Autism Spectrum Disorder and Intellectual Disabilities

ASD

umbrella term describing a variety of developmental conditions that are characterized by significant difficulties in social relationships, communication, repetitive behaviors, and overly restricted interests

ASD includes

• Childhood disintegrative disorder

• Asperger’s syndrome

• Pervasive developmental disorder – not otherwise specified (PDD)

(these disorders used to be 4 distinct diagnoses, but now they are all considered autism since 2013)

DSM

Diagnostic and Statistical Manual of Mental Disorders (we are on version 5). contains descriptions, symptoms, and other criteria for diagnosing mental disorders

2 symptom categories of ASD

deficits in social communication and social interaction

repetitive and restrictive behaviors

autism (autistic disorder)

• Severe developmental disability that shows symptoms before a child’s third birthday (diagnosis does not have to occur before 3 bday, but symptoms have to occur)

• Strong genetic component

• Boys are 4x more likely to be affected. females go misdiagnosed or they don’t get diagnosed until college or grad school or when they have kids (partly because of genetics, partly because behaviors are more prevalent in boys because girls can hide it better, and partly because of medical sexism)

hallmark characteristics of autism

1. Difficulties with social interactions

2. Communication impairment

3. Restricted and stereotypical behaviors & interests

autism at beginning

Considered to be a congenital or developmental [present at birth] disorder

First parental complaints: My child does not like to be held. My child will not look at me or interact with me

key clinical features in autism

Severe deficits in social interaction. Communication deficits. Restricted and stereotypical interests and behaviors

brain differences

Researchers have studied a brain region called the fusiform face area, which they believe is involved in "storing social knowledge.“

MRI studies show that this area, which normally lights up when a person processes faces, is impaired in autistic individuals. So, they cannot process and understand facial expressions (which is why they struggle with social interaction because much of it is nonverbal)

note about criteria

examples in these notes are illustrative, not exhaustive. see DSM for more

criteria A

Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history :

1. Deficits in social-emotional reciprocity

2. Deficits in nonverbal communicative behaviors used for social interaction

3. Deficits in developing, maintaining, and understanding relationships

specify current severity

is based on social communication impairments and restricted repetitive patterns of behavior.

criteria B

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:

1. Stereotyped or repetitive motor movements, use of objects, or speech

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (McDonald’s chicken biscuit wrapper story)

3. Highly restricted, fixated interests that are abnormal in intensity or focus

4. Hyper- or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment (not like a certain material on their skin)

criteria C

Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).

criteria D

Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

criteria E

These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Intellectual disability and autism spectrum disorder frequently co-occur

To make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level

autism testing

usually written for men. is extremely expensive to get done. so some people may not be able to do the test and therefore cannot get accommodations. cities also have more places to test than places like Farmville. there is a long waitlist to get tested

levels of autism

based on severity. it can be very muddy and unclear. also, some may only a few of the characteristics or different severities of the characteristics

level 1 of autism (considered mildest)

Social: deficits in social communication, that will include both verbal and nonverbal.

Noticeable even with extra supports in place

Difficulties with starting social interactions and have difficulties with properly interacting with peers.

Behavior/Interest: repetitive type behaviors and routines/rituals that interfere with day-to-day life.

Potential difficulty with transitions and inflexible behaviors.

Frequent enough to be noticed by those around them

When these behaviors are interrupted, the individual will become frustrated and have difficulty with being redirected from the item of interest

Asperger’s syndrome (now known as level 1 ASD)

• Defined as high or very high functioning autism.

• Language development is usually typical and with little to no delay.

• Major area of concern is in social skills development – social interaction and in using and understanding the pragmatic aspects of language.

Ex: Sheldon from Big Bang Theory

level 2 of autism

Social: Deficits in social communication, that will include both verbal and nonverbal.

Noticeable with extra supports in place for the individual

Difficulties with starting social interactions and have difficulties with properly interacting with peers.

Behavior/Interest: Repetitive type behaviors and routines/rituals that interfere with day-to-day life.

Difficulty with transitions and inflexible behaviors.

Occur frequently

main difference between level 1 and 2

level 1 may have some difficulties with transitions and inflexible behaviors. that is very prevalent in level 2. the social and behavior characteristics occur more frequently in level 2

level 3 of autism (severe)

• Social: Severe deficits in social communication, that will include both verbal and nonverbal communication.

• Severe limitations in social interactions with others

• Very little response to social interactions from others.

• Behavior/Interest: inflexible behaviors, very restrictive routines/rituals, extreme difficulty change and transitions, or other restricted behaviors that severely interfere with functioning in all areas.

• Extreme difficulty with being redirected from an item of interest. (deal with a lot of tantrums)