DSM5 Autism Spectrum Disorder –
click here for diagnosis information from – Raising Children Network
The DSM-5 made some key changes to autism spectrum disorder (ASD) diagnosis. There’s now a single diagnosis of autism spectrum disorder that replaces the different subdivisions – autistic disorder, Asperger’s disorder and pervasive developmental disorder – not otherwise specified. There’s also a separate diagnosis of social communication disorder.
Professionals diagnose autism spectrum disorder (ASD) on the basis of difficulties in two areas – social communication, and restricted, repetitive behaviour or interests.
Time for a Future -Dr Avril Brereton -Assoc. Professor Research at Deakin University Melbourne.
Fact Sheets on autism spectrum disorder http://www.timeforafuture.com.au/fact_sheets.html
The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.
Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behavior. They lack empathy.
Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.” Children with autism don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favourite topics, with little regard for the interests of the person to whom they are speaking.
Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.
Autism – Frequently Asked Questions
How common is autism?
According to latest estimates, the prevalence of ASD in Australia is estimated to be 1:100 children, with a male to female ratio of 4:1.
What is the cause of autism?
It is still not certain what causes autism, but it’s likely that both genetics and environment play a role.
Researchers have identified a number of genes associated with the disorder. Studies of people with autism have found irregularities in several regions of the brain. Other studies suggest that people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other.
While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for autism has now been disproved.
Can autism be inherited?
Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.
Is autism associated with other disorders?
Each child with autism is different from others with same diagnosis and it may present in varying degrees from very mild to severe. Estimates vary, but it would appear that approximately 75% of people with ASD also have an intellectual disability. In addition, they also have a higher than normal risk for certain co-existing conditions, including fragile X syndrome, tuberous sclerosis, epilepsy, Tourette syndrome and attention deficit disorder. For reasons that are still unclear, about 20 to 30% of children with autism develop epilepsy by the time they reach adulthood.
What is the treatment for a person with autism?
There is no cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better.
- Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counselling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child.
- Medications: Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity.
- Other therapies: There are a number of therapies or interventions available for autistic children. Some claim to have “miraculous results” whilst others emphasise more modest progress. It is recommended that any therapy is thoroughly investigated before making a commitment to it.
Many professionals still use the Asperger Syndrome terminology.
Asperger Syndrome (AS), one of the Autism Spectrum Disorders (ASD), is a developmental disorder that is characterised by:
- limited interests or an unusual preoccupation with a particular subject to the exclusion of other activities
- repetitive routines or rituals
- peculiarities in speech and language, such as speaking in an overly formal manner or in a monotone, or taking figures of speech literally
socially and emotionally inappropriate behavior and the inability to interact successfully with peers
- problems with non-verbal communication, including the restricted use of gestures, limited or inappropriate facial expressions, or a peculiar, stiff gaze
- clumsy and uncoordinated motor movements
Parents usually sense there is something unusual about a child with AS by the time of his or her third birthday, and some children may exhibit symptoms as early as infancy. Unlike children with autism, children with AS retain their early language skills. Motor development delays – crawling or walking late, clumsiness – are sometimes the first indicator of the disorder.
The incidence of AS is not well established, but experts in population studies conservatively estimate that two out of every 10,000 children have the disorder. Boys are three to four times more likely than girls to have AS.
Studies of children with AS suggest that their problems with socialisation and communication continue into adulthood. Some of these children develop additional psychiatric symptoms and disorders in adolescence and adulthood.
Asperger Syndrome – Frequently Asked Questions
Why is it called Asperger Syndrome?
In 1944, an Austrian pediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially. Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy. Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr. Asperger called the condition “autistic psychopathy” and described it as a personality disorder primarily marked by social isolation.
What are some common signs or symptoms?
The most distinguishing symptom of AS is a child’s obsessive interest in a single object or topic to the exclusion of any other. Some children with AS have become experts on vacuum cleaners, makes and models of cars, even objects as odd as deep fat fryers. Children with AS want to know everything about their topic of interest and their conversations with others will be about little else. Their expertise, high level of vocabulary, and formal speech patterns make them seem like little professors.
Children with AS will gather enormous amounts of factual information about their favorite subject and will talk incessantly about it, but the conversation may seem like a random collection of facts or statistics, with no point or conclusion.
Their speech may be marked by a lack of rhythm, an odd inflection, or a monotone pitch. Children with AS often lack the ability to modulate the volume of their voice to match their surroundings. For example, they will have to be reminded to talk softly every time they enter a library or a movie theatre.
Unlike the severe withdrawal from the rest of the world that is characteristic of autism, children with AS are isolated because of their poor social skills and narrow interests. In fact, they may approach other people, but make normal conversation impossible by inappropriate or eccentric behavior, or by wanting only to talk about their singular interest.
Children with AS usually have a history of developmental delays in motor skills such as pedaling a bike, catching a ball, or climbing outdoor play equipment. They are often awkward and poorly coordinated with a walk that can appear either stilted or bouncy.
Many children with AS are highly active in early childhood, and then develop anxiety or depression in young adulthood. Other conditions that often co-exist with AS are ADD, tic disorders (such as Tourette syndrome), depression, anxiety disorders, and OCD.
What causes Asperger Syndrome? Is it genetic?
Current research points to brain abnormalities as the cause of AS. Research has revealed structural and functional differences in specific regions of the brains of normal versus AS children. These defects are most likely caused by the abnormal migration of embryonic cells during fetal development that affects brain structure and “wiring” and then goes on to affect the neural circuits that control thought and behavior.
Research has shown that there is a genetic component to AS and the other ASDs because of their tendency to run in families. Additional evidence for the link between inherited genetic mutations and AS was observed in the higher incidence of family members who have behavioral symptoms similar to AS but in a more limited form. For example, they had slight difficulties with social interaction, language, or reading.
Are there treatments available?
The ideal treatment for AS coordinates therapies that address the three core symptoms of the disorder: poor communication skills, obsessive or repetitive routines, and physical clumsiness. There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.
An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior. This kind of program generally includes:
- social skills training, a form of group therapy that teaches children with AS the skills they need to interact more successfully with other children
- cognitive behavioral therapy, a type of “talk” therapy that can help the more explosive or anxious children to manage their emotions better and cut back on obsessive interests and repetitive routines
- medication, for co-existing conditions such as depression and anxiety
- occupational or physical therapy, for children with sensory integration problems or poor motor coordination
- specialised speech/language therapy, to help children who have trouble with the pragmatics of speech – the give and take of normal conversation
- parent training and support, to teach parents behavioural techniques to use at home
Do children with AS get better? What happens when they become adults?
With effective treatment, children with AS can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.
Source: (National Institute of Neurological Disorders and Stroke – US)