Autism spectrum disorder (ASD) is a persistent lifelong developmental disability made up of a collection of complex brain development disorders characterized by difficulties in communication, social interaction, repetitive behaviors, restricted interests, and pervasive deficits in emotional and cognitive functioning. ASD is also associated with sensory and perceptions concerns, difficulties in motor coordination, uneven cognitive abilities, deficits in emotional regulation, and pronounced difficulties adapting to the happenings of everyday life. Initial signs of ASD include the inability to meet developmental milestones, limited language advancement, and eye contact and social interaction concerns with others.
Background and Development
Key Concepts and Terms
The term autism has been around more than a hundred years. However, the terms usage in the modern sense of referring to social and emotional disturbances was first presented as part of a 1940s case report by Leo Kanner. In the medical report, Kanner described symptoms of children who tended to shut out social contacts, objectified individuals, and excessively desired for permanence in play and other childhood activities. Kanners initial observations and remarks about autism acknowledged impairments in communication, good and yet atypical cognitive abilities, and behavioral issues such as obsessiveness. Kanner emphasized, however, the central concern was the individuals inability to connect to people and relate to social situations from early in development. During this early period of treatment and research, autism was thought to be a psychotic disorder at least partially caused by genetics. Others theorized that emotionless, obsessive, and indifferent parenting played a part in causing the disorder. Currently, biological explanations of autism include neurological, environmental, physiological, and genetics.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders identified autistic disorder, Aspergers disorder, childhood disintegrative disorder, and pervasive developmental disorder (not otherwise specified) as distinct and separate disorders. In the latest revision, these unique disorders are collapsed under the category of autism spectrum disorder. Autism spectrum disorder is identified as the formal diagnosis with specifies used to classify the severity of symptoms.
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders autism spectrum disorder is a collection of neurodevelopmental disorders marked by variable degrees of persistent and pervasive impairment in social communication and pronounced difficulty in social interaction. These deficits are pronounced in social-emotional reciprocity, nonverbal communication, and social relationships.
In addition to social communication and interaction deficits, autism spectrum disorder is characterized by limited and repetitive interests, behaviors, and activities. For a diagnosis of autism spectrum disorder, symptoms must be present in early development, may not be better explained by an intellectual disability or developmental delay, and cause clinically substantial deficiencies in the childs ability to function across occupational, social, and other important areas and domains. An estimate based on observations made in multiple communities in the United States and reported by the Centers for Disease Control and Prevention indicated that roughly one out of every 68 children has autism spectrum disorder. The new 2016 estimate is about 30% higher than the previous estimation of 1 in 88 children. There is a significant gender component with autism spectrum disorder and it four times more prevalent in males than in females.
Autism spectrum disorder symptoms may develop early but may be difficult for parents and caregivers to recognize until expected social demands surpass demonstrated abilities. Diagnosing ASD can be complicated because there are no medical tests and instead clinicians must rely on parent reports and observing childs behavior. An ASD diagnosis is most dependable and valid when determined using multiple sources of information.
Autism being a spectrum disorder is noteworthy in that not all those with the disorder display all of the symptoms and the array of severity of symptoms can vary from individual to individual. The capabilities, strengths, struggles, skills, aptitudes, and deficits demonstrated vary significantly from one person to another. Those with autism spectrum disorder do not exhibit all indicators nor are they identical in the intensity of the symptoms. One commonality may be that children with ASD oftentimes develop significant needs within multiple contexts and across domains.
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Developmental Aspects of Autism Spectrum Disorder
It is widely believed that children with ASD fall into one of several major symptom onset patterns. The first pattern involves near normal early development followed by a loss of language or social skills coupled with the emergence of repetitive and stereotyped behaviors between 18 and 24 months. The second major pattern involves early and general onset of impairment and obvious signs of ASD without regression before 14 months. A third pattern involves the child developing with mild delays until about age 2 followed by gradual or abrupt developmental arrest and plateau.
The onset of symptoms and divergence from typical development indicates that ASD is a progressive disorder. This is evidenced by the childs failing to progress at an expected pace and the appearance of ASD maladaptive behaviors, such as repetitive actions and strict adherence to procedures. Social and symbolic communication appears to be particularly impacted during the second year of the childs life. Deficits of social and emotional interaction were significant between 18 and 24 months of age. Although there were different ages of onset and symptomology between the groups there are no significant differences between patterns at 36 months of age regression.
There are at least six patterns of development from the time of diagnosis to near adulthood. According to Fountain, Winter, and Bearman found that within these six patterns there is considerable heterogeneity in pathways, pace, and extent of development. In most cases there was considerable improvement in children with ASD over time. According to the study, many children with ASD experienced significant development, particularly with regard to communication. However, repetitive behavior progression was relatively flat with only some children showing improvement. Children, whose symptoms are the least severe at diagnosis, or high functioning, typically demonstrate the highest extent and fastest improvements. Many children show modest decreases in ASD core symptoms during their development; however, ASD symptoms generally persist into adulthood.
Factors that Contribute to Normal Growth and Development
Early intervention strategies have demonstrated normal development of children born with autism. Within the first 36 months of a childs development, one can be trained to walk, speak, and socially interact with others to enhance normal development. This requires early diagnosis of the child to enhance the efficacy of its outcome. When children with autism spectrum disorder gain training, they overcome their developmental challenges associated with their neurology. Such training equips them with special skill development capabilities in their brain. This can be effectively attained during early life developmental stages. Children above three years of age find it difficult to learn these skills and fain to have a normal development.
Problems and Implications
Problems Related to the Disorder
ASD is marked by persistent deficiencies in communication and social interaction. Verbal deficits include failure to perform normal back-and forth communication, reduced social-emotional reciprocity, restricted sharing of affect, and failure to initiate interactions. Up to as many as 30% of children with ASD fail to develop language-speaking ability and those who do it are often delayed and often atypical. Some children with ASD reverse their pronouns and may refer to themselves as he or you instead of I or me.
Non-verbal deficits include deficits in joint attention interactions and atypical eye contact and body language. Non-verbal communication means such as; pointing, making gestures, gazes, physical emotional responses, and facial expressions are often atypical or lacking. Children with ASD may have problems giving attention to an object or situation. They may focus on another individuals eyes or mouth differently as well.
Many, but not all, children with ASD engage in stereotyped behaviors. Lower-level repetitive behaviors may include repeated rocking or kicking. These are common with lower intelligence and younger children. Insistence on consistency in the environment, compulsively colleting items, or absorbed in hobbies are common behaviors in older children and those with higher intelligence. Many children with ASD display echolalia, which is repeating what someone else has said.
Another common problem related to the disorder is both over and under sensitivity to stimuli. Children who may be oversensitive are often disturbed by sounds, lights, and specific colors. A child with under sensitivity, which may be more common, is demonstrated by failing to respond to stimuli such as; responding to sounds or voices. Over selectivity is also common and is marked by the child focusing only on a select portion of a stimulus.
There is a wide array of intelligence, emotional abilities, and adaptive abilities in children in autism but many may experience limitations in cognitive and emotional development. It is estimated that up to 55% of those with autism have an intellectual disability. There are those who exhibit splinter and even savant abilities. Splinter abilities are specific skills in which a child with ASD is exceeding their expected skill level especially in comparison to general functioning. Some populations display Savant abilities; which may include extreme abilities in a task such; as memory or calendar calculations. Those with ASD have difficulty with adaptive abilities and struggle with day-to-day life activities.
The causes of autism are not well understood however, some have been proposed to be contributing factors for this disorder. These factors include both phenotypic and genotypic. It is believed that genes are responsible for development of autism. Some are linked to families where, family history of autism seems to contribute to its development in the generation. Genetic conditions like fragile X syndrome are contributing element in the development of autism. Environmental factors like periods of pregnancy nearing birth are believed to be significant in autism development for the child. Consumption of pharmacological prescriptions such as valproic acid during pregnancy contributes to autistic developments in the child. In addition, child bearing in old age might also contribute to development of autism in the child.
Developmental, Educational, and Social Implications
Autism Spectrum Disorder is linked to many other comobidities. Mood disorders such as depression have been linked to autism. About 2% of children with autism are diagnosed with depression. Thirty percent of children with Asparger's syndrome suffer from depression. It is considered the most common psychopathology associated with ASD. Phobias and anxiety have been observed in ASD patients. behaviors like fearing to ride in a bus, getting out of a bathroom, dental fears, and fears to swim in treated swimming pools clearly demonstrate phobias. Anxiety seems to overlap both phobias and depression. A child with autistic related anxiety was treated using dextromethorpham, an anxiety drug and responded well to the intervention. This illustrates existence of anxiety in underlying ASD conditions. In addition, behaviors present in obsessive compulsive disorder (OCD) are commonly characterized with anxiety. Although OCD can be distinguished from ASD, the basic traits of repetitive behavior are common in both conditions. It is possible for OCD to occur in ASD making anxiety a comobidity in ASD.
Children with ASD are known to have special intelligence capabilities such as enhanced visual and auditory abilities, excellent in sciences and arts, and have prolonged memory. However, their social life is challenging in most cases. They tend to be aggressive when responding to distress or anger. They find challenges in maintaining continuous one on one conversations for long periods of time. In addition, ASD children have diminished listening skills and fail to adapt easily to changes in routines. These social deficiencies leads to difficulties in their education with other children.
Alternate Actions for Prevention
Caregivers of ASD patients are randomized in different avenues including educators and guardians. It is necessary for evidence-based treatment to be provided for these diversified caregivers. Interventions such as physical, speech, and occupational therapy are effectively done in the childs home. The services required include intensive behavioral and comprehensive treatment packages. These interventions need to be generally incorporated in all environments to enhance their effectiveness. Providing such treatments through parents and caregivers of these patients can prevent progress of the disorder.
Engagement of the community by professionals will provide them with skills and education for ASD care. These include locally available services, guidelines in selection of therapy, and appropriate interventions for such conditions. They help to enable parents select appropriate schools for their children to enhance their care.
ASD can be universally prevented through frequent screening of individuals with higher risk for the disorder. Monitoring of the disorder will enhance timely interventions, which may enhance the outcome. When ASD cases are not diagnosed in time, intervention strategies are not effective. Therefore, surveillance programs can enhance interventions.
The laws have provided opportunities for children with ASD to have equal opportunities as their counterparts in education. However, awareness programs need to be implemented in schools to minimize stigmatization of children with ASD. This strategy can enhance school-based interventions applied in ASD care.
Promoting healthy development
Health development of ASD children is dependent on adequate nutritional strategies. Provision of a balanced diet is key is supply of relevant nutrient requirements for the bodys' functioning. Children with ASD tend to avoid meals due to comobidities associated with the disorder. Therefore, when bringing up the child, a good nutritional approach is needed.
Alternative Actions for Intervention
Special education can provide an alternative action for intervention. This allows systematic and individual analysis of capabilities of each child and provision of special intervention for each one of them. This strategy is implemented by a professional who can effectively analyze the needs of the children with ASD. When effectively trained, these children can improve their outcome in areas of challenges.
Treatment of gastrointestinal disorders is important in management of ASD. Some GIT infections and disorders worsen the ASD condition interfering with its primary management. In theory, some symptoms of ASD in children are associated with GI problems. These have been related to food intolerances such as lactose and gluten intolerances. This concept has not been validated considering challenges involved in researching on such a subject. However, evidences from urine protein subtypes illustrate a possibility of effects caused by these intolerances.
Treatment of sleep disorders is relevant in management of ASD. Sleep is a symptom in ASD and can be managed through behavioral interventions and pharmacological inputs. Evidence suggests that behavioral therapy is effective in children between three -10 years. On the other hand, intervention using melatonin is known to promote sleep.
Autism intervention is done at different stages of development with differing settings. It occurs at home or in preschool for children who are not attending schools. The intervention is done in schools for school goers. Adults can find intervention in vocational training setting. However, treatment can occur in clinic for individuals, homes or social groups as well as activities, and group or family work. The intervention strategies have undergone revolutionary changes from legal and federal law frameworks, enhanced researches of the nervous system with genetics, and development of pharmacological and psychological intervention strategies for autism. The law led to formation of the Individuals with Disabilities Education Act (IDEA) that allowed children with disabilities to be included in classes of typically developing peers. Advancement in education has enhanced psychological management of autism. It resulted in interventions such as picture exchange communication model, pivotal response training, descretrial training, verbal learning, and incidental training. New drugs are developing for intervention as well as alternative treatments such as gluten free diets.
Focused treatment strategies used in management of autism are modeling, schedules, behavioral package, peer training package, self-management, naturalistic teaching, and story-based intervention mechanisms. These strategies are used for children with specified challenges and require specific therapies as directed by the health proffesional.
Evidence-based intervention strategies exist and are aimed to provide comprehensive treatment for children with autism. They include EarlyStart Denver Model (ESDM), UCLA Young Autism Project, Pivotal Response Treatment, and Treatment and Education of Autistic and Communication Handicapped Children (TEACCH).
These interventions are adopted by parents and professionals that are used in management of autism but lack empirical validity and complementary scientific research. They include dietary supplementation of vitamins such as magnesium and melatonin. Other strategies propose gluten-free and casein-free diets. Therapies like immunoglobin therapy, music therapy, somatic cell therapy, animal therapy, massage therapy, craniofacial therapy, vision therapy, options therapy, holding therapy, and stem cell therapy are in this category. Antifungal, chelatation, and hyperbaric oxygen treatments are applicable. Chinese medicine as well as acupuncture is used. In addition, auditory integration training and sensory diet are used as alternative intervention strategies.
Autism spectrum disorder is a combination of five neural disorders characterized with repetitive disorder, challenges in communication, and repetitive behaviors. They present limited emotional and cognitive functions as well as repetitive interests, behaviors or activities. The pathological cause of this disorder is not well understood but it is believed to be caused by a combination of genetic and environmental factors. Its diagnosis is based on symptom presentation in children. Early detection of the condition is important for effective intervention. During the first three years of life, children with ASD can undergo training and therapy in walking, speech, and social life preventing prolonged challenges associated with this disease. In the recent years, much development has been done in legislation, research, and education. This led to provision of rights to ASD children. The medical front has also developed psychotherapeutic approaches helpful in its management. However, to enhance the output of intervention strategies used in ASD, education, awareness, and surveillance needs to be incorporated.