Autism Spectrum Disorders
What is an autism spectrum disorder (ASD)?
Autism spectrum disorders include Autistic Disorder (AD), Asperger syndrome (AS), and
Pervasive Developmental Disorder- Not Otherwise Specified (PDD- NOS). These are
neurodevelopment disorders characterized by deficits in social interaction, communication, and
repetitive or unusual intense behaviors or interests. The diagnosis is made based on medical and
developmental evaluations and the criteria in the Diagnostic and Statistical Manual of Mental
Disorders DSM-IV-TR. The diagnosis of autism can be made as early as 18 months of age but
is more often diagnosed in children around three years of age. The characteristics of autism vary
in intensity but delays in the acquisition of developmental skills and atypical patterns of
development are seen in all children with autism.
The Individuals with Disabilities Education Act (IDEA) defines the disorder as “a developmental
disability significantly affecting verbal and nonverbal communication and social interaction,
generally evident before age 3, which adversely affects a child’s educational performance. Other
characteristics often associated with autism are engagement in repetitive activities and
stereotyped movements, resistance to environmental change or change in daily routines, and
unusual responses to sensory experiences.” [See 34 Code of Federal Regulations §300.8(c)(1).]
Associated Disorders
There are other disorders that are often confused with or accompany autism spectrum disorders.
These include: intellectual disability, Rett syndrome, childhood disintegrative disorder, fragile X
syndrome, tuberous sclerosis, phenylketonuria, fetal alcohol spectrum disorder, Angelman
syndrome, Smith-Lenli-Opitz syndrome, CHARGE syndrome, Down syndrome and
schizophrenia. It is important to determine during the diagnostic process if these associated
disorders are present.
Children with ASD may also have seizures, intellectual disabilities, learning disabilities,
gastrointestinal disorders, sensory processing disorders, attention deficit hyperactivity disorder,
and sleep disturbances.
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How many children have autism?
There currently is not an accurate estimate of the number of people with ASD in the United
States and controversy exists over how we diagnose and categorize who has an autism spectrum
disorder (ASD). However, the Center for Disease Control and Prevention estimated that in 2007
about 1 in 150 8 year old children had an ASD based on data gathered from government surveys
of selected community, health, and medical records through the Autism and Developmental
Disabilities Monitoring Network project. Estimates of the prevalence also vary by region and it
is difficult to determine if the overall prevalence rate is increasing, decreasing or remaining the
same. The prevalence rate is for higher for boys than girls and ASDs are more common than
Down syndrome (1 in 800) and childhood cancers (1.5 in 10,000). For more information about
the prevalence rate of ASDs, see the Center for Disease Control and Prevention, Autism
Information Center at http://www.cdc.gov/ncbddd/autism/index.html
Description of Autism Spectrum Disorders
Currently, there is no one medical test to determine if a child has ASD and the etiology of autism
is unknown. The diagnosis is made through a combination of observations, parent, caregiver and
educator interviews, and meeting a threshold of criteria from the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV-TR). Autistic spectrum disorder is diagnosed when a
child meets a total of six or more of the criteria in the areas of qualitative social impairment (at
least two of these criteria), qualitative communication impairments (at least one) and restricted,
repetitive, and stereotyped patterns of behavior, interests, and activities (at least one) and
manifests these delays by age three when Rett syndrome and child disintegrative disorder have
been ruled out.
The criteria for the diagnosis of Asperger syndrome are similar to ASD. Individuals with
Asperger syndrome have qualitative impairments in social interactions and restricted, repetitive,
and stereotyped patterns of behavior, interests, and activities with significant social skill and
pragmatic language impairments but without delays in receptive and expressive language,
cognitive or adaptive (self-help) skills. Schizophrenia must also be ruled out in order for
Asperger syndrome to be diagnosed.
Children with pervasive developmental disorder, not otherwise specified (PDD-NOS) also
demonstrate atypical social interactions, delays in communication skills, and restrictive or
intense behaviors or interests thus meeting many of the criteria to be diagnosed with ASD, but
just below the threshold to make the diagnosis of ASD.
For a detailed description of the criteria, see the Autism Information Center at the Center for
Disease Control and Prevention http://www.cdc.gov/ncbddd/autism/hcp-dsm.html
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Autism Spectrum Disorders
Type
Autistic Disorder
Asperger
Syndrome
Pervasive
Developmental
Disorder, Not
Otherwise
Specified PDDNOS
Characteristics
Delays in social, communication, and adaptive skill development
with repetitive, restrictive or intense patterns of behavior, interest
and activities.
Delays in social skills and pragmatic language, with repetitive,
restrictive or intense patterns of behavior, interest and activities
without delays in cognitive, adaptive, or language development.
Delays in social, communication, and adaptive skill development
with repetitive, restrictive or intense patterns of behavior, interest
and activities but do not meet the threshold of criteria for a
diagnosis of Autistic Disorder.
What are causes of autism?
The cause is still unknown. Children are at higher risk of having ASDs if there is a history of the
disorder in the family, parents are of advanced maternal or paternal age, or there has been
exposure in utero to environmental toxins.
What are interventions used for individuals with autism?
The goal of intervention is to promote participation in naturally occurring activities and routines.
Intervention often focuses on social and communication skill development. There are a wide
variety of behavioral, educational, medical, and communication interventions available to
promote learning, social interaction, communication, and adaptive development for children with
ASD. Not all of the interventions used have strong evidence to support their effectiveness. The
chart below is a quick reference list of the more common interventions used with children with
ASD divided into types and categories of “Established” Interventions; “Emerging” Interventions;
and “Unestablished” Interventions based on research and the National Standards Report
published by the National Autism Center in 2009. As defined by in the report, “Established”
Interventions are those with sufficient evidence to confidently determine a treatment produces
beneficial treatment effects. “Emerging” Interventions are those that have one or more studies
suggesting a treatment will produce beneficial treatment effects but need further study on
effectiveness. “Unestablished” interventions are those with little or no evidence to support their
use. It is beyond the purpose of this document to describe each of these interventions in detail, a
few are brief descriptions are included below. Refer to the National Autism Center reports and
listed resources for more comprehensive information about any of these interventions.
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Common Interventions for ASD
Type
Behavioral
CommunicationBased
Educational
Established
Emerging
Applied Behavioral Analysis (ABA)
Differential reinforcement
Discrete Trial Teaching (DTT)
Functional Communication Training
(FCT)
Task Analysis
Token Economy
Behavioral toilet training
Behavior chain interruption
Cueing and prompting
Noncontingent reinforcement
Self Management
Schedules
Cognitive Behavioral Interventions
Naturalistic Teaching Strategies
Pivotal Response Treatment (PRT)
Story Based
Unestablished
Exposure-Based Interventions (ie: exposure
to increasingly anxiety provoking situations;
preventing maladaptive strategies)
Alternative and Augmentative
Communication (AAC)
Language Production Training
 Echo relevant word training
 Structured discourse
Picture Exchange Communication System
(PECS)
Sign Instruction
Hannen® Method
Total Communication
Initiation Training
Music Therapy
Structured Teaching/ Treatment and
Education of Autistic and related
communication-handicapped children
(TEACCH)
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Auditory Integration Training
Facilitated Communication
Academic Interventions:
 The Expression Connection
 Picture to text matching
 Handwriting training
Type
Relationships-Based
Established
Emerging
Joint Attention Based
Modeling
Peer Training
Developmental Relationships-Based
Treatment
Denver Model
Developmental, Individual Differences,
Relationships-Based (DIR/Floortime)
Relationship Development Intervention
Imitation-Based Interactions
Theory of Mind Training
Social, Communication, Emotional
Regulation, Tansactional Support
(SCERTS™)
Relationship Development Intervention
(RDI)
Exercise-Based Interventions
Massage/Touch Therapy
Alert Program
Sensory Diet
Sensory-Motor
Pharmacological
Unestablished
Sensory-Integration Therapy
Medications including anticonvulsants,
antidepressants, stimulants, and
antipsychotics have been used to improve
attention and reduce anxiety, obsessivecompulsive behaviors, irritability,
tantrums, self-injury and aggression in
children with ASD.
Defeat Autism Now (DAN)
Protocol
Gluten & Casein-Free Diet
Omega 3 Fatty Acids
Dietary
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Brief Descriptions of Common Interventions
Behavioral/Educational
Applied Behavioral Analysis (ABA)
Intensive programming (25-40 hours/week)
One to one interaction
Applies task analysis
Strict behavior modification
Discrete Trial Training, Lovass Method
Treatment & Education of Autistic and
Communication Handicapped Children
(TEACCH)
Classroom based program
Strong parent training component
Incorporates:
 Visual organization
 Behaviorally training
 Developmentally appropriate practices
Relationship Based
Developmental, Individual-Difference,
Relationship Based (DIR)
Builds on social communication
Focuses on the relationship between child and
parent
Child directed play
Builds shared attention
Stresses engagement in the relationship
Floortime
Relationship Development Intervention
(RDI)
Addresses social learning
Uses natural occurring activities and routines
to shape language and social interactions
Parents are primary facilitators
Language
Hanen Method
Pragmatics
Based on social-interactionist
theory
Emphasizes importance of
contingent, simplified
language
Natural occurring activities
and routines
Families are primary
facilitators
Practical use of language
Use of gestures, expression,
proximity, inflection
Uses social situations to
rehearse appropriate
communication
Social Stories (Gray)
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Alternative and
Augmentative
Communication (AAC)
Low and high tech devices
such as:
Picture boards
Picture Exchange
Communication System
(PECS)
Signs
Gestures
Computers
Synthesized speech
Voice Output Communication
Aids (VOCA)
According to the National Academies of Science
(http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10017) intervention is
most successful when:
 The child begins to receive intervention as early as possible,
 There is active engagement in intensive instructional programming for the equivalent of a
full school day, including services that may be offered in different sites,
 Services are provided for a minimum of 5 days a week all year,
 Use of planned teaching opportunities, organized around relatively brief periods of time for
the youngest children (e.g., 15- to 20-minute intervals), and
 Sufficient amounts of adult attention in one-to-one or small group instruction
in order to meet individualized goals.
Although there are differences in the philosophies that guide interventions, effective programs
offer similar levels of intensity and organization, staffing, ongoing monitoring, and the use of
discrete trials, incidental learning, and structured teaching periods embedded into the program.
Tools used to help identify young children with ASD
In addition to medical, educational, developmental assessments to determine skill performance
and developmental skill acquisition there are several tools that have been developed specifically
for children with autism:
 Autism Behavior Checklist (ABC)
 Autism Diagnostic Interview-Revised (ADI-R)
 Autism Diagnostic Observation Schedules (ADOS)
Focus: social communication
 Checklist for Autism in Toddlers (CHAT)
Focus: Development of attention and early communication
 Childhood Autism Rating Scales (CARS)
Focus: Sensory motor behaviors
 Detection of Autism by Infant Sociability Interview (DAISI)
Focus: Social engagement
 Gilliam Autism Rating scale (GARS)
Focus: Behavior, communication, development, interaction
 Screening Tool for Autism in Two-Year Olds (STAT)
Focus: Play, imitation, communication
References
Hyman, S. & Towbin, K.E. (2007). Autism spectrum disorders. In M.L. Batshaw , L. Pellegrino,
& N. J. Roizen (Eds.), Children with Disabilities (6th ed.) (pp.325-344). Baltimore: Paul H.
Brookes Publishing Company.
Johnson, C.P., Myers, S.M., & the Council on Children with Disabilities (2007). Identification
and evaluation of children with autism spectrum disorders. Pediatrics 120 (5), 1183-1215.
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Greenspan, S.I., Brazelton,T. B., Cordero, J., Solomon, R., Bauman, M.L., Robinson, R.,
Shanker, S. & Breinbauer (2008). Guidelines for early identification, screening, and clinical
management of children with autism spectrum disorders. Pediatrics 2008;121;828-830.
Kelly, A.B., Garnett, M.S., Attwood, T. & Peterson,C. (2008). Autism spectrum
symptomatology in children: The impact of the family and peer relationships. Journal of
Abnormal Child Psychology. 38, 1069-1081.
National Center for Health Statistics, Center of Disease Control and Prevention, U.S. Department
of Human Services. Available at http://www.cdc.gov/nchs/
Resources
Autism Society of America
http://www.autism-society.org/
Autism Speaks
http://www.autismspeaks.org/
Autism Speaks Family Services Kit
http://www.autismspeaks.org/community/family_services/100_day_kit.php
Association for Science in Autism Treatment
http://www.asatonline.org
Center for Disease Control and Prevention, Act Early
http://www.cdc.gov/ncbddd/autism/actearly/default.htm
Center for Disease Control and Prevention, Autism Information Center
http://www.cdc.gov/ncbddd/autism/
Interdisciplinary Council on Developmental and Learning Disorders
www.icdl.com
MAAP Services for Autism, Asperger Syndrome, and PDD
http://www.maapservices.org
National Dissemination Center for Children with Disabilities
http://www.nichcy.org
National Institutes of Mental Health
http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmentaldisorders/index.shtml
National Institute of Child Health and Human Development (NICHD)
http://www.nichd.nih.gov
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National Institute on Deafness and Other Communication Disorders Information Clearinghouse
http://www.nidcd.nih.gov
Committee on Educational Interventions for Children with Autism, National Research Council.
(2001). Educating Children with Autism. Washington, DC: National Academies Press.
http://www.nap.edu/openbook.php?isbn=0309072697&page=R5
Online Asperger Syndrome Information and Support
http://www.udel.edu/bkirby/asperger/as_thru_years.html
Professional Development Resources
Autism Internet Modules
http://www.autisminternetmodules.org/
Interactive Collaborative Autism Network (ICAN) Learning Modules
http://www.autismnetwork.org/modules/index.html
The National Professional Development Center on Autism Spectrum Disorders
http://autismpdc.fpg.unc.edu/content/autism-internet-modules-aim
The PDA Center: Professional Development in Autism
http://depts.washington.edu/pdacent/courses/autism101.html#
Cite As: Georgetown University Center for Child and Human Development. Contemporary
Practices in Early Intervention: Autism Primer. 2011. Available online at
http://www.teachingei.org.
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