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Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is a new diagnosis, or umbrella term, that has been added to the DSM-V, which encompasses 4 previously separate diagnoses that were included in the DSM-IV
ASD has combined:
1) Asperger's Disorder
2) Childhood Disintegrated Disorder
3) Autistic Disorder (Autism)
4) Pervasive Developmental Disorder NOS (not otherwise specified)
with the consensus that these 4 DSM-4 diagnoses are a single condition
What Does Autism Look Like and How is it Diagnosed?
(American Psychiatric Association, 2013)
According to the DSM-V, ASD is characterized by 2 domains, which have similar characteristics to the criteria of these 4 diagnoses and includes:
1) Deficits in social communication and social interaction
2) Restricted repetitive behaviours, interests, and activities
The following criteria for a diagnosis of ASD is outlined in the DSM-V:
1) Deficits in social communication and social interaction manifested by:
1. Deficits in social-emotional reciprocity: Ex. abnormal social approach, reduced sharing of interests, emotions or affect, failure to initiate/respond to social interactions
2. Deficits in non-verbal communicative behaviours with social interactions: Ex. poorly integrated, abnormal, or a lack of verbal/non-verbal communication
3. Deficits in developing, maintaining, and understanding relationships: Ex. difficulties with: sharing imaginative play, making friends, being interested in peers and adjusting behaviours to fit social contexts
2) Restricted repetitive behaviours, interests or activities manifested by at least 2 of the
1. Stereotyped/repetitive motor movements, use of objects or speech: Ex. echolalia
2. Insistence on sameness, inflexible adherence to routines or ritualized patterns: Ex. extreme distress at small changes, difficulties with transitions, and ritualistic behaviours
3. Highly restricted, fixated interests that are abnormal in intensity or focus: Ex. Strong attachment or preoccupation with unusual objects
4. Hyper- or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment: Ex. Adverse response to specific sounds or textures, visual fascination with lights or movement
A diagnosis of ASD also requires symptoms to cause clinically significant impairment in social, occupational or other important areas of current functioning
In order for a diagnosis to be made, the person must be assessed by a health care professional who specializes in mental health and can legally diagnose. Ex. psychiatrist
Individuals must also meet the criteria outlined in the DSM-5
(Centers for Disease Control and Prevention, 2015)
Studies have shown that parents of children with ASD notice a developmental problem before their child's first birthday. Concerns about vision and hearing were more often reported in the first year, and differences in social, communication, and fine motor skills were evident from 6 months of age.
ASD is almost 5 times more common among boys (1 in 42) than among girls (1 in 189)
Parents who have a child with ASD have a 2%–18% chance of having a second child who is also affected
ASD tends to occur more often in people who have certain genetic or chromosomal conditions; about 10% of children with autism are also identified as having down syndrome, fragile X syndrome, tuberous sclerosis or other genetic and chromosomal disorders
Common Misconceptions of ASD
1. Autism is a single condition
As mentioned previously, the DSM-V has multiple criteria under the diagnosis of ASD which includes the presentation of at least 5 major symptoms (3 symptoms under Deficits in social communication and social interaction and 2 or more under Restricted repetitive behaviours, interests or activities)
Parents of children may attribute one major symptom that their child may be displaying, such as deficits in communication, as a sole result of ASD
2. Only symptomatic children should be screened for ASD
Physicians should be prepared to evaluate any child whose parents raise concerns about their child's development during a routine visit, regardless if the child is not displaying obvious symptoms at that time
3. Since ASD cannot be cured, early intervention offers no benefit
While there is no “cure” for ASD, there are many ASD strategies/supports and proven benefits of early intervention
Strategies/supports can range from diet to medication and behavioral skills development at early development
4. Individuals with ASD are intellectually disabled and can't function independently
Although many people assume that children with ASD are intellectually disabled, less than 1 in 5 (19%) has an intellectual disability
Many adults diagnosed with ASD have trouble with independence an social isolation, as a result of communication deficits etc.
5. Thimerosal vaccines cause ASD
The controversy and concern about a correlation between mercury and ASD began in the late 1990s from a published study suggesting that thimerosal-containing vaccines has lead to increasing incidence of autism.
The correlation has been disproved by a number of studies and further review of the initial studies revealed them to be flawed
Strategies/Supports to Cope With and Manage the Symptoms/Behaviours of ASD
Randomized controlled trials of early developmental and behavioral therapy have shown promise in decreasing ASD symptoms and improving parent-child communication and social engagement
A systematic review found that young children with ASD can improve cognitive performance, language skills, and adaptive behavioral skills through behavioral interventions or more comprehensive approaches using developmental and behavioral frameworks.
A team of health care professionals including developmental pediatrician, psychiatrist, neurologist, speech pathologist, audiologist, physical therapist, and special education teacher, working with families who have children with ASD from the start is essential.
They will help to assess any deficits in early developmental stages, make referrals, and help to establish useful strategies that will benefit the family and child
Early intervention programs that improve communication and social skills can have a significant impact on the individual’s eventual quality of life (QOL), employability, and independence
Picture Exchange Communication System (PECS)
(Flippin, Reszka & Watson, 2010)
PECS is a behaviorally-based pictorial communication system designed for children with social-communicative deficits
Communication skills are targeted through the training of requests and comments.
“Children using PECS are taught to approach and give a picture of a desired item to a communicative partner in exchange for that item. By doing so, the child initiates a communicative act for a concrete item within a social context.”
Delayed language development is an early and persistent marker of autism and should be targeted as early as possible
A Family Approach
(Russa, Matthews, & Owen-DeSchryver, 2013)
Active engagement of family support is essential in order for children with ASD to be able to cope with and manage their symptoms
Parents of children with ASD report more stress than parents of typically developing children before (unusual behaviours or delayed skill development occurs) and after their child is diagnosed (stress of interactions with professionals etc.)
For children with ASD, the family-centered model emphasizes the interdependence of family members where active engagement of parents is recognized as a hallmark of high-quality ASD intervention because parents fulfill a variety of roles for their child such as: an advocate, teacher, collaborator
In order for this type of intervention to become useful, supports for parents must be put in place first such as:
Research and information conducted on their child's rights, diagnosis etc to know what their child may be able to receive for government -issued supports.
Resources relevant to sources of funding, assistive devices, individual education plans etc.
Parent training by specialists: provides parents with the opportunity to learn and practice specialized skills they can use to teach their children such as how to implement behaviour interventions to decrease unwanted behaviours and increase desired behaviours, and teaching social skills and communication
American Psychiatric Association (2013). Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing. Retrieved from http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
American Psychiatric Association (2013). Autism spectrum disorder. American Psychiatric Publishing. Retrieved from http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf
Centers for Disease Control and Prevention (2015). Autism spectrum disorder: data and statistics. National Center on Birth Defects and Developmental Disabilities. Retrieved from http://www.cdc.gov/ncbddd/autism/data.html
The Diagnostic and Statistical Manual
Russa, M. B., Matthews, A. L., & Owen-DeSchryver E.S. (2013). Expanding supports to improve the lives of families of children with autism spectrum isorder. Journal of Positive Behaviour Interventions. 17(2) 95-104. doi: 10.1177/1098300714532134
Savoy, M. (2014). Autism: 5 misconceptions that can complicate care. The Journal of Family Practice. 63(6).