Autism Spectrum Disorder: A Brief Overview

A Note to Readers

As many of you know, I am actively pursuing a degree in Social Work. In meeting the requirements of my curriculum, I had the opportunity to write a paper on any disorder included in the DSM-5. It is, I am sure, no surprise to any of my readers that I wrote a paper called Autism Spectrum Disorder: A Brief Overview. Because of the strict specifications for content and length, it is not the paper I would have chosen to write but I am, nonetheless, proud of it. With some changes for SEO optimization, I have copy/pasted it below. Note: Our program requires person-first language, so that is what I used.

Introduction

The Centers for Disease Control and Prevention (CDC) defines Autism Spectrum Disorder (ASD) as “a developmental disability that can cause significant social, communication and behavioral challenges.”  ¹Centers for Disease Control and Prevention (2020-b). What is Autism Spectrum Disorder? Retrieved August 24, 2020, from https://www.cdc.gov/ncbddd/autism/facts.html Communication delays and repetitive behaviors are the defining diagnostic factors.  It is a spectrum disorder; hence, the needs of people with autism are on a continuum. Some individuals require total care while some are fully functional. Even others have higher than average IQs and attend college.

Although some may find it natural to assume, the amount of care an individual with ASD requires is not proportionate to how much happiness or stress they have because of their autism. A well known quote within the autism community says, “[So-called] Mild autism doesn’t mean one experiences autism mildly . . . It means YOU experience their autism mildly. You may not know how hard they’ve had to work to get to the level they are.” ²Walton, A. (2020, March 31). 106 Favorite Quotes About Autism and Aspergers. Retrieved August 27, 2020, from https://the-art-of-autism.com/favorite-quotes-about-autism-and-aspergers/

Prevalence

Approximately one in fifty-four, (19 out of every thousand or about 2% of) children in the United States have been identified as having Autism Spectrum Disorder as of 2016, according to CDC statistics. ³Centers for Disease Control and Prevention; Statistics on Autism Spectrum Disorder. (2020, September 25). Retrieved December 25, 2020, from https://www.cdc.gov/ncbddd/autism/data.html This number is up from 2014 when one the ratio was in fifty-nine (still 2% but a lower decimal at 17 out of every thousand).

The CDC obtains these statistics through several sources and publishes them every other year. In no particular order, they are:

• Autism and Developmental Disabilities Monitoring (ADDM) Network, which is a network that reviews screening and evaluation data from eleven states regarding eight-year olds.
• Medicaid statistics
• State Employee Charitable Campaign (SECC)
• National Survey of Children’s Health (NSCH) (CDC, 2020-a)

Autism Spectrum Disorder: A Brief Overview Symptoms

ASD has 4 criteria for diagnosis. First, the client must suffer significant impairment in social interaction and communication. Secondly, restricted patterns of behavior, interests, or activities must be identified. Thirdly, symptoms must have been present from childhood and must fourth, limit or impair everyday function. ⁴(DSM 5^th Ed., 2013)

According to the DSM, the communication and social impairments must be “sustained and pervasive”. Communication deficits can range from complete lack of speech, repeating words, through poor understanding of language and overly literal speech. Even when individuals have seemingly good command of the language, they often have difficulties understanding nonverbal social cues and nuances of the spoken word. Adults without language impairment or intellectual disability have trouble responding appropriately to nonverbal social cues and are unable to participate in back and forth conversations and share thoughts and feelings (social-emotional reciprocity). Another communication hallmark of autism is lack of eye contact.

Stimming

People who have autism also show restricted interests and patterns of behaviors. This may exhibit as the stereotypical hand-flapping or finger-flicking or may manifest as spinning coins, lining up toys, vocalizing repetitive sounds, repeating the words said by others (echolalia), grunting, spinning in circles, and body rocking. These behaviors are known as “stimming,” short for “self-stimulating behaviors”.

People who have autism have been very vocal about stimming behaviors. Most describe them as calming, a helpful response to sensory overload, and giving them a sense of control. ⁵Kapp, S., PhD. (2020, April 16). Stimming, therapeutic for autistic people, deserves acceptance. Retrieved August 25, 2020, from https://www.spectrumnews.org/opinion/viewpoint/stimming-therapeutic-autistic-people-deserves-acceptance/ Conversely, some researchers criticize the concept of repetitive behavior being classified as “self-soothing” or “self-stimulating” for fear that if the public views it in that light, they may expect people who have autism to suppress their repetitive their behaviors in public. ⁶DeWeerdt, S. (2020, April 09). Repetitive behaviors and ‘stimming’ in autism, explained. Retrieved August 25, 2020, from https://www.spectrumnews.org/news/repetitive-behaviors-and-stimming-in-autism-explained/

As of now, research has provided no concrete answers about why autistic people stim. Some believe repetitive behaviors are a way that autistic people shut out the world and others believe it is the product of a “disorganized nervous system”. ⁷Kapp, S., PhD. (2020, April 16). Stimming, therapeutic for autistic people, deserves acceptance. Retrieved August 25, 2020, from https://www.spectrumnews.org/opinion/viewpoint/stimming-therapeutic-autistic-people-deserves-acceptance/

Autism Spectrum Disorder: A Brief Overview Cultural Considerations

ASD is found in all ethnic, racial, and socioeconomic groups. The prevalence of ASD in Asia, Europe, and North America is 1% to 2%.  In 2012, white children were identified as having ASD at a rate 1.2% higher than black children and 1.5% higher than Hispanic children. In 2014, white children were identified as having ASD at a rate 1.1% higher than black children and 1.2% higher than Hispanic children. ⁸Centers for Disease Control and Prevention. (2019-c). Spotlight On: Racial and Ethnic Differences in Children Identified with Autism Spectrum Disorder. Retrieved August 26, 2020, from https://www.cdc.gov/ncbddd/autism/addm-community-report/differences-in-children.html

When this type of discrepancy exists there is always the question of whether the disorder occurs at a lower rate or simply being diagnosed at a lower rate. It could be that, as in the case of ADHD and other psychiatric disorders, minority families are less inclined to believe that behavioral disorders are secondary to a health condition. ⁹Bussing, R., Schoenberg, N. E., & Perwien, A. R. (1998). Knowledge and information about ADHD: Evidence of cultural differences among African-American and white parents. Social Science & Medicine, 46(7), 919-928.

Cultural Views on Disabilities

We know that culture affects how parents view autism and its etiology. ¹⁰Pitten, K. (2008). How cultural values influence diagnosis, treatment and the welfare of families with an autistic child. InSight: Rivier Academic Journal, 4, 1–5. Kathryn Pitten’s 2008 research shed some light on cultural perspectives regarding the etiology of autism. Her study revealed that Anglo Americans tend to accept the notion of physicality, with some believing that autism was a result of immunizations or some other physical element while African Americans were more likely to believe it was caused by diet, food processing, or contamination. Asian Americans in the study held the viewpoint that disabilities were cosmic payback for having made a religious or moral mistake. Latino mothers, on the other hand, felt blessed and chosen by God to serve another.

Autism Spectrum Disorder: A Brief Overview Evidence Based Treatment

In 2005 the National Autism Center launched the National Standards Project. A comprehensive study designed to answer the question, “How do we effectively treat individuals with ASD”? The center initially looked at 7,000 abstracts with an international team of scientists, and narrowed them down to 750 and studied them. In the end, the team identified eleven “established” treatments. Established treatments refer to treatments refer to treatments that have been researched thoroughly and there is sufficient evidence that they are effective for ASD.

It is important to note that medication therapy was excluded ¹¹Wilczynski, S. M., & Pollack, E. G. (2009). Setting the Standard for Autism Treatments: National Autism Center Releases Groundbreaking Report. Exceptional Parent, 39(12), 50–51.. They were put into 14 categories: behavioral interventions (including cognitive and comprehensive), treatment for young children, language training, modeling, natural teaching strategies, parent training, peer training, pivotal response training, schedules, scripting, self-management, social skills training, and story-based intervention. ¹²National Autism Center (NAC). National Standards Project Phase II. (2015) Retrieved August 26, 2020 from https://www.nationalautismcenter.org/national-standards-project/phase-2/¹²  The spectrum is broad, and symptoms can be as different as the person who has the disorder. For this reason, there is no rule about which treatment is “correct”. There is, however, one thing that experts agree on, “every child with ASD can benefit from early intervention”.¹³ Children’s Hospital of Philadelphia. (2017, June 09). Evidence-based Treatment Options for Autism. Retrieved August 27, 2020, from https://www.chop.edu/news/evidence-based-treatment-options-autism Children who had Early Intervention two years prior to the start of school showed significant improvements and some were even able to enter a non-specialized school setting. ¹⁴ Children’s Hospital of Philadelphia. (2017, June 09). Evidence-based Treatment Options for Autism. Retrieved August 27, 2020, from https://www.chop.edu/news/evidence-based-treatment-options-autism

Conclusion

The number of autism cases is rising in the United States. Although Autism and ADHD share some symptoms, an ASD diagnosis requires that the individual have language delays, and repetitive behaviors. ASD can be debilitating and require total care or no care at all, but it is no less stressful for the individual who has it. There are 14 established treatments for ASD in the United States right now ¹⁵National Autism Center (NAC). National Standards Project Phase II. (2015) Retrieved August 26, 2020 from https://www.nationalautismcenter.org/national-standards-project/phase-2/, and early intervention may be the key to significant improvements.