Autism Spectrum Disorder

What is Autism Spectrum Disorder (ASD)?

Autism Spectrum Disorder (ASD) as defined in the Diagnostic and Statistical Manual of Mental Disorders 5th (DSM 5) Edition is characterized by “persistent impairments in reciprocal social communication and social interaction…, and restricted, repetitive, patterns of behavior, interests, or activities…”   The symptoms must be present in the early developmental period and cause clinically significant impairments in functioning.

Why does it vary in its presentation?

ASD involves a wide spectrum of behaviors that range from mild to severe.  People with ASD show different combinations of these behaviors in varied degrees of severity.  Frequently associated features with ASD include intellectual disability or varied profiles of abilities, language impairment, motor difficulties, self-injurious behaviors, and disruptive or challenging behaviors. Adolescents and adults with ASD are prone to anxiety and depression. Thus, two people may have the same diagnosis but show very different behaviors.

How common is ASD?

The Center for Disease Control (CDC) reports that 1 in 88 children has been identified with an ASD.  ASDs are nearly 5 times more common among boys (1 in 54) than among girls (1 in 252).  ASDs occur across racial, ethnic, and socioeconomic groups.

What causes ASD?

Though the exact cause of ASD is unknown, it is generally accepted that abnormalities in brain structure or function underlies the disorder. Research has suggested that there is a genetic component because the risk of having ASD increases to about 1 in 5 if the child has a brother or sister with ASD.  ASD occurs more frequently in people with certain medical conditions such as Fragile X syndrome and tuberous sclerosis.  We do know that ASD is not caused by bad parenting.

Is there a cure for ASD?

At this time, there is no cure for ASD.  However, early intensive behavioral intervention has been shown to help children with ASD improve their socialization and communication skills. Factors that impact individual outcomes for ASD include the presence or absence of associated intellectual disability and language impairment and additional mental health problems.

How is ASD different from the previous DSM 5 diagnoses of Autism, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified?

There are many similarities between the DSM 5 diagnosis of ASD and the previous DSM 5 diagnoses but also some differences. Rather than the 3 domains identified in the DSM 5 diagnostic criteria for Autism, DSM 5 has two domains:

Social Communication and Social Interaction:

·         Difficulties with social communication

·         Failure to initiate or respond to conversation

·         Atypical eye contact, gestures, or body language

·         Difficulties in sharing imaginary play

·         Absence of interest in peers or difficulty making friends

Restricted, Repetitive patterns of behavior, interests, or activities

·         Stereotyped or repetitive motor movements, use of objects, or speech (e.g., hand flapping)

·         Adherence to routines or ritualized patterns of behavior or speech (e.g., eating the same food every day)

·         Interests that are atypical in intensity or focus (e.g., preoccupation with unusual objects)

·         Hyper-or hyporeactivity to sensory input or unusual interest in sensory stimuli (e.g., appearing indifferent to pain)

A delay or lack of speech was removed from the criteria for DSM 5 as this was not unique to children ASD. The focus was changed from looking at individual pretend play to whether the individual can cooperatively play with others. Hyper or hyporeactivity to sensory stimuli was added to DSM 5 criteria.

DSM 5 also requires identification of the current severity of symptoms with each domain of social communication and social interaction and restricted, repetitive patterns of behavior. Determination of severity is based upon the level of impairment an individual with ASD. Severity can range from “requiring support” to “requiring very substantial support” to function in daily activities.  The severity of symptoms within each domain can vary based upon the situation. The severity of symptoms may also vary over time.

My child was diagnosed with autistic disorder, Asperger’s Disorder, or pervasive developmental disorder not otherwise specified under DSM IV.  Does he/she need to be re-evaluated?

It is very important to note that DSM 5 states: “Individuals with a well-established DSM5 diagnosis of autistic disorder, Asperger’s disorder or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder.” 

  Click here to learn about treatment options for ASD.