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AUTISM SPECTRUM DISORDER

Interesting changes to the diagnosis of Autism

The diagnostic categories for Autism changed in 2014. Previously Autistic Disorder fell under the umbrella term, Pervasive Developmental Disorder (PDD). PDD included a variety of different disorders including Autistic Disorder and Asperger’s Syndrome (among others). Since 2014, the umbrella term has become Autism Spectrum Disorder (ASD), and the other disorders (e.g., Asperger’s Syndrome) no longer exist as diagnoses on their own but now fall under ASD. There have also been some changes in the diagnostic criteria for ASD. ASD is on the rise Between 2012 and 2014 the official prevalence of ASD rose by 30%, from 1 in 88 to 1 in 68 children. In 2015, a government parent survey suggested 1 in 45 children in the US had ASD. This increase cannot only be explained by better awareness. The exact cause of ASD is still unknown. Research shows a strong genetic component to ASD but something in the environment is triggering the genetic predisposition in more individuals than before. Studies have identified correlations between ASD and environmental risk factors such as the mother (or father’s) prenatal exposure to food or environmental toxins; infections, illness, or certain medications taken by mothers while pregnant; preterm deliveries; and even the older age of parents. There is also a higher prevalence in boys than girls with one girl versus five boys diagnosed with ASD. There are a number of theories that have arisen to explain this discrepancy, one of which is that girls with ASD present differently from boys and may be less understood or misdiagnosed. Further research is being conducted into these differences. Signs and Symptoms of ASD Symptoms of ASD fall on a spectrum (or continuum) because there are varying combinations and severity of symptoms. It is possible to have a relatively mild or severe form of the condition (or anywhere in between). This is why no two individuals with ASD are alike.

The following list of symptoms includes some of the signs to look out for:

Deficits in social communication and social interaction

Individuals with ASD display deficits in ALL of the following areas:

• Deficits in their ability to respond to others on a social level. This is often seen in a difficulty approaching others socially, being socially awkward, difficulty with back-and-forth conversations, one-sided conversations, little concern for the interests of others, or difficulty sharing their interests and emotions with others.
• Deficits in nonverbal communicative behaviors used for social interaction. This can be seen in weak eye contact, difficulties using or understanding the use of body language or gestures to communicate; and difficulties using facial expressions to communicate.
• Deficits in developing, maintaining, and understanding relationships. This could range from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to a complete absence of interest in peers.

Restricted, repetitive patterns of behavior, interests, or activities

Individuals with ASD display at least two of the following:

• Stereotyped or repetitive motor movements (e.g., hand/arm flapping). There may be peculiar or stereotyped use of objects lining up toys or flipping objects, or they may use repetitive or stereotyped speech (repeating words or phrases over and over).
• Strong need for routine or sameness. This is often seen in a strong need for things remain the same, a need to take the same route or eat the same food every day. They can become extremely distressed at small changes or have difficulty with changing from one activity to another. They may display very concrete thinking patterns and take things literally, not catching jokes or understanding implied meanings. They may have specific rituals that need to be performed in a certain way.
• Fixations or limited interests. They may become obsessive or fixated on a certain item, toy, TV programme, or topic. Young children my cling to a certain toy or object and become extremely distressed when it is removed. Older verbal children may talk incessantly about a topic in an obsessive way.
• Over/under-reactivity to sensory input. Under-reactivity to sensory input may be seen in an indifference to pain or temperature, unusual interests in sensory aspects of the environment or seeking out stronger sensory input than is typical e.g., excessive smelling or touching of objects, visual fascination with lights or movement, a need for excessive movement, spinning, twirling. Over-reactivity to sensory elements could be evidenced by negative responses to specific sounds (crying at the sound of a vacuum cleaner for example) or textures (not wanting to wear certain clothes). It is important to note that sensory abnormalities alone are not an indication of ASD but when combined with a combination of the above symptoms, they could point towards the presence of ASD.

For a diagnosis to be made the individual should display a combination of the above symptoms (may vary from mild to severe) and they should cause significant impairment. They should be seen in the child’s early years, however in some individuals they become more apparent as social demands increase. In some adolescents or adults, the severity of symptoms can be masked somewhat by learned strategies. ASD is not an intellectual disorder. Some individuals have normal to above average intellectual functioning, however, for many there can be an accompanying intellectual impairment. Similarly, many individuals with ASD do not display a delay in language and can even have advanced vocabulary. Nevertheless, for many there is accompanying language impairment. Some speak late and others don’t develop language at all. ASD can also be accompanied by other medical (e.g., seizure disorders); genetic conditions (e.g., syndromes); or neurodevelopmental, mental, or behavioral disorders (e.g., Attention-Deficit Hyperactivity Disorder, Anxiety Disorders, Mood Disorders etc.).

Getting a diagnosis of ASD

The diagnosis of ASD is usually made by a professional such as a Paediatric Neurologist, Specialist Psychiatrist, or Clinical Psychologist (with a special interest in neurodevelopmental disorders). There are no neurological or medical tests that diagnose ASD although these should be done to rule out other neurological abnormalities or associated conditions. ASD is a diagnosis that is made based on the clinical presentation of the individual. There are assessments and checklists that can be used to assist the professional in making the diagnosis. Developmental assessments are also useful to inform interventions and track progress over time. Intellectual tests can be helpful for informing how a child is likely to cope with mainstream schooling. It is important to note that these tests are often not a true reflection of an ASD child’s intellectual capacity and should be interpreted with caution. Getting a diagnosis provides so much more than a label. It informs intervention, helps to highlight and draw on specific strengths and weaknesses, informs educators on how best to teach or support the child, and most importantly, provides a platform from which parents can better understand the way their child thinks and sees the world. As a result, parents and professionals can better support the child in achieving their true potential.

Article written by: Nikki Simons (Clinical Psychologist)