Autism spectrum disorder (ASD) is a grouping Autism spectrum disorder (ASD) is a grouping of three closely-related developmental disabilities that are neurobiological in origin and are characterized by impaired social function, impaired communication and restrictive, repetitive interests, activities and behaviors (Jones et al, 2006). The three disorders that comprise ASD are Asperger’s Syndrome (AS), Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and Autistic Disorder (AD), sometimes referred to as “classic autism” (Johnson et al, 2007). The generic term “autism” can be used to describe any of the autism spectrum disorders.
By definition, ASD is manifest by age 3, but often diagnosis is not made until several years later, with some people not being diagnosed until adulthood. Diagnosis is based on the patient meeting a specific set of behavior characteristics and frequently occurs after other possible conditions have been excluded. The criterion is defined in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and can be found at http://www.cdc.gov/ncbddd/autism/hcp-dsm.html.*
Behavioral examples include:
Impaired Social Interaction ---------------------------------
Impaired Communication ------------------------------------------------
Restrictive, Repetitive, Behaviors, Interests and Activities --------------------------------------------
Poor Eye Contact
Poor use of facial expressions/gestures
Lack of interest in socializing with peers
Isolation / Resisting inclusion in group activities
Inability to recognize effect of their behavior on others
Delay or absence of speech
Inability to perceive humor, sarcasm, idolism (takes everything seriously)
Inability to begin/sustain conversation
Inability to interpret other’s non-verbal communications (gesturing/facial expressions)
Lack of non-verbal communication (pointing, etc)
Stereotyped motor mannerisms (hand-flapping/rocking)
Rigid, inflexible adherence to nonfunctional routines and rituals
Excessive preoccupation towards specific topics/interests
The most current data indicates that approximately 1 in 91 children (age 3-17 years old) in the US are affected by the condition (Kogan et al, 2009) and the Autism Society of America (2008) estimates that 1.5 million American have a diagnosis on the spectrum. It affects males about 4 times more often than females. There are no significant differences in social-economic classes or nationality of those affected. However, ASDs affect white, non-Hispanic persons more than the black or Hispanic populations. The reason for this is not yet well understood and the prevalence between races is small (Centers for Disease Control, 2007).
The cause of ASD is not well understood. A genetic connection has been demonstrated, although specific genes have yet to be identified and the heredity model is very complex. (Newschaffer, et al, 2007). The only known risk factors are heredity (children with a sibling with an ASD are more likely to have an ASD) and chromosomal anomalies (children with certain genetic conditions are more likely to be diagnosed with an ASD).
Environmental factors were once thought to be responsible for autism, although data does not support this link. There is interest, however, of a genetic predisposition combined with an environmental “trigger,” causing the onset of symptoms (Lawler, et al, 2004). Vaccinations have also historically been blamed for causing ASD and there are many persons today still promoting this theory. However, multiple recent studies, including Fombonne, et al (2001), the Institute of Medicine (2004) and others have concluded quite clearly that vaccinations do not cause autism spectrum disorders. There are other factors that have been falsely accused of causing autism, such as stress, early life trauma, traumatic exposures (Autism Society of America, 2008) or “bad” parents or poor parental styles. It is important to remember that none of these are true; in fact, parents now play a key role in effective treatment and support of the persons affected by autism (Myers et al, 2003).
American Psychiatric Association, (2000). Diagnostic and statistical manual (fourth edition), text revision (DSM-IV-TR). Washington: American Psychiatric Association.
Centers for Disease Control, (2007). Prevalence of autism spectrum disorders – autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR. 56(SS01), 12-28.
Fombonne, E., Chakrabarti, S. (2001). No evidence for a new variant of measles-mump-rubella-induced autism. Pediatrics. 108(4), e58-e64
Institute of Medicine, (2004). Immunization safety review: Vaccinations and autism (2004). Washington: The National Academies Press.
Johnson, C. P., Myers, S.M. & the Council on Children with Disabilities (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics. 120(5), 1183-1215.
Jones, A., Cork, C., & Chowdhury, U. (2006). Autism spectrum disorders. Community Practitioner. 79(3), 97-98.
Kogan, M.D., Blumberg, S.J., Schieve, L.A., et al (2009). Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007. Pediatrics. 124(5), 1395-1403
Myers S.M., Johnson, C.P. & the Council on Children with Disabilities (2007). Management of children with autism spectrum disorders. Pediatrics. 120(5), 1162-1182.
Newschaffer, C.J., Croen, L.A., Daniels, J., Giarelli, E., Grether, J.K., Levy, S.E., Mandell, D.S., Miller, L.A., Pinto-Martin, J., Reaven, J., Reynolds, A.M., Rice, C.E., Schendel, D., & Windham, G.C. (2007). The epidemiology of autism spectrum disorders. Annual Review of Public Health. 28, 235-258.
*ASD typically are described as AS, PDD-NOS, and AD. The general grouping “pervasive developmental disorders” (PDD) includes these three diagnosis, plus childhood disintegrative disorder (CDD) and Rett’s disorder. CDD and Rett’s disorder are included in the DSM-IV-TR diagnostic descriptions listed by the CDC on this link, but are not included for discussion elsewhere at this time.