AUTISM SPECTRUM

DISORDER
Autism spectrum disorder

◦ Autism spectrum disorder (ASD) is a neurodevelopmental disorder

that, at its core, affects how one perceives and socializes with others
◦ DSM 5 – Category falls under neurodevelopmental disorders

◦ ICD 10- Categorized in pervasive developmental disorders which

comes under disorders of psychological development

◦ PREVALENCE-1 IN 68
Two major characteristics of ASD are expressed in DSM-5:
◦ 1) impairments in social communication and social interaction, and
◦ 2) restricted, repetitive patterns of behavior, interests, or activities
◦ In addition, DSM-5 recognizes that the impairments are present in
early childhood and that they limit daily functioning.
Examples of Problems with communication and social interaction :

◦From birth: trouble maintaining eye contact

◦By 9 months: not responding to their name
◦By 9 months: not displaying facial expressions reflective of their emotions (like
surprise or anger)
◦By 12 months: not engaging in basic interactive games, like peek-a-boo or pat-a-cake
◦By 12 months: not using (or only using a few) hand gestures, like hand-waving
◦By 15 months: not sharing their interests with others (by showing someone a favorite
toy, for example)
◦By 18 months: not pointing or looking where others point
◦By 24 months: not noticing when others appear sad or hurt
◦By 30 months: not engaging in “pretend play,” like caring for a baby doll or playing
with figurines
◦By 60 months of age: not playing turn-taking games, like duck-duck goose
Examples of Restricted /repetitive behaviours
◦ repetitive movements, like rocking, flapping their arms, spinning, or running back and
forth
◦ lining objects, like toys, up in strict order and getting upset when that order is disturbed
◦ attachment to strict routines, like those around bedtime or getting to school
◦ Repeating  words or phrases they hear someone say over and over again
◦ getting upset over minor changes
◦ focusing intently on parts of objects
◦ unusual reactions to sensory input, like sounds, smells, and tastes
◦ obsessive interests
◦ exceptional abilities, like musical talent or memory capabilities
DSM-5 introduced three levels of severity:
`
◦ Level 1— “Requiring support,”
◦ Level 2— “Requiring substantial support,”
◦ Level 3— “Requiring very substantial support.”
◦ Separate ratings are provided for social/ communication interaction and
for restricted interests and repetitive behaviors.
◦ Each level of support is described qualitatively and, as yet, has no
quantitative equivalent.
◦ TYPES THAT COME UNDER AUTISM SPECTRUM DISORDERS
Task---to find out details of the following
and their inclusion in DSM5
◦ ASPERGERS SYNDROME
◦ RETT SYNDROME
◦ CHILDHOOD DISINTEGRATIVE DISORDER
◦ KANNERS SYNDROME
◦ PERVASIVE DEVELOPMENTAL DISORDER (OTHERWISE NOT SPECIFIED)
Task???
◦ Any famous people????

◦ Asperger?ASD?
 DSM5
A. Persistent deficits in social communication and social interaction
across multiple contexts, as manifested by the following,
◦ 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(joint attention), emotions,
and 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 and 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
1. Stereotyped or repetitive motor movements, use of objects or, speech;
(e.g., simple motor stereotypes, lining up toys or flipping objects).
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,).
3.Highly restricted, fixated interests that are abnormal in intensity or focus
(e.g., strong attachment to or preoccupation with objects).

4. Hyper- or hypo reactivity 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).
 Causes

◦ Historically, ASD was seen as the result of failed parenting

◦ Mothers and fathers of children with the more severe form of ASD
were characterized as perfectionistic, cold, and aloof
◦ Lack of self awareness theory—tendency to avoid first person
pronoun(he or she instead of I /me) ---more common among children
with cognitive disabilities/delays
◦ Savant skills – only one third of total ASD-superior working memory
highly focused attention
◦ Media/movies- wrongly or doesn’t full represent the full range
manifestation of the complex disorder
◦ Genetics and neurobiological influences. 
- Autism spectrum disorder can be associated with genetic disorders like
fragile X syndrome.
- genetic changes (mutations) may increase the risk of autism spectrum
disorder.
- Role of genes responsible for brain chemical –oxytocin—lower levels
—affecting social bonding
◦ Age of parents -risk increases with age (both paternal and maternal—
risk of mutation)
-Amygdala –larger in ASD children-----hence anxiety and fear more ---more
cortisol released due to increased anxiety and fear---damages
amygdala(Adulthood)reducing neurons —which may n turn affect
responses to social situations among 
-Vaccines—MMR--/Mercury which is used as for preserving vaccines
◦Environmental factors. 

- Researchers are currently exploring whether factors such as viral infections,

medications or complications during pregnancy, or air pollutants play a role
in triggering autism spectrum disorder
 TREATMENT
◦ Psychosocial treatment
Shaping
ABA-reward system for positive behaviors
CBT
Social skills training
Occupational therapy
◦ Biological treatment- Medical intervention-not much positive effects
but helps decreasing agitation(tranquilizers)
◦ Integrating treatments
severity Social communication Restricted and repetitive
behaviour

Level 1 Without support in place: Lack of flexibility of behavior

"Requiring causes significant interference with
support" -deficits in social communication cause noticeable functioning in one or more contexts.
impairments.
Difficulty switching between
-Difficulty initiating social interactions, and clear examples activities.
of atypical or unsuccessful responses to social overtures
from others. Problems of organization and
planning hamper independence
-May appear to have decreased interest in social
interactions.
Severity Social communication
Level 2 Marked deficits in verbal and
"Requiring substantial support" nonverbal social communication
skills
social impairments apparent even
with supports in place
limited initiation of social
interactions
reduced or abnormal responses to
social overtures from others.  focus or action.
Restricted and repetitive
behaviour
Inflexibility of behavior, difficulty
coping with change
Other restricted/repetitive behaviors
appear frequently enough to be
obvious to the casual observer and
interfere with functioning in a
variety of contexts.
Distress and/or difficulty changing
Severity Social communication
Level 3 Severe deficits in verbal and
"Requiring very substantial nonverbal social communication
support" skills cause severe impairments in
functioning,
very limited initiation of social
interactions,
and minimal response to social
overtures from other
Restricted and repetitive
behaviour
Lack of flexibility of behavior,
extreme difficulty coping with
change
other restricted/repetitive behaviors
markedly interferes with
functioning in all spheres
Great distress/difficulty changing
focus or action.
Specific learning disabilities
◦ Specific learning disorder is characterized by
◦ performance that is substantially below what
would be expected
◦ given the person’s age, intelligence quotient
(IQ) score, and education
Specific criteria:
◦ Significantly low Performance academically, compared to a typical person of same age, cognitive
ability(as measured by (IQ tests)and educational background
◦ The person’s disability not be cause by sensory difficulties-vision/hearing

DSM IV TR –reading writing and mathematics –separate disorders

DSM5 – all combined ,to mention in specifiers

Earlier definition – discrepancy of more than 2 standard deviation between achievement and IQ –helped in
identifiying children with learning disabilities---disadvantage---delay
To rectify--- response to intervention approach---early reading programs
◦ DSM-5 Diagnostic Criteria
◦ Criterion A
◦ Difficulties learning and using academic skills, as indicated by the
presence of at least one of the following symptoms that have
persisted for at least 6 months, despite the provision of
interventions that target those difficulties:

◦ Inaccurate or slow and effortful word reading (e.g. - has difficulty

sounding out words).

◦ Difficulty understanding the meaning of what is read (e.g. - not

understand relationships, inferences, or deeper meanings of what is read).
◦ Difficulties with spelling (e.g. - may add, omit, or substitute vowels or
consonants)

◦ Difficulties with written expression (e.g. - makes multiple

grammatical or punctuation errors within sentences

◦ Difficulties mastering number sense, number facts, or calculation

M(e.g. - has poor understanding of numbers, their magnitude, and
relationships; counts on fingers to add single-digit numbers).
◦ Criterion B
◦ academic skills are substantially and quantifiably below those
expected for the individual’s chronological age,
◦ cause significant interference with academic or occupational
performance, or with activities of daily living,
as confirmed by individually administered standardized achievement
measures and comprehensive clinical assessment.
◦ Criterion C
◦ The learning difficulties begin during school-age years but may not
become fully manifest until the demands for those affected
academic skills exceed the individual’s limited capacities

◦ (e.g. - as in timed tests, reading or writing lengthy complex reports

for a tight deadline, excessively heavy academic loads).
◦ Criterion D
◦ The learning difficulties are not better accounted for by intellectual
disabilities, uncorrected visual or auditory acuity, other mental or
neurological disorders, psychosocial adversity, lack of proficiency
in the language of academic instruction, or inadequate educational
instruction.

These four diagnostic criteria are to be met based on a clinical

synthesis of the individual’s history (developmental, medical, family,
educational), school reports etc.
◦ DYSLEXIA
◦ DYSCALCULIA
◦ DYSGRAPHIA
STATISTICS AND PREVALENCE
◦ MORE – Reading—then mathematics and least written expression

◦ Students with learning disorders are more likely to drop out of

school
◦ more likely to be unemployed and more likely to have suicidal
thoughts and attempt suicide (Daniel et al., 2006).
◦ Analyses of the genes involved suggest that many effects are not
specific—meaning that there are not different genes responsible for
reading disorders and mathematics disorders.
◦ Instead, there are genes that affect learning and they may contribute
to problems across domains (reading, mathematics, writing).
◦ The different problems associated with learning themselves have
different origins
◦ Reading disorders may include problems with word recognition
(difficulty decoding single words—sometimes called dyslexia),
fluency (problems being able to read words and sentences smoothly
and automatically), and comprehension (difficulty getting
meaning from what is read)
◦ Genes located on chromosomes 1, 2, 3, 6, 11, 12, 15, and 18 have
all been repeatedly linked to SLD

◦ three areas of the left hemisphere appear to be involved in problems

with dyslexia (word recognition)—
Broca’s area (which affects articulation and word analysis),
left parietotemporal area and left occipitotemporal area
◦ intraparietal sulcus—seems to be critical for the development of a
sense of numbers and is implicated in mathematics disorder

◦ Nature of the language

The characteristics of the English and French languages may make
them more difficult languages to read, thus accounting for these
cultural differences in rates of diagnosis for reading disorders.
Treatment
◦ Cases of intellectual disability, learning disorders
primarily require educational intervention.
◦ Biological (drug) treatment is typically restricted to
those individuals who may also have comorbid
ADHD, which involves impulsivity and an inability to
sustain attention and can be helped with certain
medications
◦ Educational efforts can be broadly categorized into (1) specific
skills instruction, including instruction on vocabulary, finding the
main idea, and finding facts in readings, and
◦ (2) strategy instruction, which includes efforts to improve
cognitive skills through decision making and critical thinking
◦ One approach that has received considerable research support is
called Direct Instruction (Kame’enui, Fien,& Korgesaar, 2013).
◦ This program includes several components;
◦ 1. systematic instruction (using highly scripted lesson plans that
place students together in small groups based on their progress)
◦ 2. teaching for mastery (teaching students until they understand all
concepts).
◦ In addition, children are constantly assessed, and plans are
modified based on progress or lack of progress
◦ behavioral interventions can change the way the brain works and
can help individuals with significant problems