Introduction
Autism spectrum disorder (ASD) is a collection of neurological conditions in which a person’s speech, motor motions, and social interaction are disrupted. ASD is categorized as a cognitive disorder as its symptoms usually develop within the first two years of life. Autism is classified as a spectrum condition since its symptoms can range from mild to severe and involve a range of disorders such as Rett syndrome, childhood disintegrative disorder, Kanner’s syndrome, and pervasive developmental disorder. The World Health Organization (WHO) estimates that 1 in every 100 children is autistic (Center for Disease Control and Prevention, 2018). Autism is a neurological difference that rises to the level of disability only when the consequences of that neurological difference interfere with basic functioning. It is technically listed as a disorder under the DSM-5, but that classification is controversial with autistic people who do not experience disability and do not think their neurological differences are abnormal.
Autism spectrum disorder affects people in two ways, leading to different abilities: high functioning and low functioning. High-functioning individuals may have behavior issues but can function independently. Low-functioning individuals have trouble being independent as their symptoms are severe, and they may not be able to talk properly for years after birth. All autistic disorders are part of the spectrum as they range from many types of autistic conditions. Because each child’s severity and presentation differ, predicting their future life highly depends on the individual child and the therapy used. However, a child can have a learning disability or high intelligence quotient, thus excelling in various aspects such as mathematics and art.
Signs and Symptoms
Autism spectrum disorder begins in early childhood, often before age three, and can last throughout a person’s life. Some children show ASD symptoms within the first year, while some gain skills and meet developmental milestones until 18 to 24 months when they develop autism symptoms. There are three main autistic spectrum disorder symptoms: delayed milestones, verbal and nonverbal communication issues, and social abnormality. Child milestones include cooing, babbling, and sitting up at an expected age (Campisi et al., 2018). Children with autism do not meet these developmental milestones by age six, such as using facial expressions in conversations and cooing when upset.
Examples of repetitive behavior inherent in autistic children include incoherent repetition of new words, gestures like rocking objects, flapping arms, and organizing objects in strict routines. In addition, the child becomes upset when the routine or arrangement is distorted. The child may get upset over minor behavior changes, focus intently on objects, have an obsessive interest, and have unusual reactions to sensory inputs. Symptoms of issues regarding social behavior involve avoiding eye contact and the inability to engage in communal play, preferring to play alone. The child does not respond to their name, does not like to be touched, and has trouble understanding emotions in a conversation (Lord et al., 2018). An autistic child inappropriately engages in social conversations by being aggressive or passive, does not understand simple directions, and cannot engage in long conversations, only starting a social interaction to request items. In addition, one does not recognize non-verbal cues such as facial expressions and body postures.
Diagnostic Criteria
A child must meet the criteria for chronic deficiencies in three areas of social communication and interaction, as well as at least two types of repetitive, limited conduct to be diagnosed with an autism spectrum disorder. First, multiple scenarios must highlight persistent deficiencies in social communication and social engagement. These include deficits in understanding social-emotional interactions, including failure to engage in continuous dialogue, inability to initiate or respond to social encounters, and limited sharing of interests (Hodges, Fealko, & Soares, 2020). Face expressions, gestures, eye contact, and body language are examples of nonverbal communication characteristics lacking in social interactions. Furthermore, there is a deficiency in building and maintaining relationships due to a lack of interest in peers and difficulties in modifying conduct to fit social circumstances.
The second primary diagnostic criteria entail repetitive and restricted behavior patterns manifested by two of the four criteria symptoms. The first includes repetitive motor movements and lining objects in a familiar pattern. The second symptom consists of an insistence on following routines and developing extreme distress at the slight distortion of arrangement. The third primary criteria include an obsessive interest in unusual objects and increased fixation for long hours. The fourth primary criterion consists of an abnormal interest in sensory aspects of the environment, such as varying responses to pain, sounds, and texture. The other minor criteria entail the development of symptoms in the early life and significant impairment in social life due to the condition. People who receive a diagnosis have different levels of severity pertaining to the considerable symptoms entailing social communication and repetitive behavior.
Differential Diagnosis
There are five differential diagnoses for ASD, including Rett syndrome, Language disorders, social communication disorders, and attention deficit hyperactivity disorder. Rett syndrome entails disruption of social interactions during the first four years, affecting many young girls who meet the diagnostic criteria for autism spectrum disorder. However, most individuals improve social interaction skills; thus, autistic symptoms do not affect milestone development. Language disorders and social communication disorders affect communication and social skills in children. These diseases are not associated with atypical nonverbal communication or incoherent repetitive behavior; hence the diagnosis of social communication disorder takes precedence over autism spectrum disorder.
Attention deficit hyperactivity disorder (ADHD) symptoms such as easy distraction and obsessive focus are inherent in ASD. An ADHD diagnosis is considered when attention difficulties exceed the standard hyperactivity in people of similar age (Lord et al., 2018). In addition, most autistic individuals have psychiatric symptoms that are not included in the diagnostic formulation, such as depression and anxiety disorders. Medical conditions associated with ASD include sleep issues, epilepsy, and constipation. These conditions are noted under specific specifiers during diagnosis.
Causes and Risk Factors
There is no known cause of ASD, but several theories and risk factors are involved in developing the condition, including genetic and environmental factors. Genetic mutation is the leading cause of ASD as the condition is hereditary. The most prominent gene mutation is when the body produces chemicals against its tissues leading to abnormal development. Environmental factors include advanced parental age, viral infections, and birth weight that increases the risk of ASD.
The risk factors in ASD involve gender, as males are four times more likely to be diagnosed with the condition than females (Center for Disease Control and Prevention, 2018). Families with children or relatives with the condition are at an increased risk of having another child with ASD. Complications associated with ASD include disrupted learning in settings with agemates through social interactions. Routines interfere with adaptive skills regarding planning and organization. In adulthood, individuals have difficulties establishing independence and gaining meaningful employment.
Screening Tools
Diagnostic tools assess ASD in children but should not be used as the basis for diagnosis without medical practitioner approval. The diagnostic tool relies on parents’ and caregivers’ observations of their children’s behavior. There are four major diagnostic tools, including the ADI-R (Autism Diagnostic Interview-Revised), ADOS (Autism Diagnostic Observation Schedule), and DISCO tool (Diagnostic Interview for Social and Communication Disorders). The ADI-R is a clinical diagnostic instrument for assessing autism in children and adults aged 18 months and above (Parmeggiani, Corinaldesi, & Posar, 2019). The tool focuses on social interactions, reciprocity, communication and language, and repetitive behaviors.
The ADOS tool is the standardized assessment tool as it does not base its diagnosis on developmental milestones but current behavior skills and behavior (Parmeggiani, Corinaldesi, & Posar, 2019). The ADOS tool evaluates individuals at all developmental levels in all aspects. DISCO tool (Diagnostic Interview for Social and Communication Disorders) entails a semi-structured interview designed to assess an individual’s skills from birth to the present. The tool collects information regarding each individual’s skills and challenges, not ASD features.
Interventions
There is no standardized treatment for autism spectrum disorder as most treatment options manage the symptoms but do not cure the condition. All states must provide early intervention services for children under three years. Interventions available for managing ASD symptoms are behavioral therapies, including applied behavioral analysis (ABA), occupational therapy, speech therapy, and pharmacological and physical therapy. The most effective intervention entails ABA as it works to maximize functional independence and quality of life while minimizing the associated impacts of ASD deficiencies (Campisi et al., 2018). ABA therapies focus on reinforcing skills that form the foundation of developmental milestones while decreasing negative behaviors.
The treatment uses positivity to break down complex behaviors into smaller tasks that are easy to learn. The goals of ABA therapy entail promoting a child’s social development by removing harmful behaviors, thus helping children develop life skills. The children can apply the positive skills to new situations, thus reducing the impact of the condition. The applicable ABA therapies in autism intervention include Early Intensive Behavioral Intervention (EIBI), Pivotal Response Training, and Discrete Trial Teaching. New research into interventions discovered that cannabis extracts are a safe and efficient treatment for ASD symptoms in children.
Conclusion
Autism spectrum disorder is categorized as a mental condition as individuals do not fit within society’s normal standards in the social construction of the neurotypical brain. Autism is on a spectrum as its condition depends on the severity of the case, including Rett syndrome, childhood disintegrative disorder, Kanner’s syndrome, and pervasive developmental disorder. Autism becomes a disorder if it causes significant distress and impairs the daily functioning of individuals.
The condition has no defined cause or cure but prevents individuals from performing specific actions. Autism spectrum disorder affects people differently, but most symptoms entail social and behavioral incoherence. Autistic individuals have issues in social situations as they cannot communicate effectively and have limited knowledge of social cues and behaviors, such as trouble controlling their pitch. In addition, people with the condition are sensitive to perceptions such as lights and smell. Some individuals are high functioning becoming experts in different fields, while others are low functioning and thus have learning disabilities. Autistic individuals are usually introverted and do not reciprocate gestures or start or maintain conversations. They have extreme routine practices and get offended when distorted.
For an individual to be diagnosed with ASD, one must exhibit symptoms of social inactiveness and repetitive behavior in children below the age of three, as it’s the most critical time for neurological development. Genetics and environmental factors such as advanced parental age, viral infections, increased birth weight, family genetics and gender increase the susceptibility to the condition. The most effective intervention is using applied behavioral analysis as it maximizes functionality while minimizing the associated impacts of ASD deficiencies.
References
Campisi, L., Imran, N., Nazeer, A., Skokauskas, N., & Azeem, M. W. (2018). Autism spectrum disorder. British Medical Bulletin, 127(1). Web.
Centers for Disease Control and Prevention. (2018). Autism Spectrum Disorder (ASD). Centers for Disease Control and Prevention. Web.
Hodges, H., Fealko, C., & Soares, N. (2020). Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Translational Pediatrics, 9(Suppl 1), S55–S65. Web.
Lord, C., Elsabbagh, M., Baird, G., & Veenstra-Vanderweele, J. (2018). Autism spectrum disorder. The lancet, 392(10146), 508-520. Web.
Parmeggiani, A., Corinaldesi, A., & Posar, A. (2019). Early features of autism spectrum disorder: a cross-sectional study. Italian journal of pediatrics, 45(1), 1-8. Web.