Autism Spectrum Disorder

What is an autism spectrum disorder?

There is a rise in Autism Spectrum Disorder (ASD) diagnoses among children these days which has made it more important for clinicians to get acquainted with strategies to enrich clients' lives and increase their functioning in different aspects of daily living. In regard to the treatment of ASD, a holistic approach is followed by clinicians but still, there is a lack of research on evidence-based practices.

Diagnostic Criteria

Autism Spectrum Disorder affects many aspects of an individual's life by deteriorating or affecting their functioning level to a major extent. The diagnosis of ASD can vary from individual to individual in terms of its severity and symptoms. According to the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V), a diagnosis of ASD must exist in early development, generally before age 6. In addition, when diagnosing ASD, it is necessary to first rule out the diagnosis of intellectual development disorder or global developmental delay. A diagnosis of ASD always includes the following

aspects: Persistent current or past behavior across a variety of settings with shortfalls in emotional and social exchanges, nonverbal communication, as well as forming, upholding, and comprehending relationships.

Specific, repetitive activities, hobbies, and actions that include stereotyped movements, rituals or inflexibility, extreme abnormal interests, and/or problems with sensory reactions. The DSM-V also declares the level of severity of the disorder which ranges from one to three. The severity of one indicates that a child requires support and severity of level three indicates that the individual requires very substantial support 

Causes of Autism Spectrum Disorder

The exact cause of ASD is currently unknown, but there are many theorized causes that have been suspected over the course of time. These causes range from genetic factors to neurological abnormalities to environmental factors. Genetics. Numerous studies have found links between ASD and genetics.

It is supported by the fact that every twin study focused on ASD found that monozygotic twins have a higher co-occurrence of ASD (Geschwind, 2011). This is also supported in a study by Bolton and his colleagues, who found that relatives of individuals with ASD have a significantly higher risk of also having the disease than the general population (Bolton, et al., 1994).

Therefore, genetics could significantly contribute to some cases of ASD, but it is suspected that it is in combination with a variety of other causes. Environmental. Several researchers have examined various environmental combinations to determine the cause of ASD. Parental age at the time of birth is a risk factor for the development of ASD, higher the age, the higher are the risks of attaining ASD. Conditions at the time of birth may also contribute to increased risk factors such as low birth weight and age of gestation (Kolevzon, Gross & Reichenberg, 2007).

Neurological abnormalities: Various researchers have focused on finding a neurologic link to the cause of ASD. A study concluded that the left superior frontal gyrus of female children with ASD had more grey matter than the control group of female children.

The study also revealed that the females with ASD had a more complex circuit of increased cortical volume (Calderoni, et al., 2012). Piven, Saliba, Bailey, and Arndt (1997) found that in individuals with ASD the cerebellar volume is enlarged compared to individuals without ASD, possibly contributing to the cause of the disorder. The number of Purkinje cells found in the brains of those with ASD has been discovered to be significantly low, contributing to possible causes of ASD (Rivito et al., 1986).

Finally, decreased activation of the frontal lobe has been found in individuals with ASD as well (United Kingdom Medical Research Council, 2001). In summary, increased gray matter, cortical and cerebellar volume, as well as decreased Purkinje cells, and activation of the frontal lobe can all attribute to the cause of ASD.

Prevalence and Incidence of Autism Spectrum Disorder

The number of diagnoses of ASD is increasing at a rapid rate. According to a population-based estimate by the Centers for Disease Control, 14.7 children out of 1,000 children in 11 communities in the United States are identified to have ASD. The same study states that a diagnosis of ASD is four and a half times more common for males than females.

AUTISM SPECTRUM DISORDER

In the prevalence of one in 42 boys compared to one in 189 girls. Children who are Caucasian have a 50% higher rate than Hispanic children of being diagnosed with ASD, and a 30% higher rate than African American children. The average age when a child is first diagnosed with ASD is near the age of four (2010). Caucasian males are the most likely to be diagnosed with ASD.

Impact of Condition on Client Factors

The impact due to ASD on client factors ranges variably from one individual to another. It is important to understand ASD's influence on these client factors as they can greatly affect performance skills and functioning.

Sensory system: As said by Dawson and Watling, the sensory system serves as a compass for one's body and guides children through development. Individuals with ASD do not have difficulties with perceiving sensory information, rather they have a hard time processing the information, causing them to react abnormally.

Children with ASD are known to often rely on their visual processing skills in order to cope with the symptoms of ASD. Although it is likely for these visual processing skills to be intact, most children with ASD have a deficiency integrating details of a figure into a whole (Deruelle, Rondan, Gepner & Tardiff, 2004). Children with ASD frequently struggle with auditory processing. children tend to be over-responsive to some common noises, while they may not respond to other common noises.

These children also have mixed responses to vestibular sensations ( Shangraw, 2012). numerous children with ASD exhibit patterns of inappropriate smelling of objects as well as attachment and extreme avoidance of certain smells  Thus, although children with ASD rely on strong visual processing skills, these children may have issues with other visual functions, as well as auditory, vestibular, and olfactory processing. Mental function. Attention deficits are the wider implications for individuals with ASD.

Although cognitive impairments do not occur in every individual with ASD, a low IQ rate affects roughly three-fourths of the ASD population (American Psychiatric Association, 2013). Lord and McGee summarize that children with ASD often have problems playing with toys appropriately and symbolically and generalizing concepts (Shangraw, 2012). children's ability to use executive functioning skills in learning is also negatively impacted when they have ASD (Shangraw, 2012). Attention, memory, and cognitive issues may be a consequence of ASD. Digestive system function. Children with ASD often report gastrointestinal problems such as gastritis or reflux. Urinary function. Although urinary functions are not normally impaired in ASD, children who have significant cognitive issues or sensory issues may struggle with toilet training.

Gross and fine motor skills. Generally, children with ASD have some degree of motor impairments. Rapin, Dawson, and Watling, argue that motor joint laxity, clumsiness, apraxia, toe-walking, and hypotonia, along with issues in hand-eye skills, speed, praxis, imitation, posture, balance, and problems with the skilled movement have been noted in children with ASD. Motor stereotypes are typical for children with ASD, made evident by hand flapping, pacing, running in circles, spinning, flipping light switches, and sometimes self-injurious behaviors like biting, hitting, or head banging ASD (Shangraw, 2012). These motor impairments and stereotypes can negatively impact children's occupational performance.

Comorbidities

Sensory Processing Disorders. Although Sensory Processing Disorders (SPD) and ASD are two different disorders, they share many similar symptoms. Individuals with ASD face numerous sensory issues. In a study by Tomcheck and Dunn (2007), it was concluded that 95% of their sample population of children with ASD had some degree of SPD Food selectivity. Closely tied with SPD, children with ASD may have mild to severe issues with food selectivity. Sometimes misinterpreted as children who are picky eaters, food selectivity is an aversion to certain foods, drinks, and medicine due to their appearance, taste, smell, and/or tactile sensation. This selectivity can affect children's social and home life, as well as result in nutritional deficiencies and missed medications. According to a narrative literature review by Cermak, Curtin, and Bandini, many studies link a high prevalence.

AUTISM SPECTRUM DISORDER of food selectivity and children with ASD, although it is difficult to conclude the scale and impact of the problem with the current research. Attention-deficit/hyperactivity disorder. Several symptoms of ASD and attention deficit hyperactivity disorder (ADHD) overlap, making this disorder common comorbidity with Autism. children with ASD frequently have attention deficits.

According to research done by Matson, Rieske, and Williams (2013) recent estimates of ADHD within the ASD population have ranged from 20 to 70%. Obsessive-compulsive disorder. Obsessive-compulsive disorder (OCD) also shares some similarities with ASD such as stereotypical or repetitive motor movements. In a study, 37% of children with ASD additionally met the criteria at the time to be diagnosed with OCD

Anxiety. Anxiety is a disorder where an individual feels excessive and uncontrollable worry and/or fear. Some symptoms of anxiety include restlessness, fatigue, concentration issues, irritability, and sleep disturbances. The symptoms of anxiety can cause issues for a child's home, school, and social life. White, Oswald, Ollendick, & Scahill (2009) found that various studies have shown a percentage of 11% to 84% of children diagnosed with ASD suffering from life impairing anxiety.

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