Autism Spectrum Disorder

Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder. Individuals on the Autism Spectrum experience difficulties with social communication and interaction and also exhibit restricted, repetitive patterns of behavior, interests, or activities. Symptoms are typically recognized between one and two years of age given significant efforts over the past 20 years of so regarding the early identification of ASD.

In the United States, a revision to Autism Spectrum Disorder (ASD) was presented in the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), released May 2013. The new diagnosis encompasses previous diagnoses of Autism, Asperger Syndrome, PDD-NOS and other diagnoses. Compared with the prior diagnostic manual, the DSM-IV, the DSM-5 diagnosis of ASD no longer includes communication as a separate criterion, and has merged social interaction and communication into one category. Slightly different diagnostic definitions are used in other countries. Within this category, the DSM-5 has proposed a framework of differentiating each individual by dimensions of severity, as well as associated features (i.e., known genetic disorders, and intellectual disability). A new diagnosis was also included in the section with Autism Spectrum Disorder and that is Social (Pragmatic) Communication Disorder (SCD). Like SCD, Autism Spectrum Disorder involves difficulty with social communication skills. However, Autism has the additional defining characteristic of restricted and/or repetitive behaviors. Therefore, an evaluation must rule out Autism Spectrum Disorder before reaching a diagnosis of SCD. 

Most parents report that the onset of ASD symptoms occur within the first year of life. There are two possible developmental courses of autism spectrum disorder. One course of development is more gradual in nature, in which parents report concerns in development over the first two years of life and diagnosis is made around 3–4 years of age. Some of the early signs of ASD in this course include decreased eye contact, failure to look/turn when name is called, failure to show interests by showing or pointing, and delayed imaginative play. A second course of development is characterized by normal or near-normal development in the first 15 months to 3 years before onset of regression or loss of skills. Regression may occur in a variety of domains, including communication, social, cognitive, and self-help skills; however, the most common regression is loss of language. There are varying clinical research opinions over the differential outcomes based on these two developmental courses.

Overall, the literature stresses the importance of early intervention in achieving positive longitudinal outcomes. Although evidence-based interventions for children with ASD vary in their methods, many adopt a psychoeducational approach to enhancing cognitive, communication, and social skills while minimizing problem behaviors. The treatment is typically tailored to the child's needs and intensive, sustained special education programs and therapies early in life can help children acquire adaptive, social, and language skills. Available approaches include applied behavior analysis, developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy.