Posted On: January 31, 2020
Autism Spectrum Disorder (ASD) is a behavioral pattern of clinical significance that appear or associated with the emotional or physical discomfort of the affected persons. Undoubtedly, this kind of health challenge is a disability, deterioration in daily functioning, loss of freedom or even a significantly increased risk of engaging in behaviors that are counterproductive or leads to premature death.
According to National Alliance on Mental Illness, 1 in 6 US youths aged 6-17 experience a mental health disorder each year, while 19.1% of US adults experienced mental illness in 2018 alone, accounting for 47.6 million people. Also, according to the European study led by Wittchen et al. (2011), 32.8% of Europeans suffer from a mental disorder, but only one-third of them receive treatment.
Consequently, some mental illness has been in increase without appropriate treatment or control, especially among children. That is why we continue to record a considerable increase in the number of students with an Autism Spectrum Disorder (ASD) educated in the public and private sectors according to researches. It is now one of the most represented categories of students with disabilities or with adjustment or learning difficulties in some parts of the world.
Autism Spectrum Disorder (ASD) as the case may be, is a spectrum of human development disorders characterized by abnormalities in social interaction and communication, as well as restricted interests and repetitive behaviors. Autism spectrum disorder is located on a continuum and helps identify the level of severity and associated disorders. It is a neurodevelopmental disorder of neurobiological origin, which begins in childhood and affects the development of social communication, such as behavior, with the presence of repetitive and restricted behaviors and interests.
It presents a chronic evolution, with different degrees of affectation, functional adaptation and functioning in the areas of language and intellectual development, according to the case and evolutionary moment. According to the American Psychiatric Association (2013), the manifestations observed vary widely depending on the severity of the damage, the person’s level of development and their chronological age.
ASD however, is a complex and highly heterogeneous disorder, both in relation to the etiology and in the manifestation and evolution of the symptoms in the different stages of development, in its expression and presentation according to the sex, age or co-existing comorbidities. In the data collected by the Centers for Disease Control and Prevention (CDC), from health and special education records of 8-year-old children living in 11 areas of the United States during 2014 indicates that “an average of 1 in every 59 (1.7%) 8-year-old children were identified as having ASD in 2014 and that ASD is four times more common in boys (2.7%) than in girls (0.7%), while this mental disorder can be reordered in all racial and ethnic groups”.
The development of individuals with an autism spectrum disorder is strongly linked to the presence or absence of an intellectual disability or a language disorder. In young children, difficulties in communication and social interaction can compromise certain learning, especially when they take place in the context of social interaction or in contexts of socialization with peers.
In everyday life, difficulties in experiencing changes and sensory difficulties can interfere with lifestyle habits such as sleep and eating. For all these reasons, it often happens that adaptive capacities such as organization, planning and adapting to change are below what is expected according to their intellectual potential, which negatively affects their autonomy and social participation. The implementation of specific support measures can then help to realize their full potential.
To assess and diagnose Autism Spectrum Disorder (ASD), healthcare professionals in North America use the fifth edition of the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 2013. Hence, the conceptualization, definition and diagnostic criteria of ASD have been modified, complemented and adjusted, taking into account the results of the investigations, and the DSM5, which includes a generic designation of ASD and eliminates the subcategories of DSM IV-TRR acquiring a dimensional concept of autism.
With the publication of DSM5 (APA, 2014) in 2013, the classification and criteria in the field of autism were significantly modified compared to previous classifications (DSM-IV-TR). In the DSM5, the different autism spectrum disorders included in the DSM IV-TR (autistic disorder, Asperger syndrome and generalized developmental disorder not specified, among others) disappear to be all encompassed in a single nomenclature of autism spectrum disorders (ASD).
Part of the diagnosis of the DSM5 includes the addition of degrees of severity in 3 grades for both the symptoms of social communication and for restricted and repetitive behaviors: grade 3 “Requires very important support/help”; grade 2 “Requires significant support/help”; and grade 1 “Requires support/help”
The diagnosis of autism requires a multidisciplinary approach. The evaluation should include information from the parents, the observation of the child, the interaction with him and the clinical judgment. There are diagnostic clinical instruments with proven reliability in the diagnosis of ASD, especially ADI-R (autism diagnostic interview-revised) or ADOS (autism diagnostic observational schedule), available and recently updated to ADOS. ADI-R and ADOS are considered key instruments in the clinical and research evaluation of ASD.
The ADI-R is an interview with parents or caregivers of children, adolescents, and adults with ASD. It includes a diagnostic algorithm with reference mainly at 4-5 years and another algorithm of the current age. this is also used for children with ages over 2 years; although, currently, an algorithm is being developed for children with mental ages over 12 months.
The ADOS is a semi-structured interview for children, adolescents, or adults with ASD. Through the game, conversation, images, and books, the interviewer is causing “autistic behaviors” that he scores in order to obtain diagnostic algorithms that classify cases into normality, autism or autism spectrum disorder. The ADOS has 5 application modules and diagnostic algorithms classified by age and language level. These tools must be used by professionals trained in their use. They require time for their application. The ADOS includes the incorporation of a new T module for young children with chronological or non-verbal age over 12 months.
Autism spectrum disorder is characterized by significant difficulties in two major areas: communication and social interactions and restricted or repetitive behaviors, activities and interests. However, the clinical picture can vary greatly from one person to another. Each has a unique combination of signs and symptoms. The degree of involvement is also different according to age, cognitive and behavioral characteristics and the presence of associated conditions. Manifestations can also change over time. Autistic people represent such a heterogeneous group that it is often said that there are as many forms of autism as autistic people.
There are persistent difficulties marked by an absence or lack of social reciprocity. Between paying no attention to the other and not knowing how to initiate an interaction, several manifestations are possible. Difficulties are also present in non-verbal communication. For example, it is often complex for an autistic person to understand what is implied in the intonation used by his interlocutor.
Besides, skills in those children are delayed and unusual. This ranges from excessive isolation, through social passivity to one-way relationships, and excessive demand for attention, depending on the child’s level of development. Language development is also delayed and unusual in nature. Children with an autism spectrum disorder may be silent, not fluent, or speak strangely. Their structurally correct and meaningful verbalizations do not always have the value of communication. These characters can be summarized thus:
In some people with autism, we see that the interests may be few, but very developed. We often notice repetitive activities or behaviors such as strange manipulation of objects, unusual body movements (swaying, twisting or clapping of hands), etc. The changes can lead to significant distress accompanied by often sudden and disproportionate emotional reactions. Repetitive activities have a reassuring effect because of their familiarity.
Some see these as often repetitive behaviors that are abnormal in their forms, their intensities, their frequencies, and their persistence. Play is often limited to these repetitive activities at the expense of symbolic play. Hence, these restricted or repetitive behaviors, activities, and interests can be summarized as:
In treating Autism Spectrum Disorder (ASD), there are different priorities of the intervention depending on the evolutionary moment and the abilities of each child. But the early detection and the consequent implementation of an early intervention program continues to be the quintessential option, as it relates to a better clinical evolution of the child.
As a basic general principle in any child or adolescent population, pharmacological and psychosocial treatment is always established in close collaboration with parents. An important guide in this vulnerable population is to avoid hospital admissions and chronic solutions to acute problems so frequent in people with autism in the face of changes, new or unexpected situations. It is absolutely important that before an abrupt worsening of behavior, we must evaluate the existence of associated comorbidity, for which the diagnosis by a professional expert in the subject considered to be essential.
Despite any type of intervention, either pharmacological or psychosocial, treatment must meet the following requirements:
In view of the foregoing, it is therefore important that all stakeholders in the education and health sectors be equipped to understand the strengths and challenges specific to these people. Likewise, all their relatives and the significant people around them have an advantage in knowing well the particular neurological functioning and the impacts of these children with ASD on their development of academic, social or professional skills.
This will allow effective and relevant accommodations and strategies to be put in place based on the unique profile of each of these children, in order to optimize their chances of realizing their potential.
Autism spectrum disorder is part of the set of neurodevelopmental disorders described in the DSM-V. This is characterized by significant difficulties in two areas: communication and social interactions and restricted or repetitive behaviors, activities and interests. It usually emanates in early childhood but may appear more clearly upon entering school and manifests itself differently depending on individual and age.