Autism Spectrum Disorder

What is Autism Spectrum Disorder?

Autism, or Autism Spectrum Disorders (ASD), is a complex neurodevelopmental condition (considered a developmental disability) characterised by challenges in social interaction, communication, sensory processing and repetitive behaviours or restricted interests. The symptoms and their severity can vary widely among individuals, which is why it is referred to as a "spectrum" disorder.

Causes of Autism Spectrum Disorder

ASD is a developmental disability caused by a range of factors. The entry of autism and Asperger syndrome (AS) into the history of psychopathology was marked by extraordinary coincidences. Both disorders were first described by Kanner (1943) and Asperger (1944), respectively. Both were Austrian-born physicians and, though unaware of each other’s writings, both used the term “autistic” to describe a unique group of children who shared features of impaired social interaction and restricted, repetitive behaviours and interests.

AS had already been described in 1981 by Lorna Wing, who first proposed the term to refer to a special subgroup of children who, according to Asperger’s original description, were characterised by: social isolation and lack of reciprocity in social interactions; normal or precocious language acquisition, with above-average linguistic skills but subtle abnormalities of verbal and non-verbal communication (e.g., atypical syntax, pedantic vocabulary and absent or stereotyped prosody); a narrow focus of interests, often restricted to unpragmatic and highly original themes; overachievement in specific cognitive domains; and motor clumsiness (Wing, 1981).

In 1943, Austrian American psychiatrist, Dr Leo Kanner, described “early infantile autism” as a distinct clinical syndrome. However, until the late 1970s and 1980s, ASD was considered a psychological disorder that was caused by poor parenting, specifically the role of the mother. Dr. Kanner coined the phrase “refrigerator mother” to describe the notion that ASD was caused by the mother being cold, distant, unresponsive, and rejecting of her child. However, we now know that it is not a psychological disorder and not caused by poor parenting it is a neurodevelopmental disorder.

The exact cause of ASD is currently unknown.  The DSM-5 states that there is no exact cause of ASD, which is not surprising given the diversity of its unique presentation in each individual in terms of symptoms, skills, and severity.  Instead, it’s rather the interaction between the risk factors that may contribute to its development. 

These may include:

• Genetic factors – there is no single gene causing ASD, instead, over hundreds of different genes are involved. Certain genes inherited from the parent can make the child vulnerable to developing ASD. Also, having a parent, sibling, uncle, or aunt with ASD also increases the likelihood of the child having ASD.

• Neurobiological factors – abnormalities in the genetic code may result in changes in the way the brain develops and works.

• Environmental factors – parental health (e.g. infections and diseases the mother might have had during pregnancy); maternal use of medications, drugs, and toxic chemicals during pregnancy, low birth weight, childhood illness, food intolerance, and reactions to pollutants may contribute to the child developing ASD.

It is important to remember that there is insufficient evidence to implicate any one environmental factor to the child's development of ASD; instead, they increase the risk of the development of ASD in children who are genetically predisposed.

Important Note: Vaccines do not cause Autism Spectrum Disorder

An article by Wakefield et al. (1998) proposed a link between the Measles-Mumps – Rubella (MMR) vaccine, colitis and the development of ASD in 12 children.

By 2004, 11 of the contributing authors retracted their interpretation that there was a causal link between the MMR vaccine and ASD in their article (Murch et al., 2004).  Furthermore, a formal investigation by the British Medical Council in 2010 also found that the study by Wakefield et.al. (1998) had not been approved by the bioethics committee. Further investigation revealed that the facts about the children’s histories that were part of the study had been altered and none of their medical records could be reconciled with the descriptions in the published paper. Based on these findings, Wakefield’s licence to practice medicine was revoked.

Since then, several scientific studies have consistently and effectively ruled out receiving vaccines and developing ASD throughout the world. For example, in an article by Taylor et al. (2014), they completed a meta-analysis, combining the results of 10 studies on over 1.2 million children and found no causal link between vaccines and ASD.

Autism Symptoms

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V), is a handbook used by professionals around the world to diagnose mental disorders. The DSM-V contains descriptions, symptoms, and other criteria (such as how many of these symptoms must be present) to diagnose a disorder. 

The DSM-V classifies Autism Spectrum Disorder as a type of neurodevelopmental disorder characterised by difficulties in two domains:

Social Communication and Social Interaction

Domain 1 – Persistent difficulties in social communication and social interaction as evidenced by the presence of all of the following symptoms, across multiple contexts, currently or historically:

• Difficulty with social-emotional reciprocity: this can range from abnormal initiation of social interactions and difficulty with normal back-and-forth conversation; to reduced sharing of interests, emotions, or thoughts; to a complete lack of initiating or responding to social interactions.

• Difficulties with nonverbal communication: this can range from poorly integrating nonverbal communication like body language with verbal communication; to abnormalities in eye contact and body language or difficulty understanding and using gestures; to a total lack of facial expressions and nonverbal communication.

• Deficits in developing, maintaining, and understanding relationships: this can range from difficulties adjusting behaviour to suit various social contexts; to difficulties making friends; to a complete lack of interest in peers.  See 'Simple Strategies for Teaching Social Skills to Children with Autism Spectrum Disorder' for more help.

Restricted, repetitive patterns of behaviour, interests, or activities

Domain 2 – Restricted or repetitive behaviours, interests, or activities, as evidenced by the presence of at least two of the following symptoms, currently or historically:

• Stereotyped or repetitive movements, use of objects, or speech, such as lining up toys or flipping objects, repeating the words of others back to them, or repeating idiosyncratic phrases.

• Insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal and nonverbal behaviour, such as extreme distress at small changes, difficulties with transitioning between places or activities, rigid thinking patterns, or greeting rituals.

• Highly restricted, fixated interests that are abnormal in intensity or focus, such as strong attachment to or preoccupation with unusual objects.

• Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment, such as apparent indifference to pain or temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, or visual fascination with lights or movement.

For an individual to be diagnosed with ASD, symptoms must be present at an early age, but may not fully manifest until social demands exceed the ability of the individual to deal with them. The symptoms should cause significant impairment on social, occupational or other important areas and not be better explained by intellectual disability or global development delay.

Presence of other conditions

When diagnosing Autism Spectrum Disorder (ASD), medical professionals may also identify the presence of other conditions or specify additional diagnostic details to provide a more comprehensive understanding of the individual's unique profile. Here are the key specifiers:

Specifiers in ASD Diagnosis

1. With or without accompanying Intellectual impairment

   • With intellectual impairment: Some individuals with ASD also have intellectual disabilities, which means they have significant limitations in intellectual functioning (e.g., reasoning, learning, problem-solving) and adaptive behaviour.

   • Without intellectual impairment: Others may have average or above-average intellectual abilities.

2. With or without accompanying language impairment

   • With language impairment: This includes delays in or a complete lack of spoken language, difficulties in maintaining a conversation, or challenges in the use and understanding of language.

   • Without language impairment: Some individuals with ASD have typical language development and use language appropriately for communication.

3. Associated with a known medical or genetic condition or environmental Factor

   • This specifier is used if the individual has a medical or genetic condition (e.g., fragile X syndrome, Rett syndrome, tuberous sclerosis) or an environmental factor (e.g., prenatal exposure to alcohol, fetal valproate syndrome) known to be associated with ASD.

4. Associated with another neurodevelopmental, mental, or behavioural disorder

   • Many individuals with ASD also have other neurodevelopmental disorders (e.g., ADHD), mental health disorders (e.g., anxiety disorders, depression), or behavioural disorders.

5. With catatonia

   • Catatonia is a state characterised by a range of motor behaviours and symptoms, including stupor, mutism, negativism, posturing, and rigidity. If an individual with ASD exhibits signs of catatonia, this specifier is used.

Importance of specifiers

These specifiers help in tailoring the intervention and support strategies to the individual's specific needs. For instance:

• Intellectual impairment: Knowing whether an individual has an intellectual disability can inform the level of support needed for learning and daily activities.

• Language impairment: Understanding the presence and extent of language impairments helps in planning speech and language therapy.

• Medical or genetic conditions: Identifying associated medical or genetic conditions can guide medical management and provide a better understanding of the individual's overall health profile.

• Comorbid disorders: Awareness of co-occurring neurodevelopmental, mental, or behavioural disorders allows for comprehensive treatment plans that address all relevant areas.

Catatonia: Recognising catatonia ensures that appropriate interventions are implemented to manage these symptoms effectively.

Historical and Diagnostic Terms

Historically and in different contexts, various terms have been used to describe aspects of autism. Here are some of the different names and terms that have been associated with autism spectrum:

Historical Terminology

• Autistic Disorder: Once referred to as "classic autism," this term was used for individuals with significant challenges in communication, social interaction, and behaviour.

• Asperger's Syndrome: This term was used for individuals with milder symptoms of autism, particularly characterised by strong verbal skills and average or above-average intelligence, but significant difficulties in social interaction.

• Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS): This was a diagnosis for individuals who didn't fully meet the criteria for autistic disorder or Asperger's syndrome but still had significant challenges in social and communicative functioning.

• Childhood Disintegrative Disorder: A rare condition where children develop typically for at least two years but then lose previously acquired skills.

• Rett Syndrome: A genetic disorder that used to be included under the autism spectrum but is now recognised as a separate condition.

   

Modern Terminology

• Autism Spectrum Disorder (ASD): The current term used in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which encompasses all the previously mentioned categories under a single diagnosis.

• Neurodiversity: A concept that promotes the idea of viewing autism as a variation in human neurology rather than a disorder to be cured.

• Neurodivergent: A term used to describe individuals whose neurological development and functioning are atypical, including those with autism.

• Autistic Traits: Used to describe behaviours and characteristics that are associated with autism but may not meet the full criteria for an ASD diagnosis.

What is High-Functioning Autism?

High-functioning autism (HFA) is not an official medical diagnosis, but rather a term commonly used to describe individuals on the autism spectrum who have average or above-average intelligence and exhibit fewer severe symptoms.

This term often refers to those who do not require the same level of support as others on the spectrum but still face challenges in social interaction, communication, and behaviour. HFA is frequently associated with what was previously known as Asperger’s Syndrome, a condition that shared many traits with autism but without the significant language delays.

Characteristics of High-Functioning Autism

1. Social Interaction: Individuals with HFA often struggle with social nuances. They may find it difficult to understand social cues, body language, and the subtleties of conversations. Despite their often good language skills, they might have trouble forming and maintaining friendships.

2. Communication: While those with HFA generally have strong verbal skills, they may exhibit unusual speech patterns such as a monotone voice, or use overly formal language. They might also have difficulty with nonverbal communication like maintaining eye contact or understanding facial expressions.

3. behavioural Patterns: Repetitive behaviours and a strong need for routine are common. People with HFA might develop intense interests in specific subjects, sometimes referred to as “special interests,” which they pursue with great enthusiasm and detail.

4. Sensory Sensitivities: Sensory processing issues can also be present. Individuals with HFA might be overly sensitive to sounds, lights, textures, or other sensory inputs, leading to discomfort or overstimulation.

Misconceptions about High-Functioning Autism

The term "high-functioning" can be misleading. It implies that individuals face fewer challenges, which is not always the case. They may struggle significantly in social situations, daily living skills, or managing sensory sensitivities, which can impact their quality of life. Additionally, their intelligence or ability to articulate thoughts can mask underlying difficulties, leading to a lack of necessary support.

Historical Context

Historically, high-functioning autism was often referred to as Asperger’s Syndrome, named after Dr. Hans Asperger, who first described the condition in the 1940s.

Asperger’s Syndrome was recognised for its unique profile of social and communication difficulties alongside strong verbal abilities and a narrow range of interests.

However, in 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reclassified Asperger’s Syndrome under the broader category of Autism Spectrum Disorder (ASD) to better reflect the continuum of symptoms and support needs.

Importance of Support and Understanding

Even though individuals with high-functioning autism might not require as much support as those with more severe forms of autism, they still benefit greatly from tailored interventions and understanding from those around them. Support strategies might include:

• Social Skills Training: Programs that teach social interaction skills, help with understanding social cues, and practice forming relationships.

• behavioural Therapy: Techniques like Cognitive behavioural Therapy (CBT) can help manage anxiety and improve coping mechanisms.

• Sensory Integration Therapy: Helps individuals better manage sensory processing issues.

• Educational Support: Accommodations in school to support learning styles and needs.

Recognising and respecting the unique challenges faced by individuals with high-functioning autism is crucial in providing them with the right tools and environment to thrive. This involves a collaborative effort from families, educators, and the community to create inclusive and supportive spaces.

By understanding high-functioning autism, we can better appreciate the diverse experiences and capabilities of those on the autism spectrum, ensuring that they receive the empathy, respect, and assistance they need to lead fulfilling lives.

Positive Behaviour Support and Autism Spectrum Disorder

Positive Behaviour Support (PBS) is an evidence-based approach that focuses on improving the quality of life for individuals with Autism Spectrum Disorder (ASD) by addressing challenging behaviours and promoting positive behaviours. PBS integrates principles from applied behaviour analysis (ABA) with person-centered values to create individualised support plans. Here’s how PBS is applied in the context of autism:

Key Components of Positive Behaviour Support

1. Functional Behaviour Assessment (FBA)

   • Identifying triggers and functions: Conducting an FBA helps to understand the reasons behind behaviours of concern by identifying their triggers and functions. This assessment involves gathering information from observations, interviews, and data analysis.

   • Example: For example, Kelly is a 12-year-old adolescent with a diagnosis of Autism Spectrum Disorder. Kelly will bang her IPAD with great force causing the screen to crack. Triggers (reasons) for Kelly engaging in this behaviour of concern include the IPAD battery running out her favourite app not working or freezing and a video being deleted.

2. Person-Centered Planning

   • Individualised plans: PBS emphasises tailoring interventions to the unique needs, preferences, and strengths of the individual. This involves creating support plans that are respectful and aligned with the person’s goals.

   • Example: Developing a communication system so that Kelly can express any issues related to the IPAD to a communication partner so that they can assist her.

3. Prevention Strategies

   • Modifying the environment: Changing aspects of the environment to reduce the likelihood of behaviours of concern. This might include altering physical spaces, routines, or social contexts.

   • Example: Kelly finds it difficult to regulate her temperature. If she gets too hot or cold it affects her ability to regulate her emotions and stay calm. By ensuring her environment is at 18 degrees at all times helps her better deal with stressors.

     4.Teaching Alternative Skills

     • Skill Development: Teaching individuals new skills that serve the same function as the challenging behaviour but are more appropriate. This can include communication, social, and coping skills.

     Example Teaching Kelly how to use the communication system to express her needs, wants and feelings. As well as supporting her to engage in an increased variety of recreational activities can reduce her reliance on the IPAD.

4. Reinforcement strategies

   • Positive reinforcement: Encouraging desired behaviours by providing positive consequences, such as praise, rewards, or preferred activities.

5. Consistent implementation

   • Collaborative approach: Ensuring that all caregivers, educators, and therapists are consistent in applying the PBS strategies. Regular communication and collaboration among team members are crucial.

   • Example: Training all staff in a school to use the same reinforcement techniques and communication methods used at home with Kelly.

Benefits of Positive Behaviour Support for Individuals with Autism

1. Reduces behaviours of concern

   • By addressing the root causes of challenging behaviours and teaching alternative skills, PBS can significantly reduce the frequency and intensity of these behaviours.

2. Improves communication and social skills

   • PBS interventions often focus on enhancing communication and social interaction, which are core areas of difficulty for individuals with autism.

3. Enhances quality of life

   • By promoting positive behaviours and skills, PBS helps individuals with autism participate more fully in everyday activities, leading to a better quality of life.

4. Empowers caregivers and educators

   • Providing caregivers and educators with effective strategies and tools to support.

Positive Behaviour Support offers a compassionate and effective framework for supporting individuals with autism. By focusing on understanding and addressing the underlying reasons for behaviours of concern and promoting positive alternatives, PBS enhances the well-being and quality of life for individuals with autism and those who support them.

Note: This is not an exhaustive list of all the possible causes, symptoms and interventions but some general information that can be further explored. Based on what you have read if you have any concerns about an individual, please raise them with the individual/s. The caregiver can then raise these concerns with their local doctor who can provide a referral to the relevant professional (e.g. paediatrician, psychologist, psychiatrist, allied health professional and learning specialists) for diagnosis and interventions accordingly.

Positive Behaviour Support Resource for Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts how people interact with others, communicate, learn and behave. Repetitive and characteristic patterns of behaviour, interests, or activities are common. Each child with ASD presents with unique needs that when left unmet can result in exhibiting behaviours that can disrupt their learning and the learning of others. Without the necessary knowledge and tools, educators can often find it difficult to meet the needs of their students effectively. Does this sound familiar?

Positive Behaviour Support Strategies for Students with Autism Spectrum Disorder: A Step-by-Step Guide to Assessing, Managing, and Preventing Emotional and Behavioural Difficulties is a highly practical book that can be used by educators in childcare, preschool, schools, and community services to learn the evidence-based approach of Positive Behaviour Support (PBS) to assess, manage, and prevent challenging behaviours in children of all ages with ASD.

Learn how to complete a functional behaviour analysis to document behaviour incidents, identify triggers, and determine the reasons for specific challenging behaviours. Consult the bank of proactive strategies that can be tailored to an individual child’s environment to prevent triggers and promote positive ways of communicating, behaving, and managing emotions. Develop an escalation profile to describe the different verbal and non-verbal signals the child exhibits as their levels of stress, anger, and/or frustration increase, and determine strategies for responding to each escalation stage.

This book provides templates, banks of practical strategies, and a framework for developing a behaviour management plan so that all staff supporting a child can respond to challenging behaviours effectively and efficiently in a planned, safe, and least disruptive manner. This book will educate, empower, and enable you to help your child learn positive ways of behaving and managing their emotions. They can spend more time learning and developing, and you can spend more time doing what you do best: teaching.

This invaluable resource is useful for parents, caregivers, childcare educators, primary and secondary educators, supervisory, allied health professionals, and mental health professionals.

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.

Murch, S., Anthony, A., Casson, D., Malik, M., Berelowitz, M., Dhillon A., et al. (2004). Retraction of an interpretation, Lancet, 363 (9411), p. 750.  

Taylor, L.E., Swerdfeger, A.L. & Eslick, (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), p. 3623–3629.

Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson D.M., Malik, M. Berelowitz, M., Dhillon, A.P., Thomson, M.A., Harvey, Pl, et al. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retraction published in Lancet. 2010; 375(9713): 445]. Lancet, 35(9103), p. 637–641.

Wing, Lorna. (1981). Asperger syndrome?: A clinical account. Psychological Medicine, 11(1), 115-129. 

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous child, 2(3), 217-250.