Autistic traits have been depicted in numerous "Hollywood" movies. Rain Man staring Dustin Hoffman and Tom Cruise was one of the first movies to depict autistic traits, and how it was perceived culturally. The actual portrayal for Rain Man was a 71-year-old male who has memorized thousands of books and has extensive knowledge of geography, music, and sports (Peek & Hanson 2008). He can accurately name all the US area codes and major city zip codes and can precisely advise how to get from one US city to another.
However, while Rain Man may have been liberating, with later movies (e.g., The Accountant - Ben Affleck) and tv shows (The good doctor) following in the same direction, these "Hollywood" depictions focus less on the daily difficulties individuals with Autism may experience and more on inherent special abilities (e.g., savant syndrome).
Savant syndrome is defined as profound abilities (e.g., mathematics or mechanical domains) which may occur in 10-30% of children with ASD, versus 1% of non ASD children. The term "savants" is often referred to as "island of genius in a sea of deficits", as the special talents contrast significantly with the daily challenges of ASD. Lastly, savants appear to be much common in males, then females, with a sex ratio of 6:1 from recent research.
The term "savants" may also annoy parents or caregivers when people inquire "what is your child's special talents". I knew a friend that would say it's "having a meltdown in the store because something made them uncomfortable”. These "melt downs" may be due to children with ASD struggling to deal with their social environment, frequent change during developmental stages, and cognitive skills that assist emotion regulation. On the other hand, when identifying special interests and abilities, these can help increase self‐esteem and opportunities for future social interactions.
Autism Spectrum Disorder (ASD)
ASD is a neurodevelopmental disorder characterized by a range of challenges related to:
(1) social interaction,
(2) communication,
(3) and repetitive behaviors.
It is referred to as a "spectrum" because individuals with ASD can exhibit a wide range of symptoms and severity levels. More recently the term "neurodiversity" has been used to refer to how every person diagnosed with Autism is unique, where each person experiences their external and internal world differently from all other people with or without Autism.
Key features of Autism Spectrum Disorder include:
Social Challenges:
Individuals with ASD often have difficulty with social interaction, communication and social - emotional reciprocity (e.g., empathy). Children may struggle with understanding and interpreting social cues, making eye contact, and developing age-appropriate peer relationships.
More simply stated, children may struggle with initiating conversation outside their interests and display difficulty with small talk across multiple settings (e.g., school, home or sporting activities). It may also appear like they have no interest in other children's hobbies, making social connection more difficult, leading to difficulty in making and maintaining friends. Noteworthy, a key challenge is maintaining and understanding relationships, ranging from difficulties adjusting behavior to suit various social contexts; to an attenuated absence in the interests of their peers.
Communication Difficulties:
Language development can vary among children with ASD. Some children may have delayed language development, while others may have well-developed language skills. However, communication challenges may include difficulties with conversation and nonverbal communication (e.g., poor eye contact and reading facial expressions).
Repetitive Behaviors:
Many children with ASD engage in repetitive behaviors or activities. This can include repetitive movements (e.g., hand flapping or rocking), echolalia, adherence to routines, and an intense focus on narrow interests (e.g., space, dinosaurs, planets).
Sensory Sensitivities:
Individuals with ASD may be hypersensitive or hyposensitive to sensory stimuli (e.g., acoustic, visual or tactile). This can manifest as heightened sensitivity to light, sound, touch, taste, or smell. Sensory sensitivities can significantly impact daily life.
Difficulty with Change:
Children with ASD may struggle with changes to routine or unexpected transitions. Predictability and routine can provide a sense of security.
Strengths:
While children with ASD face challenges, they also possess unique strengths. Some may excel in areas such as mathematics, music, art, or memory.
Diagnosing Autism Spectrum Disorder (ASD) is a comprehensive assessment process that considers various aspects of the child's behavior, affect regulation, communication skills, social interactions, and developmental history.
The diagnostic process is typically conducted by a team of professionals, which may include:
(1) psychologists,
(2) Developmental pediatricians,
(3) Neurologists,
(4) Speech-language pathologists, and
(5) other specialists
Key steps involved in diagnosing ASD;
Comprehensive Developmental Evaluation:
Obtaining a developmental history. This involves a thorough assessment of the child's developmental history, communication skills, social interactions, play, and behavior. Observations of the child in different settings are often included.
Autism Diagnostic Interview-Revised (ADI-R):
A structured interview conducted with the parents or caregivers to gather detailed information about the child's social interactions, communication skills, and repetitive behaviors.
Autism Diagnostic Observation Schedule Second Edition (ADOS - 2):
While insufficient on its own for a diagnosis, the ADOS-2 is considered the field’s “gold-standard” for collecting standardized and objective information about social communication skills, restricted interests, and repetitive behaviors. It is often used to provide additional information for the diagnosis.
Diagnostic Criteria:
The diagnostic criteria for ASD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. To receive a diagnosis of ASD, an individual must meet specific criteria related to social communication and behavior.
Intelligence Testing:
The Wechsler Intelligence Scale for Children (WISC) is not specifically designed to diagnose Autism Spectrum Disorder (ASD). The WISC is a standardized intelligence test used to assess cognitive abilities of children and adolescents. It provides measures of a child's general cognitive functioning across the domains of;
(1) Verbal comprehension,
(2) Perceptual reasoning,
(3) Working memory,
(4) Processing speed,
(5) Visual spatial
While the WISC is not a diagnostic tool for ASD, it can be a valuable component of a comprehensive assessment when evaluating a child for developmental concerns, including ASD. The test results can provide information about a child's cognitive strengths and weaknesses, which may be useful in understanding their overall cognitive profile and assisting with their ongoing learning and development.
It's important to note that a diagnosis of ASD should be made by qualified healthcare professionals, such as:
(1) developmental pediatrician,
(2) child psychiatrist, or
(3) psychologist with expertise in autism.
The evaluation process typically involves collaboration among various professionals to gather a comprehensive understanding of the child's strengths and challenges.
At this stage there is no "cure" for autism spectrum disorder, however early intervention and several effective interventions are reported to assist a child or adolescents functioning.
Treatment for ASD typically involves a multidisciplinary approach, tailored to the child or adolescents challenges and strengths. Some evidence based interventions for the treatment of ASD;
Behavioral Therapies: Applied Behavior Analysis (ABA):
ABA is a evidence-based treatment that focuses on modifying behaviors by reducing them into smaller, manageable components. It involves behavioral principles like positive reinforcement and systematic teaching methods to improve social, communication, and adaptive skills.
Early Intensive Behavioral Intervention (EIBI):
EIBI is a type of ABA that is often used with young children. It involves one-on-one therapy to target specific behaviors.
Social Skills Training:
This focuses on improving social interactions and communication skills. It may involve role-playing and modeling to enhance social understanding. This can also be undertaken in group or individual settings, this intervention helps children work with other children with autism to improve their ability to navigate social situations.
Speech and Language Therapy:
Speech and language therapy assists communication concerns associated with ASD. Therapists work on improving expressive and receptive language skills, along with nonverbal communication.
Occupational Therapy:
Occupational therapy can help individuals with ASD develop and improve skills related to daily living, fine motor coordination, sensory processing, and self-regulation.
Treating co-occurring conditions:
Children with autism experience insomnia, anxiety, and depression more often than peers without autism. They also more often have ADHD. Children with autism may have intellectual disability and this needs to be addressed. The impact of these conditions can be reduced with the proper services, which include all of the above, in addition psychotherapy and/or medication treatment
Medication:
Medication may be prescribed to manage specific symptoms associated with ASD, such as possible anxiety, aggression, or attention difficulties which may be common in ASD. However, medication is not the primary treatment for the core features of ASD. A child psychiatrist can evaluate for co-morbid depression, anxiety, and impulsivity. If appropriate medications can be helpful. For example, autism-related irritability can be reduced by medications such as aripiprazole and risperidone (the two medications approved by the Food and Drug Administration for irritability associated with autism), prescribed judiciously by a knowledgeable clinician in collaboration with the child's parents.
Parent Training and Support:
Parents play an important role in the treatment of ASD. Training programs provide parents with strategies to support their child's development. Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism
