Autism is a developmental disorder and encompasses certain issues in social interactions, and relationships along with difficulties in communication. It is diagnosed in early childhood. Although, in certain cases symptoms begin to become clearer as one gets older.
Autism is a lifelong condition but improvements in individual symptoms are a strong possibility given timely diagnosis and/or thorough management.
Clinical criteria for diagnosis of autism have gone through significant changes over the years. A recent development was the evidence based alterations made by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 2013). As a result, Autism is now also referred to as Autism Spectrum Disorder (ASD) by DSM-V.
Characteristics of Autism
Key characteristics of childhood autism, as evidenced in various social contexts, fall into two broad categories1,2:
- Social Interaction/Reciprocation: Lack of appropriate eye contact, issues in regulating body posture and gestures during social communication, issues in use of facial expressions, difficulties in developing peer relationships, difficulties in emotional reciprocation, low interest in peer relationships and issues related to use of spoken language.
- Restricted and/or repetitive patterns of behaviour: This includes stereotyped or repetitive movements, speech, highly restricted interests, strong adherence on same and inflexible routines, preoccupation with non-functional elements of play material, stereotyped patterns of interest, difficulties in imaginative play, sensitivity to sensory environment and excessive fascination with lights or textures.
Screening, Assessment and Diagnosis:
Autism can be diagnosed as early as three years old when certain developmental or language delays start to become apparent, or social relationships become a concern.
A typical assessment routine for ASD is an in depth procedure that can be conducted by trained professionals such a psychiatrists, clinical psychologists, speech pathologist and special educator. A multidisciplinary team approach for diagnostic procedures is often encouraged3. Assessments begin from eliciting detailed clinical information covering developmental history, family history, etc. The next step is the use of assessment tools to bolster the diagnostic process. An example is the Childhood Autism Rating Scale (CARS).
Given the wide rubric of features, detailed assessment of communication skills, neuropsychological functioning, adaptive behaviour, and motor and sensory skills is also beneficial3.
Given the pertinent need of evidence based care for ASD, current intervention strategies are based on specialized clinical judgment and care. It is also important to highlight the involvement of family members during the selection and application of treatment modules.
A broad description of some available intervention methods is as follows:
a. Communication Strategies: These strategies focus on language development and teaching expression of emotions. Usually both language and speech therapists and required along with sustained parental involvement.
b. Behavioural Interventions:
- Applied Behavioural Analysis (ABA) is a widely accepted technique that helps to uncover ways in which behaviour is influenced by environmental influences. ABA approach to autism focuses on areas such as listening, imitating, reading, building life skills etc4.
- Specific behavioural approaches have also been developed for autism. A classic example of such an approach is the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)3. This program builds on individual strengths of a child by structured teaching5. This includes setting work stations by using visual material like for example, setting a separate area for motor play by placing coloured tape along the area. Another example is the use of visual material for better communication and comprehension in autistic children with communication difficulties.
- Additional methods for behaviour modification include cognitive behaviour therapy, music therapy, sensory therapy, etc.
c.Pharmacological Approaches: Pharmacological approaches are also used but are recommended in addition to other therapeutic treatment approaches.
Each individual diagnosed with autism presents a different pattern of symptoms. Hence, it is imperative for professionals involved to develop management strategies based on individual strengths and weaknesses of the child or for an adult with autism. Effective use of these strategies can provide an impetus to manifestation of their abilities.
1.American Psychiatric Associtation. (2013).Neurodevelopmental Disorders. In Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: Author.
2.World Health Organization (1993) .Disorders of Psychological Development. In International classification of diseases-Classification of mental and behavioural disorders (5th ed.). Geneva: Author.
3.Scottish Intercollegiate Guidelines Network. (2016). Assessment, diagnosis and interventions for autism spectrum disorders-A national clinical guideline (SIGN 145). Retrieved from http://www.sign.ac.uk/assets/sign145.pdf
4.Applied Behavioural Analysis. (2017). Retrieved from https://www.autismspeaks.org/what-autism/treatment/applied-behavior analysis-aba
5.Mesibov, G., Shea, V., & Schopler, E. (2004). The TEACCH approach to autism spectrum disorders. New York, NY: Springer