Autism spectrum

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Autism spectrum

Other names Autism spectrum disorder (ASD), autism spectrum

condition (ASC)[1]

Repetitively stacking or lining up objects is associated with autism.

Specialty Psychiatry

Symptoms Problems with communication, social interaction,

restricted interests, repetitive behavior[2]

Complications Social isolation, employment problems, family

stress, bullying[3]

Usual onset By the age of 3 years[4]

Risk factors Advanced parental age, exposure

to valproate during pregnancy, low birth weight[2]

Diagnostic Based on symptoms[5]

method

Differential Intellectual disability, Rett

diagnosis syndrome, ADHD, selective mutism, childhood-

onset schizophrenia[2]

Treatment Behavioral therapy,[6] psychotropic medication[7]

Frequency 1% of people[2] (62.2 million 2015)[8]

Autism spectrum, also known as autism spectrum disorder (ASD), is a range of mental
disorders of the neurodevelopmental type. It includes autism and Asperger syndrome. Individuals
on the spectrum often experience difficulties with social communication and interaction and
restricted, repetitive patterns of behavior, interests, or activities. Symptoms are typically
recognized between one and two years of age.[2] Long-term problems may include difficulties in
performing daily tasks, creating and keeping relationships, and maintaining a job.[9]
The cause of autism spectrum is uncertain.[5] Risk factors include having an older parent, a family
history of autism, and certain genetic conditions.[5] It is estimated that between 64% and 91% of
risk is due to family history.[10] Diagnosis is based on symptoms.[5] The DSM-5 redefined the
autism spectrum disorders to encompass the previous diagnoses of autism, Asperger
syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood
disintegrative disorder.[11]
Treatment efforts are generally individualized, and can include behavioural therapy and the
teaching of coping skills.[5] Medications may be used to try to help improve symptoms.[5] Evidence
to support the use of medications, however, is not very strong.[7]
Autism spectrum is estimated to affect about 1% of people (62.2 million globally as of
2015).[2][8] Males are diagnosed more often than females.[9] The term "spectrum" can refer to the
range of symptoms or their severity, leading some to favor a distinction between severely
disabled autistics who cannot speak or look after themselves, and higher functioning autistics.

Signs and symptoms[edit]

Autism is characterized by persistent deficits in social communication and interaction across
multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities.
These deficits are present in early childhood, and lead to clinically significant functional
impairment.[22] There is also a unique form of autism called autistic savantism, where a child can
display outstanding skills in music, art, and numbers with no practice.[23] Because of its relevance
to different populations, self-injurious behaviors (SIB) are not considered a core characteristic of
the ASD population however approximately 50% of those with ASD take part in some type of SIB
(head-banging, self-biting) and are more at risk than other groups with developmental disabilities

Behavioral characteristics[edit]
Autism spectrum disorders include a wide variety of characteristics. Some of these include
behavioral characteristics which widely range from slow development of social and learning skills
to difficulties creating connections with other people. They may develop these difficulties of
creating connections due to anxiety or depression, which people with autism are more likely to
experience, and as a result isolate themselves.[29] Other behavioral characteristics include
abnormal responses to sensations including sights, sounds, touch, and smell, and problems
keeping a consistent speech rhythm. The latter problem influences an individual's social skills,
leading to potential problems in how they are understood by communication partners

Developmental course[edit]
Autism spectrum disorders are thought to follow two possible developmental courses, although
most parents report that symptom onset occurred within the first year of life.[31][32] One course of
development is more gradual in nature, in which parents report concerns in development over
the first two years of life and diagnosis is made around 3–4 years of age. Some of the early signs
of ASDs in this course include decreased looking at faces, failure to turn when name is called,
failure to show interests by showing or pointing, and delayed imaginative play.[33]
A second course of development is characterized by normal or near-normal development
followed by loss of skills or regression in the first 2–3 years. Regression may occur in a variety of
domains, including communication, social, cognitive, and self-help skills; however, the most
common regression is loss of language

Communication skills[edit]
Communication deficits are generally characterized by impairments regarding joint attention and
social reciprocity, challenges with verbal language cues, and poor nonverbal communication
skills [43] such as lack of eye contact and meaningful gestures and facial expressions.[44] Language
behaviors typically seen in children with autism may include repetitive or rigid language, specific
interests in conversation, and atypical language development.[44] ASD is a complex pragmatic
language disorder which influences communication skills significantly.[45] Many children with ASD
develop language skills at an uneven pace where they easily acquire some aspects of
communication, while never fully developing other aspects.[44] In some cases, individuals
remain completely nonverbal throughout their lives, although the accompanying levels of literacy
and nonverbal communication skills vary

Social skills[edit]
Social skills present the most challenges for individuals with ASD. This leads to problems with
friendships, romantic relationships, daily living, and vocational success.[39] Marriages are less
common for those with ASD. Many of these challenges are linked to their atypical patterns of
behavior and communication. It is common for children and adults with autism to struggle with
social interactions because they are unable to relate to their peers

Causes[edit]
Main article: Causes of autism
While specific causes of autism spectrum disorders have yet to be found, many risk factors
identified in the research literature may contribute to their development. These risk factors
include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and
environmental factors. It is possible to identify general risk factors, but much more difficult to
pinpoint specific factors. Given the current state of knowledge, prediction can only be of a global
nature and therefore requires the use of general markers

Genetic risk factors[edit]

As of 2018, understanding of genetic risk factors had shifted from a focus on a few alleles, to an
understanding that genetic involvement in ASD is probably diffuse, depending on a large number
of variants, some of which are common and have a small effect, and some of which are rare and
have a large effect. The most common gene disrupted with large effect rare variants appeared to
be CHD8, but less than 0.5% of people with ASD have such a mutation. Some ASD is
associated with clearly genetic conditions, like fragile X syndrome; however only around 2% of
people with ASD have fragile X

Prenatal and perinatal risk factors[edit]

Several prenatal and perinatal complications have been reported as possible risk factors for
autism. These risk factors include maternal gestational diabetes, maternal and paternal age over
30, bleeding after first trimester, use of prescription medication (e.g. valproate) during pregnancy,
and meconium in the amniotic fluid. While research is not conclusive on the relation of these
factors to autism, each of these factors has been identified more frequently in children with
autism, compared to their siblings who do not have autism, and other typically developing
youth.[53] While it is unclear if any single factors during the prenatal phase affect the risk of
autism,[54] complications during pregnancy may be a risk.[54]
Low vitamin D levels in early development has been hypothesized as a risk factor for autism.

Treatment[edit]
Main article: Autism therapies
There is no known cure for autism, although those with Asperger syndrome and those who have
autism and require little-to-no support are more likely to experience a lessening of symptoms
over time.[106][107][108] The main goals of treatment are to lessen associated deficits and family
distress, and to increase quality of life and functional independence. In general, higher IQs are
correlated with greater responsiveness to treatment and improved treatment
outcomes.[109][110] Although evidence-based interventions for autistic children vary in their methods,
many adopt a psychoeducational approach to enhancing cognitive, communication, and social
skills while minimizing problem behaviors. It has been argued that no single treatment is best and
treatment is typically tailored to the child's needs.[111]
Intensive, sustained special education programs and behavior therapy early in life can help
children acquire self-care, social, and job skills. Available approaches include applied behavior
analysis, developmental models, structured teaching, speech and language therapy, social
skills therapy, and occupational therapy.[111] Among these approaches, interventions either treat
autistic features comprehensively, or focus treatment on a specific area of deficit.[110] Generally,
when educating those with autism, specific tactics may be used to effectively relay information to
these individuals. Using as much social interaction as possible is key in targeting the inhibition
autistic individuals experience concerning person-to-person contact. Additionally, research has
shown that employing semantic groupings, which involves assigning words to typical conceptual
categories, can be beneficial in fostering learning.[112]
There has been increasing attention to the development of evidence-based interventions for
young children with ASD. Two theoretical frameworks outlined for early childhood intervention
include applied behavioral analysis (ABA) and the developmental social-pragmatic
model (DSP).[110] Although ABA therapy has a strong evidence base, particularly in regard to early
intensive home-based therapy, ABA's effectiveness may be limited by diagnostic severity
and IQ of the person affected by ASD.[113] The Journal of Clinical Child and Adolescent
Psychology has deemed two early childhood interventions as "well-established": individual
comprehensive ABA, and focused teacher-implemented ABA combined with DSP.[110]
Another evidence-based intervention that has demonstrated efficacy is a parent training model,
which teaches parents how to implement various ABA and DSP techniques
themselves.[110] Various DSP programs have been developed to explicitly deliver intervention
systems through at-home parent implementation.
A multitude of unresearched alternative therapies have also been implemented. Many have
resulted in harm to autistic people and should not be employed unless proven to be safe.[111]
In October 2015, the American Academy of Pediatrics (AAP) proposed new evidence-based
recommendations for early interventions in ASD for children under 3.[114] These recommendations
emphasize early involvement with both developmental and behavioral methods, support by and
for parents and caregivers, and a focus on both the core and associated symptoms of
ASD.[114] Studies on pet therapy have shown positive effects

CASE STUDY
Junaid: Excitement and Joy Through Pictures and Speech

by Aniketh Sam

Junaid is a 3-year-old boy with ASD who was referred to a university speech and
hearing center by a local school district. He attended a morning preschool at the
university center for one year in addition to his school placement.
History

Birth and Development

Junaid was a full-term baby delivered with no complications. Junaid’s mother reported
that as a baby and toddler, he was healthy and his motor development was within
normal limits for the major milestones of sitting, standing, and walking. At age 3 he was
described as low tone with awkward motor skills and inconsistent imitation skills. His
communication development was delayed; he began using vocalizations at 3 months of
age but had developed no words by 3 years.

Communication Profile at Baseline

Junaid communicated through nonverbal means and used communication solely for
behavioral regulation. He communicated requests primarily by reaching for the
communication partner’s hand and placing it on the desired object. When cued, he used
an approximation of the “more” sign when grabbing the hand along with a verbal
production of /m/.

He knew about 10 approximate signs when asked to label, but these were not used in a
communicative fashion. Protests were demonstrated most often through pushing hands.
Junaid played functionally with toys when seated and used eye gaze appropriately
during cause-and-effect play, but otherwise eye gaze was absent. He often appeared to
be non-engaged and responded inconsistently to his name.

Assessment

The Communication Symbolic and Behavior Scales Developmental Profile was used to
determine communicative competence. This norm-referenced instrument for children
6–24 months old is characterized by outstanding psychometric data (i.e.,
sensitivity=89.4%–94.4%; specificity=89.4%). Although Junaid was 36 months old, this
tool was chosen because it provides salient information about social communication
development for children from 6 months to 6 years old.

Intervention

Junaid’s team and family members developed communication goals that included
spontaneously using a consistent communication system for a variety of communicative
functions and initiating and responding to bids for joint attention. Research suggests
that joint attention is essential to the development of social, cognitive, and verbal
abilities .

Because Junaid could not meet his needs through verbal communication, AAC was
considered. He had been taught some signs but did not use them communicatively. More
importantly, his motor imitation skills were so poor that it was difficult to differentiate
his signs. His communication partners would need to learn not only standard signs, but
Junaid’s idiosyncratic signs. Therefore, the Picture Exchange Communication System
was chosen to provide him with a consistent communication system. Additionally, a
visual schedule was used at home and school to aid in transitions and to increase his
symbolization.

Incidental teaching methods including choices and incomplete activities were

embedded in home and preschool routines. In addition, a variety of joint activity
routines (e.g., singing and moving to “Ring Around the Rosie” or “Row Your Boat” while
holding hands) that were socially pleasing to Junaid were identified. These were infused
throughout his day in various settings and with various people. Picture representations
of these play routines also were represented in his PECS book.

Research

Several evidence-based strategies were chosen to support intervention, including PECS ,

visual supports and incidental teaching .

Outcomes

By the end of the year, a video taken at preschool showed that Junaid was
spontaneously using PECS for requests and protests. He was using speech along with his
PECS requests in the “I want” format. He also used speech alone for one-word requests
and for automatic routines such as counting or “ready, set, go.” He shared excitement
and joy in several joint activity routines with various people and referred to their facial
expressions for approval and reassurance.