Autism Spectrum Disorder (ASD) is defined as a disorder in neuro-development from an early age, characterized by a series of difficulties in communication and relations and by restrictive and repetitive behavior and interests (Baron-Cohen, Meng-Chuan and Lombardo, 2013). This disorder has a series of very heterogeneous symptoms, which determine the level of affectation of the person with this disorder and which can be placed in a continuum (Wing, 1995). She describes six dimensions of affectation with different levels of seriousness in them:
- Qualitative disorders in social relations
- Communicative functions disorders
- Language disorders
- Imagination disorders and limitations,
- Flexibility disorders
- Activity purpose disorders
Currently, the definition considered is the one contained in the fifth edition of the publication Diagnostic and Statistical Manual of Mental Disorders, DSM-V (American Psychiatric Association, 2013), which states that ASD has two symptomatic domains which appear in early childhood and which, the two of them, cause a limitation on everyday life activities and a need for support at different levels. – Group A: Characterized by social alterations combined with alterations in communication, presenting at the same time deficiencies in three areas: in social and emotional reciprocity; in the non-verbal communication used in interaction; in the creation of relations adequate to their vital moment. – Group B: Characterized by repetitive and restrictive behaviors, interests and activities, showing simultaneously at least two of the following conducts: language, motor conducts or even of objects in a repetitive or stereotyped way; excessive resistance to change or adherence to routine, ritual conducts, verbal or not; centers of interest highly restricted and/ or unusual with excessive intensity; hiccups or sensory hypersensitivity. This change in the conception of ASD emphasizes the individuality of every ASD afflicted person and factors in the famous triad for the diagnosis and understanding of ASD (communication deficiencies, interaction deficiency, and restricted and repetitive interests)
(Baron-Cohen et al., 2013).
CLASSIFICATION OF AUTISM
ICD-10 (World Health Organization, 1990) classifies autism under the pervasive developmental disorders, a group of conditions characterized by qualitative abnormalities in reciprocal social interaction, idiosyncratic patterns of communication and by a restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a feature of the sufferer’s
functioning in all situations. DSM-5 (American Psychiatric Association, 2013) has made significant changes to this in its latest edition. Both ICD-10 and DSM-5 utilize a list of behaviors, require that a number of criteria be met in order to warrant a diagnosis, and the two taxonomies are periodically reviewed to incorporate new research findings. DSM-5 was released in May 2013 and the revision of ICD-10 (ICD-11) is expected to be approved by the WHO in 2015. Current ICD-11 working drafts seem to incorporate similar modifications to those in DSM-5. Some of the changes incorporated in DSM5 have been controversial in scientific and lay circles. Further research is required to assess the impact of these modifications on research, clinical practice and public health policy. DSM-5 has eliminated the distinction in DSM-IV between autism, Rett’s disorder, Asperger’s disorder, childhood dis integrative disorder, and pervasive developmental disorder not otherwise specified, creating a unique ASD category,
- Persistent deficits in social communication and social interaction across multiple contexts
- Restricted, repetitive patterns of behavior, interests or activities either current or elicited through the clinical history
- Clinically significant impairment in social, occupational, or other important areas of functioning
- Presence from early childhood (although it may not become fully manifest until social demands exceed the child’s limited capacities), and Not explained better by intellectual disability or global developmental delay
DSM-5 has thus eliminated the separate diagnosis of Asperger’s disorder while formalizing the ‘spectrum’ concept espoused by Lorna Wing, who favored considering Asperger’s disorder a sub-category of a unified ASD construct (Wing et al, 2011). Many people think that these demarcations, although officially may go away, are likely to continue to be used
in clinical and lay settings. For a brief description of these changes follow the hyperlink in Susan Swedo’s video clip on the previous page; for a more detailed description follow the hyperlink to Andrés Martin’s presentation. Several welcome aspects have been incorporated in DSM-5, such as placing ASDs under the more appropriate heading of ‘neuro-developmental disorders’ – instead of ‘pervasive developmental disorders’— and the recommendation to consider ‘specifiers’ (descriptors), aimed at a more homogeneous sub grouping of individuals who share certain features (a known medical, genetic or environmental condition; intellectual and/or
language impairment; another neuro-developmental, mental or behavioral disorder, or catatonia). This improvement is accompanied by the recognition of some symptoms that, while often experienced by patients, were not considered in previous classifications: those related to hyper-
or hypo-activity to sensory stimuli or unusual interest in sensory aspects of the environment, for example, apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement.
Finally, in a salutary move towards clarifying the functional needs of the individual and the planning of support required, DSM-5 offers a table describing severity levels, which can be
- Level 1: Requiring support (e.g., without supports in place, deficits in social communication cause noticeable impairments. Difficulty in initiating social interactions, and atypical or unsuccessful responses to social overtures of others. Inflexibility causes significant interference with functioning in one or more contexts.)
- Level 2: Requiring substantial support (e.g., marked deficits in verbal and nonverbal social communication; social impairments apparent even with supports in place; limited initiation of social interactions. Inflexibility of behavior, difficulty coping with change or other restricted or repetitive behaviors appears frequently and interferes with functioning)
- Level 3: Requiring very substantial supp2ort (e.g., severe deficits in verbal and nonverbal social communication that cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others.
Inflexibility of behavior, extreme difficulty coping with changes, which markedly interfere with functioning) Perhaps the most controversial change in DSM-5 has been the creation of a new category – social (pragmatic) communication disorder – separate from ASD. According to many, social (pragmatic) communication disorder is identical to what in DSM-IV was described as pervasive developmental disorder not otherwise specified, a condition that constitutes in some specialist programs for ASD as many as 50% of their patients.
Description of the main symptoms
The detection of the disorder may vary a lot, depending on the case; the heterogeneity of autistic syndromes entails a difficult task when the diagnosis is made. There are no biological markers and this demand the use of psychological markers. In the most serious cases, the first signs are
related to retardations in development (hypotonia, hyperactivity) and the typical symptoms of autism appear later on. Normally, the signs appear from the second year of life, when serious alterations in development manifest themselves clearly, being the inter-subjective, linguistic and
cognitive abilities the ones that are affected in relation to other children who do not suffer from autism. The first suspicions aroused on the parents are usually related with the lack of response to oral demands and the absence of verbal communication (Cuxart, 2000). Taking Rivière’s
(2002) Inventory of the Autistic Spectrum as a reference, we can describe the variety of characteristics that can be found in ASD, classified into twelve dimensions with different levels of affection and/or development in each of them:
- Disorder in social relations, in the inner complicity of relations: from the impression of absolute isolation, through ignoring peers but not adults, to motivation to relate but not being able to understand the other.
- Disorder in joint reference abilities, of sharing focuses, interests or actions whose indicators are look, proto-declarative gestures: from total absence of joint actions or interests through looks without joint reference or only in directed situations.
- Qualitative disorder in communicative functions: from the absence of communication to instrumental conducts to achieve or ask for something, to communicative conducts to share experience or communicate the inner world.
- Disorder in expressive language: from total or functional silence, through isolated words or echolalias, to speech with or without limitations.
- Disorder in receptive language: from a tendency to ignore oral language to the comprehension of simple statements or statements linked to specific conducts and literal-meaning or limitless comprehension.
- Difficulties in anticipation: from big resistance to changes, adherence to stimuli, no anticipatory conducts, tantrum conducts before change, to simple anticipatory conducts, small self-regulation of routines, accepting environment versatility, etc.
- Difficulties in flexibility: from predominance of stereotyped conducts to small rituals, excessive attachment to objects, little functional interests, etc.
- Disorder in the sense of own activity: from predominance of conducts without an aim or relationship with the context, function-oriented only activities, with difficulties to refer to the future
- Disorder in fiction and imagination: which implies imaginary attribution of things or situations: from total absence of symbolic play to presence of games, albeit repetitive or simple, or complex functions of fiction with difficulties to distinguish them from reality.
- Disorder in imitation, which is a necessary resource for inter-subjective development: from Disorder in imitation, which is a necessary resource for inter-subjective development: from rigid, etc.
- Disorder in suspension: leaving an action or representation on hold with the aim of creating meanings for oneself or another person to interpret.
Children with ASD may manifest other symptoms like problems with motor functions and integrating the body scheme; motor clumsiness; different pain threshold, appearance of panic episodes, emotional self-control problems, which may lead to a high level of activity; self- lesions, alterations in nutrition or sphincter control, etc. (Morral et al., 2012). In addition, other
habitual symptoms are hyperactivity (childhood), hypo-activity (teenage and adulthood) mood instability, agitation crisis, paradoxical responses to aural stimuli, sleep alterations and epileptic crisis (20-25% of the total population) (Cuxart, 2000).
CONDITIONS THAT MAY OVERLAP WITH AUTSIM
Autism spectrum disorder (ASD) has a number of co-occurring physical and mental health
conditions. These include:
- Sleep disorders/disturbance
- Gastrointestinal disorders
- Feeding/eating challenges
- Bipolar disorder
These issues can last throughout life, but may also appear or diminish at different developmental stages. Diagnosis of comorbidities can be challenging because many people with ASD have difficulty recognizing and communicating their symptoms. Physical discomfort might prompt
spikes in self-soothing repetitive behaviors as well as irritability, aggression, self-injury, and other challenging behavioral issues. That makes it difficult to tease out whether these behaviors are related to ASD or to physical discomfort caused by a co-occurring condition.
Treatment options for autism
Scientists agree that the earlier in life a child receives early intervention services the better the child’s prognosis. All children with autism can benefit from early intervention, and some may gain enough skills to be able to attend mainstream school. Research tells us that early intervention in an appropriate educational setting for at least two years prior to the start of school can result in significant improvements for many young children with autism spectrum disorders (ASD). As soon as autism is diagnosed, early intervention instruction should begin. Effective programs focus on developing communication, social, and cognitive skills.
Early diagnosis of ASD, coupled with swift and effective intervention, is paramount to achieving the best possible prognosis for the child. Even at ages as young as six months, diagnosis of ASD is possible. The most effective treatments available today are applied behavioral analysis (ABA), occupational therapy, speech therapy, physical therapy, and pharmacological therapy. Treatment works to minimize the impact of the core features and associated deficits of ASD and to maximize functional independence and quality of life.
1. Applied Behavioral Analysis (ABA)
(ABA) works to systematically change behavior based on
principles of learning derived from behavioral psychology. ABA encourages positive behaviors and discourages negative behaviors. In addition, ABA teaches new skills and applies those skill to new situations
2. Early Intensive Behavioral Intervention (EIBI)
(EIBI) is a type of ABA for very young children with an ASD, usually younger than five, often younger than three.
3. Pivotal Response Training
Pivotal Response Training is a variation of ABA that works to increase a child’s motivation to learn, monitor his own behavior, and initiate communication with others by focusing on behaviors that are seen as key to learning other skills, such as language, play, and social skills. This training works to generalize skills across many settings with different people.
Since people with ASDs have deficits in social communication, speech therapy is an important treatment option. Speech therapy with a licensed speech-language pathologist helps to improve a
person’s communication skills, allowing him to better express his needs or wants. For individuals with ASD, speech therapy is often most effective when speech-language pathologists work with teachers, support personnel, families, and the child’s peers to promote functional communication in natural settings.
Occupational therapy is often used as a treatment for the sensory i ntegration issues associated with ASDs. It is also used to help teach life skills that involve fine-motor movements, such as dressing, using utensils, cutting with scissors, and writing. OT works to improve the individual’s quality of life and ability to participate fully in daily activities. Each occupational therapy program is based on individual evaluations and goals. Occupational therapy for young children with ASD often focuses on improving sensory integration and sensori motor issues. In older children, OT often focuses on improving social behavior and increasing independence.
Physical therapy is used to improve gross motor skills and handle sensory integration issues, particularly those involving the individual’s ability to feel and be aware of his body in space. Similar to OT, physical therapy is used to improve the individual’s ability to participate in everyday activities. PT works to teach and improve skills such as walking, sitting, coordination,
and balance. Physical therapy is most effective when integrated in an early intervention program.
Pharmaceutical treatments can help ameliorate some of the behavioral symptoms of ASD,including irritability, aggression, and self-injurious behavior. Additionally, by medically reducing interfering or disruptive behaviors, other treatments, including ABA, may be more
effective. Medications should be prescribed and monitored by a qualified physician.Other treatment options includes, behavioral management therapy, cognitive behavioral therapy,early intervention, education and school based therapies, joint attention therapy, nutrition therapy, parent mediated therapy, and social skills training
Diet plan for children with autism
Children with autism may limit their food intake or have food preferences. They may also break down fat differently. As a result, autistic children are sometimes low in certain nutrients. Some of these nutrients have been studied to see if giving children supplements of these nutrients may
help with autism symptoms. However, more research is needed. Before giving your child any of the following supplements, speak with your child’s physician or a dietitian first.
Vitamins and Minerals
Multivitamins: Some results have shown a multivitamin may help improve sleep and digestive problems in autistic children. Note that a multivitamin with iron may cause some digestive problems. Giving your child a multivitamin is not harmful and may be helpful, especially if your
child is not eating a balanced diet.
Iron: Children with autism are often low in iron, usually because many are picky eaters. Ask your child’s doctor to check iron levels regularly. Do not give an iron supplement unless your child’s iron level has been confirmed as low by a health care provider. An iron supplement may
help bring iron levels back to normal.
Vitamin B6 and magnesium: Vitamin B6 and magnesium supplements have been linked to improving behavior in autistic children. However, the research is not strong and more research is needed before these supplements are recommended for autistic children.
Some research has shown that many children with autism have low levels of omega-3 fats. Omega-3 supplements may help with hyperactivity in autistic children. However, more research is needed before omega-3 supplements can be recommended for children with autism.
The Gluten-Free, Casein-Free Diet
The Gluten-Free, Casein-Free Diet is a diet free of gluten and casein. Gluten is the main protein in wheat and other grains such as rye, barley, triticale, kamut and spelt. Casein is the main protein in dairy products such as cow’s milk, cheese, yogurt and ice cream. This diet may be
recommended to help improve behavior in autistic children. Some children with autism have a short term decrease in autistic behaviors when following this diet. However, the research is limited and more research is needed before this diet is recommended for autistic children.
Although the Centers for Disease Control and Prevention indicates that 1 in 59 children are diagnosed with autism spectrum disorder (ASD), for kids diagnosed with ASD the world can still feel lonely. ASD affects all racial, ethnic, and socioeconomic groups, but it remains largely misunderstood. Given the unique constellation of symptoms for each child, treatment and goals vary widely. While some children with ASD will exhibit difficulty with socializing and communicating with others, others might have behavioral symptoms. Though learning to manage symptoms and work toward specific goals takes time and practice, on thing is for certain: Kids with ASD can achieve success in their fields of interest. Check out
these ASD success stories.
Famous personalities with Autism
Comedic actor Dan Aykroyd was expelled from two schools as a child and was later diagnosed with Asperger’s Syndrome, a high functioning form of autism now considered part of the autism spectrum disorder diagnosis, in the 1980’s. In an interview with the Daily Mail, Aykroyd shared that one of his symptoms of ASD was his obsession with ghosts and lawenforcement. Aykroyd goes on to credit this symptom of ASD as a catalyst for Ghostbusters.
Britain’s Got Talent singing sensation Susan Boyle was
diagnosed with Asperger’s Syndrome as an adult. The Scottish singer, who was misdiagnosed with brain damage at birth,told The Guardian that her
diagnosis helps her have a better understanding of herself. Bullied as a child because she was “different,” Boyle went on to become a bestselling artist who also had a cameo role in the film, The Christmas Candle. Though Boyle also struggles with depression and mood swings, she now knows how to cope with and manage her symptoms, and credits having a great team of
supportive people with helping thrive.
we don’t know for sure. But, according to autism expert Simon Baron-Cohen from Cambridge University, Einstein showed many signs of Asperger syndrome. Other experts agree including Michael Fitzgerald, professor of psychiatry at Trinity College in Dublin. He’s also adding to the list: Isaac Newton, George Orwell, H. G. Wells Ludwig Wittgenstein, Beethoven,
Mozart, and Hans Christian Andersen.
Temple Grandin, a professor of Animal Science at Colorado State University and author of several books, including Thinking In Pictures and The Way I See It, didn’t begin speaking until she was almost four years old. Like Daryl Hannah, when Grandin was diagnosed with autism as a child, institutionalization was the recommended treatment. Her parents disagreed. In addition to her writing, Grandin is a prominent speaker on both autism and animal behavior.
Actress Daryl Hannah was diagnosed with autism as a child. In an interview with People Magazine, Hannah opened up about her “debilitating shyness” as a child and fear of fame as an adult. Hannah shared with People Magazine that she was diagnosed at a time when autism was largely misunderstood and her doctors recommended medication and institutionalization. Though her mother refused this treatment, she remained socially isolated and found solace in movies. This inspired her focus on acting.
Sir Anthony Hopkins
Oscar award-winning actor Sir Anthony Hopkins was also diagnosed with Asperger’s Syndrome, though when he was diagnosed remains unclear. Hopkins references learning differences as a child in media interviews as well as obsessive thinking and difficulty maintaining friendship even as an adult. Hopkins does credit ASD with his unique ability to look at people differently and deconstruct a character.
America’s Next Top Model contestant, Heather Kuzmich, gave viewers a behind the scenes look at Asperger’s Syndrome during the 2007 season of the show. Living in a house with twelve strangers/competitors presented challenges Kuzmich as she dealt with jokes she didn’t quite
understand, decoding difficult social innuendo, and worked through other symptoms (such as difficulty holding eye contact) as the show progressed. Kuzmich was voted viewer favorite eigh weeks a row during the competition and ended up in the top five. While these ASD success stories represent a small sample of what ASD people can do, they do
provide inspiration for the many kids out there learning to work through their own symptoms and find their passion. When young people have others to look up to, they learn that they can carve out their own paths at their own pace to leave their marks on the world as well.