FAQs

Autism, part of a group of disorders known as Autism Spectrum Disorders (ASD), is a complex neurodevelopmental disorder that typically lasts throughout a person’s lifetime. The disorder is characterized by varying degrees of impairment in communication skills, social abilities and also by repetitive behaviors.

According to the Centers for Disease Control, of the approximately 4 million babies born every year, 24,000 of them will eventually be identified as autistic. Also, recent studies suggest boys are more susceptible than girls to developing autism. In the United States alone, 1 out of 70 boys are suspected of being on the spectrum, with perhaps more going undiagnosed to this day. Studies have revealed that girls appear to manifest a more severe form of the disorder than their male counterparts.

No one knows for sure. Research says that there is a strong genetic base for this. Recent studies suggest a strong genetic basis for autism — up to 20 sets of genes may play a part in its development. Scientists also believe that environmental factors play a role in developing autism.

Each child with autism differs, but there are some signs that many of them share. Children on the spectrum generally have difficulty relating to others; they may hardly speak, and if they do, they may not communicate in ways that other people can easily understand (for example, they may scream loudly when they’re upset, instead of crying). They don’t usually sustain eye contact. It’s too intense and has trouble reading social cues. They’re also prone to repetitive behaviors, flapping their hands constantly or uttering the same phrase over and over again. Further, they may be more sensitive than typically developing children, or dramatically less so, to sights, sounds and touch.

The theory of Sensory Integration (SI) was developed in the 1960s by Dr. A. Jean Ayres, an occupational therapist who was a pioneer in the field of learning disabilities. She defined SI as the body’s capacity to organize sensory input, information and stimulation a person receives from his/her own body and the environment through the different sensory systems:

• tactile (touch)
• proprioceptive (joint and muscle impulses)
• vestibular (movement, visual, auditory)
• vision
• hearing and listening/auditory

This sensory information is then processed by the central nervous system and is used to help our body develop spatial awareness, muscle tone, postural stability and self-regulation. SI gives us the awareness of our body and the ability to use it as a tool to interact with others in our world. For those with Sensory Integration Dysfunction, the brain is not processing organizing the flow of sensory impulses properly. This can impact on a person’s functional, developmental and learning processes.

Signs of Sensory Integration Dysfunction include:
• Overly sensitive to touch, movement, sights or sounds
• Easily distractible
• Decreased awareness of surroundings
• Activity level that is unusually high or unusually low
• Impulsive, lacking in self-control
• Inability to unwind or calm self
• Poor self-concept
• Social and/or emotional problems
• Physical clumsiness or apparent carelessness
• Difficulty making transitions from one situation to another
• Delays in speech, language, or motor skills
• Delays in academic achievement
• Slow reaction to touch, movements, sights, or sounds

A Typical SI/OT Session A typical SI/OT session providing the right kinds of sensory stimulation helps in the normalization of sensory systems – tactile, vestibular, proprioceptive, auditory and visual as well as to provide the optimal state of alertness and attention. In addition, it helps to develop an adaptive response for daily functioning.

The goal of occupational therapy interventions is to enable individuals to participate in everyday occupations. This may be achieved through a range of therapy approaches such as modification of tasks and/or the environment to match individuals’ abilities, to develop skills such as posture and coordination, or for the development of daily routines and to facilitate adaptive behaviours (National Institute of Child Health and Development, 2005). Occupational therapists work with children in their natural settings; in the home with their families, in the school and in the community. Occupational therapy treatment has focused on two main areas: Sensory Motor Integration In the past, one of the more frequent sensory motor interventions in occupational therapy was sensory motor integration. However, there is evidence that children with autism do process sensory information differently from other developing children (National Institute of Child Health and Development, 2005).

Therefore, the focus in Occupational therapy has shifted to understanding how and when a child is reacting poorly to a sensory experience and structuring the environment to accommodate or minimize such reactions. Occupational therapists can use a mediator or consultation approach to work with parents and teachers providing strategies to prevent reactions to sensory experiences from limiting daily activities. For example, if a child with autism is upset by excess noise that may occur at end of a school day, they could get ready to go home before others leave. If a child is bothered by a specific clothing material (e.g. wool), this type of material could be avoided in their clothing. By adapting the tasks and environments as well as working with the families on how to teach new skills and build calming or alerting activities into their everyday routines, Occupational therapists can make a difference in the family’s day to day life.

In particular, occupational therapy focuses on self care issues, feeding, bathing, hygiene and sleep which are significant issues for children and enormous stressors for the family. In the school setting, a student’s occupational performance may be impaired by sensory, developmental, inattention and/or learning challenges .Occupational therapists may adapt classroom tasks and the school environment to promote a child’s participation. Occupational therapists can assist teaching caregivers and teachers with understanding the impact of sensory processing difficulties on daily functioning and how they can modify what they need do to maximize the child’s participation and reduce behavioural difficulties. There are 4 types of supports that could potentially have a positive impact on the lives of children with autism. The environmental supports suggested are: temporal supports (events over time – this would allow a child to prepare themselves in advance for a change in activity), procedural supports (including instructions for activities or relating people to events), spatial supports (allowing the child to organize themselves within the environment), and assertion support (aiding the child in social interactions).

Occupational therapists work with children with autism and their families to provide intervention that improves the child’s ability to participate in activities of daily living, play and school. In occupational therapy, the focus is on task analysis, breaking down a task into manageable steps for the child, teaching those steps to the key people in the child’s environment and structuring task and/or environment to support successful completion. For example, if a child with autism is having difficulty dressing himself, the occupational therapist could use a backward chaining behavioural approach which teaches skills by breaking the tasks down into manageable steps which are always performed in the exact same order.

An ADHD diagnosis alone is not enough to qualify for disability benefits. If your ADHD symptoms are well controlled, you probably aren’t disabled, in the legal sense. But if distractibility, poor time management, or other symptoms make it hard for you to complete your work, you may be legally disabled. Legally, “disability” means a physical or mental condition that significantly limits a major life activity — in this case, works

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development.

Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

Often has trouble holding attention on tasks or play activities.

Often does not seem to listen when spoken to directly.

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

Often have trouble organizing tasks and activities.

Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

Is often easily distracted

Is often forgetful in daily activities.

Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

Often fidgets with or taps hands or feet, or squirms in seat.

Often leaves seat in situations when remaining seated is expected.

Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

Often unable to play or take part in leisure activities quietly.

Is often “on the go” acting as if “driven by a motor”.

Often talks excessively.

Often blurts out an answer before a question has been completed.

Often has trouble waiting their turn.

Often interrupts or intrudes on others (e.g., butts into conversations or games)

Rett syndrome is a rare genetic neurological and developmental disorder that affects the way the brain develops, causing a progressive loss of motor skills and speech.  primarily affects girls.

Most babies with Rett syndrome seem to develop normally for the first 6 to 18 months of age, and then lose skills they previously had — such as the ability to crawl, walk, communicate or use their hands.

Although there’s no cure for Rett syndrome, potential treatments are being studied. Current treatment focuses on improving movement and communication, treating seizures, and providing care and support for children and adults with Rett syndrome and their families.

Stages of Rett syndrome

Rett syndrome is commonly divided into four stages:

  • Stage I: early onset. Signs and symptoms are subtle and easily overlooked during the first stage, which starts between 6 and 18 months of age and can last for a few months or a year. Babies in this stage may show less eye contact and start to lose interest in toys. They may also have delays in sitting or crawling.
  • Stage II: rapid deterioration. Starting between 1 and 4 years of age, children lose the ability to perform skills they previously had. This loss can be rapid or more gradual, occurring over weeks or months. Symptoms of Rett syndrome occur, such as slowed head growth, abnormal hand movements, hyperventilating, screaming or crying for no apparent reason, problems with movement and coordination, and a loss of social interaction and communication.
  • Stage III: plateau. The third stage usually begins between the ages of 2 and 10 years and can last for many years. Although problems with movement continue, behavior may have limited improvement, with less crying and irritability, and some improvement in hand use and communication. Seizures may begin in this stage and generally don’t occur before the age of 2.
  • Stage IV: late motor deterioration. This stage usually begins after the age of 10 and can last for years or decades. It’s marked by reduced mobility, muscle weakness, joint contractures and scoliosis. Understanding, communication and hand skills generally remain stable or improve slightly, and seizures may occur less often.

Rett syndrome signs and symptoms include:

  • Slowed growth. Brain growth slows after birth. Smaller than normal head size (microcephaly) is usually the first sign that a child has Rett syndrome. As children get older, delayed growth in other parts of the body becomes evident.
  • Loss of normal movement and coordination. The first signs often include reduced hand control and a decreasing ability to crawl or walk normally. At first, this loss of abilities occurs rapidly and then it continues more gradually. Eventually muscles become weak or may become rigid or spastic with abnormal movement and positioning.
  • Loss of communication abilities. Children with Rett syndrome typically begin to lose the ability to speak, to make eye contact and to communicate in other ways. They may become disinterested in other people, toys and their surroundings. Some children have rapid changes, such as a sudden loss of speech
  • Abnormal hand movements. Children with Rett syndrome typically develop repetitive, purposeless hand movements that may differ for each person. Hand movements may include hand-wringing, squeezing, clapping, tapping or rubbing.
  • Unusual eye movements. Children with Rett syndrome tend to have unusual eye movements, such as intense staring, blinking, crossed eyes or closing one eye at a time.
  • Breathing problems. These include breath-holding, abnormally rapid breathing (hyperventilation), forceful exhalation of air or saliva, and swallowing air. These problems tend to occur during waking hours, but breathing disturbances such as shallow breathing or periodic breathing can occur during sleep.
  • Irritability and crying. Children with Rett syndrome may become increasingly agitated and irritable as they get older. Periods of crying or screaming may begin suddenly, for no apparent reason, and last for hours. Some children may experience fears and anxiety.
  • Other abnormal behaviors. These may include, for example, sudden, odd facial expressions and long bouts of laughter, hand licking, and grasping of hair or clothing.
  • Cognitive disabilities. Loss of skills can be accompanied by a loss of intellectual functioning.
  • Seizures. Most people who have Rett syndrome experience seizures at some time during their lives. Multiple seizure types may occur and are accompanied by an abnormal electroencephalogram (EEG).
  • Abnormal curvature of the spine (scoliosis). Scoliosis is common with Rett syndrome. It typically begins between 8 and 11 years of age and increases with age. Surgery may be required if the curvature is severe.
  • Irregular heartbeat. This is a life-threatening problem for many children and adults with Rett syndrome and can result in sudden death.
  • Sleep disturbances. Abnormal sleep patterns can include irregular sleep times, falling asleep during the day and being awake at night, or waking in the night with crying or screaming.
  • Other symptoms. A variety of other symptoms can occur, such as thin, fragile bones prone to factures; small hands and feet that are usually cold; problems with chewing and swallowing; problems with bowel function; and teeth grinding.

There is no way to prevent autism spectrum disorder, but there are treatment options. Early diagnosis and intervention is most helpful and can improve behaviour, skills and language development.

Have regular check-up, eat well- balanced meals, and exercise during pregnancy. Make sure you have good prenatal care . Reducing exposure to toxins. The scientific community has discovered evidence that environmental factors often play a role in developing autism. Pregnant women can limit airborne toxins by wearing masks and staying indoors when air quality is low. For the duration of pregnancy, women should eliminate alcohol, tobacco, and caffeine. Switching to green personal care products is wise to lessen exposure to potentially harmful chemicals. Some doctors also suggest avoiding canned foods, plastic water bottles, and excessive cell phone use. Maintain a nutritious diet pregnant women can lower the risk for autism by eating colourful, organic diet rich in green vegetables and fruit containing antioxidants. Increasing intake of vitamin D has been linked to better neurological development in Foetuses’.

After birth if you’re concerned about your child’s development or you suspect that your child may have autism spectrum disorder, conduct routine check-ups, discuss your concerns with your doctor followed by an expert team for further interventions. The symptoms associated with the disorder can also be linked with other developmental disorders also.

If your child hasn’t really smiled or shown any type of eye contact or happy expression by 6 months or afterwards, this might be an early warning characteristic of autism.

  1. If your child hasn’t really smiled or shown any type of eye contact or happy expression by 6 months or afterwards, this might be an early warning characteristic of autism.
  2. If your child is 9 months old or older, he/she should be sharing sounds, smiles or other facial expressions.
  3. Once he/she has hit 12 months of age, your child should be pointing, showing, reaching or waving.
  4. By 16 months of age, your child should be saying at least a couple of words.
  5. By 2 years, your child should be expressing 2-word phrases by him/herself, (without imitating)
  6. If you notice any loss of speech, babbling or social skills at any age, this might be an indicator of Autism.
  7. If your child speaks with little variation in pitch, odd intonation, irregular rhythm or just a strange voice, this could be a sign of autism.
  8. Does your child repeat movements with objects over and over or repeat certain movements with his/her arms, hands, body or fingers? This is a possible red flag.
  9. If your child doesn’t want to hug or hold onto you. – but do not let this one be your sole indicator. Contrary to popular belief, some autistic children are quite affectionate.
  10.  If your child is not bringing objects to you to identify and is not pointing to objects by the time the first birthday is reached.
  11. If your child doesn’t want to interrelate with you and play games such as “peek-a-boo” or not exhibiting creative or imaginative play.
  12. If your child shows aggressive behavior on a normal basis or bangs his or her head against an object.
  13. If you notice your child  engaging in repetitive behaviors, such as opening or closing doors or drawers over and over or performing actions that are often repetitive and unchanging like twirling objects or rocking.
  14. If your child takes more fascination with parts of a toy than the action for which the toy was designed (Spinning the wheels of a toy car instead of driving it ).
  15. Learning difficulties i.e. he lacks in ability to learn inductively from surrounding events.
  16. Communication or speech problems.
  17.  Difficulty relating to people, marked by a lack of awareness of the feelings of others, indifferent to parents.
  18. Lack of social interaction.
  19. Short attention span.
  20. Reacting extremely to changes in the immediate environment.

If you are concerned, in any way, about your child’s development; speak with your child’s pediatrician. You will likely be referred to a specialist- either a child psychologist or a developmental pediatrician where your child will undergo further testing.

Your child may receive a diagnosis of ADHD, or Sensory Processing Disorder instead of Autism or in addition to autism. Sometimes the signs of ADHD may manifest or present as autism. And many autistic children also have underlying sensory issues.

It’s important to keep in mind that the earlier your child is diagnosed with autism, the earlier they can begin therapy,there will be better chance for improvement.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsivity that interferes with functioning or development.

Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.

Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.

Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have a high potential for harm, or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

As children with ADHD get older, they’ll oftentimes not have as much self-control as other children of  their own age. This can make kids and adolescents with ADHD seem immature compared to their peers where they  outburst of anger and lack of self control occur frequently. The child is viewed as immature, irritable, disruptive, demanding and uncooperative by teachers. These children also have difficulty in establishing and maintaining satisfactory social relationships.

Also the child with ADHD might:

  • daydream a lot
  • forget or lose things a lot
  • squirm or fidget
  • talk too much
  • have trouble taking turns
  • have difficulty getting along with others
  • forgetfulness
  • make careless mistakes or take unnecessary risks
  • have a hard time resisting temptation

    All children are going to exhibit some of these behaviors at some point. Daydreaming, fidgeting, and persistent interruptions are all common behaviors in children.

    You should start thinking about the next steps if:

  • your child regularly displays signs of ADHD
  • this behavior is affecting their success in school and leading to negative interactions with peers

    ADHD is treatable. If your child is diagnosed with ADHD, review all king of treatment options.

Speech therapy is a training to help children with speech and language problems to speak more clearly. The professionals deal with disorders in communication, evaluation, diagnosis and rehabilitation Individual speech therapy sessions as well as group therapies are provided by 10 highly qualified speech therapists from various institutions.

Speech therapy is an intervention service that focuses on improving a child’s speech abilities to understand and express language, including nonverbal languages. Speech therapists or speech and language pathologists are the professionals who provide these services. Speech therapy includes two components – 1) Coordinating the mouth to produce sound, to form words and sentences. 2) Understanding and expressing language. The role of SLPs also includes swallowing disorders and all aspects of feeding.

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioural challenges. The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment that people with ASD can have.  ASD affects people in different ways and can range from mild to severe. People with ASD share some symptoms, such as difficulties with social interaction, but there are differences in when the symptoms start, how severe they are, the number of symptoms, and whether other problems are present. The symptoms and their severity can change over time. The signs of ASD begin in early childhood, usually in the first 2 years of life, although a small minority of children may show hints of future problems within the first year of life.

Some autistic children are delayed in their use of language and some autistic adults don’t use speech. In those cases, other methods of communication need to be established. The person may appear not to hear what you say to them, not respond to their name, or appear indifferent to any attempts you make to communicate.

They may use some of the following to communicate with you:

  • Gestures
  • Crying
  • Taking your hand to the object they want
  • Looking at the object they want
  • Reaching
  • Using pictures
  • Challenging Behaviour
  • Echolalia (the repetition of other people’s words).

The picture exchange system (PECS) is a form of spontaneous communication for children with autism in which an individual selects a picture indicating a request.[10] PECS can be utilized in educational settings and at the child’s home

Applied Behavior Analysis (ABA) is a therapy based on the science of learning and behavior.

Behavior analysis helps us to understand:

  • How behavior works
  • How behavior is affected by the environment
  • How learning takes place

ABA therapy applies our understanding of how behavior works to real situations. The goal is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning.

ABA therapy programs can help:

  • Increase language and communication skills
  • Improve attention, focus, social skills, memory, and academics
  • Decrease problem behaviors

The methods of behavior analysis have been used and studied for decades. They have helped many kinds of learners gain different skills – from healthier lifestyles to learning a new language. Therapists have used ABA to help children with autism and related developmental disorders since the 1960s.

Applied Behavior Analysis involves many techniques for understanding and changing behavior. ABA is a flexible treatment:

  • Can be adapted to meet the needs of each unique person
  • Provided in many different locations – at home, at school, and in the community
  • Teaches skills that are useful in everyday life
  • Can involve one-to-one teaching or group instruction

Positive Reinforcement

Positive reinforcement is one of the main strategies used in ABA.

When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.

First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more.

Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.

Antecedent, Behavior, Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

Positive reinforcement is one of the main strategies used in ABA.

When a behavior is followed by something that is valued (a reward), a person is more likely to repeat that behavior. Over time, this encourages positive behavior change.

First, the therapist identifies a goal behavior. Each time the person uses the behavior or skill successfully, they get a reward. The reward is meaningful to the individual – examples include praise, a toy or book, watching a video, access to playground or other location, and more.

Positive rewards encourage the person to continue using the skill. Over time this leads to meaningful behavior change.

Antecedent, Behavior, Consequence

Understanding antecedents (what happens before a behavior occurs) and consequences (what happens after the behavior) is another important part of any ABA program.

The following three steps – the “A-B-Cs” – help us teach and understand behavior:

    • An antecedent: this is what occurs right before the target behavior. It can be verbal, such as a command or request. It can also be physical, such a toy or object, or a light, sound, or something else in the environment. An antecedent may come from the environment, from another person, or be internal (such as a thought or feeling).
    • A resulting behavior: this is the person’s response or lack of response to the antecedent. It can be an action, a verbal response, or something else.
    • consequence: this is what comes directly after the behavior. It can include positive reinforcement of the desired behavior, or no reaction for incorrect/inappropriate responses.

Looking at A-B-Cs helps us understand:

  1. Why a behavior may be happening
  2. How different consequences could affect whether the behavior is likely to happen again

Example:

  • Antecedent:The teacher says “It’s time to clean up your toys” at the end of the day.
  • Behavior:The student yells “no!”
  • Consequence: The teacher removes the toys and says “Okay, toys are all done.”

How could ABA help the student learn a more appropriate behavior in this situation?

  • Antecedent: The teacher says “time to clean up” at the end of the day.
  • Behavior:The student is reminded to ask, “Can I have 5 more minutes?”
  • Consequence: The teacher says, “Of course you can have 5 more minutes!”

With continued practice, the student will be able to replace the inappropriate behavior with one that is more helpful. This is an easier way for the student to get what she needs!

Social Communication Impairments

All individuals with ASD exhibit social communication impairments. In the first few years of life, salient signs of autism include lack of appropriate eye contact and inability to initiate or respond to joint attention (i.e., sharing social experiences with a communication partner). Common social difficulties include:

  • Demonstrating appropriate play skills, such as cooperative play with others. Some children with ASD may appear uninterested in playing with peers.
  • Some may reject or ignore the social approaches of others.
  • Responding to and initiating joint attention for social purposes. For example, many individuals with ASD are skilled at requesting items but are less likely to communicate for the purpose of sharing a social experience. Some individuals with ASD may lack interest in conversations that do not include topics of interests.
  • Using and interpreting body language. For example, individuals with ASD may have challenges understanding tone of voice or facial expression in social situations.
  • Staying on topic, turn-taking, and asking related or appropriate questions during conversations.
  • Taking their communication partner’s perspective, checking for understanding, or predicting what information may already be known about a concept or situation during conversations.

Speech/Language Impairments

Persons with ASD may have specific difficulties in the areas of receptive and expressive language. Receptive language is the comprehension of language (e.g., following directions), while expressive language is the ability to express desires and thoughts to other persons. Some individuals with ASD express their thoughts verbally, while others may be nonverbal and require a communication device.

Those who are nonverbal may demonstrate the following:

  • Delay in, or lack of, spoken speech/language, impacting approximately 20-30% of the population.
  • Lack of an effective way to communicate may lead to the need for the use of alternative augmentative communication (AAC), such as sign language, pictures, or a voice output device.

Those who are verbal may demonstrate the following:

  • Delayed or immediate echolalia as a means of conversation with others, for self-management, or for self-stimulation. For example, a dialogue from television programs or videos may be used as a means of conversation.
  • Stereotyped or repetitive use of non-echolalia language routines that serve various functions such as initiating or sustaining a conversation.
  • Use of idiosyncratic speech (e.g., inappropriate word use).
  • Grammatical structure which may appear immature (i.e., telegraphic speech, improper tense or use of pronouns) or grammatical structure which may appear pedantic (e.g., monologue, advanced vocabulary in an area of interest).
  • Abnormal use of pitch, intonation, rhythm or stress. For example, speech may be monotone or hypernasal, and declarative sentences may end with a rising tone to signal the asking of a question.

Both verbal and nonverbal individuals may demonstrate difficulties with receptive language such as:

  • Delayed vocabulary development;
  • Difficulty following directions;
  • Difficulty understanding abstract concepts; and
  • Difficulty interpreting social language, such as sarcasm and jokes.

 

Restricted Repetitive and Stereotyped Patterns of Behavior, Interests, and Activities

Although people with ASD may enjoy the same activities as typical same-age peers, the intensity and focus of their interests may differ. This may be due to the fact that some have a limited repertoire of alternative behaviors, or that they prefer and feel comfortable repeatedly performing certain tasks. Behavior under this category includes:

  • Stereotyped or repetitive motor movements such as hand flapping or finger flicking, use of objects such as spinning coins or lining up toys, or use of speech such as echolalia (delayed or immediate parroting of heard words), use of “you” when referring to self or stereotyped use of words or phrases.
  • Excessive adherences to routines and sameness such as being distressed by changes in the schedule, insisting on adherence to rules, or having inflexible thinking.
  • Ritualized patterns of behavior such as repetitive questioning or pacing.
  • Highly restricted, fixated interests that is abnormal in intensity or focus. A toddler may have a parent’s belt that they carry everywhere, a child may have a preoccupation with vacuums, or an adult may spend hours memorizing facts about their favorite baseball team.

In the DSM-5, sensory differences are categorized under restricted repetitive behaviors. Individuals with sensory differences will be under (hypo) or over (hyper) sensitive to a variety of sensory inputs:

  • Visual input sensitivities are staring at spinning objects, being bothered by fluorescent lights, or having trouble with keeping their place when reading.
  • Auditory input sensitivities are covering ears during loud noises, preferring loud music or none at all in the car, or not being able to respond to verbal prompts when in a noisy area.
  • Tactile input sensitivities dislike getting hands or feet messy, avoiding/preferring certain surfaces, textures, or fabrics, or finding specific types of touch aversive (light touch on the shoulder vs. deep pressure hug).
  • Taste/Smell sensitivities are not eating certain foods, licking or tasting non-food items, or finding strong perfume or cologne aversive.
  • Proprioceptive Input sensitivities are difficulties interpreting sensations from muscles, joints, ligaments, and tendons (e.g., putting too much pressure on pencil when writing or falling/crashing into things).
  • Vestibular input sensitivities are over or under sensitivities to balance and movement sensations, such as having trouble staying seated, constantly leaning head on hands and arms, or easily losing balance.

Executive Function Impairments

Executive functioning refers to advanced cognitive skills, such as attention, working memory, planning, reasoning, sequencing, and flexible thinking. In typically developing people, these skills benefit not only social interactions but also academics, learning, self-regulation, and activities of daily living.

  • Individuals with ASD may have difficulty with a wide range of executive functioning tasks, such as sequencing the order in which to dress themselves, tie their shoes, pack for a trip, or complete a homework assignment.
  • Rigid, inflexible thinking is a common characteristic of individuals with ASD, and therefore individuals may have trouble problem-solving or generating more than one solution to a problem.
  • Individuals with ASD may have executive functioning difficulties at more basic levels, such as sustaining prolonged attention to an activity, or dividing their attention between two activities at once.

Asperger syndrome (AS) is a neuro developmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests. Asperger Syndrome is a neurobiological disorder characterized by abnormalities in social interaction and language acquisition. Asperger Syndrome is considered to be on the mild end of the spectrum. People with Asperger Syndrome exhibit three primary symptoms: Having difficulty with social interaction, engaging in repetitive behavior, standing firm on what they think and focusing on rules and routines. Often, individuals diagnosed with AS have normal or above normal intelligence. In addition, people with this condition are frequently able to be educated in mainstream classrooms and hold jobs. Early diagnosis and intervention can help a child make social connections, achieve their potential, and lead a productive life. Symptoms vary from person to person, but children with AS often have an obsessive focus on a narrow topic of interest. Many people with AS find it hard to recognize other people’s feelings. It’s common for people with this condition to avoid eye contact when speaking with other. Genetic factors and exposure to environmental toxins, such as chemicals or viruses, have been identified as potential contributors to the development of the disorder. Boys are more likely to develop AS than girls. There’s no single test that can tell you whether your child has AS. In many cases, parents report developmental or behavioral delays or difficulties.

 

A lack of demonstrated empathy affects aspects of communal living for persons with Asperger syndrome. Individuals with Asperger Syndrome experience difficulties in basic elements of social interaction, which may include a failure to develop friendships or to seek shared enjoyments or achievements with others (for example, showing others objects of interest); a lack of social or emotional reciprocity (social “games” give-and-take mechanic); and impaired nonverbal behaviors in areas such as eye contact, facial expression, posture, and gesture. People with Asperger syndrome can display behavior, interests, and activities that are restricted and repetitive and are sometimes abnormally intense or focused. They may stick to inflexible routines, move in stereotyped and repetitive ways, preoccupy themselves with parts of objects, or engage in compulsive behaviors like lining objects up to form patterns.

The onset of Asperger syndrome commonly occurs after the age of 3. Some individuals who exhibit features of autism (a developmental brain disorder characterized by impaired social interaction and communication skills) but who have well-developed language skills may be diagnosed with Asperger syndrome. There is no specific course of treatment or cure for Asperger syndrome. Treatment, which is symptomatic and rehabilitation, may include speech therapy, occupational therapy and special education. Children with Asperger syndrome have a better outlook than those with other forms of pervasive developmental disorders and are much more likely to grow up to be independently functioning adults.

Asperger’s and autism are no longer considered separate diagnoses. People who may have previously received an Asperger’s diagnosis instead now receive an autism diagnosis. But many people who were diagnosed with Asperger’s before the diagnostic criteria changed in 2013 are still perceived as “having Asperger’s.” And many people also consider Asperger’s as part of their identity. This is especially considering the stigma that still surrounds autism diagnoses in many communities around the world. Yet the only real “difference” between the two diagnoses is that people with Asperger’s may be considered as having an easier time “passing” as neurotypical with only “mild” signs and symptoms that may resemble those of autism. Not all autistic children exhibit the same signs of autism or experience these signs to the same degree. That’s why autism is considered to be on a spectrum. There’s a wide range of behaviors and experiences that are considered to fall under the umbrella of an autism diagnosis. Here’s a brief overview of behaviors that may cause someone to be diagnosed with autism:

  • Differences in processing sensory experiences, like touch or sound, from those who are considered “ neurotypical’’
  • differences in learning styles and problem-solving approaches, like quickly learning complex or difficult topics but having difficulty mastering physical tasks or conversational turn-taking
  • Deep, sustained special interests in specific topics
  • Repetitive movements or behaviors (sometimes called “stimming”), like flapping hands or rocking back and forth
  • strong desire to maintain routines or establishing order, like following the same schedule each day or organizing personal belongings a certain way
  • Difficulty processing and producing verbal or nonverbal communication, like having trouble expressing thoughts in words or displaying emotions outwardly
  • Difficulty processing or participating in neurotypical social interactive contexts, like by greeting someone back who’s greeted them

Asperger’s syndrome was previously considered a “mild” or “high-functioning” form of autism. This means people who received an Asperger’s diagnosis tended to experience behaviors of autism that were often considered minimally different from those of neurotypical people. Asperger’s was first introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994.  The symptoms are:

  • having difficulty with verbal or nonverbal communication, such as eye contact or sarcasm having few or no long-term social relationships with peers
  • Lack of interest in taking part in activities or interests with others showing little to no response to social or emotional experiences
  • having a sustained interest in a single special topic or very few topics
  • Strict adherence to routine or ritual behaviors
  • Repetitive behaviors or movements intense interest in specific aspects of objects
  • experiencing difficulty in maintaining relationships, jobs, or other aspects of daily life because of these previously listed sign
  • not having any delay in language learning or cognitive development typical of other, similar neuro developmental conditions

When they were considered to be separate diagnoses, Asperger’s was differentiated from autism in two main areas:

  • Severity. Those diagnosed with Asperger’s were higher functioning and typically had average to superior IQs, requiring less support than those diagnosed with autism.
  • Language. Those diagnosed with Asperger’s had no speech or language impairment

Children at all levels of the spectrum may have social awkwardness and experience isolation. People with Asperger’s have better language skills but still may have difficulty conversing with others. Identifying social cues can be difficult, although kids with Asperger’s often have an easier time making eye contact, which aids in social interaction. One similarity that all people across the spectrum have is the human ability to love, and the desire to be loved in return.

Appearing to be obsessively focused on objects and sameness, the children ranged from nonverbal to [having] language abilities like that of ‘little professors.’ This divergence in language abilities led to the split between autistic and Asperger’s, or low and high functioning.  There are many theories, but no conclusions, about the exact cause of Asperger’s syndrome and autism. A new brain-tissue study indicates that people with ASD have more connections (synapses) between their brain cells than neurotypical people do. ASD has no one cause, but is brought about by a combination of genetic and environmental factors. These may include:

  • Family history of autism
  • Familial or parental diagnoses of conditions such as bipolar disorder or anxiety disorder
  • Advanced paternal or maternal age
  • Being part of a twin or triplet set
  • Prematurity of less than 26 weeks
  • Low birth weight
  • Prenatal exposure to heavy metals and toxins