Autism Spectrum Disorder

Often, when people learn I work with students on the autism spectrum, they ask me to describe autism. It has taken me some time to come up with an answer that I feel adequately encompasses a definition of autism. The difficulty, in part, is that the students I have worked with have been so varied. They have ranged from very little language to very articulate, and from an aversivion to touch to highly affectionate, etc. With that being said, I hope my discussion below will give you a fuller understanding of autism spectrum disorder.

Autism Spectrum Disorder (ASD) is a multifaceted neurological developmental disorder where there are significant language delays, impairments in social interaction involving verbal and nonverbal communication, and restricted interests and behaviors. It can more adequately be described using the five categories: language, social, cognitive, interests, and sensory.

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), updated the definition of autism. The manual placed previous sub-classifications of autism under the one umbrella, Autism Spectrum Disorder.

Prior to the 2013 update, autism was broken into recognizable categories, such as Asperger’s Syndrome. Though the categories below were removed from the DSM-5, the subcategories are still referred to in describing autism. As such, these are helpful to know for reference:

  • Autistic Disorder (also called “classic” autism) This is what most people think of when hearing the word “autism.” People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have an intellectual disability.
  • Asperger Syndrome People with Asperger syndrome usually have some milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have problems with language or intellectual disability. Asperger’s has recently been placed under Autism Spectrum Disorder in the DSM-V.
  • Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; also called “atypical autism”) People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS usually have fewer and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges.(Taken from the CDC.)

Another category of autism is Regressive or Late-Onset Autism. These children exhibit typical age-appropriate milestones in speech, cognition, and socialization until about age two. Between the age of eighteen months and three, sometimes over a period of a few weeks, the child begins to lose language, becomes self-absorbed, and loses social skills. By age three, the child has all the characteristics of an infant who showed signs of autism. Late-onset autism prevalence is about 20 to 40% for those on the spectrum. (This is why many people are concerned with vaccinations–whether or not it has been substantiated that vaccines have a part in triggering regressive autism).

As of 2017, it is estimated one in 1 in 68 births will result in the disorder. It is about four and a half times more common for boys than girls to be on the autism spectrum. (1 in 42 boys, and 1 in 189 girls).

The primary difference between children with Asperger syndrome and classic autism is children with Asperger syndrome do not exhibit language delays. Children or adults on the ASD who are labeled as high functioning typically have an IQ over 70, are verbal, and exhibit greater adaptive skills.

All children are unique, and this is definitely the case with children on the spectrum as well. The intent of the descriptions below is to give an overview of the characteristics of autism. Not all people on the spectrum will display all of the characteristics below, and the extent to which they are exhibit these characteristics will vary as well. Also, some students on the spectrum will also have secondary conditions.

Language

Children and adults on the autism spectrum often have difficulty communicating and sharing feelings, beliefs, and knowledge with other people.

Children who fall under the category of “classic” autism have delayed speech, and approximately 40% of children with autism will not talk at all. Depending where a person falls along the autism spectrum, he may have difficulty using words/“symbols” for communication intent. For some, saying words does not mean the child or adult is using them correctly to express his/her intentions. One example would be a child may associate the word “cookies” for “I am happy.” She says “cookies” not to mean “cookies,” but the feeling of happiness. Some people on the spectrum use a type of picture exchange for communication (see PECS under terminology section).

A child may also use echolalia, a repetition of what was said by another, be it from another person, T.V. show, commercial, etc. Echolalia should not be dissuaded as this can be a step towards learning to use language.

Children with autism have difficulties with what is known as Joint Attention (JA). Joint Attention occurs when a child is able to consciously focus of the same event or object as another person and is aware of sharing the experience. An example of early Joint Attention behavior is a peek a boo game where the child interacts with the parent and is aware of the game and the role each person plays in it.

Another difficulty with langugage and communication arises when there is a lack of Theory of Mind (ToM). Theory of Mind describes the ability to recognize and understand other people’s thoughts, feelings, desires, and intentions in order to make sense of their behavior and be able to predict what they will do next. Children and adults who have not developed Joint Attention struggle with Theory of Mind. They are unable to understand body language and often have difficulty acting socially appropriate. An example would be talking nonstop to peers about dinosaurs and not realizing it is a monologue, and that the other child is no longer interested, or perhaps the other child tries to interact, but is cut off due to the one-sidedness of the monologue.

Another difficulty with communication can arise from sensory processing disorders (SPD). Children and adults may have an auditory processing disorder where sound is distorted interrupting language acquisition. It may be difficult to distinguish certain sounds from other sounds. Some people with autism report distorted hearing as well as difficulty with volume control where it sounds like the volume is being turned up and down. Certain pitches may grate on their ears and be intolerable.

Other people on the spectrum may have difficulties with oral-motor skills that can affect the formulation of words. If there is a visual processing disorder, this will also affect communication in that we take in much communication via body language, and if there is a visual distortion, then it is more likely body language cues will be missed as well as an awareness that comes from taking in one’s environment.

Autism is a spectrum disorder, and as such, there is a wide variety in children/adults and their ability to communicate. Children and adults who are non-verbal are considered low-functioning on the spectrum. Children labeled with Asperger’s may have a very sophisticated vocabulary and will not exhibit language delays. However, they will struggle with Joint Attention and Theory of Mind.

Social

Children and adults on the spectrum often have difficulty with the social aspects of life. Being social is affected by a deficit in Joint Attention and Theory of Mind as described above under communication. Children on the autism spectrum can range from not being interested in other people at all, to tolerating people, to trying to engage with people, but lacking the social skills needed.

To be social, one must have an awareness of social rules. Most people acquire much of the nuances of language and social etiquette through observation. This is not the case with children with autism. Children with autism need to be taught with a direct teaching approach when it comes to social rules and norms. That is, they need to be told directly about social rules and they need to practice these rules over a variety of settings. An example is, children with autism need to be taught and practice turn taking in playing board games; the rules need to be explained and practiced over a variety of different games in order for them to generalize.

A common difficulty for people on the autism spectrum is engaging in a give and take conversation. This might especially be the case if the person has an overwhelming or obsessive interest in a certain topic. For example, if a child is fixated on elevators, he will tell the other person all the data he knows about elevators. It is actually more like a monologue than a conversation. If the topic is changed, the person with autism will revert the conversation back to elevators. There is a rigidity and inflexibility in listening to any other topic other than elevators. This greatly limits social interactions.

Studies have shown that children with autism focus their eyes more on the mouth rather than on another person’s eyes. It could be that the child is over stimulated when making eye contact. Some people with autism report they have difficulty focusing on a persons eyes because they see the constant rapid movement of the eyes (they are visually hyper-sensitive). Others report needing to focus only on one sense at a time; in this case if the other person is talking, they focus on hearing. This causes difficulty in social settings as people communicate with their eyes as well as verbally.

Adults on the autism spectrum report having difficulty discerning emotions from facial expressions. Again, they need direct instruction using multiple examples and pictures of facial expressions expressing various feelings. For example, they need to be taught, “This is what it looks like to be angry,” and given multiple pictures of angry faces. It is understandable how confusing this could be–think of the difficulty of trying to understand “tears of joy” for the person who has difficulty understanding body language.

If a person has difficulty hearing speech, hears a jumbling of words, or only a portion of what is being said due to an auditory processing disorder, this of course affects a person’s ability to socialize.

Children and adults on the spectrum often are very literal in understanding language. Idiomatic language is confusing to them. This also needs to be taught directly. For example, saying “Time flies when you are having fun,” or “Let’s hit the road” can be confusing as these sayings have a different meaning than the literal interpretation. If a person is in a social setting and does not understand multiple meanings of language, this can be socially confusing.

Cognitive

Children and adults on the autistic spectrum have a range of cognitive abilities. Depending on which study/statistic you look at, approximately 40% of children on the ASD have an Intellectual Disability (an IQ less than 70). Autism also often co-exists with other diagnoses such as: Down syndrome, cerebral palsy, muscular dystrophy, epilepsy, motor and vocal tics, metabolic defects, anxiety disorders, depression, attention-deficit/hyperactivity disorder, oppositional defiant disorder, etc.

When the child reaches an age where he or she can be formally tested for academic ability, there are typically discrepancies in ability. For example, a child may score very high in decoding and very low in comprehension. Or a child may appear to have the intellectual capacity to learn to read, but have a very hard time learning how to read.

There is a misconception that all children/adults with autism have special talents and abilities and are savants. The actual number of children on the spectrum with savant abilities is approximately 10%. These children have abilities that exceed their overall level of ability. For example, a child may be able to calculate large mathematical equations, but have very limited verbal communication.

People on the spectrum can have difficulty with time management and organizational skills as well as learning concepts that need to be generalized. For example, a child can be taught it is dangerous to run out into the street in front of his or her house, but will not generalize this to understand the concept that running out into other streets is dangerous as well. There is a tendency for people on the spectrum to see the details before the larger concept can be understood.

Interests

Children and adults on the ASD often have unusual and/or obsessive interests and unusual play patterns. These interests and forms of play can be all encompassing–to the point of excluding other topics and aspects of life.

An example of an interest that may be typical but that could also be obsessive would be Thomas the Train for a preschooler; as the child ages, this becomes less and less age-appropriate. Examples of unusual obsessive interests are: elevators, microwaves, or frogs.

The person with the obsessive interest is often able to recite large amounts of information regarding the topic and talks exclusively about his/her favorite interest. Every conversation will be reverted back to interest.

Examples of unusual forms of play can be fixating on one part of a toy, such as spinning the wheel over and over, or lining toys up systematically, but using no imaginative play. Children and adults with ASD also may be interested in objects for their texture, the way they feel or look, rather than using them in a typical fashion.

In teaching people on the spectrum, it is important to remember that interests can be used as a motivator for the child to learn. Interests also can possibly lead to careers. This was the case with Temple Grandin, a Ph.D. on the spectrum. She used her interests in cattle, squeeze machines, and her ability to draw in perspective and think visually to develop a career. Today she is one of the leading experts in designing livestock-handling facilities.

Sensory

Children and adults with autism often have varying levels of sensory input and feel driven to either increase them or avoid them. When you read “sensory issues,” think of the five senses plus two you might not be familiar with: sight, sound, touch, taste, smell, vestibular, and proprioceptive.

Your vestibular sense is involved in balance, space, and motion sense. It orients you to the world. Your proprioceptive sense is involved in your body position. This sense allows you to understand body awareness and tells you where parts of your body are in relation to the rest of your body. (These two additional senses are important terms and definitions to learn, especially is your child is receiving occupational therapy (OT), as the therapist will refer to them).

Some examples of sensory issues reported by adults with autism are: jumbling of speech, pain at certain pitches, hearing fluorescent lights buzz and/or seeing them flicker, images looking two-dimensional and distorted, sound distortion as if a volume control switch is being turned up and down, difficulty with food textures and smells, difficulty focusing on the big picture but rather focusing on only a portion of the picture, difficulty feeling their body and its connectedness, severe pain caused by touch or a lack of feeling pain (under- or over-arousal).

With sensory issues, there is also a spectrum ranging from sensory avoidant to sensory seeking, and anywhere in between. What can be confusing for a teacher or parent is that sensory sensitivity can vary at different times. For example, a child who is rested may not be affected by going to a grocery store where there is a lot of sensory input. The same child may not be able to tolerate the same situation at the end of a school day. His or her senses may be on the brink of sensory overload.

Sensory seeking children and adults may seem to be uninterested in their environment. They may be slow to respond to stimuli in the classroom and slow to respond to teacher directives. They may need extra visual, auditory, and textural information to remain engaged.

Sensory avoidant children and adults may go to great lengths to block out their environment. This is one reason why people on the spectrum like schedules and predictability. It helps them to be prepared for sensory input. These children and adults typically prefer a calm, quiet predictable environment with little change.

A common misconception regarding autism is that all people with autism do not like to be touched. This is not true. I have personally had very affectionate students on the spectrum. They liked to give hugs, hold hands, and were/are very affectionate with their parents.

In observing your child or student for sensory processing issues, try to determine if there is pattern as to whether s/he is sensory seeking or sensory avoidant, and make accommodations for this. Remember, depending on the day and environment, this can change.

Note: This information is copyrighted. I hope you have found it helpful! Please contact me for any comments or questions. This information is not intended for diagnostic or legal purposes. It is intended for educational purposes.

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