Autism Spectrum Disorder (ASD) is a broad term that encompasses a group of disorder including Autistic disorder, Asperger's Disorder, and Pervasive Developmental Disorder-not otherwise specified. ASD is frequently characterized by: 1) Deficits in social communication and interaction, and 2) Restricted, repetitive patterns of behavior, interests, and activities. It is a common, biologically based, neurodevelopmental disorder reported in all racial, ethnic, and socioeconomic groups, affecting about 1 in 59 children, and about 4.2 times more common in boys than girls.
Although there is as yet no cure for ASD, effective therapies have been developed that can reduce symptoms and improve life satisfaction. As many of these therapies are known to work better with earlier implementation, early diagnosis and prompt intervention are essential. As ASD is often detectable by 18 months, and reliably diagnosed by 24 months, experts agree that every child should be screened for ASD at ages 18 and 24 months. Parents who have one child with ASD have a 2%-18% chance of having a second child with ASD, thus early screening is important.
While it is true that some children will outgrow their ASD diagnosis, or benefit so much from treatment that the diagnosis becomes inappropriate or unnecessary, many others, despite treatment, will continue to be severely affected throughout their lives. Even the most severely affected individuals though, with timely, aggressive, and high quality treatment, can achieve significant and lasting improvement in their daily functioning and quality of life.
In Arizona, about 1 in 64 (1.5%) children are identified with ASD, similar to the nationwide average percentage of 1.5%. In the United States, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is most commonly used for diagnostic criteria. According to the DSM-5 criteria, a diagnosis of ASD requires all of the following:
- Persistent deficits in social communication and social interaction across contexts, not account for by general developmental delays, and demonstrated by deficits in all three of the following symptoms:
- Deficits in social-emotional reciprocity (from abnormal social approach and failure of normal conversation to total lack of initiation of social interaction).
- Deficits in non-verbal communicative behaviors used for social interaction (from poorly integrated verbal and nonverbal communication to total lack of facial expression or gestures).
- Deficits in developing and maintaining relationships appropriate to developmental level (from difficulties adjusting behavior to suit different social contexts to an apparent absence of interest in people).
- Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least 2 of 4 symptoms:
- Stereotyped or repetitive speech, motor movements, or use of objects.
- Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change.
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment.
- Symptoms must be present in early childhood (though may not become fully manifest until social demands exceed limited capacities).
- Symptoms together limit and impair everyday functioning.
- These disturbances are not better explained by intellectual disability 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. (Reynolds, C. & Kamphaus, R., n.d.)
The DSM-5 then categorizes severity into three different levels*:
|Severity level||Social communication||Restricted, repetitive behaviors|
Level 3"Requiring very substantial support"
|Severed deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interation and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.||Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficult changin focus or action.|
Level 2"Requiring substantial support"
|Marked deficits in verbal arid nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions: and reduced or abnormal responses to social overtures from others. For example, a person who speaks in simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.||Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.|
Level 1"Requiring support"
|Without supports in place, deficits in social communication cause noticable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able co speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.||Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hampering independence.|
*(Reynolds, C. & Kamphaus, R., n.d.)