Autism Spectrum Disorder

When one thinks of an exceptional individual, one might think that it is a person who has characteristics different than or unique to the majority of the people in the society. Such an example of exceptionality is Autism Spectrum Disorder (ASD). ASD is a disorder, which affects neurodevelopment and is characterized by deficiencies in social communication, interacting people, and consists patterns of repetitive behaviors and or speech (American Speech-Language-Hearing Association, n.d, overview section para.1). These characteristics mentioned differ in terms of their degree and intensity and may demonstrate different symptoms from person to person (Pratt, Hopf, & Quest, 2017, Para.

1). Even though the characteristics may vary, most of the symptoms are seen affecting the development of the social communication skills (ASHA, n.d, Signs and Symptoms section, Para.1).

Generally, an individual not able to initiate joint attention or unable to form eye contact with the person communicating to in the first years of life is considered to be one of the diagnosing sign of ASD (Pratt, Hopf, & Quest, 2017, Para.2). Impairments in social communication in children with ASD are seen when he/she is playing around their peers and show no interest in playing with others. Other social communication impairments may include: the individual not understanding the so-called non-verbal cues such as the vocal tone or facial expressions; avoiding social interactions; difficulty staying on topic when conversing; asking topic related questions when conversing; and difficulty understanding other’s perspective (Pratt, Hopf, & Quest, 2017, Para.3). Symptoms regarding speech and language include: individuals unable to form word combinations; difficulty in comprehending the verbal and nonverbal aspects of communication such as body language, gestures, facial expressions, and understanding the receiving language; vocal development impairments; use of repetitive speech; difficulty understanding sentences with double meaning such as sarcasm; literacy impairments such as difficulty in reading for meaning and summarizing; and executive function impairments such as limited problem solving, organizing, and inhibition (ASHA, n.

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d, Signs and Symptoms section, Para.5-14).

Additionally, individuals with ASD prefer performing certain tasks again and again because of their comfort towards repetition. Symptoms regarding behavior include repetitive use of hand flapping, lining up the toys; difficulty coping with a change in daily schedule; repetitively asking questions; and having an obsessive attachment towards specific things (Pratt, Hopf, & Quest, 2017, Para. 8-9). The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) categorizes sensory input differences as hyposensitive and hypersensitive. It includes sensory symptoms such as auditory sensitivity, tactile sensitivity, taste or smell sensitivity, and sensation sensitivity (Pratt, Hopf, & Quest, 2017, Para. 10-11).

Moreover, the DSM-5 emphasizes that when diagnosing ASD the health care provider needs to make sure that the symptoms observed are present in early developmental period, and that symptoms should cause clinically important deficits in the areas of functioning (as cited in Autism Speaks, DSM-5 Diagnostic Criteria, 2013, Para. 15-16). Furthermore, some additional conditions are considered in terms of ASD such as seizure activity, medication usage for mental health, sleep abnormalities, and self-hurting behaviors (Pratt, Hopf, & Quest, 2017, Para. 17).

Assessment and Classification of ASD

When considering diagnosing and assessing any disorder, it is essential to look over the suggested criteria used by the healthcare providers in order to accurately identify the disorder. Early identification is always helpful in the long run when it comes to treating the disorder and also it makes disorders like ASD less severe in terms of its symptoms. Symptoms of ASD may occur as early as the age of 12 months. Although some children are diagnosed by the age of two years, most other children are diagnosed until years later. Delay in the identification is considered to be a big problem because early diagnosis can make a significant difference in the child’s health (Aspy & Grossman, 2007, p. 11,12). Early identification also allows parents to receive diagnosis referrals and early intervention services (ASHA, n.d, Assessment section, Para.5).

Many factors like culture, race, and gender affect the severity of the symptoms and may cause a delay in identification. For example, different cultures have different ideology and attitudes towards disorders. The definition of the disorder used in the U.S might be different than the definition used in other cultures, which would also interfere in the identification. Some cultures view disorders as negative and any kind of disability puts parents under the societal embarrassment, because of which the disorder might be kept hidden and not willing to be diagnosed at all. Additionally, direct eye contact may be disrespectful in some cultures and may be out of the norm. That is the reason why healthcare professionals should incorporate cultural competence into their systems (ASHA, n.d, Assessment section, Para.8-9).

Furthermore, it is very essential for the parents to work with both the educator and the healthcare professional to gain the best resources for their child’s health and educational needs. Assessing the disorder with the best instruments but with a health care provider who is not trained well enough may result in identification delay and or faulty diagnosis of the disorder. Healthcare professionals such as psychologists, psychiatrists, and neurologists may conduct assessments of ASD (Aspy & Grossman, 2007, p. 12,13). Screening procedures such as interviews, observations, parent-teacher report, and hearing screenings are conducted to screen for any deficiency in language development, pointing towards the object of interests, eye gaze, nonverbal communication, and pretend play. In addition, if the individuals are suspicious symptoms of ASD, then they are referred to the Speech-language pathologist (SLP). SLP needs to use cultural competence in his/her assessment. Assessments used by the SLP may include: case history, neurodevelopmental and physical examination, medical history of the individual’s family, metabolic testing, genetic testing, and comprehensive speech and language assessment testing for receptive and expressive language, literacy skills, and the many aspects of social communication (ASHA, n.d, Assessment section, Para.10-21). More evaluations covering social, sensory, cognitive, emotional and adaptive behavior are conducted to get a more accurate in-depth diagnosis (Aspy & Grossman, 2007, p. 13).

In addition, DSM-5 mentions the 3 severity levels of ASD as follows: Level 1 being the lowest requires support, Level 2 requires substantial support, and level 3 being the highest requires very substantial support. The higher the severity level of ASD, the more in detail assessments are needed (as cited in Autism Speaks, DSM-5 Diagnostic Criteria, 2013, Table 2)

Prevalence Information About ASD

Centers for Disease Control Prevention (CDC) mentions that about 1 in 59 children were diagnosed with ASD. Boys have a chance of having ASD 4 times more than girls; it is not race-specific because it is reported to be in all the racial, socioeconomic, and ethnic groups (Prevention, 2018, para. 1). CDC also found that 1 on 54 (18.4/1000) males and 1 in 252 (4.0/1000) females were diagnosed with ASD (ASHA, n.d, Incidence and prevalence section, Para.3). In the year 2014, about 11 of the ADDM sites reported that about 1 in 59 individuals were diagnosed with ASD who were born in the year 2006 (Prevention, 2018, para. 1).

Moreover, CDC mentions that if one of the children among identical twins has ASD, there chance of the other twin being affected is 36-95%. Children who are born prematurely with low birth weights are more prone to having ASD. The median age for ASD diagnosis is 4 years and 8 months. The co-occurrence of one or more than one developmental non-ASD diagnosis is 83% (Prevention, 2018, para. 2-3). In the year 201, the total cost for children with ASD in the U.S was recorded to be between $11.5 billion to $60.9 billion. Average medical expenditure for children and adolescents with ASD was $4,110-$6,200 per year. In the year 2005, average Medicaid enrolled children with ASD cost was $10,709 per child (Prevention, 2018, para. 4).

Etiologies of ASD

There is no single cause identified for ASD. However, several studies have indicated different causing factors for ASD (ASHA, n.d, Causes section, Para.1). Most emphasis is given to genetic factors related to ASD and major research has been done regarding the heritability of ASD individuals. On the other hand, very less emphasis is given towards environmental causes in terms of research. One twin study suggested that they were higher concordance rates in monozygotic twins than dizygotic twins of ASD. Another study estimated Autism heritability to be about 55%. According to two studies conducted, simplex families had higher prevalence rates for de novo chromosomal rearrangements than the multiplex families (Chaste & Leboyer, 2012, para. 4-6). Additionally, genetic differences regarding the X chromosome might be the reason behind ASD being more common in males than in females. In a recent study, about 20% of infants who had an older biological sibling with ASD acquired ASD (ASHA, n.d, Causes section, Para.2).

Further, in the most recent meta-analysis, increased risk of Autism was found when exposed to medication during pregnancy. Children exposed to valproate in utero had an 8-fold increase in having ASD (Chaste & Leboyer, 2012, para. 27). Genetic code abnormalities may cause abnormal mechanisms for brain development, resulting in symptomatic behaviors; cognitive, neurobiological, structural and functional brain abnormalities. Although many studies are being conducted regarding the etiology of ASD, there is much more research needed on the genetic and environmental interactions that lead to the development of ASD (ASHA, n.d, Causes section, Para.5-6).

Educational and/or Non-educational Interventions of ASD

Firstly, it is important that parents seek help from educators and healthcare providers. There are many ways a child with ASD can be comfortable and progress in academics at school. The first step is an assessment in public schools, which allows considering the eligibility of the student for the special education services. In order to be eligible for special education services; a disability should adversely affect a student’s academic performance (Aspy & Grossman, 2007, p. 12). With appropriate aids and resources present, students with ASD can be inclusive in general education classrooms. Using visuals like computer aid can help students with ASD understand instructions and perform specific tasks. The instructor can provide students with a daily fixed class schedule. That way, students with ASD can get adapted to the schedule and not be rejecting towards any tasks. Using direct language in classrooms helps students with ASD comprehend instructions because of them having difficulty with nonverbal cues. And when it comes to instructions, educators need to keep it short and simple because long directions would deviate students from the point. Additional educational considerations would be having sensory activities so that students with ASD can be protected from being oversensitive towards their sensory stimulus. Moreover, the addition of a break in class schedule will allow students to take a break from the outside world. This break needs to be taken in a designated place in the class where there is peace and a low light setting. Additionally, the educator must educate classmates about the disorder, so that kids are more culturally sensitive and empathetic towards ASD (Greene, 2018, Para. 5-13).

Secondly, the instructor needs to address students as students with ASD and not as autistic students. This brings a sense of equality from the teacher to the student and also delivers respect towards parents when conversing about their child. Outside of school, parents need to be their child’s best teacher and expert. There are many ways in which a child with ASD can benefit from home. At first, the parent needs to be accepting of the child’s behavior and disorder. Then, the parent needs to be consistent in interacting with the child, should stick to a structured routine, use positive reinforcements by praising good behavior, use nonverbal cues that the child may find interesting to use, and find out ways to make the child laugh and have fun. Further, the parent should observe the child’s sensory sensitivities towards sound, light, taste, touch, and smell to figure out what is calming and what is stressful for the child. The parent needs to become an expert in knowing the child’s strengths and weaknesses, child’s interests, best learning technique for the child, and so forth. Finally, the parents need to seek help from SLP, school educator, and other healthcare providers to find treatments and to make the child succeed. There are also many organizations that the parent can seek help from in order to help their child with ASD (Smith, Segal, & Hutman, 2018).

Current Topics Related to ASD

A study regarding aggressive behavior and ASD was published by the Educational publishing foundation (Newcomb, Wright, & Camblin, 2018). In this study, a 13-year old boy who was diagnosed with ASD was case studied and examined through physical attention. Firstly, back massage in a seated position and deep pressure to upper legs and torso in the supine position was chosen as the stimuli to be performed in the classroom. Researchers fixed therapy to be for 2 minutes every 20 minutes during the school day. Once the 2-minute session ended the participant was told to start on his next task on the schedule. Secondly, the second stimulus for treatment was used to be noncontingent access with the basketball for 10 seconds before delivering of any verbal instruction. The participant was given continuous access to basketball through the end of the transition. After the transition had taken place, the participant was instructed to give back the basketball, and the participant consistently followed the instruction. If sometimes aggression did take place, it was just he the participant dropping the ball. Results from NCR for both of these therapies indicated that the rates of problematic behavior became lower post-intervention. Aggression during the daily activities was recorded to be approximately 4.25 occurrences/hour whereas; post-intervention the aggression was recorded to be 0.76 occurrences/hour. This was a reduction of about 82% (Newcomb, Wright, & Camblin, 2018).

Additionally, a different study regarding learning a musical instrument and its effect on ASD was published by the Educational publishing foundation (Rose, Jones, & Heaton, 2018). The study was conducted with a male, 8 years old participant and 38 other participants ranging from between 7-9-year-olds. This male participant was diagnosed with ASD, ADHD, dyslexia, sensory processing difficulties, and dyspraxia. This male participant was encouraged to play tenor horn and was evaluated on development measuring battery before and after 1 year of learning music. Many aspects were tested such as rhythm, tonal, vocabulary, attention, WASI full-scale IQ, and so on. ON the WASI full scale of IQ, the participant scored 103 before musical training and scored 112 after the musical training. Before the musical learning, the male participant had an average IQ score and a high musical score of aptitude. In contrast, he had very low scores when measured for motor abilities, social-emotion skills, and executive function. The overall effect of the musical training resulted in the male participant improvement in motor skills, and fluid intelligence, and music skills. But, also suggested a decline in the social-emotional functioning of the male participant (Rose, Jones, & Heaton, 2018).