Autism or as it has been defined as of 2013 in the DSM-5, Autism Spectrum Disorder is persistent deficits in social communication or interactions across multiple contexts, either currently or by history; restrictive, repetitive patterns of behavior, interests, or activities, either currently or by history. (American Psychiatric Association, May 18, 2013).
Children have different milestones that are reached at similar ages, they are narrowed down to the following categories of socializing, language and communication, problem solving and physical. When one of this milestones is not reached, it is described as a possible neurodevelopment disorder. Neurodevelopmental disorders are a group of disorders in which the development of the central nervous system is disturbed. This can include developmental brain dysfunction, which can manifest as neuropsychiatric problems or impaired motor function, learning, language or non-verbal communication. (NatureResearch, 2019) When socializing and/or language and communication milestones are not reached, this results in isolation.
Autism which comes from auto and self, people who are autistic are generally removed from social interactions and communication. (Knowledge Diffusion Inc, 2018) Since the understanding of social and language skills are a requirement to be able to interact and survive in a human world, people under the ASD endure vast difficulties understanding and integrating into society.
DEFINITION OF AUTISM SPECTRUM DISORDER
Autism Spectrum Disorder encompasses a spectrum of characteristics and the diagnosis depends on the severity of each one. This fall under two main categories: Social Communication and Interactions which deals with social reciprocity, attention, nonverbal communication, and social relationships. Restrictive or repetitive behavior which deals with behavioral, interest, and activities. By categorizing main categories and later adding subsections to the main categories, reaching a diagnosis that helps identify where in the spectrum the person falls under has been made simpler for mental health professionals. As Autism falls within a spectrum, the level of self-isolation within each category and sub category will vary and therefore the severity of the disorder will vary from diagnosed person to person.
Social Communication and Interactions:
- Social reciprocity, involves how the person can respond and reciprocate social queues.
- Join attention, Wanting to share interest, a person with ASD who has not undergone therapy rarely shares interests of things. This is mostly observed with children playing with toys, a non ASD child will try to get others to join their game, ASD children will keep to themselves.
- Non verbal communications, an ASD person will not be able to understand facial expressions, for example a child misbehaved and the mother has a frown, the child will not understand why the mother has an angry face.
- Social relationships when developing and maintaining friends. In adults, they might be fond of a person and a friendship may evolved but eventually the non ASD person might become overwhelmed by not understanding how to deal with the ASD friend.
Restrictive and repetitive behavior examples:
- Lining of toys, flapping of hands, imitation of sounds or movements.
- Fixed on certain routines, for example always wanting to seat in the same place in the diner table and will refuse to eat if the seating order has changed.
- Restrictive thinking or specific knowledge, for example being very knowledgeable about one topic but finding it difficult to talk about other things or subjects.
Speech development does suffer regardless of which category surfaces the most for the person, since in the eyes of children and non-autism savvy adults, an ASD sufferer can be mistaken for a rude, misbehaved or antisocial person. Hence causing people to keep their distance from the ASD sufferer and to a certain extent to self-imposed isolation to avoid being emotionally hurt by not being understood.
DIAGNOSING AUTISM SPECTRUM DISORDER
In modern times Autism is generally diagnosed by observing milestones and on the other hand interactions and behavior, work to treat a possible ASD patient usually begins from as young as 18 months old, but an actual diagnosis may take several years to be reached, due to many neurological disorders that can cause developmental milestones not to be reached. The clinician will need to work on therapy sessions and reports from the people who spend the most time with the patient. This people are usually the patient’s parents and teachers, therefore the clinician may ask for detailed reports from them in order to establish the proper line of treatment and eventually be able to reach a diagnosis.
As previously mentioned Autism is a spectrum and some symptoms may be more prevalent than other, so the diagnosis is done by level of severity and which symptoms are most prevalent in a patient. They range from level 1 to level 3. For example a level one ASD person, requires minimal assistance for daily living, the main symptoms may fall under social communication where they can express themselves properly but have trouble keeping a fluid conversation or might fall under the repetitive restrictive where they might have slight difficulties changing activities. Then up to a level 3 ASD person, which requires a substantial amount of assistance for their daily living, where in the social interactions the person can only express a few words and in the restrictive behavior they are extremely resistive to change in activities to the point that it affects their daily life.
Diagnosis is reached by a group Mental health professional working in unison together with parents, legal guardians and teachers of the potential ASD patient, as for the categories and sub categories, there are several point systems that vary depending on the methodology used to reach a diagnosis. Since autism is a spectrum, each case is different and treatment has to be tailored on a per case basis.
CAUSES OF AUTISM
There has been significant advance in the diagnosis and treatment of autism, yet the cause of Autism has not been determined. A general consensus has been formed that there may be a genetic as well as environmental factors that are the leading cause to autism. One in every Eighty Eight children are diagnosed with autism, so in the medical community they are wondering if there is an autism epidemic or as the disorder has been better defined as time has passed a clear guideline for diagnosis has been established. (Chung, 2014) Males are affected four to one in relation to females. (Chung, 2014)
To determine that there is party a genetic factor, investigators look at the concordance rate, in other words if one sibling has Autism what is the chance that the other sibling will develop autism. (Chung, 2014) By observing three types of siblings. Identical twins meaning that they share %100 of the DNA and the same gestation environment; fraternal twins sharing %50 of their dna and the same gestation environment; non-twin siblings that share %50 of their dna but not the same gestation environment. %70 of identical twins, %31 of fraternal twins and %20 of non-twin siblings will both develop autism. Meaning there must be a genetic factor, but there is also an environmental factor because if it was purely genetic then identical twins should both develop autism %100 of the time. There is some consensus that there might be an environmental factor, which may cause a gene or genetic mutation, that may lead to autism in a person.
AUTISM AND SCHOOL
Children and adults who fall under the Autism Spectrum disorder are fit and capable of learning and adapting with the proper treatment and good line of communication between school, parents and mental health professional. Fortunately there has been great strides in understanding Autism and how people who have ASD can function and be part of a classroom environment. Though there are many challenges that both parents and teachers have to tackle to be able to provide a safe environment for the ASD person and classmates.
First and foremost, it is the parents or legal guardians responsibility to inform the school and teachers that there will be a person with ASD attending class. With help from a report written by the mental health professional and experience that the parents have had with handling the person, an action plan should be developed in order to keep the ASD person and school attendees in a safe environment. Education and information is key to be able to manage an ASD person as with any other person with a neurological development disability.
The teacher will face many challenges, and getting the ASD person to follow task and schoolwork. Since ASD person tend to understand everything in a literal sense there might be times when the educator or classmates might consider the ASD person is goofing around or misbehaving. Therefore, it is best for the educator to call the ASD person by name and give a clear message about what is going on or what is expected of the person.
As the ASD person has difficulty changing task, then at times, the ASD person may fall behind with their task or outright refuse to do their task. The educator can try to establish a pattern and provide visual and audio queues that allow the ASD person to identify a pattern and complete their school work.
Furthermore, the educator together with the parents or legal guardians of the ASD person, must work on teaching how to identify or learn how to identify non-verbal communication, as well as try to get the person to challenge themselves to try to engage in verbal social communication. This could be tried with visual aids that together with the Educator and parents both saying in direct language feelings and what was the cause of the feeling.
Finally, the main challenge of both the parents and educators are moments when the usual environment might have some slight changes that will affect the ASD person. Taking part in a group project, participating in a school play, decorations due to season or festivities. Sounds, lights and changes in color can all trigger bad reactions in ASD people, the main challenge is preparing with due time the ASD person for the upcoming change.
To sumarize Autism Spectrum Disorder is a neurodevelopment disorder that has not had a specific cause to why the disorder is develop. There are genetic and enviromental factors that may be the cause as to why ASD exists. There have been significant strides done in the mental health areas for developing proper diagnosis tecnics. Since ASD is a spectrum each case is unique and each treatment has to be develop on a case by case basis.
As ASD affects the development of socializing, and restricts behavior, without early intervention and treatment it will have a long lasting and profound negative effect on the development of proper language comprehencion and speech. Which makes it difficult for the ASD person to function in society without assistance, and the level of assistance required depends on the level of ASD that the person has and which spectrum of ASD the person falls under. Therefore, early diagnosis and appropriate treatment must be provided to allow for the ASD person to be able to develop proper speech.
Finally, an ASD person be part of school and eventually become a profesional. The key is creating a proper education plan and establishing a good line of communication between parents or legal guardian, educators and treating mental health profesionals. The school enviroment in all its levels allows the ASD person to cope and develop necessary skills to become a functioning adult with the goal to depend on as little assistance as possible.
American Psychiatric Association. (May 18, 2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington: American Psychiatric Association.
ASD info Wales. (3 de February de 2017). Autism- Advice for teachers. Cardiff, WALES, UK.
Chung, W. (28 de April de 2014). Autism: What we know (and what we don’t know).
Knowledge Diffusion Inc. (9 de January de 2018). Autism Spectrum Disorder | Clinical Presentation. Baltimore, MD, United States.
NatureResearch. (2019). Neurodevelopmental disorders. New York: Springer Nature Publishing AG.