WHAT IS AN AUTISM SPECTRUM DISORDER?

Autism Spectrum Disorders (ASDs) are developmental disabilities that significantly impair a child’s ability to learn necessary social behavior and other skills in typical settings. According to the Centers for Disease Control the prevalence of ASD is currently 1 in 110 births. Autism is referred to as a spectrum disorder because the manner and degree to which a person may experience the characteristics commonly associated with autism can vary dramatically. All children with ASD experience problems developing social skills. Otherwise, the behavioral characteristics of a child with ASD is highly varied. Some children develop no spoken language at all, others are verbally proficient. Some children demonstrate tantrums, aggression and self-injurious behavior, while others demonstrate none of these behaviors. Some children are highly ritualistic and become agitated when a routine is not followed, others can be flexible. The American Psychological Association has attempted to place some kind of order to the diagnosis by classifying 3 different diagnoses under the ASD umbrella. According to the Diagnostic Statistical Manual 4R used by psychologists, there are 3 forms of ASD that are currently recognized:

• Autism
• Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
• Asperger Syndrome

Leo Kanner first identified 11 children with Autism (LINK to the DSM criteria) in 1943 (which at that time was referred to as “Kanner’s Syndrome”). Since then, the knowledge and questions about the cause of autism and the treatments have continued to grow. It is now known that autism affects a person’s ability to socialize, communicate, and relate to objects in appropriate ways and is classified as a developmental disorder marked by a qualitative impairment in social interaction, communication, and restricted repetitive and stereotyped patterns of behavior, interests, and activities. In order to be diagnosed with autism, a child must exhibit significant problems in these 3 main areas.

First, a child must have a delay in their development of social skills. When you compare a child with autism to their peers, one might notice some differences in the manner in which they interact with peers and with their environment. For example, a child with autism might seem more interested in picking at dirt on the ground or spinning in circles than in participating on the playground. Most children with autism have poor eye contact and have trouble picking up on social cues. Some children have severe social delays, in which they simply do not appear to be interested in others. They might actively avoid engaging with others (particularly other children or adults that may place demands on them) or seem not to be aware of their surroundings. For others the delay is not as clear, but is still clinically significant. They may attempt to interact with peers but exhibit odd social behaviors and therefore be repeatedly rejected by peers. They may show an interest in peers but remain “on the sidelines,” apparently unsure of how to act or what to say.

The second significant problem that must be present to be diagnosed with autism are language and communication delays. Some children with autism develop words very slowly; others develop words, lose them for a period of time, and then slowly regain them once again at a slow pace; some children do not speak until much later in development than expected; and still others gain very few words at all. Many children with autism develop echolalia (repeating words and phrases that have just been said or that they have heard in the past). But it is not just spoken language that is delayed in a child with autism. General communication is affected. A child with autism will likely have trouble understanding and using nonverbal language such as gestures, facial expressions and body language.

The third characteristic of autism is unusual or repetitive behaviors or interests. These difficulties can be presented in any number of ways. Some children engage in self-stimulatory behaviors, such as spinning themselves or objects (such as the wheels of cars or a toy train), visually regarding long and thin objects, smearing, etc. Some children also engage in perseverative behavior, in which they engage in the same behavior repeatedly such as touching an object in the same way each time it is played with, drawing the same shapes each time the child is given a piece of paper, or walking through the school hallway in the same manner each time. These perseverations can take a verbal form as well. More verbally advanced children with autism sometimes exhibit intense interests on topics such as trains, volcanoes, ocean life, animals, movies, etc. Verbal perseverations can be quite challenging to manage, as children often seem only interested in their perseveration and it can be difficult to steer conversations in different directions.

To qualify for PDD-NOS (LINK to the DSM criteria), a child must have symptoms similar to those described above, yet the severity or number of qualifying characteristics may be less than in a child diagnosed with autism. For example, a child with PDD-NOS may have social and communication delays but not many problems with unusual behaviors or intense interests. This diagnosis might be considered a catch-all for the children that do not perfectly fit the criteria for the full diagnosis of autism but who certainly have autistic characteristics.

People with Asperger Syndrome (LINK to DSM criteria) have some similarities to those diagnosed with autism but some characteristics that make it distinct from autism and PDD-NOS. A person with Asperger Syndrome does not have the language delays seen in children with autism and PDD-NOS. In fact, many diagnosed with Asperger Syndrome have superb vocabularies and high IQs as well. However, they generally exhibit intense interests that often impact their ability to succeed in all subjects in school. They also experience difficulties with social skills. A child with Asperger Syndrome may be aware that they are different from their peers, and this can cause collateral emotional problems as well (such as depression). Other children may not recognize their differences as readily, but may be angry or confused as to why adults make so many demands on them (requiring them to do PE, chores, learn about Africa, etc.) while they would be perfectly content reading about volcanoes all day. In school, a child with Asperger Syndrome normally does quite well in certain subjects but struggles in others.