What is Autism Spectrum Disorder?
By Gillian Feit
Autism Spectrum Disorder (ASD) is a complex heterogeneous neurodevelopmental disorder. Specifically, “Autism spectrum disorder is a construct used to describe individuals with a specific combination of impairments in social communication and repetitive behaviors, highly restricted interests and/or sensory behaviors beginning early in life” (Lord et al., 2020). According to the World Health Organization, as of their most recent data (November, 2023), approximately 1 in 100 children have autism (Autism, 2023). Moreover, ASD diagnoses have been increasing for years, but researchers cannot determine whether the trend is a result of increased awareness, improved detection, expanding definition, or an actual increase in incidence or a combination of these factors (Yasmin, 2014). Understanding the disorder correctly, receiving the correct diagnoses and implementing important interventions are vital to a successful trajectory for an individual with ASD.
Autism could be diagnosed at any age; however, it is described as a ‘developmental disorder’ because symptoms generally appear around 12 months and become more pronounced at 18 months. “By age 2, developmental precursors of autism symptoms can be used to diagnose children reliably, and by age 3, the diagnosis is thought to be relatively stable” (Webb & Jones, 2009). There are a significant number of different types of doctors that families seek for the diagnoses; however, the most popular doctors who diagnose ASD are neurologists, neuropsychologists, and developmental pediatricians followed by psychologists and psychiatrists (Goin-Kochel et al., 2006). A family will begin to seek a diagnosis when they first notice early onset observable markers. Some of the early onset symptoms include; “subtle disruptions in social interest and attention, communication, temperament, and head circumference growth that occur prior to the onset of clinical symptoms” (Webb & Jones, 2009). Other markers are; “socio-emotional responding, such as a failure to engage in shared positive affect; social attention, such as a failure to orient to social signals, such a child’s own name being called; social interaction, such as failing to maintain interactions with other children; and social gestures, such as a failure to wave hello or engage in other greeting responses” (Pierce et al., 2009).
When you begin to have a suspicion about an individual due to developmental delays or abnormal behavior, you should seek to get them tested for autism. Although there is no singular test, brain scan, or blood work that entirely says whether an individual is autistic or not, professionals diagnose individuals according to the Diagnostic and Statistical Manual of Mental Disorders handbook. It is understood in both DSM-IV and DSM-5 that those who meet the criteria for autism often have symptoms of other disorders (anxiety disorders, affective disorders, attention deficit hyperactivity disorder, specific language disorders, and intellectual disability in particular). The presence of these other symptoms should be noted, and, if necessary, the patient should be treated. If the symptoms are sufficient to meet criteria for other disorders, then the patient should be diagnosed with comorbidities (Tanguay, 2011). ASD comorbidity is significant and can impact occupational, academic, autonomy, and other important areas of functioning. “Attention deficit hyperactivity disorder (ADHD) was the most common comorbidity, affecting more than 1 in every 3 children with ASD (35.3%), much higher than 1 in 6 (16.8%) among non-ASD siblings. Learning disability (23.5%) and intellectual disability (21.7%) were the next most-common comorbid conditions among children with ASD” (Khachadourian et al., 2023). Moreover, psychometric tools include ADOS, CARS, ADI-R, M-CHAT-R, Cognitive and developmental tests (Mullen Scales of Early Learning and The Wechsler Intelligence Scale for Children (WISC). Considering ASD can have profound impacts on different domains of functioning, more comprehensive evaluations also include speech and language exams as well as occupational therapy assessments. Furthermore, the children that are most affected are those with a delayed diagnosis, many of them only being diagnosed after visiting several different professionals. Only a small percentage of children are diagnosed before age three, and in most cases it is their teacher who identifies difficulties in school (Rey et al., 2019). When you begin to see abnormalities, it is crucial to get your loved one assessed.
Once the individual has been diagnosed with autism, after reaching out to specialists and receiving the correct tests, post-diagnosis support and interventions come into play. Children may have an Individualized Education Plan (IEP) and continued support by parents and loved ones, as well as, evidence-based therapeutic approaches (early intensive behavioral interventions (EIBI), developmental interventions (DEV), naturalistic developmental behavioral interventions (NDBI) and parent-mediated interventions (PMI) in preschool). Specifically, a recent meta-review noted that “the efficacy of many of these psychosocial interventions was supposed by highly suggestive or suggestive evidence depending on the age of the participants and the outcome under consideration. In preschool children EIBI, NDBI, DEV and PMI were supported by suggestive evidence: on social communication impairment, adaptive behaviors and IQ for EIBI, and on social communication for NDBI, PMI and DEV. In early school-aged children, highly suggestive evidence was found for the efficacy of PMI on disruptive behaviors. In late school-aged children and in adolescents, suggestive evidence was found for SSG on social communication and overall ASD symptoms” (Gosling et al., 2022). Early interventions make a significant difference in how a child with autism develops, and the earlier the help, the better.
Not only are evidence based therapeutic approaches vital to ensuring an individual with the most effective approaches but, the role of parent and play are also crucial. “Parents are especially important because the time they spend with the child can lead to teaching opportunities (Symon), and they can provide information regarding important family values and routines and the child's strengths and preferences (Buschbacher, Fox, & Clarke, 2004). Furthermore, research has shown that parents can implement continuous treatment and can be effective interventionists (Koegel, Bimbela, & Schreibman, 1996). When parents are included in treatment, they can continue to teach children with ASD skills in the home environment, which improves the parent-child interactions and increases the amount of intervention they receive (Girolametto & Tannock, 1994). This is critical because research suggests that children who receive intensive treatment show significantly more improvement than those receiving less treatment (Anderson, Avery, DiPietro, Edwards, & Glynnis, 1987; Lovaas, 1987)” (Burrell & Borrego, 2012).
Psychosocial interventions in children may improve specific behaviors, such as joint attention, language and social engagement, that can affect future development and may reduce symptom severity; however, many question about the identification of children, their needs, and the qualities of appropriate services (Lord et al., 2020). For example, “controversial issues include the use of widely criticized methods for (a) identifying the needs of young children, (b) diagnosing and labeling childhood disorders, and (c) placing children into potentially ineffective programs. Thus, enthusiasm must be tempered by potential risks, including the possibility that children may be misidentified and that interventions may result in either inconsequential or even harmful” (Barnett et al., 1992).
Myths and misconceptions are vital to debunk for anything, especially when it comes to developmental disorders. In the more recent years, people are believing that screens cause autism. An article written by Waldman et al., (2006) says “our precipitation tests indicate that just under forty percent of autism diagnoses in the three states studied is the result of television watching due to precipitation, while our cable tests indicate that approximately seventeen percent of the growth in autism in California and Pennsylvania during the 1970s and 1980s is due to the growth of cable television. These findings are consistent with early childhood television viewing being an important trigger for autism”. Ultimately, these researchers are claiming that early exposure to screens can result in developmental delays across language, cognitive and relational domains in which case children’s skills begin to mimic ASD symptomatology. The children then receive a misdiagnosis and parents begin to interact with the child as if they have ASD. Overall, this is an example of correlation not equalling causation rather than screens genuinely leading to ASD.
Overall, ASD is a complex neurological and developmental condition that significantly impacts individuals. Despite the ability to diagnose autism at any age, symptoms typically emerge within the first two years of life, and early identification and intervention are crucial; they can profoundly influence the developmental trajectory of individuals diagnosed with the disorder. Given the rising rate of autism diagnoses, understanding the disorders’ characteristics and recognizing the variability among those affected are more crucial than ever.
References
Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones, R. M., Pickles, A., State, M. W., Taylor, J. L., & Veenstra-VanderWeele, J. (2020). Autism spectrum disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8900942/#R43
Autism. (2023, November 15). World Health Organization (WHO). Retrieved July 3, 2024, from https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders
Yasmin, N. H. (2014). Increasing Prevalence, Changes in Diagnostic Criteria, and Nutritional Risk Factors for Autism Spectrum Disorders. ISRN Nutrition. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045304/
Webb, S. J., & Jones, E. J. H. (2009). Early Identification of Autism Early Characteristics, Onset of Symptoms, and Diagnostic Stability. Infants & Young Children, 22(2), 100-118. https://journals.lww.com/iycjournal/abstract/2009/04000/early_identification_of_autism__early.4.aspx
Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2006). How many doctors does it take to make an autism spectrum diagnosis?. Autism, 10(5), 439-451. https://journals.sagepub.com/doi/10.1177/1362361306066601
Pierce, K., Glatt, S. J., Liptak, G. S., & McIntyre, L. L. (2009). The power and promise of identifying autism early: Insights from the search for clinical and biological markers. Ann Clin Psychiatry, 21(3), 132-147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872627/
Tanguay, P. E. (2011). Autism in DSM-5. The American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2011.11071024
Khachadourian, V., Mahjani, B., Sandin, S., Kolevzon, A., Buxbaum, J. D., Reichenberg, A., & Janecka, M. (2023). Comorbidities in autism spectrum disorder and their etiologies. Translational Psychiatry, 13. https://www.nature.com/articles/s41398-023-02374-w
Rey, F., Rodriguez, S., Linares, L., Vives, V., Vives, C., Vives, T., & Vives, M. (2019). A Systematic Review of Instruments for Early Detection of Autism Spectrum Disorders. International Journal of Psychology & Psychological Therapy, 19(1). https://dialnet.unirioja.es/servlet/articulo?codigo=6887337
Gosling, C. J., Cartigny, A., Mellier, B. C., Solanes, A., Radua, J., & Delorme, R. (2022). Efficacy of psychosocial interventions for Autism spectrum disorder: An umbrella review. Molecular Psychiatry, 27(9), 3647-3656. https://www.nature.com/articles/s41380-022-01670-z
Burrell, L., & Borrego, J. (2012). Parents' Involvement in ASD Treatment: What Is Their Role? Cognitive and Behavioral Practice, 19(3), 423-432. https://www.sciencedirect.com/science/article/pii/S1077722911000745
Barnett, D. W., Macmann, G. M., & Carey, K. T. (1992). Early Intervention and the Assessment of Developmental Skills: Challenges and Directions. Topics in Early Childhood Special Education, 12(1). https://journals.sagepub.com/doi/abs/10.1177/027112149201200105
Waldman, M., Nicholson, S., & Adilov, N. (2006). Does Television Cause Autism? https://www.nber.org/system/files/working_papers/w12632/w12632.pdf
Nicholas, J. S., Charles, J. M., Carpenter, L. A., King, L. B., Jenner, W., & Spratt, E. G. (2008). Prevalence and Characteristics of Children With Autism-Spectrum Disorders. Annals of Epidemiology, 18(2). https://www.sciencedirect.com/science/article/pii/S1047279707004632