AUTISM: THE SPECTRUM DISORDER What is It, Symptoms, Causes and Treatment.

AUTISM: THE SPECTRUM DISORDERWhat is It, Symptoms, Causes and Treatment

Did You Know?

Autism… now affects 1 in 88 children and 1 in 54 boys is the fastest-growing serious developmental

disability in the U.S. costs a family $60,000 a year on average receives less than 5% of the research funding of

many less prevalent childhood diseases Boys are nearly five times more likely than

girls to have autism There is no medical detection or cure for

autism

What is Autism? What is Autism Spectrum Disorder?

A group of complex disorders of brain development

Characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors

Originally recognized as distinct subtypes

Now all autism are merged under one umbrella diagnosis of ASD

All of these disorders are on the Spectrum of Autism. Asperger’s was originally considered an autistic disorder but is now a separate disorder under the spectrum.

The Umbrella of ASD

Autism Spectrum Disorder Diagnosis Criteria

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history 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

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

Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers

Autism Spectrum Disorder Diagnosis Criteria

Restricted, repetitive patterns of behavior, interests, or activities, of at least two of the following: Stereotyped or repetitive motor movements, use of objects, or

speech Insistence on sameness, inflexible adherence to routines, or

ritualized patterns or verbal nonverbal behavior Highly restricted, fixated interests that are abnormal in

intensity or focus Hyper- or hyperactivity to sensory input or unusual interests in

sensory aspects of the environment (i.e. apparent indifference to pain/temperature, adverse response to specific sounds or textures)

Autism Spectrum Disorder Diagnosis Criteria

Symptoms must be present in the early developmental period (but may not become fully apparent until social demands exceed limited capacities, or may be masked by learned strategies in later life)

Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

These disturbances are not better explained by intellectual disability (intellectual developmental disorder).

Autism Spectrum Disorder Diagnosis Criteria

Severity dependent on social communication impairments and restricted repetitive patterns of behavior (Table)

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.

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 With catatonia (state of unresponsiveness to external stimuli)

Severity levels for Autism Spectrum Disorder

Severity Level Social Communication

Restricted, Repetitive Behaviors

Level 3"Requiring very substantial support”

Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others.

Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.

A person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.

Severity levels for Autism Spectrum Disorder

Severity Level Social Communication

Restricted, Repetitive Behaviors

Level 2"Requiring substantial support”

Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others.

Inflexibility of behavior, difficulty coping with change, or 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 focus or action.

A person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.

Severity levels for Autism Spectrum Disorder

Severity Level Social Communication

Restricted, Repetitive Behaviors

Level 1"Requiring support”

Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions.

Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

A person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.

http://youtu.be/FuWWie1DlJY

A Look at the Symptoms

Symptoms: Social Challenges Difficulty in engaging in the give-and-take of everyday human interactions

By 8 to 10 months of age, many infants who later develop autism are showing some symptoms such as failure to respond to their names, reduced interest in people and delayed babbling. By toddlerhood, many children with autism have difficulty playing social games, don’t imitate the actions of others and prefer to play alone. They may fail to seek comfort or respond to parents' displays of anger or affection in typical ways.

Attached to their parents The way they express this attachment can be unusual. To parents, it may seem

as if their child is disconnected. Both children and adults with autism have difficulty interpreting what others are

thinking and feeling. Things like waving and smiling go without recognition. Without the ability to interpret gestures and facial expressions, the social world can seem bewildering.

Difficulty seeing things from another person's perspective Most five year olds understand that other people have different thoughts,

feelings and goals than they have. A person with autism may lack such understanding. This can interfere with the ability to predict or understand another person’s actions.

Common difficulty regulating emotions “Immature” behavior such as crying or having outbursts in inappropriate

situations. Disruptive and physically aggressive behavior

Symptoms: Communication Difficulties

Delayed in babbling and speaking and learning to use gestures Significant language delays and don’t begin to speak until much later in

life Many nonverbal or nearly nonverbal children and adults learn to use

communication systems such as pictures, sign language, electronic word processors or even speech-generating devices 

When language begins to develop, they may use speech in unusual ways and have difficulty combining words into meaningful sentences They may speak only single words or repeat the same phrase over and over. Some go through

a stage where they repeat what they hear verbatim.

Slight delays in language or develop precocious language and unusually large vocabularies They may carry on monologues on a favorite subject

Inability to understand body language, tone of voice and expressions that aren’t meant to be taken literally 

May not exhibit typical body language. Facial expressions, movements and gestures may not match what they are saying. Their tone of voice does not reflect their feelings. Some use a high-pitched sing-song or a flat, robot-like voice. This can lead to frustration and inappropriate behavior (such as screaming or grabbing) on the part of the person with autism.

Symptoms: Repetitive Behaviors

Common repetitive behaviors include hand-flapping, rocking, jumping and twirling, arranging and rearranging objects, and repeating sounds, words, or phrases. Sometimes the repetitive behavior is self-stimulating, such as wiggling fingers in

front of the eyes.

Tendency to engage in a restricted range of activities Some spend hours lining up toys in a specific way instead of using them for

pretend play. Some adults are preoccupied with having household or other objects in a fixed

order or place. It can prove extremely upsetting if someone or something disrupts the order.

Many children and adults with autism need and demand extreme consistency in their environment and daily routine. Slight changes can be extremely stressful and lead to outbursts 

Repetitive behaviors can take the form of intense preoccupations, or obsessions. These extreme interests are either an object’s content (fans, vacuum cleaners or

toilets) or depth of knowledge (knowing and repeating astonishingly detailed information about Thomas the Tank Engine or astronomy).

Older children and adults with autism may develop tremendous interest in numbers, symbols, dates or science topics.

Associated Medical Conditions: Genetic Disorders

Some children with autism have an identifiable genetic condition that affects brain development. Fragile X syndrome Angelman syndrome Tuberous sclerosis Chromosome 15 duplication syndrome and other

single-gene and chromosomal disorders Single gene disorders appear to affect 15 to 20

percent of those with ASD. Some of these syndromes have characteristic features or family histories. 

Associated Medical Conditions: Gastrointestinal (GI)Disorder

GI distress affects up to 85 percent of children with ASD.

These conditions range in severity from a tendency for chronic constipation or diarrhea to inflammatory bowel disease.

Pain caused by GI issues can prompt behavioral changes such as increased self soothing (rocking, head banging, etc) or outbursts of aggression or self-injury. Conversely, appropriate treatment can improve behavior and quality of life.

Associated Medical Conditions: Seizure Disorder

Seizure disorders (such as epilepsy) occur in as many as 39 percent of those with autism.

It is more common in people with autism who also have intellectual disability than those without.

Someone with autism may experience more than one type of seizure.

Seizures associated with autism tend to start in either early childhood or adolescence.

Associated Medical Conditions: Sensory Processing Problems

Many persons with autism have unusual responses to sensory input.

They have difficulty processing and integrating sensory information, or stimuli, such as sights, sounds smells, tastes and/or movement.

They may experience seemingly ordinary stimuli as painful, unpleasant or confusing.

They can be hypersensitive to sounds or touch, a condition also known as sensory defensiveness.

Others are under-responsive, or hyposensitive.

Associated Medical Conditions: Pica and Sleep Dysfunction Disorder

Pica is a tendency to eat things that are not food. Eating non-food items is a normal part of

development between the ages of 18 and 24 months.

Some children and adults with autism and other developmental disabilities continue to eat items such as dirt, clay, chalk or paint chips.

Sleep problems are common among children and adolescents with autism and may likewise affect many adults.

Causes

There is no known single cause for autism, but it is generally accepted that it is caused by abnormalities in brain structure or function

Brain scans show differences in the shape and structure of the brain in children with autism versus in neurotypical children

Researchers are investigating a number of theories, including the links among heredity, genetics and medical problems.

The brain of an individual with autism is larger than the brain of someone without the disorder. It also has significantly less activity and active growth.

Control Brain vs Autistic Brain

Causes: Genetic

In many families, there is a pattern of autism or related disabilities

No one gene has been identified as causing autism Researchers are searching for irregular segments of

genetic code that children with autism may have inherited.

Some children are born with a susceptibility to autism, but researchers have not identified a single "trigger" that causes autism to develop

Other researchers are investigating the possibility that under certain conditions that a cluster of unstable genes may interfere with brain development resulting in autism.

Causes: Environmental Factors

Environmental toxins (e.g. heavy metals such as mercury) are more prevalent in our environment than in the past

Findings indicate many children with autism or at risk have a metabolic impairment that reduces their ability to rid their bodies of heavy metals and other toxins

Buildup of these toxins in the body can lead to brain and nervous system damage and developmental delays.

Causes: Disorder of the Limbic Brain

Richard Lathe believes the disorder is a disorder of the limbic brain

The limbic brain is very sensitive to environmental toxins

He found children with autism exert behaviors similar to people who have suffered injuries in the hippocampus and amygdala

Treatment

Each child or adult with autism is unique so each autism intervention plan is addressed to their specific needs

Intervention can involve behavioral treatments, medicines or both

Addressing other medical issues such as sleep disturbance, seizures and gastrointestinal (GI) distress associated with autism can improve attention, learning and related behaviors

Treatment

Early intensive behavioral intervention involves a child's entire family, working closely with a team of professionals

In some early intervention programs, therapists come into the home to deliver services This can include parent training with the parent

leading therapy sessions under the supervision of the therapist.

Other programs deliver therapy in a specialized center, classroom or preschool.

Treatment

Different interventions and supports change as a child develops and acquires social and learning skills As children with autism enter school, they may

benefit from targeted social skills training and specialized approaches to teaching

Transition services are used for adolescents that promote a successful maturation into independence and employment opportunities of adulthood Meant for less severe forms of autism

Treatment Options for Toddlers and Preschool Children: Early Intensive Behavioral Intervention The child receives structured, therapeutic activities for at least 25

hours per week Highly trained therapists and/or teachers deliver the intervention Therapy is guided by specific and well-defined learning objectives, and

the child’s progress is regularly evaluated and recorded Focuses on the core areas affected by autism

These are social skills, language and communication, imitation, play skills, daily living and motor skills

Provides the child with opportunities to interact with typically developing peers

The program actively engages parents in the intervention in decision making and the delivery of treatment

The therapists make clear their respect for the unique needs, values and perspectives of the child and his or her family

The program involves a multidisciplinary team that includes a physician, speech-language pathologist and occupational therapist

Medical Treatments

Medicines for treating autism are most effective when used in conjunction with behavioral therapies

Treating the three core symptoms of autism (communication difficulties, social challenges and repetitive behavior) has not been met

Difficult because what works well for one individual may not for another

The cause of autism is unknown Treatments are effective for treating

associated medical and psychiatric conditions of autism but not the disability itself

More research is needed to determine the cause so more effective treatments can be made and a cure could be discovered.

Autism Spectrum Disorder. (2014, January 2). Retrieved January 7, 2014, from Autism Society: http://www.autism-society.org/

What is Autism? (2014, January). Retrieved December 11, 2013, from Autism Speaks:

http://www.autismspeaks.org

Resources