Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a developmental disorder which is characterized by impairments in social functioning, communication and by restricted and/or repetitive behaviors. The Diagnostic and Statistical Manual, Fifth Edition (DSM-V) which was published in 2013 outlined three subcategories of ASD, ranging from Severity level 1 (requiring support), level 2 (requiring substantial support), and level  3 (requiring very substantial support). Although many are familiar with what was previously referred to as   ‘classic autism’ or ‘autistic disorder’ (per older editions of the DSM),  research in the field of neurodevelopmental disorders has led to the understanding of autism as a ‘spectrum disorder’ such that individuals who have deficits on the autism spectrum may demonstrate milder or slightly varying symptomatic presentations from one another.

Therefore, although many children who have significant developmental delays (such as speech delay or highly atypical social behavior), may be identified as young as 18 months, children with mild autism spectrum disorder (ASD) may be identified much later. In fact, it is the norm rather than the exception, that children with mild ASD may be incorrectly labeled as young children as either having ADHD, oppositional/defiant, anxious/fearful, or simply seen by parents and teachers as being ‘strong-willed’ or ‘stubborn’. The new DSM attempted to describe autism as a ‘spectrum’, utilizing the variable of ‘extent of support required’ as the defining factor as to which Level of ASD a child is exhibiting.

The earlier we are able to identify ASD in children, the greater gains we can make in maximizing their developmental potential.  Children with ASD who are not identified and provided with support and/or treatment may experience:

  • Social struggles (e.g. have difficulty making friends, OR keeping them; gravitating towards adults, older peers, or younger peers; sticking to one ‘best friend’ in lieu of interacting with groups of peers).
  • Difficulty in social interactions with friends or family (e.g. struggles with appropriate ‘give and take’ interactions, seeking to direct play, resistance to following the direction of others, difficulty interacting with same-age peers, adhering to personal ‘agenda’ as opposed to responding to the social expectations of others, difficulty seeing the perspectives of others or understanding what others may be thinking/feeling).
  • Academic challenges in school with abstract reading comprehension (e.g. reading between the lines) and/or written expression
  • Low self-esteem/self-confidence
  • Anxiety or fears about specific situations and/or environments
  • Low frustration tolerance
  • Heightened social anxiety (e.g. fears of being perceived as ‘different’)
  • Perfectionism
  • Tendency to be ‘black and white’ in their thinking
  • Resistance to being directed
  • Tendency to be argumentative, rigid, strong-willed, stubborn
  • Challenges in ‘going with the flow’
  • Increased meltdowns, tantrums, or outbursts for age
  • Difficulty with attention, focus, and distractibility when the task is of little interest. Heightened attention/focus when engaged in a task of high interest/motivation.
  • Excellent memory for material / subject matter of interest
  • Passions for intellectual subjects and/or activities that may, at times, seem excessive.

A thorough and accurate evaluation incorporating testing, information from parents and teachers, school observations (when appropriate) and in-office assessment is crucial in making a diagnostic determination. Creating an individualized developmental profile of your child’s strengths as well as their weaknesses is much more important than the label itself, as it will enable us to provide you with a tailored action plan that truly promotes your child’s growth.

If you are concerned about your child and whether or not he/she exhibits possible signs of ASD, it is recommended you consider the following:

  1. Schedule a one-hour consultationwith one of our specialists to review your concerns.
  2. Schedule a one-hour screening with one of our specialists, so we can meet your child and provide you with preliminary feedback.
  3. Watch our Bright Stars Free Preview video to learn more about bright children with mild ASD.
  4. Visit our blog to read more articles pertaining to children with ASD
  5. If you aren’t sure which path is the right one for you, please submit a contact form with some preliminary information about you and your child . One of our specialists will get back to you regarding a personalized action plan that best addresses your concerns and goals.

 

For those of you that are interested, here are the former diagnostic categories that comprise the current term, Autism Spectrum Disorder. The below article was written to reflect the categories from our former diagnostic manual (DSM-IV) which is no longer in use.

 

Autism/Asperger’s Disorder/Pervasive Developmental Disorder (PDD) per the DSM-IV (prior to 2013).

Please note this article was written prior to 2013 when the DSM-V (fifth edition) was published. This old article is published here to give you historical information only on former diagnostic categories, and is not reflective of current diagnostic categories.

 

Autism is a developmental disorder which is characterized by impairments in social functioning, communication and by restricted and/or repetitive behaviors. Although many are familiar with the more classic definition of autism, research in the field of neurodevelopmental disorders has led to the identification of two additional diagnoses to incorporate children with deficits along the same developmental domains, with milder or slightly varying symptomatic presentations. The diagnoses of Asperger’s Disorder and Pervasive Developmental Disorder, Not Otherwise Specified are listed as two other disorders which in addition to Autistic Disorder (or classic ‘autism’) make up the ‘autism spectrum’. Early diagnosis and identification of children who have an autism spectrum disorder is crucial as those who receive early intervention such as behavioral therapies, speech therapy, social skills training, and/or communication skills training yield the most substantial gains.

  1. Autism (or Autistic Disorder): Children who meet the diagnostic criteria for the full diagnosis of Autism demonstrate at least 6 symptoms across 3 domains: deficits in social interaction, communication, and/or restrictive/repetitive behaviors. These deficits are not related to cognitive functioning, as 1/3 of children with autism test with IQs at or above average. Social characteristics observed in children with autism may include: difficulty with appropriate ‘give and take’ interactions, seeking to direct play, resistance to following the direction of others, difficulty interacting with same-age peers, adhering to personal ‘agenda’ as opposed to responding to the social expectations of others. Typical communication impairments may include: speech/language delay, a failure to develop appropriate conversational skills compared with same-age peers (in children with adequate speech), repetitive or rote language (e.g. reciting songs or dialogue from memory, using particular phrases learned from adult caregivers repeatedly). Restricted/repetitive behaviors may include: excessive interests in narrow, circumscribed areas (e.g. such as trains, Star Wars, etc.), insistence on things being a ‘certain way’, behavioral or cognitive rigidity/inflexibility (e.g. resisting change, resisting when things go against their own preferred agenda’), or difficulty with transitions.

 

  1. Asperger’s Disorder: These are children who typically show no history of speech/language delay, and demonstrate advanced verbal skills. They typically possess a highly developed vocabulary and demonstrate outstanding verbal memory for facts and information relevant to their area of interest. Children with Asperger’s Disorder typically demonstrate higher than average IQ, and are often described by parents and teachers as being bright, inquisitive, and academically capable. They also are often described as socially awkward, and lacking in social and conversational skills. Children with Asperger’s Disorder may also demonstrate gross or fine motor impairments, although this is not required for the diagnosis. Much debate in the field exists as to whether Asperger’s Disorder really should be a separate and distinct disorder or whether it simply is an alternate label for ‘high functioning autism’.

 

  1. Pervasive Developmental Disorder, Not Otherwise Specified: For children who show some but not all symptoms of Autism or Asperger’s Disorder, OR for children who demonstrate impairments in a limited number of contexts, a diagnosis of PDD, NOS is given. Children in this category show the widest variation in type and severity of symptoms. As the presentation is milder, diagnoses are often made later on in childhood. Many children with PDD, NOS may be misdiagnosed with oppositional-defiant disorder due to their significant rigidity, preference for doing things ‘their way’ or on ‘their schedule’, resistance to following direction from parents and/or teachers, and lack of cooperation in non-preferred tasks/activities. In school, children may not participate in social routines (e.g. circle), may not follow directions, may appear inattentive, and may exhibit behaviors which are inappropriate for the classroom context.

A thorough and accurate evaluation incorporating testing, information from parents and teachers, school observations (when appropriate) and in-office assessment is crucial in making a diagnostic determination. Creating an individualized developmental profile of your child’s strengths as well as their weaknesses is much more important than the label itself, as it will enable the clinician to provide a tailored action plan that truly promotes your child’s growth. For more information on assessments and evaluations, please visit our services page.