Autism Spectrum Disorder

According to the Diagnostic and Statistical manual of Mental Disorders (DSM-5), autism has been defined as persistent deficits in social communication and social interaction across multiple contexts along with restricted, repetitive patterns of behaviour, or interests, or activities.

This is also known as triad of impairment in autism.

The ways in which these characteristics are manifested, however, are extremely divergent. Whereas some individuals with autism are aloof and socially disinterested, others are affectionate, attached to others, and desirous of interaction. Whereas some individuals with autism lack vocal language ability, others may engage in simple echoing or may use vocal speech communicatively. When speech is used communicatively, however, there are often still idiosyncratic uses of the speech, or the speech may fail to represent the full range of communication potential. For example, a child may only request wanted items and not be able to hold conversations, or may converse only about topics of special interest. Restricted behaviors and interests may manifest themselves as classically autistic rocking or flapping. Alternately, it may present as lining up toys, adhering to a routine, or becoming fixated on a single object or topic.

In addition to all these characteristic features of autism, individuals with autism show tremendous fluctuations in behaviors (restlessness, fidgeting, alert, hyper/hypo-active, clumsy, emotional ups and downs etc) problematic in day to day life tasks; they face great challenges in using their body and body parts effectively during interaction with the human and non-human environments. One major aim of the habilitation in such disabling condition is to optimize the level of arousal, activity level and organized behavior and then to make the individual minimally self help independent to maximally productive to the society. Sensory integration therapy plays crucial role in this regard. It is assumed that once the behavior becomes organized it becomes easy to make them learn adaptive skills. This can help in accomplishing other life tasks.

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It is estimated that about 75% of children with autism have developmental delays (APA, 2000). There is also a tendency for the development to be uneven, with clear strengths and weaknesses evident. Behavioral difficulties occur in about 90% of individuals with autism, and at least 10 to 20% exhibit severe behaviors such as aggression and self-injury (Lovaas, 1987; Smith et al., 2007).

The autism spectrum disorders are more common in the pediatric population than are some better-known disorders such as diabetics, spina bifida or Down’s syndrome. Prevalent studies have been done in UK, Europe and Asia regarding the issue. Prevalence estimate range from 2 to 6 per 1000 children.
Etiology of Autism: Kanner (1943) suggested in his description about autism that from early infancy symptoms were present. So it can be said that autism is the result of an inborn defect. Kanner’s description gives rise to the role of genetic or biochemical factors behind the cause of autism. Many researches have ruled out the contribution of biochemical defect.

Some experts have claimed that certain genetic factors might be responsible for the development of autism. On the other hand, Paul’s (1987) observation confirmed that no specific genetic defect has been found out. Spence et al., (1985) reported only one genetic linkage study found in favour of autism and some statistics indicate that in families with already one autistic child, there is a great possibility of having another child susceptible to the development of the disorder.

Characteristic Features of Autism: The essential features of autistic disorder are the presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests. The features (triad of impairment in autism) are:
Impairment in Socialization: The most characteristic deficit in autism is the impairment in social interaction, which often presents itself as the inability to form relationships and to reciprocate. The social deficits in autism are found in basic social communicative behaviors, i.e., lack of eye contact and facial expression, in contexts in which coordination of these behaviors results in a “social-cognitive event,” such as pointing, and in reciprocal relationships. Three forms of social phenotypes have been reported in the literature: aloof, passive, and active but odd.

Impairment in Communication: Impairments in communication include both verbal and nonverbal language. There is an overlap between social skills and communication. Nonverbal communicative behaviors, such as facial expressions and eye contact are classified under the social domain. However, use of gestures, such as pointing, nodding, and showing are considered communicative behaviors. Deficits in nonverbal communication have been repeatedly reported in the autistic population. About half of autistic children are considered to be nonverbal, but this number seems to be decreasing with early intervention programs. For verbal autistic persons, there is a multitude of deficits reported, including deficits in pragmatics, variable expressive, and receptive difficulties, semantic impairments, and occasionally phonology abnormalities. Autistic patients may initiate conversation about preoccupations or routine details and some children are quite talkative, but their speech output is more like a monologue than directed communication. In other words, their language lacks a social quality. Additionally, echolalia, reversing pronouns, neologisms, abnormalities in the rhythm, and intonation have all been observed.

Restricted, Repetitive, and Stereotyped Patterns of Behaviour, Interests, and Activities: Restrictive and/or repetitive behaviors are the third category required by DSM V and ICD-10 to make the diagnosis of ASD. There may be an encompassing preoccupation with one or more stereotyped and restricted patterns that is abnormal either in intensity or focus. Individuals with autistic disorder display a markedly restricted range of interests and are often preoccupied with one narrow interest and sometimes show compulsive behviors. Compulsive behavior is intended and appears to follow rules, such as arranging objects in stacks or lines; they may line up an exact numbers of play thing in the same manner over and over again or repetitively mimic the actions of a television actor. They may insist on sameness. Sameness is resistance to changes or distress over trivial changes; for example, insisting that the furniture not be moved or refusing to be interrupted.

There is often an interest in non-functional routines or rituals (e.g., taking exactly the same route to school everyday). Ritualistic behavior involves an unvarying pattern of daily activities, such as an unchanging menu or a dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors. Individual with autism shows stereotyped and repetitive motor mannerisms such as those related with the hands (flapping, clapping, finger flicking) or whole body (rocking, dipping, and swaying). Abnormalities of postures may be present (walking on tip toe, odd hand movements and body postures). These individuals show persistent preoccupation with parts of objects such as buttons, parts of the body. There may also be fascination with movement (e.g., the spinning wheels of toys, the opening or closing of doors, an electric fan or other revolving objects). The person may be highly attached to some inanimate object (e.g., a piece of string or a rubber band). Self-injurious behaviors are also common to autism. Self injurious behaviors include movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging. No single repetitive or self-injurious behavior seems to be specific to autism, but only autism appears to have an elevated pattern of occurrence and severity of these behaviors.

Intervention of Autism:

  • Medication
  • Sensory Integration Therapy
  • Behavior Therapy
  • Biomedical Interventions such as The Gluten-Free Casein-Free (GFCF) Diet
  • Vitamin Therapy
  • Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH)

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