Autism Spectrum Disorder (ASD), as defined by the Diagnostic and Statistical Manual Fifth Edition of the American Psychiatric Association (DSM 5)*, is a complex developmental disorder associated with symptoms that include "persistent deficits in social communication and social interaction across multiple contexts" and "restricted, repetitive patterns of behavior, interests, or activities." The DSM 5 gives examples of these two broad categorizes:
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive):
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understand relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive):
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
- Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
These symptoms result from underlying challenges in a child’s ability to take in the world through his senses, and to use his body and thoughts to respond to it. When these challenges are significant, they interfere with a child’s ability to grow and learn, and may lead to a diagnosis of autism.
It is important to note that when the challenges of autism are understood and appropriately addressed, and the autistic is accepted for who they are, the potential of a person on the autism spectrum is no less than a neurotypical person. Too many professionals look at autism as something that needs to be managed or controlled. We look at autism as a neurodiversity that needs to be understood. Once understood, then the person's potential can be realized.
Autism and Related Conditions
Children with difficulties or differences in relating and communicating may fall within a broad spectrum of diagnoses or challenges that includes language processing disorders, attention disorders, sensory or regulatory disorders, and Autism Spectrum Disorder. These challenges often involve a number of different underlying difficulties, including:
- Taking in sensations or information: the child may be under or over reactive to the information received through his senses of vision, hearing, touch, smell, taste and body awareness.
- Processing information: the child may have difficulty understanding or organizing the sensory information he receives.
- Planning or executing responses: the child may have trouble using his body or his thoughts to respond to the information he has taken in.
A child may develop unusual or concerning behaviors in response to these difficulties or differences. For example, a child may be so under-reactive to sensation that he spins in circles in an attempt to increase his sensory input; another child, overwhelmed by the confusing information he’s receiving about his world may withdraw, finding security in lining up his cars over and over again. Examples of behaviors parents may observe, by area of difficulty, are:
Relating and emotion
- a tendency to avoid interaction
- difficulty paying attention
- limited eye contact with others
- repetitive statements, play, or behaviors
- failure to develop pretend play
- intense fears about ordinary objects, activities or events
- problems following simple directions
- echolalia, or repeating what has just been said
- difficulty making needs and desires known by gestures, words or play
Regulatory and sensory-motor
- difficulty dealing with changes in environment
- avoidance of hugs or light touch
- does not point to show you things
- poor coordination
- “self-stimulatory” behaviors: spinning, hand flapping, head banging
A child receives a diagnosis based on observation of the behaviors outlined above. However, though a child may share a common diagnosis with other children, each has a unique pattern of development and functioning. Each child is unique in his processing of sensory and other information, and his motor planning (the ability to plan and carry out actions). Some children are over reactive to sensations, such as touch and sound, while others are under reactive. Some children have relatively strong auditory memories, and can memorize entire scripts; others have relatively strong visual memories. Some children are able to plan and carry out a number of actions in a row, such as going upstairs, getting a toy and bringing it back down, while others are only able to carry out one action at a time, becoming very fragmented in their behavior.
In addition to differences in sensory processing and motor planning, children differ in their basic mastery of the foundations for relating, communicating, and thinking. Some children with ASD can form relationships and engage in two-way communication, while others appear to be very self-absorbed and aimless. Some children can focus and attend and engage with others, but can only participate in a back-and-forth flow of communication in a limited way finding it difficult to use language meaningfully or connect ideas together for logical and reflective thinking. Other children show some mastery of the basics, and the ability to engage in more complex communication as well as the ability to create ideas and use them logically, but are very limited in their capacity to apply these abilities to a broad range of situations. Therefore, while some children may exhibit common symptoms that lead to a diagnosis of an autistic spectrum disorder, their individual patterns – and therefore their paths toward recovery - are quite varied.
Click here to read our "Advances in Autism" handout.
Some suggest that children with autistic spectrum disorders cannot love with the same degree of warmth and intimacy as others. Learn more about this myth and others in Autism Myths and Facts.
Read “A New Look at Autism,” a letter from Dr. Stanley Greenspan, which sheds light on the modern way of understanding and treating autism.
Dr. Greenspan explains how AFFECT is tied to many core capacities that can be difficult to develop for the child on the ASD spectrum because of biological differences. He presented his theory on the role of affect in a paper entitled "THE AFFECT DIATHESIS HYPOTHESIS:The Role of Emotions in the Core Deficit inAutism and in the Development of Intelligenceand Social Skills."
*American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.