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What is Autism?

BrainfunctionsAutism is a complex, lifelong developmental disability that affects essential human behaviors such as social interaction, the ability to communicate ideas and feelings, imagination, self-regulation, and the ability to establish relationships with others. Although precise neurobiological mechanisms have not yet been established, it is clear that this disability reflects the operation of factors in the developing brain.

An Explanation of Affected Characteristics

Deficits in Socialization and Communication

  • Most communication between neurotypical individuals is nonverbal. People with autism often have trouble reading nonverbal communication or may not use it themselves. A common example is difficulty with eye contact, although not everyone with autism has this difficulty.
  • Expressive language is our ability to communicate our wants, needs, and feelings. Receptive language is our ability to take in information. Someone with autism could have challenges with either or both of these.
  • Processing time is the length of time it takes to process information. Some people need more time than others. It could take 5, 10, or even 20 seconds for someone’s brain to comprehend the words they just heard.

Restricted, Repetitive Patterns of Behaviors 

  • Topics of interest may be narrow and strong. Or in other words: I like what I like and that’s what I like. Someone on the spectrum may have a special interest he or she can talk about for hours. 
  • People with autism often rely on routines and schedules, and can struggle with change or being flexible. 
  • Many people on the spectrum find repeated behaviors (physical, vocal, or otherwise) comforting and useful for emotional regulation. Some people call these behaviors “stims”. 

flexedarmSplinter Skills
Atypical brain development leads to challenges in certain areas as well as strengths in others. Sometimes we call these differences splinter skills. For example a person may be able to complete high level calculus in his or her head, but can’t balance a budget.

thoughtbubbleTheory of Mind
The ability to recognize and understand the thoughts, feelings, and intentions of others is called theory of mind. Many people with autism struggle to understand that other people have different thoughts, beliefs, values, and experiences than their own, due to difficulty with theory of mind.

calendarExecutive Functioning
This is the part of the brain in control of strategizing, organizing, working memory, attention, and inhibitory control. Often people with autism have difficulties in one or more areas of executive functioning. If an individual on the spectrum procrastinates, has difficulty with memory, struggles to make plans, or has bad time management skills, he or she is struggling because of executive functioning impairment.

earSensory Processing
All of us receive sensory input from our bodies that our brains turn into understandable information. Many people on the spectrum have difficulty with the processing step. They can be over or under sensitive to any sense: Over – It’s too much. Under – I need more. This also may apply to our 6th, 7th, and 8th senses:

  • Vestibular: sense of balance (movement)
  • Proprioceptive: sense of body position (pressure)
  • Interoception: sense of the physiological condition of the body (hunger, cramps, exhaustion, and more)

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Prevalence Rates

Autism is estimated to occur in as many as 1 in 68 individuals (Center for Disease Control and Prevention). Autism is five times more prevalent in boys than in girls and knows no racial, ethnic, or social boundaries. Family income, life-style, and educational levels do not affect the chance of a child having autism. Autism is currently thought of as a “spectrum disorder.” This means that the severity of symptoms differs in people with ASD.

DSM Defined Types of Autism (1994)

Mental health professionals diagnose based on the Diagnostic and Statistical Manual of the American Psychiatric Association, fourth edition (DSM-IV). DSM-IV was published in 1994. It is the first edition of the DSM to include both autism and Asperger syndrome as diagnoses. The DSM does not use the term autism spectrum. Autism and Asperger's syndrome are listed in the category Pervasive Developmental Disorders. There are three diagnoses in this category that are autism spectrum diagnoses, autism, Asperger's syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS).

Autism is characterized in the DSM-IV by:

  • Qualitative impairment in social interaction
  • Qualitative impairment in communication
  • Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities

Asperger's syndrome is characterized by:

  • Qualitative impairment in social interaction
  • Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities
  • No clinically significant delay in the acquisition of speech

Diagnosis of autism requires a total of six (or more) items from the three areas, with at least two in the area of social interaction and at least one in the other two areas. Diagnosis of Asperger syndrome requires at least three items with at least one in the area of social interaction. If a clinician feels that there are concerns in all three areas but there are not enough specific items to diagnose autism or Asperger's syndrome he/she might diagnose PDD-NOS. Characteristics of autism change with age and learning. The qualitative differences look different in two-year-olds and twenty-year-olds so some clinicians may diagnose PDD-NOS when they are not sure whether a behavior meets criteria.

DSM-V Changes in Diagnoses (2012)

In late 2012, the American Psychiatric Association (APA) approved a fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), signing off on a sweeping change to the definition of autism. The DSM-V, scheduled to go into effect in May 2013, eliminates autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified) by dissolving them into one diagnosis called autism spectrum disorder. According to the APA, this represents an effort to more accurately diagnose all individuals showing the signs of autism. 

The DSM-V is important because it provides the diagnostic labels that governments, insurance companies, schools and other institutions use to determine the services needed by each individual. There is concern that changes in diagnostic labels will change access to services and programs for individuals with autism. Broad diagnostic criteria also could make it more difficult to grasp an already complex disorder that manifests itself differently in each individual, resulting in misdiagnosis and improper treatment.