Characteristics of ASD Page |1 Characteristics of Autism Spectrum Disorders (ASD) Purpose: The purpose of this unit is to introduce you to ASD and the major characteristics of the primary disorders that are included in the spectrum. This unit serves as a foundation for the intervention units that are included in this training and includes basic information about ASD and characteristics specific to each category, a quiz, and related resources. What is ASD? The term autism spectrum disorders (ASD) is used to describe a collection of disabilities that share similar characteristics. There has been some controversy regarding terminology. While ASD is not commonly used as a diagnostic category, it is currently used in the professional literature. Generally, ASD is interchangeable with the term pervasive developmental disorders (PDD), a category of disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association [APA], 2000). Several distinct disorders are included under the PDD umbrella: (a) autistic disorder, (b) Asperger disorder, (c) Rett’s disorder, (d) childhood disintegrative disorder, and (e) pervasive developmental disorder, not otherwise specified (PDD-NOS). Specifically, individuals with ASD display varying degrees of deficits in social interaction as well as repetitive, restricted, and stereotyped behavior (APA, 2000). Those who are most impacted by ASD also have deficits in communication. In this Unit, autism, Asperger syndrome, and PDD-NOS will be discussed. Characteristics of ASD Page |2 Brief History of Identification of Autism Spectrum Disorders (ASD) Leo Kanner and Hans Asperger are credited with separately identifying autism as a distinct group of symptoms in the 1940s. Kanner (1943), an American psychiatrist, wrote in-depth case studies of 11 children with characteristics that would fit the current definitions of autism, and that he believed comprised a disorder unique from others including mental retardation and schizophrenia. He called this disorder early infantile autism. The characteristics included (a) difficulties relating to others, (b) language delays, such as inability to develop speech, echolalia, and literal interpretation of language; and (c) unusual behaviors, such as obsessions, insistence on routine and sameness, and self-stimulatory behaviors. Kanner’s work sparked interest in the disorder and lead to further research on characteristics and treatment. At about the same in Germany, Asperger (1944) described children who demonstrated social deficits similar and maybe milder than those in children with autism, but who had average or better cognitive functioning. Asperger’s work was largely ignored outside of Germany until recently. Wing (1981) rediscovered Asperger’s research and hypothesized that the characteristics he was describing were a subtype of Kanner’s autism. She described over 30 additional individuals with characteristics similar to those identified by Asperger. Prevalence Early prevalence estimates proposed a rate of autism in 4 to 5 of 10,000 births (Janzen, 2003). More recent prevalence rates estimated a ratio of 2 in 1000 (Wing & Gould, 1979). Present Characteristics of ASD Page |3 investigations indicate a much higher rate and have raised alarm about contemporary increases in the number of individuals with ASD The Centers for Disease Control and Prevention (CDC) recently conducted studies in two metropolitan areas. A study of children from 3 to 10 years old in metropolitan Atlanta, Georgia (Yeargin-Allsopp, et al., 2003), found an ASD rate of 3.4 per 1,000 children (about 1:300), including autistic disorder, Asperger disorder, and PDD-NOS, according to DSM IV criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; American Psychological Association, 1994). Boys were identified at approximately a rate four times higher than for girls; however, this ratio decreased as cognitive impairment increased. For more information visit the website on the Metropolitan Atlanta Developmental Disabilities Surveillance Program of the CDC. Another study using the same criteria examined the population of Brick Township, New Jersey (Bertrand, et al., 2001). This investigation found an overall ASD rate of 6.7 per 1,000 children (approximately 1:150). Specifically, 4.0 in 1000 were diagnosed with autistic disorder. Of note, there were 2.2 boys for every girl with autistic disorder, a lower ratio than in previous studies. Approximately two thirds of the children with autistic disorder and half of the children with PDD-NOS were also diagnosed with mental retardation. For further information, visit the CDC’s report. A report from the Department of Developmental Services (2003) in California indicates similar rapid increases in the rate of individuals with ASD receiving their services. According to their data, the current estimated prevalence rate of autism, excluding other pervasive developmental disorders, in California is 3.1 in 1,000 (approximately 1:320), a rise of 774% between 1970 and Characteristics of ASD Page |4 1997. The gender ratio was approximately 4 males to 1 female, similar to previous reports of ratios between 3:1 and 5:1 (Lord & Schopler, 1987; Ritvo & Freeman, 1978; Simpson & Myles, 1998). Forty-four percent of the individuals with autism in California were also diagnosed with mental retardation. The dramatic rise in the rate of ASD has stirred a debate about the cause. Some theorize that the increase may be due to inconsistency of diagnostic criteria and methods, broadening of definitions to include higher functioning individuals with ASD, increased awareness among practitioners, parents, and physicians, or improved and increased services (Simpson & Myles, 1998; Yeargin-Allsopp, 2002). This debate may also be linked to disagreements about the causes of ASD. Currently, there is no clearly identified single cause of ASD, but these disorders are thought to be linked to factors such as (a) genetic or chromosomal disorders, such as Fragile X syndrome (Rutter, 2000); (b) infections, such as congenital rubella; (c) metabolic disorders; (d) toxins, such as alcohol and lead poisoning; (e) anoxia (i.e., loss of oxygen at birth); or (f) traumatic brain injury (Janzen, 2003). In a nutshell: Current estimates of prevalence of autism spectrum disorders (combined): 1:250 to 1:320 Approximately 44-67% of children with autistic disorder also have mental retardation The ratio is 4 boys to every girl diagnosed with ASD Categories of ASD In the United States, the most commonly recognized definitions of ASD are those found in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.–TR; DSM-IV-TR; APA, 2000). Characteristics of ASD Page |5 Within the DSM-IV-TR, autism spectrum disorders are defined under the heading of pervasive developmental disorders. In this Unit, we will discuss autism, Asperger syndrome, and PDDNOS, the most common Pervasive Developmental Disorders. For a more thorough discussion of the diagnostic criteria, visit the assessment Unit. Please note that there is a great deal of overlap among the categories of ASD and that characteristics described under one heading may be applicable to others. Autism Overview The definition of autism, or autistic disorder as it is referred to in the DMS-IV-TR (APA, 2000), describes individuals with impairments that are evident prior to 36 months of age. Those diagnosed with autism are on the more severely impaired end of the spectrum and many also have mental retardation (Simpson & Myles, 1998). Impairments in autism can be described within three categories: (a) social skills; (b) communication; and (c) repetitive, restrictive, and stereotyped behavior. Each of these areas will be discussed briefly. Social Skills Children and adults with autism display deficits in social skills (APA, 2000). Differences from the norm may be evident in two or more of the following ways: They may have deficits or differences in nonverbal communication skills, such as use of eye contact, body language, gestures, and facial expressions. While they may use some eye contact, it is not as frequent or sustained \ as in their typical peers (Janzen, 2003). Characteristics of ASD Page |6 Some children with autism do not appear to notice others, failing to look at or initiate contact with others. They often do not build relationships with others their age at a level expected considering their overall development. They rarely share attention with others, such as by showing something, pointing, or pointing out interests or accomplishments. They do not demonstrate emotional reciprocity. They infrequently take turns in play or conversation (Janzen, 2003). For example, typical 18-month-olds spontaneously hold out food for their caregivers to share a bite, but children with autism have to be directly taught to do so. They also rarely spontaneously imitate the actions of others in play or otherwise. Christopher, a nonverbal 12-year-old, demonstrates several social skill deficits indicative of autism. During a recent assessment, the examiner noted that although he occasionally made good eye contact, such as when his favorite crackers were put on a shelf out of reach Christopher did not share enjoyment with others. For example, when the examiner activated a remotecontrol car, he played with it, but did not look at his mother or the examiner to see if they also enjoyed the car, nor did he point at it. Further, when two sets of toy tools were placed on the table and the examiner pretended to build a chair, Christopher did not imitate her actions. Instead he repeatedly banged the screwdriver on the table. Additionally, when questioned, his mother reported that he did not have any particular “friends” he liked to play with. Communication Skills Individuals with autism demonstrate impairments in communication skills in at least one of the following areas (APA, 2000): Characteristics of ASD Page |7 They may have delayed speech, or no speech at all, make no effort to make up for these deficits with nonverbal communication (APA, 2000). Instead of compensating for their lack of expressive speech through gestures, individuals with ASD use fewer gestures and those they use are limited in function (Ogletree, 1998). For example, a child with autism may reach for a item to let someone know he wants something on the shelf but will not point to comment on something in the environment. Those who speak are unable to open or keep conversations going (APA, 2000). They frequently engage in repetitive or stereotypic speech or vocalizations, such as echolalia (APA, 2000). Echolalia, repeating utterances of others, is common in students with autism (Janzen, 2003). Such instances may occur immediately. For example, Mom says, “Whose brush is that?” and the child repeats, “brush is that,” in the same intonation. Echolalia may also be delayed. When playing with clay, Chin repeatedly says, “I have the green clay, green clay, green clay,” which had been modeled for him when the clay was first introduced. Previously, echolalia was thought to have no communicative function. However, it is currently believed to have a variety of meanings and may be useful in language instruction (Janzen, 2003; Prizant, 1988). They may lack pretend play of the same quality, quantity, and variety of their same-age peers (APA, 2000). Teddy is a 4-year-old with autism, who attends an integrated preschool where about half of the children have disabilities and the rest are typically developing. Communicatively, he lags behind his peers. Most 4-year-olds speak in sentences of three or more words and use a variety of purposes for communicating, such as asking for what they want (“Gimme the red car”), commenting on novel objects in the environment (“Look at that butterfly!”), and sharing their emotions (“I’m so mad!”). During a recent diagnostic assessment, Teddy infrequently used words to make requests. However, he did ask for bubbles by grabbing the bubble wand and saying, “bubu.” Other Characteristics of ASD Page |8 requests for objects included, “ju” [juice] and “car.” In addition, Teddy frequently took the teacher’s hand and placed it on items he needed help with, such as to open a zipper baggie with crackers in it. The only other communicative purpose expressed was a refusal to play in the sandbox, when Teddy yelled, “no!” and pushed the teacher away. Teddy also displayed immediate echolalia frequently, such as repeating “truck,” when the teacher said, “here comes the truck,” and “pop” while the teacher was blowing bubbles. While typically developing children may use some echolalia as toddlers, they outgrow it by 2 or 3 years of age. Several specific communication differences have been noted in individuals with autism: Generally, across the spectrum, the higher a child’s measured IQ, the better his or her language skills are; however, some individuals with lower IQs demonstrate normal language skills (Kjelkaard & Tager-Flusberg, 2001). While articulation skills may not be impaired, content and grammar frequently are delayed. Specifically, many children with autism have a rigid understanding of words (Janzen, 2003). They may have difficulty with the concept that objects can have more than one name (e.g., dog/pet/animal, crayon/color/writing utensil) and that words may have more than one meaning (e.g., iron can mean the mineral, the act of smoothing wrinkles in clothing, or figuratively, “iron out,” means to solve a problem). Restrictive, Repetitive, and Stereotyped Behavior Restrictive, repetitive, and stereotyped behavior may be exhibited in at least one of the following ways by individuals with ASD (APA, 2000): They may have an unusually strong or focused interest or fixation. They may be overly drawn to routines and rituals and be unable or unwilling to be flexible in adhering to these routines. Characteristics of ASD Page |9 They may demonstrate repetitive complex body or other motor movements, such as spinning, rocking, or finger flicking. These self-stimulatory behaviors may occur so frequently that they interfere with engagement in productive activities and may take up the majority of a child’s waking hours if allowed (Simpson & Myles, 1998). They may show intense interest in parts of objects, as opposed to using the entire toy or object (APA, 2000). Reese, a toddler with autism, was recently observed in his playroom. Most toddlers would play with a variety of toys in the room, such as stacking blocks, playing musical instruments, and making animal noises with the animals in a toy farm. Instead, Reese was observed lying on the floor pushing a toy car back and forth, closely watching the wheels for 20 minutes. He also periodically flicked his fingers between his eyes and the overhead light. The ability and desire to learn routines can be considered a strength in individuals with ASD. However, at times it may also be a drawback (Janzen, 2003). While they may quickly learn routines, they may not understand the purpose or significant portions of the routine and, thus, be inflexible in the use of such routines. Mari’s mother taught the nonverbal 8-year-old with autism to set the table. After each step, her mother told her what to do next, such as “plates,” “napkins.” After two weeks of giving Mari these prompts, her mother wanted her to complete the task independently, but after each step, Mari looked at her mom to be told what to do next. Her mother had accidentally built her verbal prompts into the routine The pattern of restricted interests found in many individuals with ASD may present itself as decreased motivation to engage in learning activities (Olley, 1992; Simpson & Myles, 1998). Often, they are motivated to engage only in activities that reflect their own interests; however, C h a r a c t e r i s t i c s o f A S D P a g e | 10 this can serve as an avenue for intervention, using special interests as the basis for developing curriculum. The desire for routine and predictability along with visual strengths may serve as avenues for intervention. We suggest visiting the Transition Strategies and Visual Schedules topics to learn strategies utilizing routines and visual strengths. Some of these repetitive behaviors may be related to sensory differences in individuals with ASD. These factors and potential interventions are discussed in the Sensory Interventions Units. Asperger Overview Asperger Syndrome (AS), called Asperger disorder in the DSM-IV-TR, is similar to autism, except that individuals with AS do not demonstrate the severe impairments in speech and language evident in those with autism (APA, 2000). That is, they generally speak in one-word utterances by age 2 and phrases by age 3, but they do have socio-communicative impairments. In addition, individuals with AS are rarely also diagnosed with mental retardation. Impairments characteristic of AS fall within two categories: (a) social skills and (b) repetitive, restrictive, and stereotyped behavior. Each of these areas will be discussed briefly. Social Skills Social skill impairment is the primary area of deficit in individuals with AS (APA, 2000). The social skill criteria for AS is the same as for children with autism, although they may manifest themselves differently. Deficits are found in at least two of the following areas: As in autism, children with AS may have deficits or differences in nonverbal communication skills, such as use of eye contact, body language, gestures, and facial C h a r a c t e r i s t i c s o f A S D P a g e | 11 expressions (APA, 2000). Janzen (2003) has noted that individuals with AS frequently have difficulty using and interpreting communication that involves nonverbal cues or paralanguage. They take others’ speech literally and have difficulty interpreting tone of voice (e.g., sarcasm, humor) and body language (e.g., facial expressions of boredom or confusion), often mistakenly basing their understanding solely on the words spoken. Jiro told his teacher how well he had done on an earth science exam. Pleasantly surprised the teacher responded, “No way! Get outta here!” Interpreting her words literally, Jiro immediately left the room. They often do not build relationships with others their age to the extent expected based on level of development (APA, 2000). Many individuals with AS desire socialization, but have difficulties understanding social situations (Janzen, 2003). Specifically, they may not comprehend others’ points –of –view, and find it difficult to determine social responses to fit a wide variety of situations (Myles & Simpson, 2002). They rarely share attention with others, such as by showing something, pointing, or pointing out interests or accomplishments (APA, 2000; Janzen, 2003). They do not demonstrate social reciprocity (APA, 2000). That is, students with AS may learn to initiate greetings and conversations, but lack the ability to extend such interactions (Myles & Simpson, 2002). They may conduct one-sided conversations, monopolizing or failing to contribute to conversational turn-taking (Myles & Southwick, 1999). Young children with AS often seem uninterested in or unable to participate in play with peers (Attwood, 1998). They tend to boss other children around or get angry when the others do not play according to their rules. Delta is an 18-year-old with Asperger Syndrome. She attends general education classes, and has some special education support to help her organize her C h a r a c t e r i s t i c s o f A S D P a g e | 12 homework folder at the end and beginning of the day. Unlike individuals with PDD-NOS or autism, Delta’s language seemed to develop normally quantitatively. However, as she got older, some unusual qualitative differences in socio-communicative skills were noticed. For example, while Delta has a vocabulary and the sentence syntax appropriate for her age, she does not demonstrate the same give-and-take conversational skills as her peers. For example, recently, in her math class, after the teacher passed out the results of a test, she looked at the paper belonging to the boy next to her and said, “I got a 98 and you only got a 75.” In addition, while at lunch recently, she spoke non-stop to the girl sitting near, listing the entire casts of popular movies, and failing to give her classmate a chance to speak. She never noticed the bored expression on her classmate’s face. As a result of these and other social skill deficits, none of her classmates invites her out or chooses to sit with her at lunch although Delta says she wants friends. A related aspect of social skills impairment in ASD is a difficulty with theory of mind, or the ability to put oneself into someone else’s shoes and imagine what that other person may be thinking and feeling. For information on this deficit, visit the Unit on Theory of Mind in autism. In addition, please visit the Social Interventions UnitS for strategies to address social skill deficits. Repetitive, Restrictive, and Stereotyped Behavior As in autism, restrictive, repetitive, and stereotyped behavior may be exhibited in at least one of the following ways in individuals with AS (APA, 2000): They may have an unusually strong or focused interest or fixation. Myles and Simpson (2002) have noted that in those with AS, these interests may seem similar to those of same-age peers, but differ in intensity, extent of knowledge, or interest in the topic to the exclusion of other interests. They may be overly drawn to routines and rituals, and be unable or unwilling to be flexible in adhering to these routines (APA, 2000). C h a r a c t e r i s t i c s o f A S D P a g e | 13 They may demonstrate repetitive complex body or other motor movements, such as spinning, rocking, or finger flicking. However, this is thought to occur less often in those with AS compared to those with autism. They may show intense interest in parts of objects, as opposed to using the entire toy or object. Jessie is a bright fifth-grader with AS. Cognitively, he is far beyond his peers. However, his teacher reports that he rarely completes or turns in work that is not related to his special interests in American colonial history and European geography. In fact, these interests are so all-encompassing for Jessie that he rarely willingly takes part in conversations with his classmates unless they involve those topics. While he does engage in self-stimulatory behaviors, particularly finger movements, he has been taught to make those look more “typical,” so that now he frequently fingers small items such as key chains. PDD-NOS Overview Children are diagnosed with pervasive developmental disorders, not otherwise specified (PDDNOS) when they do not meet enough of the criteria for specific ASD, but demonstrate some similarities to others on the autism spectrum (APA, 2000). Thus, these children are an especially heterogeneous group. Armando is 7-year-old with PDD-NOS, who spends part of his school day in a self-contained special education classroom and part of his day in the general education setting. He speaks most often in three-word phrases or more and uses a few communicative purposes, but these are limited when compared to his peers. During a recent observation in his home, Armando spontaneously asked his momr, “Teddy bear cookies, please.” He also greeted a visitor by saying, “Hi, I Mando,” when his mom asked, “what do you say?” However, he rarely shares enjoyment or spontaneously initiates conversations with others. Occasionally, Armando repeats out-of-context phrases from favorite videos, such as, “Uh oh! The cow is loose!” which he was observed to repeat about a dozen times within 10 minutes, always with the same intonation pattern as the original video. C h a r a c t e r i s t i c s o f A S D P a g e | 14 Additional Learning Characteristics In addition to the criteria specified in the DSM-IV-TR (APA, 2000), students with autism spectrum disorders (ASD) may display a wide variety of other learning characteristics (Janzen, 2003; Simpson & Myles, 1998) that can be described under the following categories: (a) general cognitive and academic functioning, (b) attention, (c) generalization, (d) visual thinking, and (e) problem solving. Cognitive and Academic Functioning in General Individuals with ASD display a wide variety of cognitive skills, from moderate or severe mental retardation to average or above-average intelligence (APA, 2000). Thus, possible educational placements may include self-contained schools or classrooms and general education classrooms for those with Asperger syndrome and some with PDD-NOS (Simpson & Myles, 1998). However, despite average or above-average intelligence and strengths in memory and cognition, many students have difficulties in general education due to restricted interests, problems with abstract concepts, difficulty generalizing information, and weak organizational skills (Myles & Simpson, 2002). Attention Many individuals with ASD display difficulties in attention (Janzen, 2003). Specifically, they have difficulty regulating attention, similar to individuals with attention deficit hyperactivity disorder (Myles & Southwick, 1999). Examples include daydreaming and difficulty completing complex directions due to a loss of focus in the early stages of the task. These attention problems interfere with the ability to choose what in the environment is significant and what should be ignored. In addition, they may not be able to easily shift attention between two items. C h a r a c t e r i s t i c s o f A S D P a g e | 15 Ross, a high-functioning fifth-grader with PDD-NOS, was academically on par with the other children in his math class. However, he was concentrating so hard on completing his division problems that he missed his teacher’s repeated directions to put his math away and line up for lunch, resulting in a loss of 5 minutes of recess for “non-compliance.” Associated with difficulties in attention, children with ASD tend toward stimulus overselectivity (Simpson & Myles, 1998). This means that they attend to few cues in the environment and often respond to the wrong or insignificant cues. Armen used a photographic visual schedule to transition from one activity in the classroom to another. When he took the photo indicating circle time, he walked over to the fish tank and peered inside. The teacher told him repeatedly to sit on his spot, but he stayed at the tank. When he looked at the picture of the circle time area, he noticed and attended only to the small piece of the fish tank in the photo. Alfredo was a nonverbal preschooler with autism. While teaching him to identify colors, the teacher used a red, blue, and yellow toy car. He had mastered the task of handing the blue car to the teacher when asked to “give me the blue car,” but when it was lost and replaced with an identical toy car, Alfredo could no longer complete the task correctly. He had noticed the missing hubcap on the blue car and had incorrectly associated that with the word “blue” instead of paying attention to the color of the car. These types of deficits also contribute to difficulties with social conventions. Thus, they find it challenging simultaneously to pay attention to what someone is saying, to facial expression, body language, and tone of voice. Generalization Individuals with ASD often have trouble generalizing information to new settings, people, and materials as a result of difficulties organizing information meaningfully (Janzen, 2003; Simpson & Myles, 1998). Consequently, tasks mastered in only one teaching environment are not C h a r a c t e r i s t i c s o f A S D P a g e | 16 automatically demonstrated in others. Therefore, academic planning should include specific attention to ensuring generalization takes place. Allison was unable to make transitions from activity to activity in her classroom, to the frustration of herself and her teacher. For example, after breakfast, her teacher said, “Allison, it’s time to go to the bathroom.” Allison did not comply. When the teacher repeated it four more times in an increasingly louder voice, Allison threw herself to the floor, kicking and screaming. The next day, her teacher instead handed her a photograph of the restroom door and said, “bathroom.” Allison went without a fuss. Problem Solving Students with ASD have difficulty with the flexible thinking involved in solving problems (Janzen, 2003). They find it challenging to creatively generate a variety of options, think about multiple pieces of information at once, and evaluate possibilities. Often, when students with AS have learned a solution to a problem, they continue to try that solution even if it does not work (Myles & Southwick, 1999). Even when they have learned multiple solutions to problems through discussion and role-play, the have difficulty retrieving or generalizing them to authentic situations. These deficits in problem solving extend to academics, involving problems such as with math word problems and estimation. Mellisande generally performed well on exams in her high school U.S. history class. She easily memorized dates, names, events, and places. However, when the teacher gave a writing assignment involving brainstorming possible ways of preventing the Vietnam War, she could not interrelate the facts she had memorized to produce creative solutions. C h a r a c t e r i s t i c s o f A S D P a g e | 17 Quiz – Characteristics of ASD 1 Which of the following is an autism spectrum disorder? A. Autism B. Asperger syndrome C. Pervasive developmental disorder, not otherwise specified D. All of the above 2 Which of the following people is NOT given credit for the identification of autism spectrum disorders? A. Tony Attwood B. Leo Kanner C. Hans Asperger D. Lorna Wing 3 Current prevalence studies estimate a rate of approximately _______ births. A. 6:10,000 B. 1:300 C. 1:850 D. None of the above 4 More boys are diagnosed with autism spectrum disorders than girls True False 5 Impairments in autism are generally described within all of the following categories EXCEPT: C h a r a c t e r i s t i c s o f A S D P a g e | 18 A. Social skills B. Communication C. Repetitive, restrictive, and stereotyped behavior D. Motor skills 6 Some children with autism fail to make eye contact with or look at their peers. True False 7 All students with autism speak. True False 8 Echolalia is uncommon in individuals with autism spectrum disorders. True False 9 Self-stimulatory behaviors may include which of the following: A. Finger flicking B. Rocking C. Spinning D. All of the above C h a r a c t e r i s t i c s o f A S D P a g e | 19 10 A major difference between autism and Asperger syndrome (AS) is that individuals with autism have clinically significant deficits in communication skills, while those with AS do not. True False 11 Students with AS find it easy to understand and use nonverbal communication and abstract language. True False 12 Students with AS typically have difficulty with: A. Fine-motor skills, such as handwriting B. Speaking in more than two-word utterances C. Determining others’ points of view D. All of the above 13 Individuals with AS often have intense interests that are unusual in terms of: A. Intensity B. Extent of knowledge C. Exclusion of any other interests D. All of the above 14 Which of the following is true? A. Individuals with PDD-NOS always have speech delays B. Individuals with PDD-NOS are similar to others on the autism spectrum but they C h a r a c t e r i s t i c s o f A S D P a g e | 20 do not meet enough of the criteria for a specific category C. Individuals with PDD-NOS are a homogenous group D. All of the above 15 Intelligence in individuals with ASD: A. Ranges from severe mental retardation to average or above-average intellectual functioning B. Is below average C. Ranges from severe to mild mental retardation D. Is far above average 16 Specific difficulties related to attention are found in individuals with ASD include: A. Difficulty regulating attention B. Stimulus overselectivity C. Difficulty completing complex directions D. All of the above 17 Which of the following is NOT a problem associated with learning and academics in those with ASD? A. Rote memory B. Attention C. Generalization D. Problem solving