Autism Spectrum Disorders

Autism Spectrum Disorders

Autism Spectrum Disorder is a developmental condition characterized by major impairments in communication and social functioning, rigid, stereotyped or obsessive-compulsive patterns of behavior, and restricted or peculiar interests and movements.  This diagnosis covers an enormous range of abilities and functioning.

Up until 2013, Pervasive Developmental Disorders were divided into categories including Autistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified.  However, this has been revised in DSM-5, the newest version of the “dictionary” of generally accepted developmental and psychological diagnoses.

Henceforth, there is one single category for ASD, with diagnostic qualifiers based upon how the individual is functioning along a number of important dimensions including severity and adaptive functioning.  How this change will affect who will and will not fall under this diagnostic category, and the way services and benefits are allocated, will only become apparent over time.

Once thought to be far less common, alarmingly, the statistics regarding rates of ASD seem to be ever increasing.  Some current estimates suggest that ASD might affect as many as 1 in 50 children. Why this is happening is a topic that has received enormous attention, but to date no definitive explanation has been found.  Broadening of diagnostic criteria and increasing public and professional awareness in recent years may be contributory, though this still does not seem to account for such a dramatic acceleration in prevalence.

Research suggests ASD is four times more common in boys than in girls, which may reflect actual gender related factors, but also some differences in symptom presentation and social norms that complicate identifying females. In any event, there is no question that ASD is being diagnosed far more often, and earlier, than in previous generations.

Thus far, the search for an ultimate cause of an ASD in a particular person, the so-called “magic bullet,” has not been successful.  As ASD is heterogeneous, meaning that there are numerous “varieties,” it appears there are likely to be many causal factors involved, including familial genetic vulnerabilities, dysfunction in certain brain structures and pathways, and diverse environmental and medical triggers, as yet not adequately understood.  Recent studies did not find any connection between early childhood vaccinations and autism.

Although knowledge in this area is constantly increasing, at this point looking for “why” a given person has an ASD is a question best left to researchers, and valuable time and resources more fruitfully utilized in finding and implementing effective interventions.

Since early identification of ASD can potentially result in improved outcomes, the good news is that there are screening tools for children as young as two years old.  However, there is no single, definitive test for ASDs.  Though earlier diagnosis is now feasible, there are many who remain undiagnosed for many years, often those that are especially high functioning or live in areas with fewer specialized practitioners.

A comprehensive, multidisciplinary approach is considered “best practice.” This methodology combines family and developmental history, clinical observations, structured questionnaires, and empirically validated tests.   Some parents may delay getting their child diagnosed, worrying that their worst fears will be confirmed or fearful of stigma.  Some may believe their son or daughter is  “just immature” and will “grow out of it.”  While this is very understandable, putting off needed evaluations is not recommended.

Parents are often the first to recognize that their child is not developing typically.  If you suspect that your child may have an ASD, it’s best to trust your intuition and seek professional guidance, even if others do not share your concerns or think you are “over-reacting.”

Following identification of ASD, the most important step is to find resources and evidence-based treatments.  This process is often quite daunting.  Yet, the promise for helping children with ASD make progress has never been brighter, even in the most severe and complex cases.  Some children with ASD will require extremely intensive intervention programs, others less so.

It is also important for parents to address their own emotions and needs along with trying to assist their child.  Having a child with an ASD, or in some cases more than one child with this condition is stressful, often straining relationships, careers, finances, and life in general. On a positive note, it seems that given accurate information and positive support systems, some parents not only adjust to this situation, but learn to find purpose and joy as they help their child thrive and move forward toward reaching their highest potential.

No one, not even experts, can totally predict individual outcomes for ASD.  However, there has been a considerable improvement in understanding prognostic factors.  Moreover, with consistently implemented evidence-based treatments more persons with ASD seem to be doing “better than expected.”  While everyone hopes their own child will “beat the odds” and be able to function independently and “live a normal life,” parents and other relatives often must create new kinds of expectations and redefine what “success,” “normal,” and “a good life” means in their unique circumstances.

The reality is that someone with ASD may never be able to live on their own, work in competitive jobs, or establish truly reciprocal relationships.  However, there are also persons with ASD who have strengths that compensate for their deficits, even those with exceptional abilities whose accomplishments far surpass their “neurotypical” peers.  Wherever an individual falls on this continuum, our legal and ethical systems not only acknowledges the special needs and vulnerabilities of people with ASD, but is charged with ensuring that they receive the same rights, understanding, and respect as anyone else.

Remember, no one discipline has all the answers.  Medical doctors may be in the best position to address certain ASD related symptoms or issues, while others are best managed by psychologists, or other mental and behavioral health professionals.  Speech and language pathologists, occupational and physical therapists, or educators are often key members of a comprehensive treatment team.  The relevance of engagement in social groups and activities, opportunities for physical exercise a positive lifestyle supporting getting good nutrition, adequate sleep, and opportunities for physical exercise should not be underestimated.