diagnosed, particularly when other symptoms already suggest a genetic cause.
Autism [SEP] Although genetic technology allows clinical geneticists to link an estimated 40% of cases to genetic causes, consensus guidelines in the US and UK are limited to high-resolution chromosome and fragile X testing. A genotype-first model of diagnosis has been proposed, which would routinely assess the genome's copy number variations. As new genetic tests are developed several ethical, legal, and social issues will emerge. Commercial availability of tests may precede adequate understanding of how to use test results, given the complexity of autism's genetics.
Autism [SEP] Metabolic and neuroimaging tests are sometimes helpful, but are not routine. ASD can sometimes be diagnosed by age 14 months, although diagnosis becomes increasingly stable over the first three years of life: for example, a one-year-old who meets diagnostic criteria for ASD is less likely than a three-year-old to continue to do so a few years later.
Autism [SEP] In the UK the National Autism Plan for Children recommends at most 30 weeks from first concern to completed diagnosis and assessment, though few cases are handled that quickly in practice. Although the symptoms of autism and ASD begin early in childhood, they are sometimes missed; years later, adults may seek diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some locations to claim disability living allowances or other benefits. Girls are often diagnosed later than boys.
Autism [SEP] Underdiagnosis and overdiagnosis are problems in marginal cases, and much of the recent increase in the number of reported ASD cases is likely due to changes in diagnostic practices. The increasing popularity of drug treatment options and the expansion of benefits has given providers incentives to diagnose ASD, resulting in some overdiagnosis of children with uncertain symptoms. Conversely, the cost of screening and diagnosis and the challenge of obtaining payment can inhibit or delay diagnosis.
Autism [SEP] It is particularly hard to diagnose autism among the visually impaired, partly because some of its diagnostic criteria depend on vision, and partly because autistic symptoms overlap with those of common blindness syndromes or blindisms. Autism is one of the five pervasive developmental disorders (PDD), which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests and highly repetitive behavior. These symptoms do not imply sickness, fragility, or emotional disturbance.
Autism [SEP] Of the five PDD forms, Asperger syndrome is closest to autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with autism, but may have unrelated causes; PDD not otherwise specified (PDD-NOS; also called "atypical autism") is diagnosed when the criteria are not met for a more specific disorder. Unlike with autism, people with Asperger syndrome have no substantial delay in language development.
Autism [SEP] The terminology of autism can be bewildering, with autism, Asperger syndrome and PDD-NOS often called the "autism spectrum disorders" (ASD) or sometimes the "autistic disorders", whereas autism itself is often called "autistic disorder", "childhood autism", or "infantile autism". In this article, "autism" refers to the classic autistic disorder; in clinical practice, though, "autism", "ASD", and "PDD" are often used interchangeably.
Autism [SEP] ASD, in turn, is a subset of the broader autism phenotype, which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact. The manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, developmentally disabled, and locked into hand flapping and rocking—to high functioning individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication.
Autism [SEP] Because the behavior spectrum is continuous, boundaries between diagnostic categories are necessarily somewhat arbitrary. Sometimes the syndrome is divided into low-, medium- or high-functioning autism (LFA, MFA, and HFA), based on IQ thresholds, or on how much support the individual requires in daily life; these subdivisions are not standardized and are controversial.
Autism [SEP] Autism can also be divided into syndromal and non-syndromal autism; the syndromal autism is associated with severe or profound intellectual disability or a congenital syndrome with physical symptoms, such as tuberous sclerosis. Although individuals with Asperger syndrome tend to perform better cognitively than those with autism, the extent of the overlap between Asperger syndrome, HFA, and non-syndromal autism is unclear.
Autism [SEP] Some studies have reported diagnoses of autism in children due to a loss of language or social skills, as opposed to a failure to make progress, typically from 15 to 30 months of age. The validity of this distinction remains controversial; it is possible that regressive autism is a specific subtype, or that there is a continuum of behaviors between autism with and without regression.
Autism [SEP] Research into causes has been hampered by the inability to identify biologically meaningful subgroups within the autistic population and by the traditional boundaries between the disciplines of psychiatry, psychology, neurology and pediatrics. Newer technologies such as fMRI and diffusion tensor imaging can help identify biologically relevant phenotypes (observable traits) that can be viewed on brain scans, to help further neurogenetic studies of autism; one example is lowered activity in the fusiform face area of the brain, which is associated with impaired perception of people versus objects.
Autism [SEP] It has been proposed to classify autism using genetics as well as behavior. About half of parents of children with ASD notice their child's unusual behaviors by age 18 months, and about four-fifths notice by age 24 months. According to an article, failure to meet any of the following milestones "is an absolute indication to proceed with further evaluations. Delay in referral for such testing may delay early diagnosis and treatment and affect the long-term outcome".
Autism [SEP] The United States Preventive Services Task Force in 2016 found it was unclear if screening was beneficial or harmful among children in whom there is no concerns. The Japanese practice is to screen all children for ASD at 18 and 24 months, using autism-specific formal screening tests. In contrast, in the UK, children whose families or doctors recognize possible signs of autism are screened. It is not known which approach is more effective.
Autism [SEP] Screening tools include the Modified Checklist for Autism in Toddlers (M-CHAT), the Early Screening of Autistic Traits Questionnaire, and the First Year Inventory; initial data on M-CHAT and its predecessor, the Checklist for Autism in Toddlers (CHAT), on children aged 18–30 months suggests that it is best used in a clinical setting and that it has low sensitivity (many false-negatives) but good specificity (few false-positives).
Autism [SEP] It may be more accurate to precede these tests with a broadband screener that does not distinguish ASD from other developmental disorders. Screening tools designed for one culture's norms for behaviors like eye contact may be inappropriate for a different culture. Although genetic screening for autism is generally still impractical, it can be considered in some cases, such as children with neurological symptoms and dysmorphic features. While infection with rubella during pregnancy causes fewer than 1% of cases of autism, vaccination against rubella can prevent many of those cases.
Autism [SEP] The main goals when treating children with autism are to lessen associated deficits and family distress, and to increase quality of life and functional independence. In general, higher IQs are correlated with greater responsiveness to treatment and improved treatment outcomes. No single treatment is best and treatment is typically tailored to the child's needs. Families and the educational system are the main resources for treatment. Services should be carried out by behavior analysts, special education teachers, speech pathologists, and licensed psychologists.
Autism [SEP] Studies of interventions have methodological problems that prevent definitive conclusions about efficacy. However, the development of evidence-based interventions has advanced in recent years. Although many psychosocial interventions have some positive evidence, suggesting that some form of treatment is preferable to no treatment, the methodological quality of systematic reviews of these studies has generally been poor, their clinical results are mostly tentative, and there is little evidence for the relative effectiveness of treatment options.
Autism [SEP] Intensive, sustained special education programs and behavior therapy early in life can help children acquire self-care, communication, and job skills, and often improve functioning and decrease symptom severity and maladaptive behaviors; claims that intervention by around age three years is crucial are not substantiated. While medications have not been found to help with core symptoms, they may be used for associated symptoms, such as irritability, inattention, or repetitive behavior patterns.
Autism [SEP] Educational interventions often used include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy. Among these approaches, interventions either treat autistic features comprehensively, or focalize treatment on a specific area of deficit.
Autism [SEP] The quality of research for early intensive behavioral intervention (EIBI)—a treatment procedure carried out with very young children that incorporates over thirty hours per week of the structured type of ABA—is currently low, and more vigorous research designs with larger sample sizes are needed. Two theoretical frameworks outlined for early childhood intervention include structured and naturalistic ABA interventions, and developmental social pragmatic models (DSP).
Autism [SEP] One interventional strategy utilizes a parent training model, which teaches parents how to implement various ABA and DSP techniques, allowing for parents to disseminate interventions themselves. Various DSP programs have been developed to explicitly deliver intervention systems through at-home parent implementation. Despite the recent development of parent training models, these interventions have demonstrated effectiveness in numerous studies, being evaluated as a probable efficacious mode of treatment.
Autism [SEP] Early, intensive ABA therapy has demonstrated effectiveness in enhancing communication, as well as adaptive and global functioning in preschool children; it is well-established for improving the intellectual performance of that age group. Similarly, a teacher-implemented intervention that utilizes a more naturalistic form of ABA combined with a developmental social pragmatic approach has been found to be beneficial in improving social-communication skills in young children, although there is less evidence in its treatment of global symptoms.
Autism [SEP] Neuropsychological reports are often poorly communicated to educators, resulting in a gap between what a report recommends and what education is provided. It is not known whether treatment programs for children lead to significant improvements after the children grow up, and the limited research on the effectiveness of adult residential programs shows mixed results. The appropriateness of including children with varying severity of autism spectrum disorders in the general education population is a subject of current debate among educators and researchers.
Autism [SEP] Medications may be used to treat ASD symptoms that interfere with integrating a child into home or school when behavioral treatment fails. They may also be used for associated health problems, such as ADHD or anxiety. More than half of US children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics. The atypical antipsychotic drugs risperidone and aripiprazole are FDA-approved for treating associated aggressive and self-injurious behaviors.
Autism [SEP] However, their side effects must be weighed against their potential benefits, and people with autism may respond atypically. Side effects, for example, may include weight gain, tiredness, drooling, and aggression. SSRI antidepressants, such as fluoxetine and fluvoxamine, have been shown to be effective in reducing repetitive and ritualistic behaviors, while the stimulant medication methylphenidate is beneficial for some children with co-morbid inattentiveness or hyperactivity. There is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.
Autism [SEP] No known medication relieves autism's core symptoms of social and communication impairments. Experiments in mice have reversed or reduced some symptoms related to autism by replacing or modulating gene function, suggesting the possibility of targeting therapies to specific rare mutations known to cause autism. Although many alternative therapies and interventions are available, few are supported by scientific studies. Treatment approaches have little empirical support in quality-of-life contexts, and many programs focus on success measures that lack predictive validity and real-world relevance.
Autism [SEP] Some alternative treatments may place the child at risk. The preference that children with autism have for unconventional foods can lead to reduction in bone cortical thickness with this being greater in those on casein-free diets, as a consequence of the low intake of calcium and vitamin D; however, suboptimal bone development in ASD has also been associated with lack of exercise and gastrointestinal disorders. In 2005, botched chelation therapy killed a five-year-old child with autism.
Autism [SEP] Chelation is not recommended for people with ASD since the associated risks outweigh any potential benefits. Another alternative medicine practice with no evidence is CEASE therapy, a mixture of homeopathy, supplements, and 'vaccine detoxing'. Although popularly used as an alternative treatment for people with autism, as of 2018 there is no good evidence to recommend a gluten- and casein-free diet as a standard treatment.
Autism [SEP] A 2018 review concluded that it may be a therapeutic option for specific groups of children with autism, such as those with known food intolerances or allergies, or with food intolerance markers. The authors analyzed the prospective trials conducted to date that studied the efficacy of the gluten- and casein-free diet in children with ASD (4 in total).
Autism [SEP] All of them compared gluten- and casein-free diet versus normal diet with a control group (2 double blind randomized controlled trials, 1 double blind crossover trial, 1 single blind trial). In two of the studies, whose duration was 12 and 24 months, a significant improvement in ASD symptoms (efficacy rate 50%) was identified. In the other two studies, whose duration was 3 months, no significant effect was observed.
Autism [SEP] The authors concluded that a longer duration of the diet may be necessary to achieve the improvement of the ASD symptoms. Other problems documented in the trials carried out include transgressions of the diet, small sample size, the heterogeneity of the participants and the possibility of a placebo effect. In the subset of people who have gluten sensitivity there is limited evidence that suggests that a gluten-free diet may improve some autistic behaviors.
Autism [SEP] There is tentative evidence that music therapy may improve social interactions, verbal communication, and non-verbal communication skills. There has been early research looking at hyperbaric treatments in children with autism. There is no known cure. Children recover occasionally, so that they lose their diagnosis of ASD; this occurs sometimes after intensive treatment and sometimes not. It is not known how often recovery happens; reported rates in unselected samples have ranged from 3% to 25%.
Autism [SEP] Most children with autism acquire language by age five or younger, though a few have developed communication skills in later years. Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination. Although core difficulties tend to persist, symptoms often become less severe with age. Few high-quality studies address long-term prognosis. Some adults show modest improvement in communication skills, but a few decline; no study has focused on autism after midlife.
Autism [SEP] Acquiring language before age six, having an IQ above 50, and having a marketable skill all predict better outcomes; independent living is unlikely with severe autism. Many individuals with autism face significant obstacles in transitioning to adulthood. Compared to the general population individuals with autism are more likely to be unemployed and to have never had a job. People in their 20s with autism have an employment rate of 58%.
Autism [SEP] Most recent reviews tend to estimate a prevalence of 1–2 per 1,000 for autism and close to 6 per 1,000 for ASD, and 11 per 1,000 children in the United States for ASD as of 2008; because of inadequate data, these numbers may underestimate ASD's true rate. Globally, autism affects an estimated 24.8 million people , while Asperger syndrome affects a further 37.2 million. In 2012, the NHS estimated that the overall prevalence of autism among adults aged 18 years and over in the UK was 1.1%.
Autism [SEP] Rates of PDD-NOS's has been estimated at 3.7 per 1,000, Asperger syndrome at roughly 0.6 per 1,000, and childhood disintegrative disorder at 0.02 per 1,000. CDC estimates about 1 out of 59 (1.7%) for 2014, an increase from 1 out of every 68 children (1.5%) for 2010. The number of reported cases of autism increased dramatically in the 1990s and early 2000s.
Autism [SEP] This increase is largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness, though unidentified environmental risk factors cannot be ruled out. The available evidence does not rule out the possibility that autism's true prevalence has increased; a real increase would suggest directing more attention and funding toward changing environmental factors instead of continuing to focus on genetics. Boys are at higher risk for ASD than girls.