Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social, communication skills and repetitive behaviors that significantly impair daily functioning (APA, 2013). As the name suggests, the difficulties presented are situated on a spectrum and often vary from one person to the next.

Over the past decade, ASD has been the most rapidly growing developmental delay with children and teenagers in public schools, accounting for almost 1% of school-aged children (Ghali, et al., 2014). Contrary to popular belief, this increased prevalence is not the result of an “epidemic,” but rather that of increased knowledge, increased awareness, and increasingly accessible screening services (Fombonne, 2012). While certain autism symptoms can be identified at a very young age (under 2 years old), diagnoses are generally difficult to establish at that age due to the large variation in children’s development.

At present, ASD is attributed to genetic, environmental and neurological factors. Approximately 10% of individuals with ASD seem to have a genetic component such as a new mutation. As for the other variables, different risk factors (advanced parental age, viral infection during pregnancy, pollutants, medications during pregnancy, etc.) could interact and subsequently increase the risk of developing the disorder (Chaste et al., 2012; Gardener et al., 2009; Levy, 2009). To this end, it is important to note that those are not necessarily causal factors but rather risk factors. Lastly, although the cerebral functioning of individuals with ASD has not reached unanimity in the literature, some studies seem to suggest that the two hemispheres of the brain do not seem to be optimally synchronized, thus affecting their information processing (Dinstein et al.2011).

Common Manifestations and Symptoms of Autism Spectrum Disorder (ASD)

ASD is characterized by symptoms, which vary greatly from one person to the next. That being said, here is a list of the most frequently reported or observed behaviors or symptoms displayed by individuals with ASD:

  • Possible presence of an intellectual disability
  • Has reduced visual contact or is unable to maintain eye contact
  • Has a hyper or hypo sensory reactivity (sound, light, touch, etc.)
  • Walks on tiptoes
  • Displays repetitive movements (walking in circles, torso rocking, etc.)
  • Maintains specific and rigid routines
  • Perseveres in his actions (listens to the same songs, draws the same drawings, etc.)
  • Presents food rigidity
  • Can throw tantrums or resist changes and transitions
  • Has a language delay or makes atypical use of language
  • Repeats sentences/expressions (echolalia)
  • Has a monotonous speech or an unusual speech intonation
  • Understands instructions or expressions literally
  • Has a hard time interacting and maintaining a two-way conversation
  • Has a hard time expressing and understanding emotions
  • Lacks understanding of non-verbal communication such as facial expressions
  • Experiences academic difficulties
  • Has difficulty generalizing a concept learned to different examples or contexts
  • Has very specific and intense restricted interests
  • Possesses a lot of knowledge in a specific subject
  • Is fascinated by the details of an object
  • Has limited imitation and imaginative play
  • Insists that all rules and regulations be followed religiously
  • Has difficulty making friends or sharing others’ interests
  • May be direct in his remarks and perceived as rude
  • Often plays alone and isolates himself from a group
ASD Levels of Severity

ASD is a neurodevelopmental disorder with symptoms varying on a spectrum. As such, ASD is a very heterogeneous disorder in terms of strengths and weaknesses presented. While some individuals are verbal, others are not, while some have very good academic skills, others have intellectual disabilities.

Diagnostic Criteria for Autism Spectrum Disorder (ASD)

Following the publication of the DSM-5, Autism Spectrum Disorder diagnostic criteria have been revised. The new DSM-V diagnostic criteria for ASD are the following:

  • Persistent deficits in communication and social interaction skills displayed in several contexts. For example:
    1. Deficits in social and emotional reciprocity: Atypical social approach, deficits or difficulty maintaining a two-way conversation, difficulties sharing interests or emotions, lack or reduction in the frequency of social initiations and responses.
    2. Deficits in non-verbal behavior in social interactions: Verbal or non-verbal communication that are inappropriate to the context, atypical visual contact and body language use, deficits in the understanding of facial expressions and non-verbal communication.
    3. Deficits in the initiation, maintenance and understanding of social relationships, ranging from the difficulty of adapting one’s behavior to the demands of different social contexts to difficulty sharing, playing an imaginary game or making friends as well as the lack of interest in one’s peers.
  • Repetitive behaviors and restricted interests or activities. For example:
    1. Stereotyped movements, repetitive motor movements, non-functional use of objects or speech: Repetitive motor or verbal behavior, toy alignment, object turning, echolalia, and use of idiosyncratic sentences.
    2. Insistence on similarity, inflexible adherence to routines, rituals: Distress following the slightest changes, difficulties with transitions, rigid thought patterns, fixed greeting rituals, need to take the same itineraries or insistence on eating the same food every day.
    3. Restricted and limited or persistent interests that are atypical in their intensity or nature: Concern with unusual objects or parts of an object (e.g. a child showing interest in lawn mower engines), or very restricted interests.
    4. Hyper-or hypo-reactivity to sensory stimuli or unusual interests in sensory aspects of the environment: Hypo or hyper-reactivity to pain or temperature, excessive reaction to certain sounds or textures, significant interest or aversion to certain odors or textures, visual fascination with light or desire to look at objects from a certain angle.
  • In general, symptoms become apparent in early childhood, although they may manifest fully when the requirements of the social environment exceed the child’s ability to respond adequately to them.
  • The symptoms displayed result in clinically observable deficits in social and occupational spheres of functioning, or in other important aspects of functioning.

Autism Spectrum Disorder (ASD) also differs in levels of severity:

Level 1: Requiring Support

  • Social Communication:
    • Without support, deficits in social communication result in significant deficits: Difficulty initiating social interactions, atypical answers or lack of responses to social attempts and reduced interest in social interactions.
  • Restricted and Repetitive Behaviours:
    • Inflexible behaviour, significant interference with functioning in one or more contexts, difficulty transitioning from one activity to the next, organizational and planning difficulties that impede their autonomy.

Level 2: Requiring Significant Support

  • Social Communication:
    • Significant deficits in verbal and non-verbal communication, apparent social impairment despite the support provided, limited social initiations, reduced or atypical responses to social attempts.
  • Restricted and Repetitive Behaviors:
    • Inflexible behavior, difficulty adapting to transitions and significant distress following a change, restricted or repetitive behaviors noticeable by a casual observer and interfering with functioning.

Level 3: Requiring Very Important Support

  • Social Communication:
    • Severe deficits in verbal and non-verbal social communication skills significantly impeding functioning, very limited social initiations and minimal response to others’ social advances.
  • Restricted and Repetitive Behaviors:
    • Lack of flexible behavior, extreme difficulty managing transitions and great distress to changes, restricted or repetitive behaviors significantly interfering with functioning in several areas of functioning.
Neuropsychological Contributions

Since Autism Spectrum Disorder (ASD) is characterized by certain symptoms that could be attributed to different disorders, the diagnostic process requires a thorough investigation of several developmental spheres. The disorders in question include language impairment, nonverbal communication disorder, which also affects social interactions, and intellectual disability that could impede learning and communication. The diagnostic process therefore becomes even more important when we consider that an incorrect diagnosis could impede a person’s development.

As such, the neuropsychologist’s role consists of properly identifying the problem as well as making a complete assessment of the person’s strengths and weaknesses using accurated and recgonized diagnostic tools for Autism Spectrum Disorder (ASD).

In this matter, an accurate diagnosis will help guide intervention in order to help an individual reach his full potential.

Text redacted in collaboration with Dre Sabine Saade Chebli, Ph.D.