Autism Spectrum Disorder (ASD) is a developmental disorder of the brain and can affect anyone, regardless of social status or intelligence. Autism is sometimes referred to as Pervasive Developmental Disorder (PDD) or Autistic Spectrum Disorder (ASD), and these are umbrella terms for some more specific disorders which all have many fundamental similarities, but also some subtle differences. Autism Disorder (also referred to as Kanner Syndrome or Classical Autism), Asperger Syndrome, Pervasive Developmental Disorder – not otherwise specified (PDD-NOS), Rett Syndrome, Childhood Disintegrative Disorder (Heller Syndrome) are all disorders that present with symptoms associated with autism.
However in 2013 the Diagnostic and Statistical Manual – DSM-5 (developed by the American Psychiatric Association to provide the criteria by which clinicians define and diagnose various psychiatric and developmental conditions, including autism spectrum disorders) refined some the above terms:
The diagnostic labels Autistic Disorder, Asperger’s Disorder, PDD-NOS and Childhood Disintegrative Disorder that were in the previous DSM edition under the heading Pervasive Developmental Disorders will no longer be used. These subcategories have been merged into the single broader diagnostic category of Autism Spectrum Disorder (ASD). A diagnosis of ASD may be considered for girls with Rett Syndrome if they present with behaviours that meet the ASD diagnostic criteria.
Despite the new guidelines from the American Psychiatric Association, it is likely that many of the previous terms will continue to be used for some time.
Prevalence and Causes of Autism
Reports on the prevalence and causes of autism vary considerably, with some reports giving a prevalence of ASD at around 6 per 1000 people. A recent CNN article (2008) claimed that there are 35 million people in the world who have autism. There appears to be an increase in the number of people being diagnosed, which some believe to be due to better diagnostic methods and awareness of the disorder. Autism is also more common in boys than girls (approximate ratio 4:1).
The exact cause of autism is still unknown and parents do not cause autism by the way they interact with their child. However, there appears to be a genetic link in some cases with brothers and sisters both being on the autistic spectrum, and other members of the family having the diagnosis or displaying autistic behaviours. There are a number of widely reported theories which discuss food allergies/additives, vaccinations or pharmacological treatments as a possible cause, but there is not a great deal of research based evidence at this time to support these theories.
Autism is not a mental illness although it was sometimes treated as such in the past. It is not curable, but symptoms may change over time and a lot can be done to help a person with autism lead a more regular life. The most important factor in outcome is early educational interventions.
The History of Autism
Autism was first described in 1943 by Leo Kanner. In 1944 Kanner renamed the disorder as Early Infantile Autism. Kanner described the main symptoms to be autistic aloofness, unable to relate to other people, and a fear of change in their environment. Hans Asperger described a similar disorder around the same time, but the children he described all had speech and language skills. Asperger Syndrome is now used to describe a particular type of autism spectrum disorder.
Unfortunately, the understanding and appropriate treatment of autism took many years to develop and a common theory for acquisition of autism was the “refrigerator mother”, where a lack of maternal warmth was blamed. Individuals with autism were often institutionalised and treatments included shock therapy, punishment, and administering LSD. More recently applied behavioural analysis (ABA) and behavioural therapy has been used more successfully to treat individuals on the autistic spectrum.
A better understanding of the disorder developed when, in 1979, Lorna Wing and Judith Gould proposed that individuals on the autistic spectrum generally presented with a ‘triad of impairments’.
These impairments presented a number of difficulties:
1) Social interaction: Individuals have difficulty making friends, understanding what others are feeling and thinking, and working co-operatively with others. Social interactions range from aloofness to unusual social behaviour. Individuals may not make eye contact or respond when spoken to.
2) Social communication: Individual’s comprehension is much poorer than expression, and expression is often echolalic (repeating words or learned scripts). There are difficulties using and understanding gesture, facial expressions, body language and intonation appropriately. Other social communication skills such as turn-taking may also be a problematic concept to learn. Speech may be delayed and there is little attempt to communicate in other ways. Some individuals with autism may rarely initiate communication.
3) Imaginative thought: Individuals have difficulties with empathy, imaginative play and become distressed when adjustments to a routine are made. Problem solving is difficult for individuals with autism and they may often take a literal perspective. Jokes, metaphor and sarcasm may not be understood. Some individuals may display repetitive movements (hand flapping, or spinning objects etc) and have obsessions or attachments with certain objects. They may also have elaborate routines that they follow in certain environments.
Wing and Gould also noted that many individuals displayed sensory sensitivities to sound, light, smell, taste and touch. Some individuals were also more prone to inappropriate and challenging behaviour, especially if they become distressed.
Many individuals with ASD will have coexisting developmental difficulties which may include learning difficulties, speech and language delay, hyperactivity, and epilepsy. Some individuals may only show mild examples of the above impairments. The triad of impairments will be noticeable to some level in all forms of autism spectrum disorder. Autism Spectrum Disorders range in severity, and different types of disorder present with certain characteristics.
Treatment for Autism
There are a number of different treatments and therapies for autism, but it is important to realise that every person with autism is different, and to have a holistic view of treatment. Often a combination of treatments is better than focussing on one approach only. Prior to intervention, we need to know the abilities and strengths of an individual, and know how they learn new information. We must also set functional goals that will allow the them to generalise their new skills.
Applied Behaviour Analysis (ABA) – skills are taught by breaking tasks into small steps and working through these steps. Prompting, Shaping and Rewarding are used to motivate the individual to complete the steps. ABA can be part of a comprehensive program, or used to attempt to teach individual tasks.
Using Visuals – many individuals with autism are visual learners and so the use of pictures, visual schedules and social stories can be a successful way to teach and communicate with individuals with autism. Visuals also enable some non-verbal individuals with autism to initiate communication using pictures (see our section on PECS – The Picture Exchange Communication System).
Social Stories – developed by Carol Gray, can be in word or picture form and help to show the individual how to respond in various social situations.
Social skills training and groups – these groups usually work better with the higher functioning individuals with ASD, often using role play, or re-enacting situations, to help train them about social skills and appropriate responses.
Speech and Language Therapy – most individuals with autism have some form of communication delay and many have cognitive difficulties. A speech and language therapist/pathologist will work on speech and language skills, literacy difficulties, social skills, alternative forms of communication, and usually be involved in any ongoing therapy programs. Ongoing input from a speech therapist is a vital part of most individual’s developmental program.
Occupational therapy – occupational therapists will help individuals develop daily living skills and self care skills. Occupational therapists will also be part of certain therapy approaches such as Sensory Integration.
There are a number of programmes dedicated to facilitating the communication and social skills of individuals on the autistic spectrum. Some of these programmes can be very expensive. Before embarking on any program investigate whether there is evidence based research to show that the program has merits and has actually been used successfully with other people. Make sure you discuss the programme with other parents or a Speech and Language Therapist / Pathologist, Doctor or Paediatrician to make sure it is right for your child.
Also go to our Autism Resources page for downloadable fact-sheets with lots of information, ideas and strategies to help individuals with autism. Click Here
The links below will take you to more specific information about autism and treatment:
Strategies for communication and Social Skills
Intensive interaction – breaking down the barriers
Functional communication – getting our priorities right and assessing what to look at first
Minimal Speech Approach
About PECS (picture exchange communication system)
Strategies in the classroom
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