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Autism Spectrum Disorder (ASD)

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Autism Spectrum Disorder (ASD)

Autism spectrum disorder (ASD) is a neurodevelopmental condition defined by deficit in interaction and social communication and stereotyped and repetitive patterns of behavior, interest, or activities (American Psychiatric Association, 2022). Symptoms must occur early in the developmental stages, leading to clinically substantial deficits in social, occupational, or other relevant aspects of the person’s life.

Signs and Symptoms According to DSM-IV

The signs and symptoms of ASD are broadly classified into two broad classes: deficits in social communication and restricted and repetitive behaviors.

Social Communication Deficits

These are as follows:

Restricted and Repetitive Behaviors

These are:

Restricted and repetitive behaviors symptoms can be simplified with the mnemonic “SIRI”:

Differential Diagnosis

ASD has numerous differential diagnoses. Below, the table summarizes the most common differential diagnoses.

Differential diagnoses Similarities to ASD Differences from ASD

 
Social (Pragmatic) Communication Disorder (SCD) Both SCD and ASD involve deficits in social communication and interaction. Unlike ASD, there are no restricted or repetitive behaviors present in SCD.
Attention-Deficit/Hyperactivity Disorder (ADHD) Both conditions may present with attention difficulties, impulsivity, and social challenges. Patients with ADHD do not have restricted interests and repetitive behaviors, which are present in ASD patients.
Specific Learning Disorder (SLD) Both conditions can present academic challenges and require educational interventions. SLD affects specific academic skills, for example, reading, while ASD involves broader deficits in communication and behavior.
Schizophrenia of childhood-onset Both conditions may present unusual behaviors such as flat affect and social detachment. While Schizophrenia typically presents with hallucinations and delusions, ASD does not.

Incidence

ASD approximately affect 1 out of 36 children in the United States (USA), making it one of the most prevalent neurodevelopmental condition. This condition affects Boys more than girls (Napolitano et al., 2022). The incidence has also increased gradually, mainly due to increased awareness, better diagnostic methods, and improved screening programs. These factors have led to increased interventions and identification of the condition at an earlier age and across different population groups.

Development and Course

The first clinical manifestations of ASD are usually seen from 18 to 24 months of age, but often, the child is diagnosed at the age of three years and above (Okoye et al., 2023). Some signs and symptoms that may be noticeable at this age include the child avoiding eye contact, not speaking as early as other children, and poor facial expressions, such as smiling. The development process may be marked by considerable variability, and there is evidence that with early, intensive intervention, some progress can be seen during the early years. However, ASD is a life-long disability, and the level of progress highly depends on the timing and quality of intervention.

Prognosis

The prognosis of  ASD depends on early intervention measures, cognitive functioning, and having functional speech by five years of age. Children treated early for their behavioral and educational issues are likely to have a better prognosis regarding their autonomy and socialization (Vinen et al., 2022). However, functional outcomes may differ from relatively independent living to totally dependent care for the rest of life. Despite these improvements, most ASD patients face considerable difficulties in social communication and the development of adaptive skills throughout their adulthood.

Culture, Gender, and Age Considerations in ASD

Cultural and socioeconomic differences make minorities get diagnosed with ASD less frequently than other population groups for several reasons, which include limited services, language barriers, and prejudice towards mental health. Another factor is that girls are often less present with the symptoms of autism, and thus, their diagnosis may be delayed or even absent. Also, females tend to hide their symptoms than males, making diagnosis difficult (Estrin et al., 2020). The symptoms are generally apparent at an early age. Still, severe disability is likely not to present until the child is faced with additional social and academic requirements as they progress through childhood.

Pharmacological Management

The pharmacological management of ASD aims to manage symptoms (Maniram et al., 2023). These medications and their side effects are presented in the table below.

Symptom Medication Medication Class Side effects
Irritability and aggression Risperidone and, Aripiprazole Second generation antipsychotics Weight gain and sedation effect.
Hyperactivity Methylphenidate central nervous system stimulant Anorexia and insomnia
Anxiety Fluoxetine selective serotonin reuptake inhibitor Insomnia and nausea


Nonpharmacological Management

These management strategies can be simplified using the Mnemonic “SOAPS”:

Diagnostics and Labs

Autism spectrum disorder cannot be diagnosed by using any lab test. Instead, diagnosis is made through clinical diagnosis. In diagnosing social communication and behavior patterns, the Autism Diagnostic Observation Schedule (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R) are typically utilized by healthcare providers (Lefort-Besnard et al., 2020). Screening tools like the Modified Checklist for Autism in Toddlers (M-CHAT) are initially used in primary care physician practices to identify children at risk.

Comorbidities

Common Comorbidities of ASD include: 

Legal and Ethical Considerations

Pertinent Patient Education Considerations

For Parents:

For Individuals with ASD:

For Educators:

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (DSM-5-TR). Psychiatry.org; American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm

Estrin, G. L., Milner, V., Spain, D., Happé, F., & Colvert, E. (2020). Barriers to autism spectrum disorder diagnosis for young women and girls: A systematic review. Review Journal of Autism and Developmental Disorders, 8(4), 454–470. https://doi.org/10.1007/s40489-020-00225-8

Gitimoghaddam, M., Chichkine, N., McArthur, L., Sangha, S. S., & Symington, V. (2022). Applied behavior analysis in children and youth with autism spectrum disorders: A scoping review. Perspectives on Behavior Science, 45(3), 521–557. https://doi.org/10.1007/s40614-022-00338-x

Lefort-Besnard, J., Vogeley, K., Schilbach, L., Varoquaux, G., Thirion, B., Dumas, G., & Bzdok, D. (2020). Patterns of autism symptoms: Hidden structure in the ADOS and ADI-R instruments. Translational Psychiatry, 10(1). https://doi.org/10.1038/s41398-020-00946-8

Maniram, J., Oosthuizen, F., & Karrim, S. B. (2023). An overview of pharmacotherapy in the management of children with autism spectrum disorder at a public hospital in KwaZulu-Natal. Child Psychiatry & Human Development, 55(6), 1655–1663. https://doi.org/10.1007/s10578-023-01514-z

Napolitano, A., Schiavi, S., La Rosa, P., Rossi-Espagnet, M. C., Petrillo, S., Bottino, F., Tagliente, E., Longo, D., Lupi, E., Casula, L., Valeri, G., Piemonte, F., Trezza, V., & Vicari, S. (2022). Sex differences in autism spectrum disorder: Diagnostic, neurobiological, and behavioral features. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.889636

Ojeda, A. B. B., & Carugno, P. (2022, September 18). Special education. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK499857/

Okoye, C., Obialo-Ibeawuchi, C. M., Obajeun, O. A., Sarwar, S., Tawfik, C., Waleed, M. S., Wasim, A. U., Mohamoud, I., Afolayan, A. Y., & Mbaezue, R. N. (2023). Early diagnosis of autism spectrum disorder: A review and analysis of the risks and benefits. Cureus, 15(8). https://doi.org/10.7759/cureus.43226

Vinen, Z., Clark, M., & Dissanayake, C. (2022). Social and behavioural outcomes of school aged autistic children who received community-based early interventions. Journal of Autism and Developmental Disorders, 53(5), 1809–1820. https://doi.org/10.1007/s10803-022-05477-3

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Question 

Autism Spectrum Disorder (ASD)

Welcome to Week 8, this week you will create a study guide. You have been assigned a specific neurodevelopmental disorder by your last name.

Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD)

Create a study guide for your assigned disorder. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the DSM-5 but also supported by at least three other scholarly resources.
Last names begin with the letter’s I-J

Autism spectrum disorder

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