WHAT IS AUTISM?
Autistic spectrum disorder (ASD)
Autism spectrum disorder (ASD) is a neurological condition affecting all aspects of development, in particular social interaction, social communication and social imagination, which have been referred to as the triad of impairments (Wing and Gould, 1979). A recent study conducted in the South Thames in England, conservatively put the prevalence of children with autistic spectrum disorder (ASD) at 116:10 000 (1:86) (Baird et al 2006).
The effects of ASD
The impact on the child
Wing and Gould (1979) were the first to refer to the three areas that characterise ASD as the triad of impairments. As mentioned above, these three areas that are affected are: social interaction, social communication and social imagination with restricted, repetitive or stereotyped interests or behaviour.
Criteria needed to obtain an ASD diagnosis, taken from one of the current popular diagnostic tools, the Diagnostic and Statistical Manual of Mental Disorder fourth edition (DSM IV) can be viewed in appendix 2.
The impacts of ASD on a child’s life include:- the triad of impairments; sensory issues; co-existing diagnoses; challenging behaviours; stigmatisation and bullying. These issues are described below.
The impairments in social interaction, social communication and social imagination as well as stereotypical and repetitive behaviours, hinder a child’s language development, ability to make friends and to learn.
Sensory Processing Disorder
Sensory Processing Disorder (SPD) is something that most individuals with ASD have. It is not one disorder but an umbrella term for a variety of neurological disabilities. It is the inability to use information received through the senses to function smoothly in everyday life. SPD can be divided into three subgroups namely Sensory Modulation Disorder, Sensory Discrimination Disorder and Sensory Motor Disorder (Kranowitz, 2005).
Some of the repetitive mannerisms or seemingly non functional behaviours mentioned above can be attributed to SPD. They can sometimes oscillate from being over-sensitive to under-sensitive in certain senses. Sensory overload is common in ASD where an individual will become highly anxious and distressed if there are too many colours, lights or noises (hyperacusis), resulting in, for example, children having temper tantrum s in supermarkets, public places or classrooms. They may be oversensitive to touch (tactile defensive) resulting in them not wanting to wear certain clothes or shoes, or avoiding hugs or touch by others, or they may be under sensitive to touch (tactile seeking) resulting in persistent inappropriate touching of themselves and others. Their sense or smell can be affected in the same way resulting in, for example, inappropriately sniffing others and objects. In addition to the aforementioned Challenging Behaviours sensory issues can also lead to self injurious behaviour (SIB).
Some diagnoses may be co-morbid (occur together) with ASD. Co-morbidities can create issues during diagnosis, with the co-morbidities sometimes diagnosed as the primary diagnosis and with the autism remaining undiagnosed. The most common co-morbidity diagnosis is learning disabilities (LD). The term learning disability (LD) has changed over the years as has the definition. The formal definition includes: a significant intellectual impairment (an intelligence quotient [IQ] score more than two standard deviations below the general population mean i.e. 70 on IQ tests such as the Wechsler Intelligence Scale for Children- 3rd edition); deficits in social functioning or adaptive behaviour (every day skills); and must be present from childhood. Emerson and Baines (2010) reviewed studies published since 2000 that estimate the prevalence of LD amongst children with ASD and found that prevalence ranged from 15% (Williams, 2008) to approximately 70% (Chakrbarti 2001 and 2005) . However there are range of many other conditions that have been found to co-exist in children and adults with autism. Many of these are health related issues and impact on areas of a person’s life, increase challenging behaviours and sensory issues and hinder learning. Such issues can decreases quality of life for both the child and the family.
Co-morbid conditions are sometimes diagnosed and viewed as separate from the autism, but treatment of some of these health issues have been reported to significantly improve the symptoms of autism in some cases (Jepson, 2007) - suggesting there may be a closer relationship between the conditions than previously thought.
Attention Deficit Hyperactivity Disorder (ADHD) (Biederman 1998; Reiersen and Todd, 2008)
Attention Deficit Disorder (ADD) (McElroy 2004)
Anxiety Disorder (White et al 2009)
Depression (Tchantchou et al 2006;James et al 2004)
Bipolar (Basco and Ramirez 2006; McElroy 2004)
Visual Impairments (Gense and Gense 2005)
Hearing Impairments (Gilberg 1999)
Sensory Issues (Rogers and Ozonoff 2005)
Non Verbal Learning Disorder (NLD)( Whitney, 2002)
Semantic Pragmatic Disorder (SPD) (Rapin and Allen, 1983; Bishop, 2000)
Hyperlexia (Newman et al 2007; Grigorenko et al 2003)
Apraxia (Hall et al 2010)
Low muscle tone (Geschwind 2009; Raiten & Massaro 1986)
Food allergies and sensitivities (Lucarelli et al 1995)am, 2004)
Anaemia (Latif et al 2002)
Vitamin and mineral deficiencies (Jepson, 2007)
Ecsema (Gurney et al 2006)
Asthma (Niehus et al 2006)
Ear, nose and throat issues (Konstantareas et al 1987)
Heavy metal toxicities (Grandjean and Landrigan 2006)
Challenging behaviours such as aggression, temper tantrums or self injurious behaviour (SIB) are common in ASD (Matson et al, 2011). They can be either an outlet for the frustration resulting from not being able to communicate, or as a form of communication itself (Clements and Zarkowska, 2000). It may also be as a result of SPD, sensory overload, or in terms of SIB it may be as a result of sensory seeking (Bogdashina, 2003; Lovaas, Newsome and Hickman, 1987).
Challenging behaviours can lead to the child being viewed poorly by the general public, stigmatising the child, and even result in exclusion from school (Matson et al, 2011).
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