Autism

IDEA 2004 Definition

A developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.


What are the characteristics of Autism?

The features of Autism include markedly impaired social interaction, communication, and a restricted repertoire of activity and interests. To qualify for a diagnosis of Autism Spectrum Disorder, there must e evidence of delays in social, interaction, language used in social communication, or imaginative play prior to three years of age. A person with autism may have a range of behavioral symptoms, including hyperactivity, inattention, impulsivity, aggressiveness, and self injurious behaviors, and tempter tantrums. Additionally he or she may be oversensitive or under sensitive to sensory stimuli.

The way a person with Autism views the world is so unique that a wide variety of challenges are present. Functioning in the world that they see so differently than the rest of us, it is often very difficult not only for the person with the disorder, but for his or her parents, and educators as well. People with Autism tend to understand the world as black and white, yet most of us view the world in gray.

A student with Autism may have difficulty relating to people and reading social cues. They may not be able to understand any point of view other than their own or they may focus on details without understanding the whole. The students often have few facial expressions and may experience difficulty reading the body language of others.

Routines are very important to a person with Autism, and any change can create a crisis in his or her mind. Additionally, they may have an unusual sensitivity to sensory stimuli such as the sound of the heater running or a light no one else notices. A person may have an interest that becomes an obsession and he or she will become an “expert” in that area.


DSM-5 Diagnostic Criteria for 299.00 Autism Spectrum Disorder

  1.  Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
    1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
    2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
    3. Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

 

  1. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
    1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
    2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
    3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
    4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

 

  1. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
  2. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
  3. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.


Tools used to help diagnose Autism

A psychologist, psychiatrist, or medical doctor can diagnose Autism. However, it is recommended that the professional should have expertise in the area of Autism. Communication between professionals and a thorough evaluation with multiple modes of assessment is essential. (See SPED testing for more information)

  • Autism evaluations such as the ADOS.  The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured, standardized assessment of communication, social interaction, and play or imaginative use of materials for children who have been referred because of possible autism spectrum disorders. The ADOS consists of four modules that each contains a group of activities designed for use with children or adults at a particular developmental and language level. The ADOS assessment uses an arena assessment and scoring model.
  • Clinical Interview – A professional will discuss the symptoms with the parent and ask questions related to the DSM-IV criteria. A lot of focus will be spent on early development and social skills.  The Autism Diagnostic Inventory, Revised (ADI-R) is an extensive interview completed with the parent or caregiver and is designed to elicit a full range of information needed to determine the likelihood of an individual having autism or an autism spectrum disorder. The interview focuses primarily on communication, social interactions, and stereotyped behaviors and restricted interests.
  • Rating Scales A rating scale will often be provided to parents, teachers, and the students to obtain information from multiple sources. These scales are useful because they help to quantify the degree of the problem by comparing the students symptoms to other children of the same age and gender.
  • Observation – Watching the child in her natural environment can help a professional see if she is displaying characteristics associated with Autism. This usually occurs in the classroom, but it is good to see a child across settings and in less structured events such as recess or lunch.
  • Educational testing data – cognitive and academic assessments are important to determine strengths and weaknesses, as well as his style of learning.
  • Medical records– to ensure the problems are not related to another medical disorder.

 


Treatment

Early intervention is recommended to help with social and educational training while a child’s brain is still forming. If you suspect Autism in your child, do not wait to have an evaluation or begin treatment.

  • Special Education Services – Talk to his teacher to see if an eligibility meeting can be convened to determine if your child is eligible to receive special education services at school. (See SPED referrals for more information)
  • Parent education and training – This may help parents understand their child better as well as give specific strategies to help. Look for groups in your area.
  • Social skills training – This will help your child better understand conventional social norms.
  • Speech and Language Therapy – Assist in pragmatics of language.
  • Sensory integration training – A child is desensitized to stimuli to which he is overly sensitive

 


References
  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

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