Autism Spectrum Disorder

Children with autism are colorful

-they are often very beautiful
and like rainbow they stand out

- Adele Devine -
Autism Spectrum Disorder (ASD)
• as defined by Individuals with Disabilities Education
Act or IDEA (2013), refers to 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.
• the spectrum within ASD are a collective of
neurobehavioral conditions that share in common
primary oddities of socialization and
communication(Schaefer and Luta, 2006).
Primary core deficit areas of ASD;
• Atypical or qualitative impairment in social
interaction,
• qualitative impairment in communication
and
• the presence of repetitive and stereotyped
patterns of behavior or activities
- David and Tsung, 2009.
• ASD is a paradigmatic condition among a class
of disorders marked by social and
communication deficits and behavioral rigidities
(American Psychiatric Association).

• Behaviors associated to ASD such as resistance

to environmental change or change in daily
routines, and unusual responses to sensory
experiences. (Diagnostic Statistical Manual V)
Types of Autism Spectrum Disorder

Classic Autism
• New (2012) characterizes children with classic autism to have
severe challenges, including impaired social and
communication interaction leading to difficulty in conversing
and relating to people.
• Qualitative impairment in social interaction marked
impairment in the use of multiple nonverbal behaviors, such
as eye-eye gaze, facial expression, body postures, and
gestures to regulate social interaction leading to difficulty in
conversing and relating to people.
• Classic autism may show repetitive or stereotyped
behavior and maybe hypersensitive to their
environment. Further, this explains why some children
with classic autism are distressed to certain sounds,
colors and textures and are anxious to differing
schedules and routines.
• Moreover, Research Autism (2016), an organization in
advocate for children with autism named other terms
for classic autism such as childhood autism, early
infantile autism and Kanner’s syndrome or infantile
psychosis.
Asperger’s Syndrome
• Asperger’s Syndrome displays symptoms that fits the
Autism Spectrum Diagnosis but presents a milder indicator
of ASD (New, 2012).
• It is characterized by social and communication skill
deficits, relatively exceptional language and cognitive
development , and the presence of idiosyncratic interests.
Moreover, individuals with Aspe rge r ’s Disorde r
frequently use pedantic speech as well as scientific or
technical vocabulary with an avoidance of slang.
• Rudy(2016) added how this type of autism is sometimes
labelled as “geek syndrome” or little professor syndrome.”
• Furthermore, because children with type of autism often interpret
things literally, they can appear socially awkward. Although
they generally test at an average to above average intelligence
level, they are usually perceived as immature and overly
emotional.
• Often not understanding conventional social rules, people with
Asperger’s Disorder appear to demonstrate a lack of “empathy”
by making limited eye contact, appearing to be unengaged in a
conversation, and being confused by the use of gestures.
• However, Risi (2012) explains that rather than a lack of empathy ,
brains of individuals with Asperger’s Disorder are differently
wired causing them to sometimes perceive things differently
from other people and often has different values and priorities
Childhood Disintegrative Disorder
• Developed in children who seem to be developing typically
by achieving the age-appropriate milestones until the child
reach the ages of three to five.
• According to Tambongan et. Al (2014), children with
Childhood Disintegrative Disorder stop talking, lose potty-
training skills, and stop socializing.
• The Special Education Guide (2013) even adds that they
may stop playing, less motor skills, and fail to make friends.
• Further, it was explored that children with this disorder
usually develop severe intellectual disabilities
Rett’s Disorder
• Developmental Disorder , not degenerative, that is mostly
prevalent in girls. Generally symptoms appear after an early
period of what seems to be usual development.
• Then the child displays a slowing down or stagnation of
skills and most likely can profoundly impair the child’s
ability to use her hands as she did before (Rudy,2016).
• Other problem may include seizures and disorganized
breathing patterns, walking on the toes, sleep problems, a
wide-based gait, difficulty chewing, slowed growth and
cognitive disabilities
Pervasive Developmental Disorder Not Otherwise Specified
(PDD-NOS)

• A disorder that often is not obvious as autism but were used

to describe individuals who did not fully fit the criteria for
other specific diagnoses but are nevertheless autistic thus
termed atypical autism (Research Autism,2016).
• People with PDD-NOS show symptoms of autism at various
times , but not often enough to get a full diagnosis of autism
thus leading to misintervened needs in social and speech.
History

Worldwide
• In 1908 the word autism was first used(Smith,2014).
Was actually been on the books for more than 70 years.
• 1943 American child psychiatrist Leo Kanner, publish a paper describing
11 children who were highly intelligent but displayed “a powerful desire for
aloneness” and “an obsessive insistence on persistent sameness.” He later
named their condition “early infantile autism.”
• 1944 a German Scientist named Hans Asperger described a “milder” form
of autism now known Asperger’s Syndrome. The case he reported were all
boys who were highly intelligent but had trouble with social interactions
and specific obsessive interest. He describe Asperger Syndrome as a type
of personality disorder.
• 1967, psychologist Bruno Bettelhein popularized the theory
that “refrigerator mothers,” as he termed them, caused autism
by not loving their children enough.
• 1968 Leo Kanner first describe autism disorder, though his
focus was on classic autism.
• Post –World War II, Psychoanalytic researches done on
autism. They looked solely on the impact of autism to the life
experiences of persons having such conditions (State,2012).
• Also reiterated that little consideration on the role of biology
or genetics was made, knowing that it was the main cause of
the disorder.
• 1967, Autism was classified under Schizophrenia in the International
Statistical Classification of Diseases and Related Health Problems
although overtime scientists made no known links between the
conditions.
• 1977 a research was conducted on twins that proved that autism is
largely caused by genetics and biological differences in brain
development (Hallmayer, 2012)
• 1980, “Infantile autism” is listed for the first time in the Diagnostic
and Statistical Manual of Mental Disorders(DSM); the condition was
officially separated from Childhood Schizophrenia
• 1987 DSM replaced “Infantile autism” with a more expansive
definition of “autism disorder” including a checklist of diagnostic
criteria
• 1988, psychologist Ivar Lovaas, published the first study showing
how intensive behavior therapy can help children with autism.
• In the same year, a movie entitled Rain Man was released starring a
child with savant autism, who has a photographic memory and can
calculate huge numbers in his head.
• 1991, the federal government made autism a special education
category. Public school begun identifying children on the spectrum
and offered them special services.
• 1994, Asperger’s syndrome is added to the DSM, expanding the
autism spectrum to include milder cases in which individuals tend to
be more highly functioning.
• 1998, a study published in The Lancet suggested that the measles-
mumps-rubella (MMR) vaccine causes autism
• 1998 vaccine manufacturers started to remove thimerosal ( a mercury
based preservative ) from all routinely given to children due to public
fears on its effect . But in 2000, the vaccine linked on autism has been
debunked.
• 2003, the U.S. Centers for Disease Control and Prevention (CDC)
estimated that one in 110 children have autism spectrum disorder and
up from one in 150 in 2017. CDC noted that the increase was due to
the improved screening and diagnostic techniques.
• 2013, the DSM – V folded all subcategories of the condition into one
umbrella diagnosis of Autism Spectrum Disorder(ASD).
Asperger’s syndrome is no longer considered separate condition.
ASD is defined by two categories
1. Impaired social communication and/or interaction
2. Restricted and/or repetitive bahaviors.
History

Philippines
• 1987, the birth of ASD in the Philippines as 11 mothers of children
with autism got together to share their experiences, concerns and
sorrows they feel regarding their children and their way of parenting
(Autism Society,2014).
• They tried to explore all possibilities of seeking help, gone through
seminars from pediatricians, psychologist, psychiatrists and therapist
and ended up more confused.
• Until they have come to sense that only parents of children with
autism can really understand their situation.
• March 8, 1989, the Foundation for Autistic Children and
Adults of the Philippines or ACAP Foundation was
formally organized and recognized, as these mothers to be
the first pioneers and advocates of ASD advocates of the
Philippines
• October 1988 a magazine published an issue about autism
and became the defining point for the organization to gain
more parents attending their meetings.
• From 11 committed parents to expand to 52 members and
the organization set branches in Davao, Cagayan de Oro
and Cebu.
• The organization started to set activities such as raising
funds to buy books to utilized by children they are helping,
setting garage sales and giving seminars

• ACAP also started to connect with other organizations

with the same mission and vision such as Autism Society
America, the National Council for the Welfare of
Disabled Persons(NCWDP) and the Kapisanan ng May
Kapansanan sa Pilipinas, Inc. (KAMPI)
CHARACTERISTICS
Social Skills Deficits
• Children with ASD exhibit deficits in social relatedness defined as the
inherent drive to connect with others and share complementary
feeling states (Diagnostic Statistical Manual V).
• Children with ASD often do not appear to seek connection with other
people.
• They are usually contented being alone, ignore their parents' efforts
for attention, and seldom make eye contact or attempt to catch others'
attention with gestures or vocalizations.
• In later years, they have difficulty sharing the emotional state of
others in cooperative games and group settings and may have few, if
any, friends
• Deficits in joint attention seem to be one of the most
distinguishing characteristics of very young children with
ASD.
• Turner, Stone, Pozdol and Coonrod(2006) defines joint
attention as a typical, spontaneously occurring behavior
whereby the infant shows enjoyment in sharing an object (or
event) with another person by looking back and forth
between the two.
• Later, gestures and/or speech also can be used to engage
another's attention with regard to the objects and events
simply for the enjoyment of sharing the experiences.
• Leekam and Ramsden (2006) state that just like other developmental skills, development of
joint attention skills is a milestone. It occurs in stages beginning in the first few months of life.
• Similar to language skills, receptive joint attention skills usually are mastered before
expressive skills.
• Joint attention begins with joyous smiling in recognition of and response to a parent or familiar
caregiver's smiles and vocalizations.
• MacDonald, Anderson and Dube (2006) added that approximately 8 months; an infant will
follow the parent's gaze and look in the same direction when a parent looks away.
• Children begin to "follow a point" at approximately 10 to 12 months of age.
• If a parent points in the direction of an interesting object or event and says, "Look!" the
typically developing child will look in the intended direction and then, after seeing the
object/event, look back at the parent in acknowledgment and shared expression. However,
infants with ASD may not follow a point, even when one tries repeatedly in a loud voice
calling their name or uses physical prompts, such as touching the child's shoulder before
pointing.
• They may look in the indicated direction eventually, but this is not followed by shared looking
and expression (Zwaigenbaum,Bryson, Rogers, Roberts, Brian and Szatmari, 2005).
• At about 12- 14 months, the typically developing child will begin
himself to initiate a point, at first to request a desired object that is out
of reach and later, to draw the parent's attention to share an interesting
object, person, or event.
• Depending on his speech skills, he may utter simple sounds or actual
words while pointing.
• Though deficits vary, some children with ASD may make rudimentary
pointing efforts by opening and closing their hand while it is raised in
the direction of the desired item but without any back-and-forth
looking between it and the caregiver (Zwaigenbaum,Bryson, Rogers,
Roberts, Brian and Szatmari, 2005)
• At 14 to 16 months, the typically developing child will begin to point
simply to"comment" about or "share" an interesting object/event.
• As he points, he will look alternatively between the object/event of
interest and the parent. It is the shared social experience, not the
tangible object/ event that the child seeks.
• Unfortunately MacDonald, Anderson and Dube (2006) found that
children with ASD consistently fail to point to "comment" at age-
appropriate times, and when they do, they are less likely to show
positive affect and connectedness during the act. Some high-
functioning children with ASD may point to label objects, shapes, and
colors that they have learned in a rote fashion, but this often is done
without any intent of communicating in a social context and is not
considered joint attention.
• In addition, social referencing is the ability to recognize the emotional states of
others as to respond to various stimuli.
• When faced with a situation, a typically developing infant might look to his
mother for an indication of delight, anger, or fear in her facial expression.
• His facial expression then usually will mimic hers, although he may not fully
understand the situation.
• But Wether by, Watt, Morgan and Shumway(2007) indicates that a child with an
ASD engages in less imitation.
• Because children with ASD lack fundamental social skill building blocks, they
may be less likely to develop appropriate peer relationships according to age
and language ability.
• They may have few or no friends, and when they do, the relationships may
evolve around the child's own special interests. Another factor that impedes
lasting friendships is impaired central coherence or the inability to interpret
stimuli in totality. Instead, they focus on the parts, make less use of context, and
miss the "big picture," which makes social interactions challenging.
Communication Deficits

• Lack of speech has been considered a hallmark of ASD,

especially when it is associated with the lack of desire to
communicate and lack of nonverbal compensatory efforts
such as gestures.
• However, children with milder symptoms, especially those
with customary cognitive skills, may have some speech.
• Their speech may not be functional or fluent and may lack
communicative intent. It can be scripted (from favorite videos
or television programs) and stereotypic (Mitchell, Brian,
Zwaigenbaum,Roberts, Szatmari, Smith and Bryson S(2006).
• Echolalia, sometimes called "parroting," is the repetition of another
person's speech.
• Echolalia is classified as "immediate" when the child repeats
vocalizations promptly after hearing them or "delayed" when there is
a time lapse (hours, days,weeks).
• Typically developing children pass through a "vocabulary-burst
stage," when brief periods of immediate echolalia are not unusual
(Mitchell, Brian, Zwaigenbaum,Roberts, Szatmari, Smith and Bryson
S(2006).
• On the other hand, echolalia in children with ASD may persist throughout the
life span and consist of a mixture of immediate and delayed varieties.
• Utterances of children with ASD may be more clearly articulated, have a more
monotone quality,and/or consist of larger verbal "chunks" (ie, entire television
advertisement jingles,video reenactments, or recitations of nursery rhymes) than
those of typically developing children.
• Sometimes, echolalia may even give the impression of "advanced"speech
because of sophisticated vocabulary, grammar, and syntax. Others may develop
advanced verbal reading without corresponding comprehension skills.
• Some children with ASD say "pop-up words" without any apparent stimulus or
communicative intent(Rudy, 2016).
• They are spontaneous and inconsistent, although some- times they may occur
during acutely stressful situations.
• These words are said out of context for a short period of time (days or weeks)
and then, as suddenly as they might pop up for no apparent reason, they
Regression

• Approximately 25% to 30% of children with ASD begin to say words

but then stop speaking, often between the ages of 15 and 24 months
(Tuchman and Rapin,2007).
• Regression of skills in children with ASD may include loss of gestural
communication and social skills or a combination of both.
• Regression can be gradual or sudden, and it may be superimposed on
subtle preexisting developmental delays or atypical development, such
as an unusually intense interest in objects or other nonsocial stimuli
during the first year of life. (Maestro, Muratori, Cesari,
Pecini,Apicella and Stern, D.,2006)
Play Skills
• Lack of, or significantly delayed, pretend play skills coupled with persistent sensory-motor
and/or ritualistic plays are characteristic of ASD.
• Some children with severe ASD may never progress past the sensory motor play stage.
• They mouth, twirl,bang, and manipulate objects in a stereotypic or ritualistic manner.
• The play of children with ASD often is repetitive and lacks creativity and imitation (Diagnostic
Statistical Manual V).
• Typical examples include spinning the wheels or lining up cars instead of "driving" them,
arranging crayons instead of coloring with them or stacking blocks in the same sequence time
after time.
• Often they prefer to play with common objects (string, sticks, rocks, or ballpoint pens) rather
than store-bought toys with the exception of trains or characters from favorite videos and
television shows(Gernsbacher, Dissanayake, Goldsmith, Mundy, Rogers and Sigman, 2005).
• Moreover,children with ASD often are content to play alone for hours, requiring little attention
or supervision.
• Often this "play" is either constructive (puzzles, computer games, and blocks), ritualistic
(lining objects up or sorting/matching shapes or colors) or sensory motor (mouthing, banging,
twirling) in nature.
Restricted, repetitive, and stereotyped patterns of behavior
• Children with ASD can demonstrate atypical behaviors in a variety of areas
including peculiar mannerisms, unusual attachments to objects,
obsessions,compulsions, self-injurious behaviors, and stereotypies.
Stereotypes are repetitive, nonfunctional, atypical behaviors such as hand
flapping, finger movements, rocking, or twirling (Chawarska and Volkmar,
2005).
• Although most stereotypies are harmless,they are problematic in that they
may prevent the child from accomplishing a task or learning new skills.
• Most children, at some time during their early development, form
attachments with a stuffed animal, special pillow, or blanket.
• Moreover, the attachment is more persistent, in that they may insist on
holding the object at all times, although these are rarely, if at all, used in
real "play" (Gernsbacher, Dissanayake, Goldsmith, Mundy,Rogers and
Sigman, 2005).