Autism Spectrum Disorder

What is ASD?
Autism Spectrum Disorder (ASD) represents a complex developmental disability that is the result of neurological differences in the brain. ASD can impact an individual’s ability to communicate, understand language, and relate to others. The term “spectrum” is used because the range of charac-teristics can occur in any combination and require varied levels of support. Every individual with ASD is unique in their abilities and challenges. At this time, there is no known etiology or reason for the neurological differences. Researchers continue to investigate a number of theories, including the impact of genetic and environmental influences. 

Primary Characteristics

Every individual with ASD is different. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) is used by clinicians and researchers to diagnose and classify disorders, including ASD. The DSM 5th edition, Text Revision (DSM-5-TR), released in 2022, provides the current criteria for Autism Spectrum Disorder based on the latest research and science. These criteria must be present during childhood, even if diagnosed later in life, and include:

1.     Persistent differences in social communication and interaction. Characteristics may include difficulty with the following:

• social-emotional reciprocity
• nonverbal communication used for social interaction
• developing and maintaining peer relationships
  • Individuals with ASD may have difficulty with language skills necessary to communicate effectively with others. Some may use single words or short phrases to communicate, while others may be nonspeaking. For those who use spoken language, their speech may have noticeable differences in volume or intonation. 
  • Individuals with ASD may exhibit limited use of nonverbal communication skills such as pointing, gesturing, and facial expressions.
  • Autistic individuals may display difficulties in relating to people and in establishing and maintaining reciprocal relationships.
    • In young children, this may be evident in play skills. They may engage with toys and games in a way that is different from their peers or may have difficulty with imaginative play.
    • Youth and teens may not understand social rules such as knowing which jokes to tell a peer and which to tell to an adult.

2.     Presence of restricted or repetitive patterns of behavior. Characteristics may include the following:

• preoccupation with objects or topics of interest
• difficulty with change in routine or transitions
• repetitive movements or speech
• differences in responses to sensory stimulation
  • Autistic individuals may display atypical behaviors or self-stimulatory body movements. This could present as flapping hands, jumping, lining up blocks, organizing objects by color, or repeatedly spinning the wheels on a car.
  • Some individuals on the spectrum may exhibit the use of immediate or delayed echolalia, the repetition of words and phrases they have heard. 
  • Those with ASD might also have difficulty transitioning from one activity to another or show distress over changes in their environment. 
  • Responses to sensory input (e.g., touch, sound, sight, taste, etc.) might also present differently in individuals on the spectrum. Some may be distressed by loud noises such as sirens and fire alarms, others may only want to wear clothes of a certain texture, and others have a very limited diet because of the unique texture of many foods.

The Latest in ASD

Recent reports estimate that as many as one in every 36 children in the United States has been identified with Autism Spectrum Disorder. Considered to be a lifelong neurological developmental disability, ASD affects individuals from all racial, ethnic, and socio-economic backgrounds. ASD is nearly four times more common in boys, with the first signs typically appearing before the age of three. The number of individuals diagnosed with ASD has dramatically increased in Virginia and across the nation over the last 20 years. This increase can be attributed to a number of factors, including increased awareness of ASD, improved diagnostic testing methods and tools, and greater access to these diagnostic tools. Children who are now accurately diagnosed with ASD may have received a different diagnosis in the past. Additionally, as evidenced in the revisions to the DSM, there have been many changes to the diagnostic criteria. While these reasons justify increases in the prevalence rate, there may be other unknown factors contributing as well.

 
Many individuals on the autism spectrum are also affected by other disabilities or disorders that may or may not be diagnosed. A few of the most frequently reported include attention deficit disorder, anxiety, depression, sleep disorders, learning and intellectual disabilities, motor delays, and epilepsy. 

References

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
• Khachadourian, V., Mahjani, B., Sandin, S. et al. (2023). Comorbidities in autism spectrum disorder and their etiologies. Transl Psychiatry 13, 71. https://doi.org/10.1038/s41398-023-02374-w
• Maenner M.J., Warren Z., Williams A.R., et al. (2023). Prevalence and characteristics of Autism Spectrum Disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ 2023, 72 (No. SS-2): 1-14. https://www.cdc.gov/mmwr/volumes/72/ss/ss7202a1.htm?s_cid=ss7202a1_w

Virginia Commonwealth University’s Autism Center for Education (VCU-RRTC-ACE) is funded by the Virginia Department of Education, contract #881-APE61172-H027A220107. Virginia Commonwealth University is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran’s status, political affiliation, or disability.  If special accommodations are needed, please contact Jennifer McDonough at jltodd@vcu.edu.