Qualitative impairment in social interaction

Parents may recall a major event preceding the change, such as the birth of a sibling, the death of a grandparent, or a physical illness, but it is unclear whether the child was truly unimpaired prior to the event. As infants, autistic children may be content to lie in their cribs or playpens by themselves for hours without crying or making demands on parents, who feel initially that they have a good, easy-to-care-for baby. Other infants may be irritable and cry frequently.

Qualitative impairment in social interaction

The social impairment in autistic disorder was viewed by Kanner as the core deficit in a syndrome manifesting with myriad features. However, research in the past few decades was directed toward elucidating the cognitive and language impairments, thought by many to be primary deficits leading to a secondary disturbance in social interaction.

The nature of the social impairment in autism varies with the child’s developmental level, and its severity often decreases as the child gets older. From the first year of life, autistic children may show an impairment in reciprocal social interaction, as seen in a failure to cuddle, failure to raise their arms in anticipation of being picked up, lack of imitation of speech and gestures, failure to point to or show objects to others, and abnormality of eye gaze behavior.

For example, although autistic children may occasionally make eye contact when giving an object to an adult, they rarely make eye contact with an adult when both child and adult are watching something of interest.

That last deficit, known as a deficit in joint attention–a concept well developed by 2 years of age-may be indicative of an inability to understand that a focus of attention or perspective may be shared. Reciprocal games such as patty cake and peek-a-boo may not appear. Although some autistic children may seem indifferent or unresponsive toward their parents’ approaches or to separation from them, others may be anxious about separation and cling to their parents. Still others may be indiscriminately friendly and kiss strangers.

Autistic children fail to develop social play with other children, often preferring solitary activities. The social aloofness seen in younger autistic children may decrease with age; nevertheless, although they may report an interest in making friendships, even the brightest children are hampered by an inability to understand many conventions of social interaction. That defect in social cognition may have its earliest roots in an inability to comprehend facial expressions or to express their own affective states vocally or by facial expression; those difficulties may underlie the autistic person’s inability to relate empathically to others, which would preclude normal social interaction. Social interactions of autistic children have been divided into three groups: aloof, passive, and active but odd. Aloof interactions are seen in the most withdrawn individuals, who are usually indifferent to or upset by social approaches and show minimal attachment behavior and affection. Passive interactions are seen in those who accept social approaches and who may play with other children if the play is structured for them. Children with active but odd interactions spontaneously approach others, but the interaction is often inappropriate and one-sided. It appears that level of cognitive functioning distinguishes the groups, with the aloof-reaction group being the most impaired and the group exhibiting active but odd interactions being the least impaired.

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