Key Features of Autism Spectrum Disorders
Every individual has a unique presentation of autism. However, a diagnosis of autism spectrum disorder (ASD) requires the following two core features:
- Persistent deficits in social communication and social interaction. These symptoms include problems with reciprocal interactions such as a back-and-forth conversation, failure to respond appropriately to interactions, and reduced sharing of emotions and interests. A child with ASD may also show problems using typical nonverbal communication, such as eye contact or body language, and will struggle with making friends and understanding relationships.
- Restricted, repetitive patterns of behavior, interests, or activities. Examples include repetitive movement or use of objects, inflexible adherence to routines and problems adjusting to changes, very focused, narrow, and intense interests, and high sensory reactivity.
What about Asperger's Disorder, Pervasive Developmental Disorder, and High Functioning Autism?
Prior to the latest edition of the diagnostic criteria-the Diagnostic and Statistical Manual (DSM), Edition 5 (2013)-there was no clear agreement on the multiple diagnostic categories in the family of developmental disorders that we now call ASD. The research evidence over time has resulted in a more streamlined set of criteria and diagnoses, eliminating the use of Asperger's and Pervasive Developmental Disorder. High Functioning Autism is not an actual diagnosis but describes a person with ASD who has average to above average intelligence. This term is often used in place of the older Asperger's diagnosis. However, it can be misleading as an individual can be highly intelligent but still struggle significantly with social and emotional concerns. We now view the autism spectrum disorders as essentially involving the same core features, but varying in terms of severity level and need for support.
Currently, the ASD diagnosis also involves a consideration of the level of severity in each of the core symptoms (social communication/interaction and restricted interests/behaviors). Level 1 means the child requires support, Level 2 indicates need for substantial support, and Level 3 requires very substantial support. Support refers to specific services needed to allow the child to function optimally.
Currently, the ASD diagnosis also involves a consideration of the level of severity in each of the core symptoms (social communication/interaction and restricted interests/behaviors). Level 1 means the child requires support, Level 2 indicates need for substantial support, and Level 3 requires very substantial support. Support refers to specific services needed to allow the child to function optimally.
What Treatments Work for Autism Spectrum Disorders?
The treatment of ASD requires a careful assessment of the severity level, main presenting symptoms, and an understanding of the child's environment. The first line treatments for autism include the following:
1. Education and support for parents and the child (at a level the child can understand) about the nature of ASD. An important aspect of education is understanding the neurological basis for ASD, what to expect over time, and helping the family to get connected with community support agencies. Another critical aspect of education is helping parents to accept and celebrate the unique gifts that their child has, regardless of the challenges.
2. Behavior therapy. In settings such as the home and school, behavioral strategies are often essential for helping the child with ASD to have expanded options for how they respond to triggers and situations they encounter. Behavior strategies are taught to caregivers, and include anticipating triggers, developing appropriate expectations, responding effectively to problem behaviors, reinforcing positive behaviors, choosing battles carefully, and creating structure, routines, and social opportunities that are most helpful for their child.
3. Social skills training. Children with ASD typically struggle with how to make sense of other people yet very much want to have social connections. They might not recognize emotions accurately, may misunderstand social cues, and may lack skills for interacting with others. Group social skills training with other children is important for developing skills to improve functioning in natural settings with peers.
4. Cognitive Behavioral Therapy (CBT). For older children, teens, and adults with ASD, becoming more aware of thoughts, emotions, and trying out alternative behaviors can be an important part of treatment. Individuals with ASD are at a higher than average risk for anxiety, depression, OCD, and other disorders, so CBT is an important tool for coping. A skilled clinician will adapt CBT to the unique needs of a person with ASD while incorporating a strengths-based approach that respects the individual's unique values, goals, and aspirations.
5. Medication as recommended by the family physician is often an important part of treatment. While there is no single medication for ASD alone, medications can be used to target specific symptoms that are often part of ASD, such as hyperactivity, problems with focus, depression, and anxiety.
6. School Support and Additional Services. Usually, children with ASD require support and accommodations to make school an optimal learning environment. In addition, children with ASD may require speech therapy and occupational therapy, either in the school setting or a separate setting.
1. Education and support for parents and the child (at a level the child can understand) about the nature of ASD. An important aspect of education is understanding the neurological basis for ASD, what to expect over time, and helping the family to get connected with community support agencies. Another critical aspect of education is helping parents to accept and celebrate the unique gifts that their child has, regardless of the challenges.
2. Behavior therapy. In settings such as the home and school, behavioral strategies are often essential for helping the child with ASD to have expanded options for how they respond to triggers and situations they encounter. Behavior strategies are taught to caregivers, and include anticipating triggers, developing appropriate expectations, responding effectively to problem behaviors, reinforcing positive behaviors, choosing battles carefully, and creating structure, routines, and social opportunities that are most helpful for their child.
3. Social skills training. Children with ASD typically struggle with how to make sense of other people yet very much want to have social connections. They might not recognize emotions accurately, may misunderstand social cues, and may lack skills for interacting with others. Group social skills training with other children is important for developing skills to improve functioning in natural settings with peers.
4. Cognitive Behavioral Therapy (CBT). For older children, teens, and adults with ASD, becoming more aware of thoughts, emotions, and trying out alternative behaviors can be an important part of treatment. Individuals with ASD are at a higher than average risk for anxiety, depression, OCD, and other disorders, so CBT is an important tool for coping. A skilled clinician will adapt CBT to the unique needs of a person with ASD while incorporating a strengths-based approach that respects the individual's unique values, goals, and aspirations.
5. Medication as recommended by the family physician is often an important part of treatment. While there is no single medication for ASD alone, medications can be used to target specific symptoms that are often part of ASD, such as hyperactivity, problems with focus, depression, and anxiety.
6. School Support and Additional Services. Usually, children with ASD require support and accommodations to make school an optimal learning environment. In addition, children with ASD may require speech therapy and occupational therapy, either in the school setting or a separate setting.