Introduction to Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) refers to a wide spectrum of complex developmental
disorders that typically appear in the first three years of life. These disorders are
characterised by impaired social interaction and communication accompanied by restricted
repetitive stereotyped interests and awkward behaviours, evident at an early stage of
development (Ozgen et al., 2009; Kanne, Randolph & Farmer, 2008; Meadan, Otrosky,
Zadhlawan & Yu, 2009).
ASD is classified in the DSM IV-TR as Pervasive Developmental Disorder. These include
Autistic Disorder, Aspersers Disorder, Rett’s Disorder, and the Childhood Disintegrative
Disorder (APA, 2000; Levy, Mandell & Schultz, 2009).
Types of ASD
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Autistic Disorders
Aspergers Disorders
Rett’s Disorders
Childhood Disintegrative Disorder
Autistic Disorder
Autism is a spectrum disorder, inferring that symptoms can range from mild to severe. As a
spectrum disorder, the level of developmental delay is unique to each individual. The onset of
Autistic Disorder is prior to 3 years of age. This disorder is typically characterised by
significant impairment in social interactions and communication. Restricted patterns of
behaviour, interest and activities are also common characteristics of this disorder.
Manifestations of this disorder also vary depending on the developmental level and
chronological age of the individual (APA, 2000). Because there is a range of symptom
severity in autism, descriptive terms are commonly used to depict the level of functional
impairment within the diagnosis.
“Classic autism” refers to the typical description of the disorder which involves a total lack of
language or minimal language that is predominately non-functional, restricted social
interaction, repetitive behaviours and stereotyped movement. Conversely there is the “high
functioning autism” that refers to those who meet the criteria for autism and are socially
withdrawn but have more developed skills in the areas of language and social interaction.
This group is more likely to be able to express themselves while still retaining a level of
abnormal speech (Phetrasuwan, Miles & Mesibov, 2009: APA, 2000).
Asperger’s Disorder
Asperser’s disorder is a continuous and lifelong disorder which involves a difficulty in
information processing. Regarded as a milder form of Autistic Disorder, the primary
characteristics of Asperger’s disorder includes qualitative impairments in social interactions as
well as restricted repetitive stereotyped patterns of behaviour, interests and activities. Unlike
Autistic Disorder, there are no clinically significant delays in language and cognitive
development or even adaptive behaviour skills nor is there any association with intellectual
impairment (Bellando & Pulliam, 2009).
Those who suffer from this disorder exhibit significant difficulty in managing non-verbal
behaviours such as eye contact, facial expressions and gestures which are central to social
interactions and communication (Bellando & Pulliam, 2009; APA, 2000).They may experience
problems in interactive language use, with respect to both language production and
comprehension (Saalasti, Lepisto, Toppila, et.al., 2008). The speech may come up as fluent
but it may be pragmatically impaired.
Individuals with this disorder lack the ability to display social and emotional reciprocity and,
like Autistic disorder, engage in repetitive and stereotyped behaviours with significant
impairment in day-to-day functioning. These repetitive behaviours may manifest as resistance
to change in personal routine or in their immediate environment (Woodbury-Smith & Volkmar,
2009). This disorder normally becomes evident in children at the age of 3 years flagged by
impaired communication.
Individuals with this disorder may have difficulty understanding social cues that are otherwise
known and understood by children of similar age. They may also exhibit difficulty in listening
to and comprehending what others say and are usually not interested in maintaining
meaningful relationships. As a result, children with this disorder tend to have preference for
solitude. Restricted range of interests, activities and gestures are some of the characteristics
of this disorder (Woodbury-Smith & Volkmar, 2009).
Rett’s Disorder
Rett’s Disorder involves a severe deficit in specific areas of development that commences
after the first five months of life, prior to which normal development is usually evident. Such
deficits include severe psychomotor retardation caused by neurodevelopment delay (APA,
2000). As a result, individuals who suffer from this disorder typically have impaired or limited
leg and body movements poorly coordinated gait or trunk movements, a loss of purposeful
hand skills that can result in repetitive hand movements that resemble hand-wringing or hand
washing, mental retardation, significant impairments in language and communication,
irregular breathing patterns and in some cases, seizures and diminished interest in social
environments. The onset of this disorder is prior to the age of four (Commonwealth of
Australia, 2006; APA, 2000; Caglayan, 2010). This disorder has only bee n reported in
females.
Childhood Disintegrative Disorder
Childhood Disintegrative Disorder (CDD) is a condition occurring in children that is
characterised by a significant loss of previously acquired skills. A deterioration of intellectual,
social and language functioning over several months are common indicators of this disorder.
Also known as disintegrative psychosis or Heller's syndrome, this rather rare condition was
described many years before autism but has only recently been 'officially' recognised (APA,
2000).
With CDD, children develop a condition which resembles autism but only manifests after a
relatively prolonged period of clearly normal development. This condition apparently differs
from autism in the pattern of onset, course, and outcome. While apparently rare, the condition
has probably been frequently misdiagnosed. This disorder can only be diagnosed if the
symptoms are preceded by at least 2 years of normal development and the onset is prior to
the age of 10 years (Commonwealth of Australia, 2006; APA, 2000).
Characteristics of ASD
Social Interaction Impairments
The inability to relate to others is a core feature of these disorders. Social impairments range
from mild difficulties such as lack of social or emotional reciprocity to extreme difficulties. The
assumption is that by the age of four years, children normally have the innate ability to sense
the state of mind of another (a kind of empathy, in a way); and to be able to see the world
through another person's eyes, another person's point of view (Oltmanns & Emery, 2010;
Flusberg, 2007). Children who suffer from autism for example fail to appreciate that others
may have a perspective that is different from their own (Oltmanns & Emery, 2010; Peterson,
Garnett, Kelly & Attwood, 2009).
They experience difficulty attributing mental states to themselves and others. In this context,
those who suffer from autism, also lack of theory of mind (Shamay-Tsoory, 2007). Theory of
mind refers to the cognitive ability to understand others and interpret their minds. It is one’s
interpretation of mental ideas. The assumption is that as early as two years of age, children
begin to display a clear understanding of other’s emotions and desires and begin to develop
the realisation that another’s perspective can differ from their own (Berk, 2007).
Sufferers of autism spectrum disorders will most likely have difficulty developing peer
relationships that are appropriate to their developmental level. Some children may have very
little or no interest in establishing friendships whereas others may have that interest to build
friendships but lack understanding of the principles of social interaction (APA, 2000).
Individuals may have impairments in their capacity to understand nonverbal language such as
eye contact, facial expressions, body gestures and posture that are necessary in regulating
social interaction.
Communication Impairments
Communication impairments are among the defining features of ASD. Communication
impairments can vary from moderate impairments to severe. They range from a delay in the
development of expressive language and problems with initiating and sustaining conversation
to excessive use of stereotyped repetitive language (for example, repeating words or phrases
regardless of meaning). The use of idiosyncratic language is also common with this disorder.
Idiosyncratic language refers to language that has meaning only to those that are familiar with
the individual’s communication style (APA, 2000).
Those suffering from ASD may experience difficulty in understanding simple questions and
directions because language comprehension is often delayed with ASD. This is commonly
showcased by the inability to understand congruence of words and gestures or understand
humour and irony with non-literal meaning. For example, children with autism have difficulty
understanding gestures and deriving meaning from such gestures.
Some of the communication problems that sufferers of autism spectrum disorders encounter
include dysprosody and echolalia. Dysprosody refers to the variations in melody, intonation,
pauses, stresses, intensity, vocal quality and accents of speech. The speech of the child with
autism may sound unusual even if the content of the speech is normal (Oltmanns & Emery,
2010; Sidtis & Sidtis, 2003). The person can comprehend language and vocalise what they
intend to say, however, they may not be able to control the way in which the words come out
of their mouth.
Echolalia refers to repeatedly uttering phrases (Oltmanns & Emery, 2010; McCann, Peppe,
Gibbon, O’Hare & Rutherford, 2008). For example, when someone asks the child "how are
you?" instead of the child responding to the question by saying how they are, the child
repeats "how are you?" Echolalia is used as a means of processing words and storing the
words or complete phrases for further use.
It is believed that through echolalia autistic children acquire language. Other researchers
suggest that even when structural language seems intact, there may be difficulty with
pragmatic language that seems to persist. This would suggest that individuals with ASD have
pragmatic impairment. Pragmatic impairment refers to the disparity between language and
the situation in which it is used, making the language inappropriate for the situation.
Restricted and Repetitive Behaviours
Individuals may display a restricted range of interests and they are often preoccupied.
Research suggests that autistic individuals have deficits in shifting and sustaining attention
(APA, 2000; Pierce, Glad & Schreibman, 1997). For example, Children with autism may
become preoccupied with one part of a toy thus restricting their play (e.g. spinning the wheel
of a toy truck over and over).
Stereotyped body movements such as repetitive hand clapping or finger flicking or whole
body movements such as constant rocking are also common characteristics of the disorders
of this spectrum. These individuals may also exhibit a preoccupation and fascination with
certain objects and movements (for example, buttons, spinning wheels). Attachment to some
objects such as a favourite toy and an item of clothing are also common (APA, 2000).
References
American Psychiatric Association, (2000). Diagnostic and Statistical Manual of Mental
Disorders. (4th ed.). Text Revision. Washington, DC: American Psychiatric Association.
Bellando, J., & Pulliam, E. (2009). Helping student with aspergers disorder with social and
behavioural issues in the school: Nursing, psychology and educators working in unison.
Journal of Specialists in Pediatric Nursing, 14, 210-214.
Caglayan, A.O. (2010). Genetic causes of syndromic and non-syndromic autism.
Developmental Medicine and Child Neurology, 52, 130-138.
Commonwealth of Australia (2006). Autism Spectrum Disorders. Canberra: CWA.
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Levy, S.E., Mandell, D.S., Schultz, R.T. (2009). Autism. Lancet, 374, 1627-1638.
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Sidtis, J.J. & Sidtis, D. (2003). Seminars in Speech and Language, 24, 93-105.
Ozgen, H.M., Staal. W.G., Barber, J.C., Jonge, M., Eleveld, M.J., Beemer, F.A.,
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Source: Autism Spectrum Disorder PD course
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