Autism Spectrum Disorder

Autism Spectrum Disorder

Dr.Sheila Addanki profile Authored by Dr.Sheila Addanki on 19 Dec 2014 - 13:29.

Autism spectrum disorder (ASD) is a serious neuro-developmental disorder. It impairs the person's ability of communication and interaction with other people. Other issues which may also affect the person are restricted repetitive behavior, activities and interests. All these issues affect the social, occupational and others areas of the patient’s life.

Autism spectrum disorder is now considered as a single disorder which includes the disorders which were considered separate previously. The disorders included are autism, Asperger's syndrome, pervasive developmental disorder and childhood disintegrative disorder. The word “spectrum” is used to refer all these disorders.

A large increase in the number of people affected by this disorder is seen. This may be due to either better diagnosis or the people getting affected are really increasing or may be due to both.

Although there is no cure for this disorder, early, intensive treatment can make a large difference in the patient’s life.

There is no single cause for this disorder as it is a complex disorder with many symptoms and varied severity. Basically the causes can be divided as genetic and environmental.

  • Genetic causes: Many genes are involved to become a cause for this disorder. Fragile X syndrome or Rett syndrome can be a genetic cause for ASD. While some genetic changes in the body makes the person more susceptible to this disorder. Some of the genes affect the development of the brain or affect the communication of the brain cells. Some of these genetic causes are known to be inherited while some of them known to occur spontaneously.
  • Environmental causes: Some of these causes include viral infections, pregnancy complications and air pollution.

The following factors increase the risk of getting affected by this disorder:

  • Gender: Males more susceptible to get affected by this disorder. The ASD ratio of gender is 4.3:1 and this ratio changes with the presence of mental retardation. The ratio of male and females is 2:1 in the presence of mental retardation and 5.5:1 in its absence.
  • Family history: Family which has a member already affected by this disorder has increased risk of having another member to get affected.
  • Other disorders: People who are already affected by certain disorders such as fragile X syndrome, Tourette syndrome and Rett syndrome are at more risk to get affected by this disorder.
  • Extremely preterm babies: there is a higher risk of ASD in babies born before 26 weeks of pregnancy.

The symptoms of autism spectrum disorder can be divided into social communication and behavioral symptoms.

Symptoms of social communication and interaction:

  • Has poor eye contact and lacks facial expression
  • Fails to respond to his or her name or appears not to hear you at times
  • Resists cuddling and holding and seems to prefer playing alone, retreats into his or her own world
  • Doesn't speak or has delayed speech, or may lose previous ability to say words or sentences
  • Speaks with an abnormal tone or rhythm - may use a singsong voice or robot-like speech
  • Can't start a conversation or keep one going, or may only start a conversation to make requests or label items
  • May repeat words or phrases verbatim, but doesn't understand how to use them
  • Doesn't appear to understand simple questions or directions
  • Doesn't point at or bring objects to share interest
  • Doesn't express emotions or feelings and appears unaware of others' feelings
  • Inappropriately approaches a social interaction by being passive, aggressive or disruptive

Symptoms involving behavior changes:

  • Performs repetitive movements, such as rocking, spinning or hand-flapping, or may perform activities that could cause harm, such as head-banging
  • Moves constantly
  • May be uncooperative or resistant to change
  • May be fascinated by details of an object, such as the spinning wheels of a toy car, but doesn't understand the "big picture" of the subject
  • Develops specific routines or rituals and becomes disturbed at the slightest change
  • Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes, and has odd, stiff or exaggerated body language
  • May be unusually sensitive to light, sound and touch, and yet oblivious to pain
  • May become fixated on an object or activity with abnormal intensity or focus
  • Does not engage in imitative or make-believe play
  • May have odd food preferences, such as eating only a few foods, or eating only foods with a certain texture

 A specialist in ASD diagnoses this disorder by evaluating some criteria as there is no specific medical test to determine it. The following points are followed to diagnose ASD:

  • Observing the patient’s social interaction, communication skills and change of behavior over time.
  • Testing the language, speech and developmental level of the patient.
  • Scoring the performance of the child in social and communication interactions.
  • Genetic testing to identify any genetic disorder such as fragile X syndrome.

Diagnostic tools:

Many diagnostic tools are available to assess ASD in children. One single tool should not be used to diagnose ASD. These diagnostic tools mainly rely on two sources for information, which are the description of the child development given by parent and the observational information of a professional about the child’s behavior.

Examples of diagnostic tools for ASD include:

  • Autism Diagnosis Interview – Revised (ADI-R)

A clinical diagnostic instrument for assessing autism in children and adults. The instrument focuses on behavior in three main areas: reciprocal social interaction; communication and language; and restricted and repetitive, stereotyped interests and behaviors. The ADI-R is appropriate for children and adults with mental ages about 18 months and above.

  • Autism Diagnostic Observation Schedule – Generic (ADOS-G)

A semi-structured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having ASDs. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language.

DSM-V Diagnostic Criteria for Autism Spectrum Disorder:

1. 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):

  • 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 non-verbal communication.
  • Deficits in developing, maintaining, and understanding 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.

2. 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):

  • 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 hypo-reactivity 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).

3. Symptoms may be present in the early developmental period (but may not become fully manifest until social demands exceed limited capabilities, or may be masked by learned strategies in later life).

4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

5. 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 co-morbid diagnoses of ASD, intellectual disability.

There is no cure for ASD. The only goal of treatment is to increase the patient’s ability to function normally by reducing the symptoms of ASD. The treatment options include:

  • Communication and behavior therapy: This therapy involves certain programs which focus on decreasing the problems in communicating with others by teaching some skills. They also teach how to act in certain social situations to help them feel normal.
  • Educational therapy: This therapy is mainly useful for the preschool children. It includes highly structured educational programs which are conducted by a team of specialists. It also includes various activities which help in improving social skills, behavior and communication.
  • Family therapy:This involves therapy to be done by parents and other family members in the way which improves the social behavior of the child.
  • Medications: Medications can help only to treat the symptoms of ASD. Antidepressants are prescribed for anxiety and antipsychotic drugs are used to treat severe behavioral problems.
  • Play therapy:Play therapy helps the children to learn words and also express them. This done by using toys as the words and the play is language.

 

References:

  • http://www.cdc.gov/ncbddd/autism/hcp-screening.html
  • http://www.cdc.gov/ncbddd/autism/hcp-dsm.html
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.