Autism Spectrum Disorder is very common. About 1 in 50 school aged children had parent reported ASD in 2011-2012. There have been changes in DSM-5 with the category of Autism Spectrum Disorder being introduced which includes Autistic disorder, Asperger’s disorder, Rett’s disorder and Pervasive Developmental Disorder-NOS from DSM-IV. Researchers have studied several important questions in this disorder.
Just what is Autism? Or What is the relationship of vaccines and autism? Or What are the best treatments for Autism including types of therapies for Autism? Or Can you cure Autism? Below you can see the best evidence based answers to these questions.
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What Is Autism Spectrum Disorder (ASD)?
Individuals with Autism Spectrum Disorder often experience:
- Difficulties in social-emotional connections
- Failure to hold a back and forth conversation, or initiate or respond to social interactions (like poor eye contact)
- Difficulties in using or understanding gestures or even total lack of facial expression
- Highly fixated interests including a preoccupation with unusual objects
- Difficulties in reacting to sensory input including indifference to pain and temperature and excessive touching or smelling of objects
- Difficulties in imaginative play, making friends, lack of interest in peers
- Repetitive patterns of behavior , interests, or activities like repetitive motor movements (lining up toys, repeating vocalizations of others)
- Insistence on sameness including extreme distress at small changes and difficulties with transitions
1 in 50 school aged children had parent reported ASD in 2011- 2012, which was a doubling of the prevalence in the last five years
School aged boys are 4X more likely to have ASD compared to school aged girls.
In families with one child with ASD there is a risk of 5% of having another child with ASD.
If one twin has ASD there is a 90% chance that the other twin will also have ASD.
60% of ASD is reported as mild by parents, 35% as moderate and 7% as severe.
7% of ASD is reported a severe by parents.
What Are the Possible Signs of Autistic Disorder?
- Does not babble or coo by 12 months of age.
- Does not gesture (point, wave, grasp, etc.) by 12 months of age.
- Does not say single words by 16 months of age.
- Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age.
- Has any loss of any language or social skill at any age.
- The child does not respond to his/her name.
- Language skills or speech are delayed.
- The child doesn't follow directions.
- The child seems to hear sometimes, but not others.
Specific Disorders in the Autism Spectrum Disorder Category of DSM 5 include:
Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills.
Asperger’s disorder is often considered a high functioning form of autism. It can lead to difficulty interacting socially, repeat behaviors, and clumsiness.
Rett’s disorder is a disorder of the nervous system that leads to developmental reversals, especially in the areas of expressive language and hand use.
Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)
A diagnosis that is used for "severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific PDD" or for several other disorders.
Childhood Disintegrative Disorder
Childhood disintegrative disorder is a condition in which children develop normally through age 3 or 4. Then, over a few months, children lose language, motor, social, and other skills that they already learned.
The History of Autism
1911 - A Swiss psychiatrist named Eugen Bleuler was the first person to use the term. He started using it around 1911 to refer to one group of symptoms of schizophrenia.
1940s - Researchers in the United States began to use the term "autism" to describe children with emotional or social problems.
1944 - German scientist Hans Asperger described a "milder" form of autism, known today as Asperger's disorder.
1960s-70s - Research into treatments for autism focused on medications such as LSD, electric shock, and behavioral change techniques. The latter relied on pain and punishment.
1965 - U.S. psychologist Bernard Rimland established the Autism Society of America, one of the first advocacy groups for parents of children with autism.
1980 – The diagnosis of Autism and Pervasive Developmental Disorders were added to DSM III.
1994 - Asperger's disorder and Rett’s disorder were officially added to the DSM-IV.
2013 - The DSM 5 introduced the category of Autism Spectrum Disorder.
Did You Know?
The DSM-5 criteria for ASD identified 91% of DSM-IV diagnosed patients with Pervasive Developmental (PDD) disorders?
Autism in the DSM-5
The specifiers for Autism Spectrum Disorder in DSM 5 include with or without language or intellectual impairment, or association with a known medical or genetic condition or environmental factor or with catatonia.
Changes in DSM 5 Criteria for Autism and Related Disorders
Single diagnostic category of Autism Spectrum Disorder (ASD) includes DSM-IV Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder- Not Otherwise specified ( PDD-NOS), Rett’s Disorder, and Childhood Disintegrative Disorder.
Three symptom domains of DSM-IV replaced by two in DSM-5 because deficits in communication are intimately related to social deficits. This will also fix the “double counting” of DSM-IV.
DSM-IV requires symptoms to begin prior to age 3 whereas DSM-5 requires symptoms to begin in early developmental period with the caveat that they may not be fully manifest until later.
DSM-5 has inclusion of specifiers, and text description to include symptoms unique to various ages and verbal abilities.
New category of Social Communication Disorder (SCD) added which includes many cases of PDD-NOS in DSM-IV.
Did You Know?
The DSM IV criteria for Asperger’s Disorder did not match the original cases described by Asperger.
Criticisms of DSM 5 Diagnosis of ASD
Asperger’s Disorder no longer a diagnosis. It is considered milder form of Autistic disorder.
Increase in requirement in social communications domain.
Research done prior to DSM 5 will not be comparable with research done afterwards.
Changes in criteria threaten delivery of services
What Causes Autism Spectrum Disorder?
Researchers have identified a number of genes associated with the disorder. Abnormalities in brain structure and function as well as neurotransmitters have also been identified.
Most common comorbid disorders in patients with ASD include mood disorders, anxiety disorders including OCD, sleep disorders, ADD and schizophrenia.
There is no evidence that vaccines or parenting behavior are associated with ASD.
How Do Doctors Treat Autism Spectrum Disorder?
They should be tried first in all patients. They address the social, language and behavioral difficulties associated with ASD. Examples include traditional Applied Behavior Analysis (ABA) therapy which is structured, adult driven and one on one, developmentally based treatments like floor time which focuses on play and is child driven or naturalistic ABA therapy which is child driven and embedded in natural child play.
Children with autism often respond well to highly structured education programs. Successful programs often include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.
Parents and family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.
Some may be helpful as an adjunct to therapies to treat symptoms of the disorder. For example risperidone and aripiprazole are FDA approved to treat irritability associated with autistic conditions. SSRIs may be helpful in some patients for anxiety, irritability or depression. Psychostimulants may be helpful for comorbid ADD-like symptoms.
Can Someone With Autistic Spectrum Disorder Still Lead a Successful Life?
There are many successful people who are autistic:
- Dan Aykroyd
- Courtney Love
- Lewis Carrol
- Dan Harmon
- Andy Warhol
- Tim Burton
- Daryl Hannah
- James Durbin
- Wolfgang Amadeus Mozart