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Categories of ASD
In the United States,
the most commonly recognized definitions of ASD are those found in the
Diagnostic and Statistical Manual of Mental Disorders
(4th ed.–TR; DSM-IV-TR; APA, 2000). Within the DSM-IV-TR, autism
spectrum disorders are defined under the heading of pervasive developmental
disorders. In this module, we will discuss autism, Asperger syndrome,
and PDD-NOS, the most common Pervasive Developmental Disorders. For
a more thorough discussion of the diagnostic criteria, visit the assessment
module. Please note that there is a great deal of overlap among the
categories of ASD and that characteristics described under one heading
may be applicable to others.
Autism
Overview
The definition
of autism, or autistic disorder as it is referred to in the DMS-IV-TR
(APA, 2000), describes individuals with impairments that are evident
prior to 36 months of age. Those diagnosed with autism are on the more
severely impaired end of the spectrum and many also have mental retardation
(Simpson & Myles, 1998).
Impairments
in autism can be described within three categories: (a) social skills;
(b) communication; and (c) repetitive, restrictive, and stereotyped
behavior. Each of these areas will be discussed briefly.
Social Skills
Children and adults with autism display deficits in social
skills (APA, 2000). Differences from the norm may be evident in two
or more of the following ways:
- They may have deficits or differences in nonverbal
communication skills, such as use of eye contact, body language, gestures,
and facial expressions. While they may use some eye contact, it is
not as frequent or sustained \ as in their typical peers (Janzen,
2003). Some children with autism do not appear to notice others, failing
to look at or initiate contact with others.
- They often do not build relationships with others
their age at a level expected considering their overall development.
- They rarely share attention with others, such as by
showing something, pointing, or pointing out interests or accomplishments.
- They do not demonstrate emotional reciprocity. They
infrequently take turns in play or conversation (Janzen, 2003). For
example, typical 18-month-olds spontaneously hold out food for their
caregivers to share a bite, but children with autism have to be directly
taught to do so. They also rarely spontaneously imitate the actions
of others in play or otherwise.
| Christopher, a nonverbal 12-year-old, demonstrates
several social skill deficits indicative of autism. During a recent
assessment, the examiner noted that although he occasionally made
good eye contact, such as when his favorite crackers were put on
a shelf out of reach Christopher did not share enjoyment with others.
For example, when the examiner activated a remote-control car, he
played with it, but did not look at his mother or the examiner to
see if they also enjoyed the car, nor did he point at it. Further,
when two sets of toy tools were placed on the table and the examiner
pretended to build a chair, Christopher did not imitate her actions.
Instead he repeatedly banged the screwdriver on the table. Additionally,
when questioned, his mother reported that he did not have any particular
“friends” he liked to play with. |
Please visit the Social
Interventions modules for strategies to address social skill deficits.
Communication Skills
Individuals with autism demonstrate impairments in communication
skills in at least one of the following areas (APA, 2000):
- They may have delayed speech, or no speech at all,
make no effort to make up for these deficits with nonverbal communication
(APA, 2000). Instead of compensating for their lack of expressive
speech through gestures, individuals with ASD use fewer gestures and
those they use are limited in function (Ogletree, 1998). For example,
a child with autism may reach for a item to let someone know he wants
something on the shelf but will not point to comment on something
in the environment.
- Those who speak are unable to open or keep conversations
going (APA, 2000).
- They frequently engage in repetitive or stereotypic
speech or vocalizations, such as echolalia (APA, 2000). Echolalia,
repeating utterances of others, is common in students with autism
(Janzen, 2003). Such instances may occur immediately. For example,
Mom says, “Whose brush is that?” and the child repeats,
“brush is that,” in the same intonation. Echolalia may
also be delayed. When playing with clay, Chin repeatedly says, “I
have the green clay, green clay, green clay,” which had been
modeled for him when the clay was first introduced. Previously, echolalia
was thought to have no communicative function. However, it is currently
believed to have a variety of meanings and may be useful in language
instruction (Janzen, 2003; Prizant, 1988).
- They may lack pretend play of the same quality, quantity,
and variety of their same-age peers (APA, 2000).
| Teddy is a 4-year-old with autism, who attends
an integrated preschool where about half of the children have disabilities
and the rest are typically developing. Communicatively, he lags
behind his peers. Most 4-year-olds speak in sentences of three or
more words and use a variety of purposes for communicating, such
as asking for what they want (“Gimme the red car”),
commenting on novel objects in the environment (“Look at that
butterfly!”), and sharing their emotions (“I’m
so mad!”). During a recent diagnostic assessment, Teddy infrequently
used words to make requests. However, he did ask for bubbles by
grabbing the bubble wand and saying, “bubu.” Other requests
for objects included, “ju” [juice] and “car.”
In addition, Teddy frequently took the teacher’s hand and
placed it on items he needed help with, such as to open a zipper
baggie with crackers in it. The only other communicative purpose
expressed was a refusal to play in the sandbox, when Teddy yelled,
“no!” and pushed the teacher away. Teddy also displayed
immediate echolalia frequently, such as repeating “truck,”
when the teacher said, “here comes the truck,” and “pop”
while the teacher was blowing bubbles. While typically developing
children may use some echolalia as toddlers, they outgrow it by
2 or 3 years of age. |
Several specific communication differences have been noted
in individuals with autism:
- Generally, across the spectrum, the higher a child’s
measured IQ, the better his or her language skills are; however, some
individuals with lower IQs demonstrate normal language skills (Kjelkaard
& Tager-Flusberg, 2001).
- While articulation skills may not be impaired, content
and grammar frequently are delayed. Specifically, many children with
autism have a rigid understanding of words (Janzen, 2003). They may
have difficulty with the concept that objects can have more than one
name (e.g., dog/pet/animal, crayon/color/writing utensil) and that
words may have more than one meaning (e.g., iron can mean the mineral,
the act of smoothing wrinkles in clothing, or figuratively, “iron
out,” means to solve a problem).
Please visit the Communication
Interventions modules for strategies to address communication deficits.
Restrictive, Repetitive, and Stereotyped
Behavior
Restrictive, repetitive, and stereotyped behavior may
be exhibited in at least one of the following ways by individuals with
ASD (APA, 2000):
- They may have an unusually strong or focused interest
or fixation.
- They may be overly drawn to routines and rituals and
be unable or unwilling to be flexible in adhering to these routines.
- They may demonstrate repetitive complex body or other
motor movements, such as spinning, rocking, or finger flicking. These
self-stimulatory behaviors may occur so frequently that they interfere
with engagement in productive activities and may take up the majority
of a child’s waking hours if allowed (Simpson & Myles, 1998).
- They may show intense interest in parts of objects,
as opposed to using the entire toy or object (APA, 2000).
| Reese, a toddler with autism, was recently observed
in his playroom. Most toddlers would play with a variety of toys
in the room, such as stacking blocks, playing musical instruments,
and making animal noises with the animals in a toy farm. Instead,
Reese was observed lying on the floor pushing a toy car back and
forth, closely watching the wheels for 20 minutes. He also periodically
flicked his fingers between his eyes and the overhead light. |
The ability and desire to learn routines can be considered
a strength in individuals with ASD. However, at times it may also be
a drawback (Janzen, 2003). While they may quickly learn routines, they
may not understand the purpose or significant portions of the routine
and, thus, be inflexible in the use of such routines.
| Mari’s mother taught the nonverbal 8-year-old
with autism to set the table. After each step, her mother told her
what to do next, such as “plates,” “napkins.”
After two weeks of giving Mari these prompts, her mother wanted
her to complete the task independently, but after each step, Mari
looked at her mom to be told what to do next. Her mother had accidentally
built her verbal prompts into the routine |
The pattern of restricted interests found in many individuals
with ASD may present itself as decreased motivation to engage in learning
activities (Olley, 1992; Simpson & Myles, 1998). Often, they are
motivated to engage only in activities that reflect their own interests;
however, this can serve as an avenue for intervention, using special
interests as the basis for developing curriculum.
The desire for routine and predictability along with
visual strengths may serve as avenues for intervention. We suggest visiting
the Transition Strategies
and Visual Schedules
topics to learn strategies utilizing routines and visual strengths.
Some of these repetitive behaviors may be related to sensory differences
in individuals with ASD. These factors and potential interventions are
discussed in the Sensory Interventions
modules.
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