AUTISM SPECTRUM DISORDER

What is Autism?
• Autism is a complex neurodevelopmental disability that
typically appears during the first three years of life
• It is widely recognized as a neurodevelopmental
disorder that affects the functioning of the brain.
• It is a spectrum disorder
• Children with autism are unable to interpret the
emotional states of others, failing to recognize anger,
sorrow or manipulative intent
• It impacts the normal development of the brain in the
areas of social interaction and communication skills
 What is Autism?
• Children and adults with autism typically have
difficulties in verbal and non-verbal communication,
social interactions, and leisure or play activities
• Stereotypic (self-stimulatory) behaviors may be
present
• In some cases, aggressive and/or self-injurious
behaviors might be present
• It is not a behavioral, emotional or conduct disorder
• It is not a mental illness
 Autism Statistics
• 1 in 1,000 individuals are diagnosed with “classic” autism
• 1 in 500 individuals are within the Autism Spectrum
Disorders (Pervasive Developmental Disorders)
• Autism is four times more prevalent in boys than girls
• It has no racial, ethnic or social boundaries
• Family income, lifestyle, and educational levels do not
affect the chance of autism’s occurrence
• Research shows that 50% of children diagnosed with
autism will remain mute throughout their lives
• Approximately 10% of autistic individuals have savant
abilities
 Pervasive Developmental Disorders – DSM
IV TR
• Autism is characterized by delays or abnormal
functioning before the age of three years in
one or more of the following domains: (1)
social interaction; (2) communication; and (3)
restricted, repetitive, and stereotyped
patterns of behavior, interests, and activities.
• Asperger Syndrome can be distinguished from
autism by the lack of delay or deviance in early
language development. Additionally, individuals
with Asperger syndrome do not have significant
cognitive delays. An individual with Asperger
syndrome typically demonstrates obsessive
interest in a single topic or activity. Other
symptoms include repetitive routines or rituals,
peculiarities in speech and language,
inappropriate affect or social behavior, problems
with non-verbal communication, and clumsy or
uncoordinated motor movements.
• Childhood Disintegrative Disorder is
characterized by significant regression or loss
of functioning after at least two years of
typical development. A child who is affected
with this condition may lose communication
skills, nonverbal behaviors, motor functioning,
and/or skills that have already been learned
(such as toy play). Other symptoms include:
lose of bowel and bladder control and
problems forming relationships with peers and
other family members.
• Rett Syndrome appears only in females and is
characterized by multiple deficits after a
period of normal functioning after birth. At
onset, Rett's Disorder is characterized by
deceleration of head growth, loss of
purposeful hand skills, loss of social
engagement and language, and poor physical
coordination.
• Pervasive Developmental Disorder Not Otherwise
Specified
(PDD-NOS) is considered "subthreshold autism"
and "atypical autism" because it is often
characterized by milder symptoms of autism or
symptoms in only one domain (such as social
difficulties). Persons with PDD-NOS may
demonstrate pervasive deficits in the
development of reciprocal social interaction or
stereotyped behaviors, but do not meet the
criteria for a specific pervasive developmental
disorder or other psychological disorders (such as
schizophrenia or avoidant personality disorder).
Autism Spectrum Disorder DSM-V

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):

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 expression 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.
 Digression Re: Criterion A
• “The really fatal flaw here is that no
instructions are given as to whether one item,
two items, or all three items must be present
to make the diagnosis of Autism Spectrum
Disorder. “
» Allen Frances, chairman of the DSM-IV task force. (Blog,
May 25, 2013)
 Autism Spectrum Disorder (DSM-5)
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):
1.  Stereotyped or repetitive motor movements,
use of objects, or speech (e.g., simple motor
stereotypies, 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, difficulty with transitions, rigid
thinking patterns, greeting rituals, need to take
same route or eat same food everyday).
 Autism Spectrum Disorder (DSM-5)

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 hypo-reactivity to sensory input or unusual
interest in sensory aspects of 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 movement).
 Autism Spectrum Disorder (DSM-5)
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.
 Specify if:
• With or without accompanying intellectual
impairment
• With or without accompanying language
impairment
• Associated with a known medical or genetic
condition or environmental factor
• Associated with another neurodevelopmental,
mental, or behavioral disorder
 Severity levels for Autism
Spectrum Disorder

• Level 1: "Requiring Support"

• Level 2: "Requiring Substantial Support"
• Level 3: "Requiring Very Substantial Support
 Autism Spectrum Disorder in DSM-5
• "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."
Social (Pragmatic) Communication
Disorder

A. Persistent difficulties in the social use of verbal and

nonverbal communication as manifested by all of the
following:
1. Deficits in using communication for social purposes,
such as greeting and sharing information, in a manner
that is appropriate for the social context.
2 . Impairment of the ability to change communication to match
context or the needs of the listener, such as speaking differently in a
classroom than on a playground, talking differently to a child than to
an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as
taking turns in conversation, rephrasing when misunderstood, and
knowing how to use verbal and nonverbal signals to regulate
interaction
4. Difficulties understanding what is not explicitly stated (e.g., making
inferences) and nonliteral or ambiguous meanings of language (e.g.,
idioms, humor, metaphors, multiple meanings that depend on the
context for interpretation.
 Social (Pragmatic)
Communication Disorder
B. The deficits result in functional limitations in effective
communication, social participation, social relationships,
academic achievement, or occupational performance,
individually or in combination.
C. The onset of the symptoms is in the early developmental
period (but deficits may not become fully manifest until social
communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or
neurological condition or to low abilities in the domains of
words structure and grammar, and are not better explained by
autism spectrum disorder, intellectual disability (intellectual
developmental disorder), global developmental delay, or
another mental disorder.
 Social (Pragmatic)
Communication Disorder
• ASD is characterized by 1) deficits in social
communication and social interaction and 2)
restricted repetitive behaviors, interests, and
activities (RRBs). Because both components
are required for diagnosis of ASD, social
communication disorder is diagnosed if no
RRBs are present.
– APA (2013).Highlights of Changes from DSM-IV-TR to DSM-5.
 ASD and S(P)CD
• ASD Social • S(P)CD criteria
Communication ― Deficits in using
criteria communication for
– Deficits in social- social purposes
emotional reciprocity — Impairment of the
– Deficits in nonverbal
ability to change
communicative
behaviors used for communication to
social interaction match context or
– Deficits in the needs of the
developing, listener
maintaining and — Difficulties following
understanding rules for
relationships
conversation and
storytelling
— Difficulties
understanding what
 When can Autism be diagnosed?
• Research has shown that ASD can be diagnosed as early as 1 year
of age
– No big smiles or other warm, joyful expressions by six months or
thereafter
– No back-and-forth sharing of sounds, smiles or other facial expressions
by nine months
– No babbling by 12 months
– No back-and-forth gestures such as pointing, showing, reaching or
waving by 12 months
– No words by 16 months
– No meaningful, two-word phrases (not including imitating or repeating)
by 24 months
– Any loss of speech, babbling or social skills at any age
 Symptoms of Children with Autism

Communications
• Avoid eye contact
• Act as if deaf
• Develop language, then abruptly stop talking
• Fail to use spoken language, without
compensating by gesture
Social Relationships
• Act as if unaware of the coming and going of
others
• Are inaccessible, as if in a shell
• Fail to seek comfort
• Fail to develop relationships with peers
• Have problems seeing things from another
person’s perspective, leaving the child unable to
predict or understand other people’s actions
• Physically attack and injure others without
provocation
Exploration of Environment

• Remain fixated on a single item or activity

• Practice strange actions like rocking or hand-flapping
• Sniff or lick toys
• Show no sensitivity to burns or bruises, and engage in
self-mutilation
• Are intensely preoccupied with a single subject, activity
or gesture
• Show distress over change
• Insist on routine or rituals with no purpose
• Lack fear
 What is The Cause of Autism?
 A specific cause is not known, but current research links
autism to biological and neurological differences in the
brain
 Studies of twins in the UK confirm that autism has a
heritable compound but suggest that environmental
influences play a role as well
• By examining the inheritance of the disorder, researchers
have shown that autism does run in families, but not in a
clear-cut way
• Siblings of people with autism have a 3 to 8 percent chance
of being diagnosed with the same disorder
 Treating Autism
• Behavioral Interventions – research suggests that early, intensive
behavioral interventions may improve outcomes for children with autism
and help the children achieve their maximum potential.

• Sensory Integration – integration and interpretation of sensory

stimulation from the environment enhances cognition.

• Diet – people with autism are more susceptible to allergies and food
sensitivities than the average person. The most common food sensitivity
in children with autism is to gluten and casein.

• Vitamin Therapy – parents have reported that they have tried

B6/magnesium and/or DMG, often with good or even spectacular
results.
Teaching Tips for Children with Autism

• Use visuals
• Avoid long strings of verbal instruction
• Encourage development of child’s special
talents
• Use child’s fixations to motivate school work
• Use concrete, visual methods to teach number
concepts
• Let child use a typewriter instead of writing
• Protect child from sounds that hurt his/her ears
• Place child near a window and avoid using fluorescent
lights
• Use weighted vests to calm nervous system
• Interact with child while he/she is swinging or rolled in
a mat
• Don’t ask child to look and listen at the same time
• Teach with tactile learning materials (e.g., sandpaper
alphabet)
• Use printed words and pictures on a flashcard
• Generalize teaching