Autism Spectrum Disorders

I remember when my nephew was four years old, he still very rarely spoke.  He had no trouble communicating what he wanted by pointing at something; however, he seemed to always be frustrated because he could not communicate his feelings.   He did eventually pick up language skills, after an extremely delayed start, but he still has a tendency to get extremely upset over minor changes, especially if he is interrupted from concentration on his current task. At times his play time is very rigid, but isn’t always the case.  His favorite task is stacking blocks in very uniform patterns, but he also enjoys pretend play like Batman.  He is a very affectionate child with his parents but has an extremely hard time getting along with other children including his siblings.

My sister was very concerned with his abnormal development of social skills and his delay in language skills.  She had read about autism and thought it could be a good possibility that her son could very well be autistic; however he did not fit the criteria of autism completely which was baffling.  After several visits to her family pediatrician, she was referred to a child neurologist for tests to be done to determine his condition.  His diagnosis: PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified).  Okay, that was certainly an unfamiliar term. 

Well, it turns out that PDD-NOS is part of group of developmental disabilities called Autism Spectrum Disorders (ASD) more recently referred to as Pervasive Development Disorders (PDD).   People with ASD process stimulus data in their brain’s differently from the way ordinary individuals do, which can cause considerable social, communication and behavioral difficulties (Center for Disease Control and Prevention, 2010).  Each individual case of ASD is different.   It occurs among individuals of all levels of intelligence from mentally handicapped to genius.   Some are affected severely, while others have it very mildly.  Some are coupled with other disorders, some not.  The term “spectrum disorders” was assumed because of the wide range of symptom severity, the various characteristics of symptoms, and the different ages that symptoms begin to show.  Autism is one of the disorders, but it also includes Asperger’s Syndrome, and PDD-NOS (Center for Disease Control and Prevention, 2010).

Autism is the first type of ASD, the most well-known, and the most severe disorder in the spectrum.  It is the disorder that people consider when they hear the word autism and is the most severe case in the spectrum and is characterized by the stereotypical behaviors, such as lack of imagination (Wing, 1996), routines or repetitive behaviors including “repeating words or actions, obsessively following routines or schedules, playing in repetitive ways, insists on sameness, and becomes distressed when routines or rituals are changed” (National Institute of Child Health and Human Development, 2010).  It also includes “challenges, disabilities, or delays in the area of social communication, sharing emotions, understanding how others think and feel, and holding a conversation.” (National Institute of Child Health and Human Development, 2010) These symptoms may start by the age of three, but there can be other indications of the disorder before the end of the first year.

Autistic individuals have trouble communicating both verbally and non-verbally, and they tend to avoid eye contact.  They may have odd habits, like having to have their plate exactly an inch from the edge of the table, and their food situated in a certain way on the plate before they can eat.  Instead of playing with their toys, they may have an obsessive habit of arranging them all in a perfectly straight line. They may spin in circles or flap their arms to express joy, or purposely injure themselves to voice discontent.  Difficulty in communication can get very frustrating for a person living with autism and for those who care for them and teach them. (National Institute of Child Health and Human Development, 2005)  Some eventually do learn language skills, but for others, it eludes them for a lifetime (Wing, 1996).

Because is it a spectrum disorder, the level of severity, as well as intelligence levels, vary from person to person.  Also, many autistic personalities are often coupled with other disorders such as mental handicaps with IQs under 70 or Attention Deficit Disorder (ADHD).  Those with IQs above 70 are considered “high functioning autistics” and are very capable of living a fairly normal life when receiving treatment (Mesibov, et. al., 2001).

Asperger’s syndrome is another type of developmental disorder on the autistic spectrum.  It is similar in nature to high functioning autism, and health care workers treat it in a similar fashion.  It was first coined Asperger’s syndrome in 1981 by an English doctor named Lorna Wing.  Wing had published a collection of research summaries about children having symptoms similar to four children that Hans Asperger had observed in 1944 (National Institute of Neurological Disorders and Stroke, 2011).  These children of normal intelligence did not communicate non-verbally and they had trouble empathizing with others around them.  They avoided eye contact with others and their speech was unusually formal and monotone for children of their age.  Likewise, their understanding of speech was extremely literal (they could not detect sarcasm). Furthermore, they were very clumsy because they lacked proficient motor skills, and they had a tendency to fixate on certain objects to the point of temper tantrums if the object was removed (Stoddard, 2004). 

Indeed, the obsessive nature of children with Asperger’s syndrome is one of the first signs that prompt caregivers into speculating abnormality (National Institute of Child Health and Human Development, 2007).  Because of their very nature of obsession, they will talk relentlessly about the object or subject of interest.  The topic of interest varies from person to person, but it could be as simple as a toaster or as complex as astrophysics.  As a result of their obsession, they are extremely knowledgeable in the subject.  For instance, if the interest was a toaster, they would know precisely how long it takes for a slice of bread to toast, down to the very second with each setting, they would know the exact temperature that it heats to, they would understand precisely how the wiring operates, and would probably know the history and detailed statistics of its development and usage.

Individuals who suffer from Asperger’s syndrome are very capable of becoming constructive, self-sufficient adults; however, just like all ASDs, they do have trouble socially because of their odd behaviors. Thus, the risk for them to become severely depressed and have trouble finding a compatible mate as adults is very high.  Fortunately, many, with treatment, learn to cope and go on to live very happy productive lives. (Aston, 2003)

Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) is yet another ASD.  For those with some autistic-like symptoms, like my nephew, but do not fully meet the principles for Asperger’s syndrome or Autism are usually categorized as PDD-NOS (Autism Speaks, n.d).  Usually, people who fit into this class of ASDs show a few very mild signs of autism, or of another type of a more clearly distinct PDD, but does not display all of the symptoms (Morris, 2008), but appear to be an otherwise normal.  It is usually evident that there is some insufficiency in their socializing with family and friends, but the problem is less severe (compared with autism).

There are really no clearly defined guidelines for diagnosing PDD-NOS which can be problematic for investigation purposes; however, a limited amount of data suggests that many children with PDD-NOS are diagnosed, on average, at a later age than autistic children because lower intelligence is uncommon.  In one particular study done on 216 children with ADS, researchers have found three different basic types of PDD-NOS.  The first is a high functioning group whose symptoms were similar to Asperger’s syndrome, except they had delays in speech and mild cognitive disability whereas with AS, there are no delays.  The next group favored similarities with autism, but acquired symptoms later in their childhood.  The last group was also very autistic-like, but had no repetitive, stereotyped behavior (Walker, et al. 2004)

When my nephew was diagnosed with PDD-NOS, it was easy to understand.  Although he does display some autistic type symptoms like his delayed speech, his mild repetitive behavior, and his extreme frustration when he is interrupted; however, he is a very imaginative child, which is very un-autistic like.  His diagnosis did not place him in a sub-group, but I believe he would fit into the last sub-group of PDD-NOS.

There is no specific treatment for ASDs, currently; but there are options available to help parents, health-care workers, and teachers to help with behavioral and learning potentials.  As a spectrum disorder, people vary with the capacity to live normal or near normal lives.  For those that are high-functioning, it is very possible for them to exist fairly independently, with treatment; nevertheless, even for those that are the lower level scale of functioning can benefit from behavioral management therapy and special educational options for these individuals (Richman, 2000)

The Applied Behavior Analysis (ABA) treatment is believed to be a good process for children suffering from an ASD.  Its various techniques teach social interaction, basic living motor skills, and verbal behaviors as well as reasoning skills (Mash & Barkley, 2006).  Parents, health-care workers, and teaches can use this approach for children with autism.  It can be extremely advantageous in helping them to learn behaviors that they would not be able to absorb by themselves.  The National Institute of Child Health and Human Development (NICHD) also consider speech and language therapy can be of great use to help them to better communicate with others; furthermore, occupational and physical therapy can be beneficial as well (National Institute of Child Health and Human Development, 2005).

ASDs do not discriminate and, although there is no conclusive evidence, it appears to be on the rise.  According to the Center for Disease Control and Prevention (CDC), it affects people from all different races, ethnicities, and socioeconomic backgrounds; although boys are four times more likely to be affected than girls.  A possible average of 1 out of every 110 children in the USA are somewhere within the spectrum.  ASD is being diagnosed more and more currently than previously, but it is difficult to determine the reason for this increase.  According to a study done on children with autistic disorder enrolled in the California Department of Developmental Services, 1987 to 1998 experienced a 273% increase in ASD cases (Mash & Barkley, 2006).  It could very well be that there truly is an increase in cases, but it could also be possible that better referral methods for expert diagnosis and treatment, higher awareness and understanding of the disorder (Wing, 1996), and a broader definition of ASDs (Center for Disease Control and Prevention, 2010) may the cause for the increase in prevalence.

The cause of autism and other ASDs is unknown; however, there is some interesting information that has been noted in studies done on ASDs.  There are most likely many factors involved because of the large variety of differences in the spectrum (Bauman & Kemper, 2004).  For instance, researchers have found in that children with autism and related disorders, their brains tend to be slightly larger than normal.  Also, if a newborn had a small head size at birth and then all of sudden there is a very fast growth in size before their first birthday is at risk for developing autism.  Additionally, parents, siblings, and other relatives of a child with autism often have some symptoms of the disorder (Yapko, 2003).

There could be some genetic and environmental factors to consider when researching the cause for ASDs. About one percent of people with autism have duplicated or missing genes on one of the pair of designated chromosome.  Autism could possibly be the result of  the interaction of several genes that may be on different chromosomes.

 There have been reports of studies that a positive association has been found between autism and vaccinations.  The rise in the amount of vaccinations given to children has seemed to rise along with prevalence in children diagnosed with autism.  Many individuals have a genetic susceptibility to acquiring autism, but according to some researchers, they may need something environmental to prompt initiation of the disorder.  It could be that vaccinations for children are the source (DeLong, 2011) in a very small amount of children (Stratton, et al, 2001); however, the most current information provided by the CDC states that there is no conclusive scientific evidence that any part of a vaccine or a combination of vaccines causes autism (Center for Disease Control and Prevention, 2010). The Immunization Safety Review committee suggests that more research needs to be done on the subject because of limitations of evidence and the significance of the subject (Stratton, et al., 2001).

Autism, Asperger’s Syndrome, and PDD-NOS are very interesting disorders.  Being that they are so varied from person to person they have been placed on a spectrum in order to label them properly.  The truth is, part of the beauty of this world is that everyone is different.  Although having these disorders does cause people to have difficulties dealing with other people, and they do need more assistance in getting along in the world we live in, I personally believe that the idea of disorder should be redefined.  As a person with a close relative with the disorder, I see nothing wrong with him.  He is just different.  The best way to help those with an ASD is to truly learn to understand them, love them, help them as best we can, and accept them.  Maybe if the world redefined what normal actually is, we would be more capable of understanding how those with an ASD see the world.

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