AUTISM SPECTRUM DISORDER
DSM V Diagnostic Criteria-
A. 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 understanding 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.
B. 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).
C. 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).
D. Symptoms cause clinically significant impairment in social, occupational, or other
important areas of current functioning.
E. 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.
HIGH FUNCTIONING-
It is important to understand that autism spectrum disorder (ASD) is a complex
neurodevelopmental disorder that affects individuals in different ways. While high IQ or
intellectual ability is not a defining characteristic of ASD, some individuals with ASD may have
above-average intellectual ability or specific strengths in certain areas.
If a 13-year-old with high functioning ASD has been identified as having above-average
intellectual ability, it may be beneficial to support and encourage their strengths and interests.
This could involve providing opportunities for intellectual and academic enrichment, such as
advanced coursework, extracurricular activities, or specialized programs that cater to their
strengths.
As a psychologist working with a 13-year-old with high functioning ASD, there are a variety of
activities that you could engage in to support their development and well-being. Some potential
activities include:
Cognitive-behavioral therapy: This type of therapy can be helpful for individuals with ASD who
struggle with anxiety or other emotional regulation difficulties. It can help them develop coping
strategies and improve their ability to manage difficult emotions.
Social skills training: As social difficulties are often a hallmark of ASD, social skills training can be
beneficial for helping individuals with ASD navigate social interactions and build positive
relationships with peers.
Executive functioning support: Executive functioning skills, such as planning, organization, and
time management, can be challenging for individuals with ASD. You could work with the
individual to develop strategies and tools for improving these skills.
Special interests and hobbies: Many individuals with ASD have specific interests or hobbies that
they are passionate about. You could support the individual in exploring these interests and
finding ways to integrate them into their daily life.
Mindfulness practices: Mindfulness practices, such as meditation or deep breathing exercises,
can be helpful for individuals with ASD who struggle with sensory overload or anxiety.
Parent education and support: Working with the parents or caregivers of the individual with
ASD can be important for developing a cohesive plan of support and intervention.
LOW FUNCTIONING:
This means that they have significant difficulties with communication, social interaction, and
daily living skills. As a result, they may require more intensive support and care to help them
reach their full potential.
Here are some steps that can be taken to support a 13-year-old with ASD who has low
functioning:
Develop an Individualized Education Plan (IEP): An IEP is a plan that outlines specific goals and
strategies for the child's education. It is developed by a team that includes the child's parents,
teachers, and other professionals. The IEP should be tailored to the child's individual needs and
should address their strengths and weaknesses.
Provide specialized therapy: Depending on the child's needs, they may benefit from specialized
therapies such as speech therapy, occupational therapy, and behavioral therapy. These
therapies can help the child develop important skills and overcome challenges.
Create a structured environment: Children with low functioning ASD often benefit from a
structured environment that provides clear routines and expectations. This can help them feel
more secure and reduce their anxiety.
Use visual aids: Many children with low functioning ASD benefit from visual aids such as
pictures, diagrams, and schedules. These can help them understand concepts and routines
more easily.
Involve the family: The child's family can play an important role in supporting them. They can
work with professionals to develop a treatment plan, provide consistent support at home, and
advocate for their child's needs.
It is important to remember that every child with ASD is unique and may require different levels
of support. Working with a team of professionals can help ensure that the child's needs are
being met and that they are making progress towards their goals.
SENSORY NEED:
Sensory needs refer to an individual's need for sensory input to regulate their arousal levels and
engage with their environment. For individuals with autism spectrum disorder (ASD), sensory
needs can be particularly important, as many individuals with ASD have sensory processing
differences or difficulties.
Some common sensory needs that individuals with ASD may have include:
Sensory seeking: Some individuals with ASD may actively seek out sensory input, such as by
spinning, rocking, or jumping.
Sensory avoiding: Other individuals with ASD may actively avoid certain types of sensory input,
such as loud noises, bright lights, or certain textures.
Sensory sensitivity: Some individuals with ASD may be particularly sensitive to certain types of
sensory input, such as certain sounds or textures. This sensitivity can be overwhelming or
painful for the individual.
Sensory integration difficulties: Some individuals with ASD may have difficulty integrating
sensory information from multiple sources. For example, they may have difficulty distinguishing
between background noise and someone speaking directly to them.
What needs to be done if he has a sensory need?
If a 13-year-old with ASD has social communication difficulties and anger issues, it is possible
that they may also have sensory processing differences or difficulties. In this case, it may be
helpful to provide sensory strategies to support their emotional regulation and communication
skills.
Here are some sensory strategies that could be helpful:
Sensory breaks: When the individual is feeling overwhelmed or frustrated, taking a break to
engage in a sensory activity can help them regulate their emotions. This could include activities
such as using a weighted blanket, doing deep breathing exercises, or taking a sensory walk.
Sensory tools: Providing sensory tools such as fidget toys, stress balls, or chewable jewelry can
provide an outlet for stress and anxiety, and can also help improve focus and attention.
Visual cues: Using visual cues such as social stories or picture schedules can help the individual
understand social situations and expectations, and can also help them anticipate transitions
and changes.
Quiet spaces: Providing a quiet, low-stimulation space for the individual to retreat to when they
feel overwhelmed can be helpful. This could be a designated sensory room, a quiet corner in a
classroom, or a designated safe space at home.
Sensory integration therapy: Working with an occupational therapist trained in sensory
integration therapy can be helpful in identifying specific sensory needs and developing a
sensory diet tailored to the individual's needs.
It is important to note that sensory needs can vary widely between individuals, and what works
for one person may not work for another. It may take some trial and error to find the strategies
that work best for the individual. Working with a team of professionals can be helpful in
identifying and addressing the individual's sensory needs.
BEHAVIOUR MODIFICATION NEEDS:
Behavior modification is a type of therapy that focuses on changing specific behaviors through a
system of rewards and consequences. It can be an effective approach for individuals with ASD
who are struggling with challenging behaviors. Here are some behavior modification strategies
that can be helpful:
Positive reinforcement: Positive reinforcement involves rewarding desired behaviors with
something the individual finds rewarding. This can be a verbal praise, a tangible reward, or
access to a preferred activity. For example, if the individual with ASD is working on improving
their social communication skills, they could be rewarded with extra time on a preferred activity
if they initiate a conversation with a peer.
Token economies: A token economy is a system in which the individual earns tokens for desired
behaviors, which can be exchanged for rewards. For example, the individual with ASD could
earn a token for completing a task or demonstrating appropriate behavior, and could then
exchange the tokens for a preferred item or activity.
Behavior contracts: A behavior contract is an agreement between the individual and the
therapist or caregiver outlining specific goals and rewards for achieving those goals. This can be
particularly effective for older children and adolescents with ASD. For example, the contract
could specify a goal of improving social communication skills, with a reward of a preferred
activity or outing once the goal is achieved.
Functional communication training: Functional communication training involves teaching the
individual with ASD more appropriate ways to communicate their needs and wants. This can
help reduce challenging behaviors that may be occurring as a result of frustration or
communication difficulties.
Differential reinforcement: Differential reinforcement involves rewarding desirable behaviors
while ignoring or redirecting undesirable behaviors. For example, if the individual with ASD is
engaging in inappropriate behavior to get attention, the caregiver or therapist could ignore the
behavior and instead provide attention when the individual engages in appropriate behavior.
DIFFERENCE BETWEEN SOCIAL SKILLS, BEHAVIOUR MODIFICATION NEED AND
OCCUPATIONAL THERAPY:
Social skills, behavior modification needs, and occupational therapy are three different
approaches to addressing challenges faced by individuals with disabilities, including Autism
Spectrum Disorder (ASD). While they may overlap in some areas, they are distinct concepts
with different goals and methods.
Social skills refer to the ability to interact and communicate effectively with others in social
situations. Social skills training is an intervention designed to teach individuals with social
difficulties how to navigate social interactions, such as initiating and maintaining conversations,
understanding social cues and body language, and developing relationships with others.
Behavior modification, on the other hand, is a therapeutic approach aimed at reducing problem
behaviors and increasing positive behaviors. This approach involves identifying the specific
behaviors that need to be modified, setting goals for improvement, and using positive
reinforcement to encourage desired behaviors while decreasing unwanted behaviors.
Occupational therapy (OT) is a type of therapy that focuses on helping individuals develop skills
for daily living and participation in daily activities, such as self-care, work, and play.
Occupational therapy for individuals with ASD can include interventions to improve sensory
processing, fine motor skills, and social skills necessary for daily living.
In summary, while social skills, behavior modification, and occupational therapy can all be
important components of a comprehensive treatment plan for individuals with ASD, they differ
in their specific goals and methods
INDIAN SCALE OF ASSESMENT OF AUTISM (ISAA):
The Indian Scale of Assessment of Autism (ISAA) is a tool developed in India for the assessment
of Autism Spectrum Disorder (ASD). It is designed to be used by mental health professionals,
pediatricians, and educators to assess the severity of symptoms in individuals with ASD.
The ISAA assesses symptoms in three domains: social interaction, communication, and
repetitive behaviors and restricted interests. The assessment is based on information gathered
from multiple sources, including observations of the individual's behavior, interviews with
parents or caregivers, and standardized tests.
The ISAA is designed to be culturally appropriate for use in India and takes into account the
unique social and cultural contexts of the country. It has been validated through research
studies and is considered to be a reliable and valid tool for the assessment of ASD in India.
While the ISAA is a useful tool for assessing the severity of symptoms in individuals with ASD in
India, it is important to note that it should not be used as the sole basis for diagnosis. A
comprehensive assessment of the individual's history, behavior, and development should be
conducted by a trained mental health professional to arrive at an accurate diagnosis of ASD.
VINELAND SOCIAL MATURITY SCALE (VSMS):
The Vineland Social Maturity Scale (VSMS) is a standardized assessment tool used to measure
an individual's social and adaptive functioning. It was first published in 1940 by Edgar Doll, a
psychologist at the University of Chicago, and has since been revised multiple times.
The VSMS assesses an individual's ability to perform daily living skills, such as personal hygiene,
dressing, and communication, as well as their social skills, including interpersonal relationships,
play, and leisure activities. The assessment is completed through interviews with the individual
and their caregivers or family members, and through observation of the individual's behavior.
The VSMS is widely used in clinical and educational settings to assess social and adaptive
functioning in individuals with a wide range of developmental, neurological, and psychiatric
conditions, including Autism Spectrum Disorder (ASD). It has been found to be a reliable and
valid tool for assessing social and adaptive functioning, and can be used to monitor progress
over time.
One of the strengths of the VSMS is its ability to provide a comprehensive picture of an
individual's social and adaptive functioning across multiple domains. This can be particularly
helpful in developing intervention plans that target specific areas of need. However, it is
important to note that the VSMS should be used in conjunction with other assessment tools
and a comprehensive evaluation of the individual's history and behavior to arrive at an accurate
diagnosis and treatment plan.
