Society would have us believe that those individuals with autism, often rock back and forth and are held captive in their own worlds, unaware of anyone or anything around them. Hollywood would tell us that autism creates someone like Dustin Hoffman’s character in Rain Man (1988). Medical doctors are seeing an increase in cases of Pervasive Developmental Disorders among children. According to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network, one in eighty-eight children are identified to have an Autism Spectrum Disorder (CDC, 2013). Educators are seeing an undeniable spike in children on the Autism Spectrum. Parents are left wondering what is the matter? Why isn’t my child acting in a typical way? There are a lot of questions out there about Autism Spectrum Disorders. In this blog post I am going to try and answer the question, “ASD, what is it?”
According to the Diagnostic and Statistical Manual of Mental Health (Autism Society, Diagnostic Classifications), there are several subtypes that fall under the classification of Pervasive Developmental Disorders or Autism Spectrum Disorders. They are Asperger’s Syndrome, Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), Rett’s Syndrome, and Childhood Disintegrative Disorder. These titles are a mouthful to say, but what do they mean? Simply stated, any individual that falls under the umbrella of Autism Spectrum Disorders (ASD) is going to have three main issues that characterize their journey. These struggles are with, social interaction, communication, and restricted/repetitive patterns of behavior/actions/or interests (WebMD, 2013). Some children that struggle with social interactions may appear to want to be alone, be hypersensitive to sounds or textures, blurt out or repeat words, or say things that are not appropriate to the situation. For example, a student who is overwhelmed by the sights and sounds of the playground at school, might choose to stand away from his classmates and observe from a distance, where it is more quiet and calm. He might have a toy in his hand that he squeezes because it gives him comfort and calms him when his anxiety level is high. Children that struggle with communication often times are unsure of what to say or how to say it. Language is confusing to these individuals. It is not unusual for a child to say one word, and mean another entirely. Communication is a learned interactive skill. If there is a break in the line of communication it can be, and often is, confusing to a child with ASD. It is often the case that, children on the spectrum will have restrictive or repetitive behaviors. For one child it might be repeating the same movie scene over and over again because it gives a sense of routine and understanding of what will happen next. Another child might memorize numbers and be a whiz at phone numbers, birthdays, license plates, or multiplication tables. There is no one thing that all children with ASD do repetitively. Each child with ASD is different, as are all children.
As I mentioned earlier, communication is one of the greatest struggles for those on the autism spectrum. From the time they are babies, these children have difficulties with joint attention, communicative intent, pragmatics, and nonverbal communication. Gestural vocabulary appears several months prior to approximations of spoken words. In typically developing children, there is an alternating eye gaze between a person and an object around this period of time. This communication is called coordinated joint attention (Hall, 2013, p.171). A child on the autism spectrum will have difficulty making the connection with eye gaze between the caregiver and the object that is wanted. It is possible that the baby will not want to be held or even share eye contact at all. Communicative intent is being able to wait to get an adult’s attention before pointing, is essence asking for assistance. It is persistence, and being able to devise a new plan when the first one didn’t work. A typical young child understands that they need to get the eye contact of mommy or daddy, because mommy or daddy will help them get what they need. Most typical children become masters at the art of getting attention. This is not the case with the ASD child. He/she struggles with eye contact or being able to devise news ways to get what they need. For example, the child might look at a cup of milk that is wanted, and just stare at it but, not put together that they need to communicate to the adult that they are interested in having more milk. Pragmatics is knowing the context in which to use language. It is “getting” the meaning of words. A child with autism has difficulty with pragmatics. Many times jokes or sarcasm are lost on a child with ASD. These children tend to be very literal and will become frustrated with abstract conversations. Finally, nonverbal communication are all those things that a typical child “reads” without thinking about it. If mom is angry, she has a scowl on her face. A child takes one look and knows mom is not happy. The ASD child will not be good at reading body language or facial expressions. This child might not even notice that mom is angry and continue to talk about other things that he/she is interested in, completely ignoring mom’s bad mood.
This chart shows the communication development of typical children up to twenty four months (Hall, 2013, pp. 170-173), along with the threshold of what is considered normal development (Mayo Clinic, Autism Symptoms). If a child is delayed at or beyond this threshold for these milestones, doctors become concerned. At that point, one might consider having the child evaluated for an Autism Spectrum Disorder.
Although, each of the subtypes of Autism Spectrum Disorders share certain characteristics as I have mentioned, they are also each unique. First, there is Asperger’s Syndrome. Asperger’s has gotten a lot of press lately, some of which is true, some which isn’t, and some is a mixture of the two. Individuals with Asperger’s usually have good “surface” language skills. They reach the language milestones at a fairly typical rate. That would be words by age two and phrases by age three (Mayo Clinic, 2010). As they get older and communicate, it becomes evident that there is an awkwardness when they talk. They do not understand the natural give and take in conversation. Often times, their conversations are one sided and many times about only the thing(s) that they are interested in. The listener might become bored and attempt to change the subject, and yet the Asperger’s individual never notices this. This type of behavior goes along with their inability to accurately read people. These individuals many times will have poor eye contact, a rigid voice tone, and not understand empathy or to be sensitive to others feelings. They might appear awkward and seem to have poor coordination. The general public has often described Asperger’s individuals as “quirky”.
Another subtype of ASD, is Autistic Disorder. The DSM-IV describes Autistic Disorder as “abnormal or impaired development in social interaction and communication, and a remarkedly restricted repertoire of activity and interest.” (Autism Society, Diagnostic Classifications) There is no medical test that a child can take and instantly be diagnosed with Autistic Disorder, although parents will usually observe that their child, at a young age, is not developing like their more typical peers. In order to be diagnosed a child is observed to see if he/she meets a set criteria of impairments in socialization, communication, and activity and interest, as I mentioned earlier. Autism is a spectrum disorder. This means that an individual can fall anywhere on the spectrum, some cases being more severe than others. Some children with autism that receive early intervention and intense training in language and communication, are able to function quite well, even with the impairments. These children are on one side of the spectrum. On the opposite end of the spectrum are children that are in their own world, and who do not communicate at all. Most children with autism will fall somewhere in between these two extremes.
Pervasive Developmental Disorder -Not Otherwise Specified, is fairly self explanatory. This Disorder is very similar to Autistic Disorder, in that they both effect a child’s ability to socialize and communicate. He or she also tends to have remarkable fixations on things that they like. The difference has to do with the age of the child at the onset of PDD-NOS. With autism, the diagnosis occurs when the child is fairly young. With PDD-NOS, the child is older. If all the other subtypes of Pervasive Developmental Disorders are ruled out, then a child might be diagnosed with PDD-NOS. Regardless of diagnosis, a child with PDD-NOS or autism should both be treated in a similar manner.
Another less heard of, subtype of Autism Spectrum Disorders is Rett’s Disorder. With Rett’s a child has normal prenatal development, and normal development through the first five months of life. The infant also has normal head circumference. At some point the child loses the ability/skill he/she had to do purposeful work with their hands. He/she begins a characteristic hand-wringing type motion. Within a few years after the onset of this hand-wringing, the child will begin to lose their desire for socialization. Both their receptive and expressive language skills also diminish.
Finally, the last subtype of PDD that I will talk about is, Childhood Disintegrative Disorder. In this particular disorder a child would have normal development for at least the first two years of their life. After birth he/she had age appropriate verbal and nonverbal communication skills as well as age appropriate social skills. He/she also had age appropriate play and adaptive skills.
A child might have CDD if there has been a clinically significant loss of acquired skills, before the age of ten years, in at least two of these areas: receptive or expressive language, social skills, play, motor skills, or bowel or bladder control. At this time there are also significant impairments in socialization, communication, and repetitive activities. In order to have this diagnosis all other PDD diagnoses must be ruled out, as well as schizophrenia.
Regardless of what type of Autism Spectrum Disorder a child has, one can be fairly certain that the child will be affected behaviorally, socially, academically, and emotionally. The behavior of children with ASD can vary, from very good to dangerous outburst and meltdowns. Anyone that has a child, or has worked with a child that has an ASD, knows about meltdowns. The child loses any perspective, tantrums, yells, and might spit or hit or even go completely limp and refuse to move. Many times the meltdowns happen because of a break in routine, not getting his/her way, having to wait, or possible sensory overload. The best way to deal with meltdowns is to try to avoid them to begin with! Preventative measures are the best line of defense against uncontrollable meltdowns. Socially, ASD children are awkward. They are behind their more typical peers in having meaningful friendships, or peer interactions. They will say inappropriate things, or perseverate on topics of their choice, not being sensitive to the wants or desires of the other person. They tend to be very egocentric. Academically, a student with ASD will struggle. They might have something that they really enjoy discussing and know much about. For example, a student that loves words and reads the dictionary because that is his “thing”, would love spelling class and probably do very well on the tests. He might not be as excited about math and the abstract concepts that go with it. He might act out during math because he is confused and does not know what the expectations are in that class. Emotionally, those on the spectrum can be distant. Having empathy for others is something that they struggle with. This type of thinking must be taught and practiced. As children become teens and young adults, statistics tell us that depression and thoughts of suicide can become more common in those with ASD. (Autism Help, Depression, Suicide Risk and Autism) The communication difficulties that these young adults have can be a problem when working through depression.
How do children acquire Autism Spectrum Disorders? That is a loaded question and one for which I wish I had the answer. There are many theories out there, but frustratingly no definitive answers. There are many people that have many different ideas on why children have autism. Some partial theories conclude that there is more accurate diagnosing of children. What once might have been diagnosed as developmental delays, or even mental disorders such as schizophrenia, are now making more sense as an autism diagnosis. Some people believe that an excess of vaccines on immature immune systems is what is to at least partially blame for the sky rocketing epidemic of autism. Many families have decided it is in their childrens best interest to not get vaccines, or at the very least to space the vaccines out over a longer period of time. Others believe that autism has a genetic link. Researchers, medical doctors and PhD’s at Brown University have studied genetics in the autism diagnosis. They say that, “Autism is a heterogeneous neurodevelopmental disorder that affects people of all races, ethnicities and backgrounds and is about four times more prevalent in males.” (Johnson, Gaitanis, Morrow, 2011, p.124) They go on to say “Genetic research has recently revealed that about 10% of autism diagnoses can be subtyped according to genetic abnormalities.” It was interesting that, “Rett’s Disorder is the only ASD with a known genetic cause: it is an X-linked, Mendelian disorder caused by mutations in the MECP2 gene.” (Johnson, Gaitanis, Morrow, 2011, p.124) Genetic research is valuable because it can allow for earlier detection for those with ASD. The earlier an ASD is detected the earlier interventions can be started. This is good news, in that early intervention is crucial for success for any child on the autism spectrum.
Although all children are unique in their own way, I have tried to show in this blog post some of the characteristics and commonalities of children with Autism Spectrum Disorders. Even though researchers, doctors, educators, and parents don’t all agree on every aspect of ASD, most do agree that more research is needed in order to better understand ASD and what can be done to help those affected by it to lead a more productive and happy life.
Autism Help. (no date). Depression, Suicide Risk and Autism. Website.
Autism Society. (?) Diagnostic Classifications. website: http://www.autism-society.org/about-autism/diagnosis/diagnostic-classifications.html
Autism Society gives diagnostic classifications of Pervasive Developmental Disorders.
Centers for Disease Control and Prevention. (2013) Autism Spectrum Disorders (ASD’s). http://www.cdc.gov/ncbddd/autism/data.html
according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network
Hall, L.J. (2013). Autism spectrum disorders: From theory to practice (2nd ed.). Upper Saddle River, NJ: Pearson Education.
Explains typical language development.
Johnson,H. Gaitanis,J.MD. Morrow E. MD.PhD. (May 2011). Genetics in Autism Diagnosis:Adding Molecular Subtypes to Neurobehavioral Diagnoses. Medicine and Health/Rhode Island Volume 94. No.5 .website:
This paper is about autism genetics research.
Mayo Clinic. (2010 November 18). Asperger’s Syndrome. website: http://www.mayoclinic.com/health/aspergers-syndrome/DS00551/DSECTION=symptoms
Symptoms of Asperger’s Syndrome
Mayo Clinic. (no date). Health / Autism. Website: http://www.mayoclinic.com/health/autism/DS00348/DSECTION=symptoms
Rain Main (1988) starring Dustin Hoffman and Tom Cruise.
This movie is about a young man and his brother, who is a savant.
Web MD. (2013). Autism Spectrum Disorders Health Center. http://www.webmd.com/brain/autism/autism-spectrum-disorders
General knowledge of the subtypes of ASD.