Description of Autism Spectrum Disorders
Autism comprises a clinically diverse group of disorders, referred to as autism spectrum disorders, that share common disabilities such as impaired social relationships, impaired language and communication, or a narrow range of interests. For most children with autism, symptoms develop gradually, although approximately 30% have a regressive onset, usually between 18 and 24 months. About 50%-70% of children with autism are identified as intellectually disabled and approximately 25% develop seizures. About 25% of children who fit the diagnostic criteria for ASD at age two to three years subsequently begin to talk and communicate, and by age six to seven years blend to varying degrees into the regular school population. They go on to live completely normal lives with no signs of a serious disorder. The remaining 75% have lifelong disability requiring intensive parental, school, and social support. (National Center of Biotechnology Information, 2010).
People with Aspergers syndrome usually have some milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have problems with language or intellectual disability. People who meet some of the criteria for autistic disorder or Aspergers syndrome, but not all, may be diagnosed with Pervasive Developmental Disorder Not Otherwise Specified. People with PDD-NOS usually have fewer and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges. (National Center of Birth Defects and Developmental Disabilities, 2012). Vikki Phelps, an intervention specialist at Olentangy Orange High school teaches many students with Autism Spectrum Disorders.
These students often have a difficult time expressing their emotions or basic needs. This becomes very irritating and frustrating for them, Phelps said in our earlier interview. (V. Phelps, personal communication, May 2012). (See Appendix 1) Children and adults with ASD often display facial expressions, movements, and gestures that do not match what they are saying. Their tone of voice may not reflect their actual feelings either. Many older children with ASD speak with an unusual tone of voice.. Children with ASD also may have trouble understanding another persons point of view. For example, by school age, most children understand that other people have different information, feelings, and goals than they have. Children with ASD may lack this understanding, leaving them unable to predict or understand other peoples actions. (National Institute of Mental Health, 2012).
To qualify for a diagnosis of autistic disorder, a child must have shown abnormalities in social interaction and language used for social communication. Children with ASD do not follow typical patterns when developing social and communication skills. Parents are usually the first to notice unusual behaviors in their child. Often, certain behaviors become more noticeable when comparing children of the same age. In some cases, babies with ASD may seem different very early in their development. Even before their first birthday, some babies become overly focused on certain objects, rarely make eye contact, and fail to engage in typical back-and-forth play and babbling with their parents. Other children may develop normally until the second or even third year of life, but then start to lose interest in others and become silent, withdrawn, or indifferent to social signals. Loss or reversal of normal development is called regression and occurs in some children with ASD. (National Institute of Mental Health, 2012).
According to the Diagnostic and Statistical manual, symptoms include making little eye contact, tendency to look and listen less to people in their environment or failure to respond to other people, do not readily seek to share their enjoyment of toys or activities by pointing or showing things to others, responding unusually when others show anger, distress, or affection. Children with autism spectrum disorders often have difficulty with communication. These symptoms include, failure or slow to respond to their name or other verbal attempts to gain their attention, failure or slow to develop gestures, such as pointing and showing things to others, coo and babble in the first year of life, but then stop doing so, develop language at a delayed pace, learn to communicate using pictures or their own sign language, speak only in single words or repeat certain phrases over and over, seeming unable to combine words into meaningful sentences, repeat words or phrases that they hear, a condition called echolalia, use words that seem odd, out of place, or have a special meaning known only to those familiar with the childs way of communicating. (Lord et al., 2006).
Children with ASD often have repetitive motions or unusual behaviors, however, not every child will develop a repetitive behavior. These behaviors may be extreme and very noticeable, or they can be mild and discreet. For example, some children may repeatedly flap their arms or walk in specific patterns, while others may subtly move their fingers by their eyes in what looks to be a gesture. Children with ASD also tend to have overly focused interests. Repetitive behavior can also take the form of a persistent, intense preoccupation.
For example, they might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Children with ASD often have great interest in numbers, symbols, or science topics. While children with ASD often do best with routine in their daily activities and surroundings, inflexibility may often be extreme and cause serious difficulties. They may insist on eating the same exact meals every day or taking the same exact route to school. A slight change in a specific routine can be extremely upsetting. Some children may even have emotional outbursts, especially when feeling angry or frustrated or when placed in a new or stimulating environment. (National Dissemination Center for Children with Disabilities, 2010).
There is no one cause of autism just as there is no one type of autism. Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by themselves. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development. (Autism Speaks, 2012). Twin and family studies have established a genetic basis of autism and indicate that the heritability of autism is over 90%. (National Center of Biotechnology Information, 2012). ASDs tend to occur more often in people who have certain genetic or chromosomal conditions.
About 10% of children with ASDs also have been identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and chromosomal disorders. Researchers are currently studying such areas as neurological damage and chemical imbalances within the brain. Increasingly, researchers are looking at the role of the immune system in autism. (Goldstein et al., 2009).
Behavioral, Cognitive, and Psychodynamic Explanations
The clearest evidence of these autism risk factors involves events before and during birth. They include advanced parental age at time of conception (both mom and dad), maternal illness during pregnancy and certain difficulties during birth, particularly those involving periods of oxygen deprivation to the babys brain. It is important to keep in mind that these factors, by themselves, do not cause autism. Rather, in combination with genetic risk factors, they appear to modestly increase risk. A small but growing body of research suggests that autism risk is less among children whose mothers took prenatal vitamins (containing folic acid) in the months before and after conception. (Autism Speaks, 2012). Scientists are studying how certain environmental factors may affect certain genes”turning them on or off, or increasing or decreasing their normal activity.
This process is called epigenetics and is providing researchers with many new ways to study how disorders like ASD develop and possibly change over time. Other parents believe their childs illness might be linked to vaccines designed to protect against more than one disease, such as the measles-mumps-rubella (MMR) vaccine, which never contained thimerosal. Many studies have been conducted to try to determine if vaccines are a possible cause of autism. As of 2010, none of the studies has linked autism and vaccines. (National Institute of Mental Health, 2012).
When taken during pregnancy, the prescription drugs valproic acid and thalidomide have been linked with a higher risk of ASDs. The once common belief that poor parenting practices cause ASDs is not true. There is some evidence that the critical period for developing ASDs occurs before birth. However, concerns about vaccines and infections have led researchers to consider risk factors before and after birth. A small percentage of children who are born prematurely or with low birth weight are at greater risk for having ASDs. (National Research Council, 2001). There are currently no cognitive or psychodynamic causes of any autism spectrum disorder.
Currently there are no medications that can cure autism spectrum disorders or all of the symptoms. The U.S. Food and Drug Administration has not approved any medications specifically for the treatment of autism, but in many cases medication can treat some of the symptoms associated with autism. Selective serotonin reuptake inhibitors (SSRIs), tricyclics, psychoactive/anti-psychotics, stimulants, and anti-anxiety drugs are among the medications that a health care provider might use to treat symptoms of autism spectrum disorders. (National Institute of Child Health and Human Development, 2011). These medications can help reduce irritability”meaning aggression, self-harming acts, or temper tantrums”in children ages 5 to 16 who have ASD. (National Institute of Mental Health, 2012).
Behavioral, Cognitive, and Psychodynamic Therapies
Research has shown that intensive behavioral therapy during the toddler or preschool years can significantly improve cognitive and language skills in young children with ASD. There is no single best treatment for all children with ASD, these are the most effective early intervention programs:
Occupational therapy teaches skills that help the person live as independently as possible. Skills might include dressing, eating, bathing, and relating to people.
Sensory Integration Therapy
Sensory integration therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched.
Speech therapy helps to improve the persons communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.
The Picture Exchange Communication System (PECS)
PECS uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation. One type of a widely accepted treatment is applied behavior analysis. The goals of this treatment are to shape and reinforce new behaviors, such as learning to speak and play, and reduce undesirable ones. ABA, which can involve intensive, one-on-one child-teacher interaction for up to 40 hours a week, has inspired the development of other, similar interventions that aim to help those with ASD reach their full potential. (Handleman & Harris, 2000). Students with ASD may benefit from some type of social skills training program. While these programs need more research, they generally seek to increase and improve skills necessary for creating positive social interactions and avoiding negative responses. For example, Childrens Friendship Training focuses on improving childrens conversation and interaction skills and teaches them how to make friends, be a good sport, and respond appropriately to teasing. (McAfee, 2002).
Effectiveness of Treatment
Although these treatments are ineffective in completely curing autism spectrum disorders, they can help encourage a positive result in eliminating many of the symptoms associated with these disorders. These therapies increase the likelihood of an adult living a successful and normal life in the future.
Different people with autism can have very different symptoms. Health care providers think of autism as a spectrum disorder, a group of disorders with similar features. One person may have mild symptoms, while another may have serious symptoms. But they both have an autism spectrum disorder. Some symptoms include, but are not limited to, making little eye contact, tendency to look and listen less to people in their environment or failure to respond to other people, do not readily seek to share their enjoyment of toys or activities by pointing or showing things to others, responding unusually when others show anger, distress, or affection. Scientists are currently experimenting with different types of pharmaceuticals to help children and adults with ASDs, however, there is not yet a cure. Therapies such as, occupational therapy, speech therapy, and applied behavior analysis can help reduce the symptoms of ASDs. The awareness of these disorders is rapidly increasing, and researchers are hopeful to find a cure sometime in the near future.