Autism Spectrum Disorder (ASD)

• Autism Spectrum Disorder (ASD) is a developmental disability that significantly affects verbal and nonverbal communication, social interaction and is generally evident before age three.
• The spectrum within ASD involves neurobehavioral conditions sharing oddities of socialization and communication.
• Primary core deficit areas of ASD include atypical impairment in social interaction, qualitative impairment in communication and the presence of repetitive and stereotyped patterns of behavior.
• ASD is a paradigmatic condition marked by social and communication deficits and behavioral rigidities.
• Behaviors associated with ASD include resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.

Types of Autism Spectrum Disorder

• New (2012) characterizes children with classic autism as having severe challenges, including impaired social and communication interaction, leading to difficulty in conversing and relating to people.
• Classic autism involves qualitative impairment in social interaction marked by difficulty in using nonverbal behaviors to regulate this interaction.
• Classic autism may involve repetitive or stereotyped behavior and hypersensitivity to their environment, leading to distress from certain sounds, colors, textures, schedules, and routines.
• Other terms for classic autism include childhood autism, early infantile autism, Kanner's syndrome, and infantile psychosis.
• Asperger’s Syndrome displays symptoms similar to ASD, but presents a milder indicator.
• Asperger’s Syndrome is characterized by social and communication skill deficits, relatively exceptional language and cognitive development, and idiosyncratic interests.
• Individuals with Asperger's Disorder often use pedantic speech and scientific or technical vocabulary, avoiding slang.
• Asperger's Syndrome is sometimes labeled as "geek syndrome" or "little professor syndrome."
• Children with Asperger's often interpret things literally and may appear socially awkward, are usually perceived as immature and overly emotional, despite often having average to above average intelligence.
• Individuals with Asperger's often do not understand conventional social rules, appearing to lack "empathy", make limited eye contact, being unengaged in a conversation, and be confused by gestures.
• The brains of individuals with Asperger's Disorder are wired differently, leading to different perceptions, values, and priorities.
• Childhood Disintegrative Disorder develops in children who seem to be developing typically until ages three to five.
• Children with Childhood Disintegrative Disorder stop talking, lose potty-training skills, and stop socializing.
• Children with Childhood Disintegrative Disorder stop playing, have less motor skills, and fail to make friends, and may develop severe intellectual disabilities.
• Rett's Disorder is a mostly developmental disorder prevalent in girls as symptoms generally appear after an early period of typical development.
• Children with Rett's Disorder display a slowing down or stagnation of skills to profoundly impair the child’s ability to use her hands as she did before.
• Other problems associated with Rett's Disorder include seizures and disorganized breathing patterns, walking on the toes, sleep problems, a wide-based gait, difficulty chewing, slowed growth and cognitive disabilities.
• Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) often lacks obvious signs of autism.
• PDD-NOS describes individuals who may not fully fit the criteria for other diagnoses are nevertheless autistic.
• People with PDD-NOS show autism symptoms at various times, but not often enough for a full diagnosis, which leads to misintervened needs in social skills and communications.

History

• In 1908, the word "autism" was first used.
• In 1943, Leo Kanner, an American child psychiatrist, published a paper on 11 highly intelligent children displaying a "powerful desire for aloneness" and an "obsessive insistence on persistent sameness," naming their condition "early infantile autism."
• In 1944, Hans Asperger described a milder autism form now known as Asperger's Syndrome, noting that the boys had trouble with social interactions and specific obsessive interests.
• In 1967, Bruno Bettelhein popularized the theory that "refrigerator mothers" caused autism by not loving their children enough.
• In 1968, Leo Kanner first described autism disorder, focusing on classic autism.
• After WWII, psychoanalytic research focused on the impact of autism on life experiences, disregarding biology or genetics.
• In 1967, autism was classified under Schizophrenia in the International Statistical Classification of Diseases although scientists made no known links between the conditions
• In 1977, twin research proved autism is largely caused by genetics and biological differences in brain development.
• In 1980, "Infantile autism" was listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), separating it from Childhood Schizophrenia.
• In 1987, the DSM replaced "Infantile autism" with a more expansive definition of "autism disorder" with a checklist of diagnostic criteria.
• In 1988, Ivar Lovaas published the first study showing how intensive behavior therapy can help children with autism.
• In the same year, a movie called Rain Man was released starring a child with savant autism, who has a photographic memory and can calculate huge numbers in his head.
• In 1991, the federal government made autism a special education category. Public school begun identifying children on the spectrum and offered them special services.
• In 1994, Asperger's syndrome was added to the DSM, expanding the autism spectrum to include milder cases.
• In 1998, a study published in The Lancet suggested that the measles-mumps-rubella (MMR) vaccine causes autism.
• In 1998, vaccine manufacturers began removing thimerosal from vaccines due to public fears, the vaccine link to autism debunked in 2000.
• In 2003, the CDC estimated that one in 110 children have autism spectrum disorder, up from one in 150 in 2017 noting that the increase was due to the improved screening and diagnostic techniques.
• In 2013, the DSM – V folded all subcategories of the condition into one umbrella diagnosis of Autism Spectrum Disorder(ASD) as Asperger’s syndrome is no longer considered separate condition.
• ASD is defined by the categories of Impaired social communication and/or interaction, and Restricted and/or repetitive bahaviors.

Philippines History

• In 1987, ASD was “born” in the Philippines when 11 mothers of children with autism got together to share experiences and concerns from parenting(Autism Society,2014).
• They explored possibilities of seeking help by attending went through seminars from pediatricians, psychologist, psychiatrists and therapist and ended up more confused.
• Parents of children with autism realized that only they can fully understand the situation.
• On March 8, 1989, the Foundation for Autistic Children and Adults of the Philippines or ACAP Foundation was formally organized and recognized with original mothers of children with austism being considered first pioneers and advocates of ASD advocates of the Philippines.
• In October 1988, a magazine published an issue about autism which became the defining point for the organization to gain more parents attending their meetings.
• The parents expanded their membership 11 committed parents to expand to 52 members setting up branches in Davao, Cagayan de Oro and Cebu..
• The organization started set up fundraising activities raising funds to buy books to utilized by children they are helping, setting garage sales and giving seminars.
• ACAP also started to connect with other organizations with the same mission and vision such as Autism Society America, the National Council for the Welfare of Disabled Persons(NCWDP) and the Kapisanan ng May Kapansanan sa Pilipinas, Inc. (KAMPI)

Characteristics of ASD

• Children with ASD exhibit deficits in social relatedness.
• These children often do not appear to seek connection with others, are usually contented with being alone and ignore parental efforts for attention.
• They seldom make eye contact or attempt to catch others' attention.
• In later years, they have difficulty sharing the emotional state of others in cooperative games and group settings and may have few friends.
• Deficits in joint attention are considered the most distinguishing characteristics of very young children with ASD.
• Joint attention is a typical, spontaneously occurring behavior in which the infant shows enjoyment by sharing an object (or event) with another person by looking back and forth between the two.
• Later, gestures and/or speech can also be used to engage another's attention with regard to the objects and events simply for enjoyment of sharing the experiences.
• Just as other developmental skills do, the development of joint attention skills is a milestone following steps that begin in the first few months with receptive joint attention skills usually were mastered before expressive skills.
• Joint attention initiates with joyous smiling in recognition of, and response to, a parent or a familiar caregiver's smiles and vocalizations.
• MacDonald, Anderson and Dube (2006) added that at approximately 8 months, an infant will follow the parent's gaze and look in the same direction when a parent looks away.
• Children begin to "follow a point" at approximately 10 to 12 months of age when typically, if a parent points in the direction of an interesting object or event and says, "Look!" the developing child will look in the intended direction and then, after seeing the object/event, look back at the parent in acknowledgment and shared expression.
• Infants with ASD may not follow a point with repeated attempts or with verbal/physical prompts, such as touching the child.
• Although they may look in the indicated direction eventually, it will not be followed by shared looking and expression (Zwaigenbaum, Bryson, Rogers, Roberts, Brian and Szatmari, 2005).
• At about 12–14 months, the typically developing child will begin to point for a desired object out of reach, or to draw the parent's attention to share an interesting object, person, or event using simple sounds or actual words.
• Some children with ASD may open and close their hand raised in the direction of the desired item without looking between it and the caregiver.
• At 14 to 16 months, the typically developing child will begin to point simply to "comment" about or "share" an interesting object/event while looking between the object/event and the parent.
• Children with ASD often fail to point to "comment" at age-appropriate times, and when they do they are less likely to show positive affect and connectedness.
• Some high-functioning children with ASD may point to label objects, shapes, and colors they have learned in a rote fashion, but without any intent of communicating in a social context of joint attention.
• Social referencing is the ability to recognize the emotional states of others.
• When faced with a situation, a typically developing infant might look to his mother for an indication of delight, anger, or fear in her facial expression, mimicking the expression, even if they do not understand situation.
• Children with an ASD engages in less imitation.
• Children with ASD lack social skill building blocks, making them be less likely to develop appropriate peer relationships according to age and language ability.
• They may have few or no friends and relationships may evolve around the child's own special interests, and have difficulties interpreting stimuli in totality and "the big picture”.

Communication Deficits

• Lack of speech is a hallmark of ASD, especially when associated with the lack of desire to communicate and nonverbal compensatory efforts like gestures.
• Children with milder symptoms and customary cognitive skills, may have some speech but their speech may not be functional or fluent, and may lack communicative intent.
• Communication deficits may be scripted (from favorite videos or television programs) and stereotypic.
• Echolalia is the repetition of another person's speech described as immediate or delayed (when there is a time lapse).
• Typically developing children pass through a "vocabulary-burst stage," when brief periods of immediate echolalia are not unusual.
• Echolalia in children with ASD may persist throughout life, mixing immediate and delayed varieties.
• Utterances of children with ASD may be more clearly articulated, sounds more monotone, consist of larger verbal "chunks" than of typically developing children.
• Echolalia may sometimes give the impression of "advanced" speech advanced with vocabulary, grammar, and syntax while others may develop advanced verbal reading without corresponding comprehension skills.
• “Pop-up words” will be spontaneously appear without stimulus or communicative intent.
• “Pop-up words” are inconsistent, may spontaneously occur during acutely stressful situations stated, and in “pop-up” short periods of time and disappear.
• 25% to 30% of children with ASD begin to say words but then stop speaking, often between 15 and 24 months.
• Regression of skills in children with ASD may include loss of gestural communication and social skills.
• Regression can be gradual or sudden, and it may be superimposed on subtle preexisting developmental delays, or an unusually intense interest in objects or other nonsocial stimuli.
• Lack of, or significantly delayed, pretend play skills coupled with persistent sensory-motor and/or ritualistic plays are characteristic of ASD.
• children with severe ASD may never progress past the sensory motor play stage.
• children with ASD, play involves mouthing, twirling, banging, and manipulating objects in a stereotypic or ritualistic manner are and lacks creativity and imitation.
• children with ASD do things like spinning the wheels or lining up cars instead of "driving" them, arranging crayons instead of coloring with them, or stacking blocks in the same sequence time after time.
• They prefer to play with common objects, or store-bought toys.
• Children with ASD are content to play alone for hours.
• the plays include construction, ritualistic practices and sensory motor movement.

Behaviors

• Restricted, repetitive, and stereotyped patterns of behavior can demonstrate atypical behaviors in mannerisms, objects, obsessions, compulsions, self-injurious behaviors and stereotypes.
• Stereotypes are repetitive, nonfunctional, atypical behaviors such as hand flapping, finger movements, rocking, or twirling.
• Although stereotypes may be harmless, they are problematic if they prevent the child from learning new skills.
• Most children form attachments with a stuffed animal, special pillow, or blanket.
• These attachments are persistent, although they are rarely, if at all, used in real "play".

This lesson discusses Autism Spectrum Disorder (ASD), a developmental disability affecting communication and social interaction, typically evident before age three. It covers the spectrum of neurobehavioral conditions, core deficit areas, and associated behaviors like resistance to change and unusual sensory responses. Also, it characterizes children with classic autism as having severe challenges.