Autism Spectrum Disorder

1. Karen Harper COH 614 Autism Spectrum Disorder

2. What is Autism Spectrum Disorder? • Autism Spectrum Disorder (ASD) is a developmental disability that most commonly causes social, communication, and behavioral challenges. • ASD is considered a “spectrum” because it affects people in different ways. The learning, thinking, and problem-solving skills of people with ASD can range from gifted to severely impaired. “If you've met one person with autism, you've met one person with autism.”

3. DSM-5 Diagnostic Criteria for ASD • 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): • 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. • 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. • Deficits in developing, maintaining, and understand 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.

4. DSM-5 Diagnostic Criteria for ASD • 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): • Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases). • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). • 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 interests). • Hyper- or hyporeactivity to sensory input or unusual interest 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.

5. DSM-5 Diagnostic Criteria for ASD • 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.

6. ASD Statistics • Prevalence: As of 2012, 1 in 68 children in the U.S. were identified as having ASD. • ASD occurs across all racial, ethnic, and socioeconomic groups. • Boys are 4.5 times more likely than girls to be diagnosed with ASD. It is currently unclear whether this is due to genetic reasons or whether girls/women are underdiagnosed. Girls and women may be better at “masking” their symptoms and may be able to adapt to mirror their neurotypical peers' behavior. • The prevalence of ASD has continued to rise from 1 in 150 children in 2000 to 1 in 68 in 2012. It is unclear whether the increase is due to better/increased screening, updated diagnostic criteria, or environmental factors. It's possible that all of these are contributing factors.

7. Possible Causes of ASD • To date, there are many hypotheses about possible causes of ASD. Genetic influences appear to be one likely factor. Among identical twins, if one twin has ASD the other is likely to also be diagnosed 36-95% of the time. Among non-identical twins, if one has ASD the other is likely to have it 0-31% of the time. Non-twin siblings have a 2-18% chance of ASD if another sibling has it. • The older the parents' age, the greater the likelihood the child may have ASD or another developmental disorder. • Environmental factors such as exposure to toxins or metals in utero have been suggested as possible factors. • No link between vaccinations and autism has been proven.

8. Economic Impact of ASD • In 2005, medical costs for Medicaid-enrolled children with ASD were estimated to be six times higher than costs for children without ASD. • Total cost per year is estimated to be between $11.5 billion-$60.9 billion. This includes medical costs, behavioral interventions, and lost parent productivity. • Many insurance plans have not paid for assessment and treatment of ASD.

9. CDC Screening Recommendations All children should be screened for developmental delays and disabilities during regular well-child doctor visits at: • 9 months • 18 months • 24 or 30 months • Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons. • In addition, all children should be screened specifically for ASD during regular well-child doctor visits at: • 18 months • 24 months • Additional screening might be needed if a child is at high risk for ASD (e.g., having a sister, brother or other family member with an ASD) or if behaviors sometimes associated with ASD are present If further evaluation is necessary, a neuropsychiatrist, psychologist, or neurologist can perform a more thorough assessment and diagnosis.

10. Treatment • There is no medication available specifically for ASD, but other medications can treat common co-occuring conditions such as depression, anxiety, ADHD, and epilepsy. • Applied Behavioral Analysis (ABA) assists children with ASD in learning to modify their behavior. ABA usually rewards “positive” behavior while ignoring “negative” behavior. • Other treatment modalities include occupational therapy, sensory integration, speech therapy, and the use of pictures to teach simple skills and communication. • Some parents have tried diet modification or alternative medicine approaches, such as chelation (removing metals from the body) to attempt to treat or cure autism. There is no evidence that these approaches work and they can be very dangerous. According to the CDC, approximately 10% of parents may have tried an alternative medicine approach which posed a danger to their child's health.

11. The Neurodiversity Movement • The Internet has enabled more people with ASD to connect and build online communities. Many in the autistic community now prefer to see themselves as “neurodiverse” or differently abled rather than as having a disability. Some autistic people feel that treatments such as ABA are demeaning to people with autism, forcing them to conform to societal expectations of normalcy instead of allowing them to act in accordance with their own innate differences. • In his book NeuroTribes: The Legacy of Autism and the Future of Neurodiversity, science writer Steve Silberman presents the history of autism and posits that instead of being an anomaly, autism is a naturally-occurring neurological variation.

12. References • Autism Spectrum Disorder. American Psychiatric Publishing, 2013. Retrieved from http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf • Autism Spectrum Disorder. Centers for Disease Control and Prevention, 2016. Retrieved from http://www.cdc.gov/ncbddd/autism/index.html • Gender and Autism. The National Autistic Society, 2016. Retrieved from http://www.autism.org.uk/about/what-is/gender.aspx • Neurodiversity. Autistic Family Collective, 2016. Retrieved from http://autisticfamilycollective.org.au/resources-links/neurodiversity/ • Silberman, S. (2015). NeuroTribes: The legacy of autism and the future of neurodiversity. New York, NY: Random House.