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Autism Spectrum Disorder (ASD)

(As written by and paraphrased from autismcanada.org)
What's the difference between Autism Spectrum Disorder and autism?

The term Autism Spectrum Disorder (ASD) includes autism, Asperger's Syndrome, and Pervasive Developmental Disorder (PDD). These disorders are so similar in characteristics, symptoms, and responses to treatment modatilities that they form an umbrella disorder.

Characteristics of Autism Spectrum Disorder

It is current theory that Autism Spectrum Disorder is a complex biomedical condition that can affect the normal function of the gastrointestinal, immune, hepatic, endocrine and nervous systems. It appears to impact normal brain development, and most individuals have some degree of communication problems, difficulty with typical social interactions, are prone to repeat specific patterns of behavior, and have a markedly restricted repertoire of activity and interests. Individuals on the Autism spectrum tend to have varied degrees of and combinations of symptoms.

Early Signs of Autism (12 to 24 Months)

Unfortunately, many pediatricians and other physicians are not experienced in diagnosing Autism Spectrum Disorder. Many physicians fear making the diagnosis because they were trained to believe that ASD is incurable and continue to believe parents will be unable to deal with the diagnosis. Should your doctor propose a "wait and see" approach or promise that your child will "catch up," please contact your local autism resources immediately for additional information. If your child has normal development and then regresses you should seek help immediately. A developing child's brain is pliable, and so there is a window of opportunity that diminishes as the child gets older. If your child has chronic diarrhea, frequently wakes at night, has a very restricted, self selected diet, has suffered repeated infections in the first year, isn't trying to say words at 18 months, has a reaction to vaccines and doesn't seem interested in other children, find a doctor to screen for ASD as soon as possible.

Strengths Exhibited by Individuals with Autism

Although some areas of development in a child with autism are delayed, children with ASD often exhibit skills beyond their years in other areas. These intellectual strengths may overshadow the developmental problem experienced by your child. These strengths may include one or more of the following:

These exceptional skills may be combined with subtle or significant delays in other areas of development. It is suggested that all individuals with the diagnosis demonstrate some of the following:

Difficulties in using and understanding verbal and non-verbal language are exceedingly common in children with autism. Deficits can be found in these areas:

Communication involves both understanding language (receptive skills) and providing information (expressive skills). The abilities of these children vary widely in that some children with autism will have a good grasp on comprehension (i.e., "sit down") but lack expressive skills (i.e. "my tummy hurts") and vice versa. Regardless, many children with autism experience difficulty with non-verbal communication (i.e. eye contact, facial expressions, smiling, etc.) They may be able to label these communications on a chart of faces but are unable to do so when dealing in a social situation with live people. Thus, they are unable to read expression and unable to predict the behaviors of others. A strict statement from an adult, even if preceded by strong looks of disapproval, is likely to catch the child off guard and cause a strong reaction. Children with autism often fail to understand words or phrases that are abstract (i.e. "We'll go swimming later" or "I love you") or that have a double meaning (i.e. the teacher says to an autistic child, "clear off the table" and he goes over and pushes everything off it). They also tend to interpret things very literally (i.e. "give yourself a hand")

Some children exhibit echolalia, which is the repetition of words, signs, phrases or sentences spoken by other people. Some children use this as a communication device (i.e. the adult says "do you want a car?" and the child might say "want a car" to mean yes.) A child may repeat the same phrase over and over again as a means of regulating their own behavior (i.e., a child repeats aloud "time to clean up" while cleaning).

Impaired Social Skills

Lack of awareness

Autism is characterized by an impaired ability to engage in social relationships and can result in serious deficits in the ability to develop friendships. In fact, children with autism often behave as if other people do not exist. This is demonstrated in various ways including failure to respond to their names when called, appearing not to listen when spoken to, an inability to display appropriate facial expressions, avoidance of eye contact, a failure to respond to affection, and sometimes treating people as if they were inanimate objects. Often children will acknowledge an adult only for the purpose of getting a need gratified and will return to ignoring the adult thereafter.

In children with Autism Spectrum Disorder, social skills tend to be characteristically rote and awkward in nature. Individuals on the spectrum may also experience problems maintaining reciprocal relationships. In other words, others may attempt to befriend a person with ASD but the ASD child is unable to respond in a like manner. Additional difficulties center around an inability to take on another's perspective (i.e., an autistic child hurts another child and cannot understand why he is crying), feelings and emotions, or provide or seek comfort, in conventional ways.

Abnormal seeking of comfort when stressed

Individuals with Autism Spectrum Disorder tend to crave predictability and function optimally in highly structured situations. Concurrently they are likely to become extremely dependant on elements of sameness in their lives, to the extent that they can have difficulty coping with changes in their environment or routine. Attempts to comfort them while they are under stress may exasperate the situation.

Impaired Imitation Skills

All children learn behavior patterns of social interaction through imitation. Very young children with Autism Spectrum Disorder will often fail to respond, or exhibit delays in responding to the gestures or playful overtures of peers, even when these are familiar to them from past experience or through repetition. Without direct and carefully planned intervention efforts, as a child on the spectrum grows older, his/her capacity for benefiting from the opportunities he/she may encounter for imitative learning will continue to be limited.

Abnormal Toy Play

When a child on the spectrum sits down to play he/she generally has a stereotypical and repetitive approach as opposed to the symbolic, creative and imaginative play behavior exhibited by the neuro-typically developing child. The child may refuse to play with toys, or if he/she does the child may do so in unusual ways. They may not see a toy car as a car but rather as an object that rattles and makes funny patterns when the wheels are spun. This unusual toy play probably accounts for part of the reason why these children have difficulty interacting with peers and joining in games with others.

Inability to Form Friendships

Children with autism lack two essential skills that are vital for peer connections:

  1. The ability to relate to peers in a positive and reciprocal manner
  2. The ability to adapt interpersonal skills to the various demands of different social situations.

These children are not out looking for opportunities to interact and may even find it difficult to be in the physical proximity of others. As the children get older, typically peers discontinue seeking them out as the reactions have given them little reason to continue.

Perseveration on Interests and Activities

Children on the autism spectrum typically have a narrow range of interests (i.e. will only go to play with one toy, will pick the same activity over and over) They also may engage in repetitive, stereotyped body movements such as hand flicking, spinning or rocking. They may insist upon carrying certain objects around with them in the classroom to keep themselves from tantrumming or to help them feel secure. Perseverations might extend to food. A child on the spectrum may have a preference or dislike certain colors, textures or temperatures of foods. Some individuals perseverate on certain topics. The child might remain intrigued with one or two topics such as music or modes of transportation, and exhaust everyone who comes into contact with him about their knowledge in that area of interest.

Dependence on Routine

Many children with autism are typically highly dependent on a set routine and can become extremely stressed when this schedule is not followed to the letter. An individual might insist on a certain bedtime, mealtime, or greeting routine. Behavior problems (i.e. screaming, tantrumming, self-injury, etc) often occur as a result of changes in routine.

Abnormal Responses to Sensory Stimulation

More often than not, children with autism spectrum disorder exhibit unconventional reactions to sensory stimulation. This may or may not be overcome as they get older. Some children show a hypersensitivity to stimuli (i.e. can hear lights buzzing, cannot tolerate touch, fascinated with spinning objects, must smell everything, etc.) while others display a hyposensitivity to stimuli (demonstrates high pain tolerance, act as if deaf, etc). A child on the spectrum may be fascinated with a piece of lint, or may spend hours rocking or watching objects twirl. In general these types of reactions are providing some sort of sensory stimulation for the child.

It is believed that these sensory difficulties stem from neurological dysfunction in the brain. Daily we are all bombarded with thousands of sensations. Our ability to integrate these sensations by attending to the important ones and filtering out the non-essential input, helps us to function efficiently. Without smooth functioning of this system, the person is unable to accurately interpret his environment and respond and adapt. It is believed that his is what happens in ASD

Behavior Problems

Many times behavior problems are associated with children with autism. These can include incidents of tantrums, self-injury, property destruction, and acts of aggression. Some behaviors are the result of developmental deficits (i.e. a child cannot speak and engages in misbehavior as a form of communication and/or the frustration of not being able to express their needs). Episodes of self-injury can be in response to abnormal response to sensory. In some cases it serves the purpose of sensory stimulation and perseverations can result that are exceedingly challenging to terminate. Regardless of the cause, it is current theory in the field, that when a child is performing self-stimulating behaviors (i.e. hand flapping, twirling, finger posturing, etc.) it is counterproductive to his learning) Response to this from some adults with ASD are not in agreement who feel that some time each day to self-stimulate is both soothing, appropriate, and allows them to calm from the anxiety of the day. Parents must decide how much self-stimulating behavior is good for the child out side of the classroom.

Variability of Intellectual Functioning

A characteristic of people with autism is the wide range of functioning within which they can fall. Individuals with autism can be severely impaired to the extent that they are unable to talk or perform independent living skills, or they may be functioning in the above-normal range of intelligence and able to go to college, have a career, and start a family.

Uneven Development Profile

Persons with autism exhibit a splintered development profile being able to function in some areas at levels perhaps higher than their overall level of functioning. For example, a five year old with autism may be reading books at a second grade level while his self-help skills are at age level and his social skills abilities are non-existent.

Difficulties in Sleeping

Some children with autism have trouble falling asleep or require only a few hours of sleep each night to function. This can be extremely problematic for families and makes it difficult for parents who start sleeping in shifts to prevent the child from getting into trouble around the house.

Immune Irregularities

Some children with autism are picky eaters, and their diets may be limited to a few preferred foods. There are those in the field who attribute this self-limited diet d to food intolerance.

Gastrointestinal Problems

Many children have problems with toileting, often related to sensory issues or actual gastrointestinal problems. A great many have diarrhea or constipation, abdominal pain, gaseousness and bloating and in many cases foul smelling light colored stools. This discomfort could be the cause of poor sleep habits as many individuals suffer from reflux esophagitis.

References:
Leap Outreach District Training Program. Leap outreach Project
Phillip Strain, Ph.D, Judy Lawry, M.S. Ed.,Ted Bovey, Kerry Parker
Children with starving brains – a medical treatment guide for Autism Spectrum Disorder
Jacquelyn McCandless, MD 2002 Bramble Books
Diagnoses

Autism is used quite generally to describe a wide spectrum of symptoms. Since children's severity of symptoms vary so widely, professionals have been using the term Autism Spectrum Disorder (ASD) to emphasize the variance. Those who are affected with ASD fit a number of descriptions in several categories, therefore labeling a child as having a particular disorder is very subjective.

Whether your child has been diagnosed with PDD-NOS or Autism, the treatment strategies are the same. Early intervention is the key to success, no matter what the diagnosis.

There are five diagnoses under the spectrum disorders:
  1. Autism—Is diagnosed four times more frequently in boys than girls and is characterized in some children by withdrawn behavior or other unusual social behaviors, problems using language to communicate, repetitive patterns of behavior and the inability to engage in imaginative play. Usually, but not always, the child begins with normal development and shows regression between 12 and 24 months of age.
  2. Asperger's Syndrome-- Many experts view Asperger's Syndrome as high functioning Autism. Children with Asperger's Disorder have no significant delays in language skills or in cognitive development, self-help skills or adaptive behavior. There is significant impairment in social functioning as well as stereotyped behaviors and repetitive mannerisms
  3. Pervasive Development Disorder- Not otherwise Specified (PDD-NOS) occurs when a child may not fall within the realm of other autism diagnosis, but nonetheless shows signs of severe and pervasive impairment in the development of reciprocal social interaction, verbal and non-verbal communication skills.
  4. Rett's Disorder has only appeared in girl's to date. These children seem to develop normally until between 5-18 months, then experience a deceleration of head growth, lose previously acquired language and hand skills, which are replaced by stereotypical behavior (Hand flapping, wringing). There is also a loss of social interaction, physical coordination and impairment in receptive and expressive language. Recently a genetic marker for Rett's syndrome has been identified.
  5. Childhood Disintegrative Disorder (CDD) also known as Heller's Disease refers to the normal development of children until 2 years of age, who then lose acquired skills. This usually occurs between 36 and 48 months of age but may occur up to 10 years of age.
Other illnesses with similar symptoms

Landua-Keffler Syndrome (LKS) or Acquired Childhood Epileptic Aphasia is not as common as Autism but can occur with autism and especially along with Childhood Disintegration Disorder. Although children with LKS demonstrate much behavior similar to autism, in all cases children with LKS have abnormal electroencephalogram (EEG), stemming from abnormal brain activity. In approximately 80% of the cases, seizures occur, and may only occur during sleep. Besides typical seizure symptoms, other types of seizures include staring spells, drooling, odd movements or smacking with the mouth, night waking, and night terrors. Hyperactivity, anxiety, aggressiveness, and depression are often associated with LKS.

If you have any cause to suspect LKS, contact a child neurologist as soon as possible, because according to experts, LKS, which is often misdiagnosed as autism, is treatable with medications or surgery, if diagnosed in its early stages.

In North America most children are screened soon after birth for Phenylketonuria, or PKU, a genetic disorder involving the inadequate metabolism of the amino acid phenylalanine. If a child is diagnosed with this disorder then a phenylalanine free diet is prescribed. If the diet is not followed, brain damage can occur resulting in mental retardation and some autism behaviors. If your child has not been tested for PKU, have your doctor do this simple test to rule out this disorder.

Fragile X Syndrome results from an abnormality of the DNA molecules of the sex chromosome X. It often causes mental retardation and has associated autism symptoms. Individuals with Fragile X Syndrome are often hypersensitive to sights, sounds, smells, and tactile stimuli. They commonly engage in hand flapping, avoid eye contact; have tactile defensiveness and perseverative speech. Physicians routinely test to rule out Fragile X Syndrome during early stages of autism diagnosis.

References:
Us Department of Health and Human services, 2001
Facing Autism, Lynn M. Hamilton. Waterbrook Press 2000