According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the formal diagnostic category for autism and Asperger’s syndrome is pervasive developmental disorder, or PDD. Pervasive developmental disorders include autistic disorder, Rett’s disorder, Asperger’s disorder (syndrome), childhood disintegrative disorder, and pervasive developmental disorder-not otherwise specified (PDD-NOS). Mental health professionals, however, often refer to each of these disorders as autism spectrum disorders (ASD), which better conveys the continuum of types and severity of symptoms delineated by this diagnostic label.
The Autism Spectrum Disorders
The first accurate description of autistic symptoms appeared in 1943, when Leo Kanner published “Autistic Disturbances of Affective Contact.” The term autism, a derivative of the Greek word autos or self, highlighted the primary symptom exhibited by the 11 children in Kanner’s study. Kanner noted that these children presented with marked deficits in their ability to relate to other people.
Over time, the conceptualization of autism has evolved into the current view of a spectrum of psychological disorders identified by a fundamental deficit in one’s ability to navigate the social world. Autistic disorder and Asperger’s disorder, for example, share a common symptom in a significant impairment in social functioning relative to the individual’s chronological age and measured intelligence.
The key distinguishing criteria for autistic disorder is a marked impairment in language, cognitive, or adaptive development before age 3. While some persons with autistic disorder are “high-functioning” (HFA), it is not uncommon for someone with autism to have severe language, emotional, and cognitive delays— including mental retardation. A classically autistic individual presents with early communication and language delays, cognitive deficits, stereotyped and restricted interests and behaviors, and a profound lack of social awareness. Stereotyped and restricted interests may include a specialized interest in a certain area or subject such as electrical wiring or computers. Stereotyped behaviors are often exhibited as repetitive hand, finger, or whole-body movements aimed at providing increased self-stimulation. These are referred to as self-stimulatory behaviors or “stimming” and should be distinguished from the motor tics that are typically observed in anxiety disorders.
A year after Kanner published his findings on autism, Hans Asperger, an Austrian pediatrician, published a paper discussing four boys who presented with symptoms similar to those described by Kanner. Asperger, however, described children that were higher-functioning in terms of developmental history than those described by Kanner.
Similar to autistic disorder, persons with Asperger’s disorder present with social difficulties that pervade their ability to establish and maintain peer relationships. Moreover, they exhibit highly specialized areas of interests and are often referred to as being “experts” on that subject. A person with Asperger’s disorder, however, is differentiated from a person with autism in that the individual does not have a history of significant cognitive, adaptive, or language delays.
While individuals with Asperger’s disorder do not have a history of communication delays, they, like persons with autistic disorder, present with peculiar linguistic tendencies, including a pedantic style, awkward tone and rate (often referred to as “robotic”), and difficulties maintaining reciprocal, give-and-take conversations. Moreover, they often avoid using idioms and figures of speech because they struggle to separate the literal meaning of these expressions from the underlying expressive connotation.
Researchers continue to struggle to identify specific causes of autism. Research strongly suggests, however, that autism may be a heritable disorder. With increased funding and support for autism research, scientists can continue to explore the genetic epidemiology of the disorder and other possible causes.
Autism spectrum disorders are formally diagnosed through a comprehensive psychological evaluation of the individual conducted by a qualified professional, such as a licensed psychologist. A thorough assessment should begin with a clinical interview that explores developmental history and current social, emotional, behavioral, and cognitive functioning. The clinician then administers standardized global assessment questionnaires that measure social, emotional, and cognitive functioning. Other standardized questionnaires and assessment tools that are specific to ASD are also administered, such as the Autism Diagnostic Observation Schedule. It is important to include a behavioral observation of the individual in an unstructured social setting.
Once a diagnosis is made, treatment recommendations can then be individualized to the individual’s specific diagnosis and needs. Researchers agree, however, that early intervention for persons with ASD is essential and can significantly improve an individual’s level of functioning.
Current research indicates that lower-functioning individuals with autistic disorder benefit from intense behavioral therapy, such as applied behavioral analysis (ABA) and verbal behavior analysis (VB), to improve functional communication skills, adaptive skills, and behavior. ABA utilizes the principles of behavioral psychology and pairs repeated trials with a positive rein-forcer to modify inappropriate behaviors by improving receptive language skills. VB also uses behavior modification techniques but emphasizes the functionality of expressive language skills. Another effective program, treatment, and education of autistic and communication handicapped children (TEACCH), uses an amalgamation of therapeutic techniques and methods to address the specific needs of each individual.
Persons with ASD often report significant problems relating to others and establishing peer relationships; thus a key component of treatment is an intensive focus aimed at improving the individual’s social skills. It is common for persons with ASD to present with social skills deficits, including difficulties establishing and maintaining reciprocal conversations, an inability to understand nonverbal social cues (e.g., facial expressions), problems communicating to others through nonverbal language (e.g., using appropriate eye contact to modulate a social interaction), and inadequately processing or a complete lack of awareness of others’ emotions. Thus, social skills training for AS focuses on topics ranging from conversational skills to personal space.
Although there are many techniques and programs designed for persons with ASD, there is no one-size-fits-all approach to treatment. Given the variability of symptoms and the frequency of comorbid disorders, it is common for clinicians to take a multidisciplinary approach in treating the disorder. Treatment teams might include licensed psychologists, occupational therapists, speech and language pathologists, medical professionals, teachers, and physical therapists.
Changes and Challenges
The autism spectrum disorders continue to be a mental health issue of intense interest for clinicians, researchers, and politicians. Increased federal funds for further research on autism and Asperger’s disorder have led to an expansion of information and resources available to both parents and clinicians. Given the heterogeneity of ASD symptoms, a large portion of these funds are allocated to improving diagnostic procedures, such as refining current assessment tools and their ability to identify persons with ASD. Moreover, the importance of early and intensive intervention as well as effective treatment across the life span have continued to be the foci of research.
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