Autism Spectrum

Patty Romanowski Bashe, MSEd.

Autism Spectrum Disorders

Autism is the general term applied to a set of neurological conditions known as pervasive developmental disorders, or PDDs.

There are five pervasive developmental disorders:

	Autistic Disorder
	Asperger Disorder (or Asperger Syndrome)
	Pervasive Developmental Disorder -- Not Otherwise Specified (PDD-NOS)
	Childhood Disintegrative Disorder (Heller's Syndrome)
	Rett Syndrome

Autism spectrum disorders share three common characteristics:

Qualitative impairment in reciprocal social interaction.
Qualitative impairment in verbal and nonverbal communication and in imaginative activity.
Markedly restricted repertoire of activities and interests [Frith,1989].

Each individual with an ASD will have a unique presentation. Virtually no one with an ASD diagnosis has every single symptom or behavior described in the diagnostic criteria. But that does not mean that the diagnoses are "vague" or that one or another (generally people are talking about PDD-NOS when they say this) is a "trashcan diagnosis"--or, in other words, the diagnosis given simply because the person didn't quite fit into any of the other four. While individuals with ASDs have these core characteristics in common, they are often said to be more different from one another than alike. One thing we know for certain about autism spectrum disorders is their tendency to change over time. This makes is nearly impossible to predict what symptoms and behaviors might emerge over time and which might be successfully addressed through education, therapy, and interventions.

What do we know?

Autism spectrum disorders have always been with us. Before the early 1960s, autism was viewed as an emotional problem--the result of uncaring "refrigerator mothers"--with a hopeless prognosis. There was little attempt to treat or educate those with autism, too many of whom were placed in institutions.

There is no question that ASDs are more frequently diagnosed today than ever before. A decade ago, experts believed that 1 in 10,000 persons had some form of autism. Today that figure is 1 in 166.

Dedicated educators and scientists have made tremendous strides in increasing our understanding of autism. What we do know, however, is that early, intensive, and highly specialized education and therapy offer hope for the best outcome a child can achieve.

What's the difference between different ASDs?

No two persons on the spectrum -- even if they have the same diagnosis -- will have exactly the strengths, deficits, behaviors, and challenges. If you read the descriptions below, for example, you will see that on paper the symptoms and behaviors for Autistic Disorder and Asperger Syndrome have much in common. The difference in diagnosis is a question of number, severity, and degree of symptoms and the presence or absence of other factors or conditions.

Childhood Disintegrative Disorder and Rett's Disorder are the two rarest forms of PDDs. What distinguishes them from the other three PDDs is the marked loss or deterioration of abilities and previously acquired skills. While children with these disorders may look "autistic," the history of their conditions are different from those of children with AD, AS, or PDD-NOS. Childhood Disintegrative Disorder occurs more often in boys than in girls. It is marked by severe regression in several areas of development following two years to four years of apparently normal development. Rett's Disorder, unlike other ASDs, is seen primarily in girls (although there have been a handful of cases of boys). In Rett's, children present with specific physical signs (decreased rate of head growth, loss of acquired hand skills, poor coordination, apraxia, or inability to perform motor functions) and impairments in language and communication. Both of these conditions are considered very rare. Rett's occurs in 1 in 10,000 to 1 in 15,000 live female births. There are no hard statistics for CDD, but Dr. Fred Volkmar estimates it is "perhaps ten times less common than more strictly defined autism."

When we talk about autism spectrum disorders, we are usually referring to the three most common: Autistic Disorder, Pervasive Developmental Disorder--Not Otherwise Specified (PDD-NOS), and Asperger Disorder (also commonly known as Asperger Syndrome).

What is Autistic Disorder?

Autistic Disorder is characterized by delays or abnormal functioning in social interaction, or social language, or symbolic or imaginative play. These delays may occur in just one of the three areas, two, or all three, and are noticeable prior before age three. Typically, an individual with AD exhibits six or more of these symptoms in specific combinations [see Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000]. Some examples of common behaviors include:

	lack of age-appropriate relationships with peers;
	a seeming lack of interest in sharing experiences, interests, feelings, or activities with others;
	a lack of social reciprocity (appearing not to notice and respond to the words, actions, feelings of others);
	delay or lack of spoken language;
	delay in or lack of ability in using nonverbal language (for example, not pointing; not gesturing; not attending to or understanding the gestures, facial expression, voice tone of others);
	unusual preoccupations or patterns of interest that are limited and/or intense (for example, staring for long periods at a fan or other spinning object; rewinding a video to view the same scene repeatedly; engaging in an appropriate activity, such as putting together a puzzle, but in an inappropriate manner, such as arranging the pieces in a line instead of putting them together);
	preoccupation with parts as opposed to the "whole" of things (for example, staring at and touching only an ear of a stuffed animal; appearing to fixate on a button on a cassette player instead of attending to the music it plays;
	extremely strong resistance to change in routines and rituals (for example, refusing to eat a sandwich cut diagonally instead of across; seeming to need to touch or interact with specific objects in a specific order);
	presence of stereotypal or repetitive motor activities (sometimes referred to as "self-stimulatory behaviors" or "stims"); for example, walking on tip toes; flapping, wringing, snapping hands or fingers; spinning, and more complex whole-body movements).

What Is PDD-NOS (Pervasive Developmental Disorder--Not Otherwise Specified)?

PDD-NOS (which includes Atypical Autism) is the appropriate diagnosis when an individual exhibits some of the behaviors and symptoms of other PDDs but does not precisely meet the diagnostic criteria for any of them. Individuals with PDD-NOS have "severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities." When there is late onset, symptoms that are atypical, or symptoms that are not as intense or frequent as those for AD or AS, "atypical autism" may be diagnosed. Although PDD-NOS is different from AD and AS, these are differences in degree; therapies and interventions that are appropriate for AD (e.g., ABA) or AS (e.g., social skills training) may also be appropriate to treat PDD-NOS.

What is Asperger Syndrome?