What is Autism? What Causes Autism?
Autism is known as a complex neurodevelopmental disability. Experts believe that overt symptoms gradually begin after the first six months and become established by age two or three years. The condition is the result of a neurological disorder that has an effect on normal brain function, affecting development of the person's communication and social interaction skills.
People with autism have difficulty with verbal and non-verbal communication, a wide range of social interactions, and activities that include an element of play and/or banter.
Genomic research is beginning to discover that people with autism spectrum disorders probably share genetic traits with individuals with ADHD (attention-deficit hyperactivity disorder), bipolar disorder, schizophrenia, or clinical depression. A team at the Cross Disorders Group of the Psychiatric Genomic Consortium suggests that the five mental disorders and illnesses have the same common inherited genetic variations.
What is Autism Spectrum disorder (ASD)?
Is the umbrella term for the once separate diagnoses label of Autistic Disorder, Asperger's Disorder, and PDD-NOS (according to the newly revised DSM-V, which stands for the Diagnostic and Statistical Manual-Fith Edition). All characterized by social deficits and communication difficulties, stereotyped or repetitive behaviors, and intrest, and in some cases, cognitive delays. Further distinctions will be made according to severity levels. The severety levels are based on the amount of support neded, due to challenges with social communication and restricted interest and repetive behaviors. For example, a person might be diagnesed with Autism Spectrum Disorder, Level 1, Level 2, or Level 3. The DSM-V revision website says the reason for using the umbrella term of "Autism Spectrum Disorder" are 1) the old way wasn't precise enough- different clinicians diagnose the same person with different disorders, and some change their diagnosis of the same symptoms differently from year to year, and 2) autism is defined by a common set of behaviors and it should be characterized by a single name according to severity.
Revisions to the specific criteria needed for a diagnosis of Autism Spectrum Disorder have also been made. The new criteria are more thorough and strict compared to the old criteria. For example, more symptoms are needed to meet criteria within the area of fixated interest and repetitive behaviors. Other changes to the criteria include reorganization. Currently, the domains for Autistic Disorder include impairments in Communication, Social Interaction, and Restricted Interest and Repetitive Behaviors. In the new edition, the Communication and SOcial Interaction domains will be combined into one, tittled "Social/Communication Deficits." Additionally, the requirement of delay in language development is no longer necessary for a diagnosis.
DSM-V Diagnostic Criteria
Social (Pragmatic) Communication Disorder 315.39 (F80.89)
A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains or word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.
Autism Spectrum Disorder 299.00 (F84.0)
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior
(see Table 2).
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior
(see Table 2).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
(Coding note: Use additional code to identify the associated medical or genetic condition.)
Associated with another neurodevelopmental, mental, or behavioral disorder
(Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)
Table 2 Severity levels for autism spectrum disorder
Severity level Social Communication Restricted, repetitive behaviors
Level 3 Severe deficits in verbal and Inflexibility of behaviors, extreme
"Requiring very nonverbal social difficulty coping with change,
substantial support” communication skills cause or other restricted/repetitive
severe impairments in behaviors markedly interfere
functioning, very limited with functioning in all spheres.
initiation of soical interactions, Great distress/difficulty
and minimal response to social changing focus or action.
overtures from others. For example,
a person with few words of
intelligible speech who rarely
initiates interaction and,
when he or she does, makes
unusual approaches to meet
needs only and responds to
very direct social approaches.
"requiring substancial Marked deficits in verbal and Inflexibility of behavior,
support" nonverbal social difficulty coping with change,
communication skills; social or other restricted/repetitive
impairments apparent even behaviors appear frequently
with supports in place; enough to be obvious to the
limited initiations; and reduced or casual observer and interfere
abnormal responses to social with functioning in a variety of
overtures from others. For context. Distress and/or
example, a person who difficulty changing focus or
speaks simple sentences, action.
whose interaction is limited
to narrow special interests,
and how has markedly odd
"Requiring support" Without support in place, Inflexibility of behaviors causes
deficits in social significant interference with
communication cause functioning in one or more
noticeable impairments. contexts. Difficulty switching
Difficulty initiating social between activities. Problems of
interactions, and clear organization and planning
examples of atypical or hamper independence.
unsuccessful response to
social overtures of others.
May appear to have
decrease interest in social
interactions. For example, a
person whom is able to speak
in full sentences and engages
in communication but whose
to- and - fro conversation with
others fails, and whose
attempts to make friends are
odd and typically
The benefits of early intervention for kids with an ASD
Children with an ASD who received early intervention tend to have better brain function, communication skills and overall social behavior compared to ASD children with no early intervention, researchers from the Yale School of Medicine reported in the Journal of Autism and Developmental Disorder (November 2012 issue).
They added that the brains of kids with autism appear to respond well to “pivotal response treatment” if it is provided early on. The program, which requires parental involvement as well as “play” situations, was created specifically for children with autism.
Treatment for Children with Autism
There are several treatments options available for children on the autism spectrum, such as Swimming with Dolphins Therapy, Hyperbaric Oxygen Therapy, TEACCH (Treatment and Education of Autistic and Related Communication - Handicap Children), etc. However, Applied Behavior Analysis (ABA) is the only treatment that is evidence based with over 30 years of research and has been proven to work for every child on the spectrum if applied ethically and appropriately is Applied Behavior Analysis.
Applied Behavior Analysis (ABA)
Applied Behavior Analysis is a scientific approach to behavior, which utilizes it's many principles to produce socially significant improvements in human behavior. It analyzes the relationship between antecedents (what happened before the behavior occurred), the behavior (what behavior actually occurred), and the consequence (what happened after the behavior occurred), educators or educational teams (teachers, principals, counselors, therapist), can begin to develop a comprehensive plan for changing behavior.
An essential element of ABA involves analyzing the function of the behavior (the purpose the behavior serves). A behavior's function can be categorized in two ways: to get something or to avoid something. Determining an effective plan for behavior is essential in designing an effective plan for behavior change. Knowing why a behavior is occurring helps educators choose an intervention that will eliminate or change that behavior.
Different methods used to educate students that are based on the principles of ABA include:
Direct Instruction- This explicit teaching method is used to accelerate
students learning by the design and delivery of instruction.
It is fast paced and provides interaction between
students and teacher with multiple practice opportunities The student
is provided with immediate feedback regarding correctness of
responses. In this approach, the task demand is the "antecedent,"
the student response is the "behavior," and praise or
corrective feedback is the "consequence."
Discrete Trial Teaching- This method views each behavior as a series
of discrete skills. Each skill is sequentially taught in a one-to-one format
using a system of cues, drills, and rewards. This instructional style
emphasizes the breakdown of skills or behaviors into simple, manageable
steps with the targeted skill or behavior systematically reached through
prompting, chaining (combining simple behaviors to form a complex behavior),
and reinforcement of the steps.
Precision Teaching- This strategy is used to build skill fluency once mastery
is achieved. Fluency-based instruction focuses on building speed and accuracy
to accelerate student achievement. Student's behavior or skill development
is monitored on a chart that allows the instructor to record several months'
progress on one page.
The Analysis of Verbal Behavior- This is an extension of the principles
of applied behavior analysis to communication. This analysis is used to
determine the function of language based upon the student's use of
vocalizations, signs, or other augmentative systems. The use of this
analysis is helpful in determining under what conditions a child
is likely to use certain words and can also guide the development
of programs to help children learn to use language effectively for
a variety of purposes.
Pennsylvania Training and Technical Assistance Network (PaTTAN)
The Behavior and Autism sections of this website have links to many websites
related to behavior analysis and autism topics.
This website provides extensive list of resources in a variety of interest
areas for both parents and professionals.
Cambridge Center for Behavioral Studies
This website provides information and resources related to many
aspects of behavior, including information about how to manage and
change behavior in the home, school, and workplace.
Journal of Applied Behavior Analysis
The primary journal for the field of Applied Behavior Analysis provides
articles on current scientific research.
Behavior Analyst Certification Board
The website provides information about certification programs
nationally and internationally for those seeking to become Board
Certified Behavior Analyst, as well as information for consumers
interested in finding professionals in the field.