Definition of Autism Spectrum Disorders

At one time, autism was thought to be an early version of schizophrenia (Rutter &
Schopler, 1987). In fact, the major journal in the field of autism, The Journal of Autism
and Developmental Disorders, was at one time called The Journal of Autism and
Childhood Schizophenia. However, over the last 20 years, there has been a growing
recognition that autism and schizophrenia are two separate disorders (Rutter &
Schoplers, 1987). Although there is widespread agreement that autism is a distinct
disorder, there remains considerable confusion about the term and its definition. It is not
unusual to find children who are called autisticlike or exhibiting autistic behaviors. These
descriptions reflect the difficulty of defining autism.

These symptoms are distributed among three general categories:

1. Qualitative impairment in social interaction

2. Qualitative impairment in communication
3. Restricted repetitive and stereotyped patterns of behavior, interests, and
activities

Recently, in the Individuals with Disabilities Education Act (IDEA), the federal
government recognized autism as a distinct disorder. The federal definition states:

Autism means a development disability significantly affecting verbal and non verbal
communication and social interaction, generally evident before age three, that adversely
affects educational performance. Characteristics of autism include irregularities and
impairments in communication, engagement in repetitive activities and stereotyped
movements, resistance to environmental charge or change in daily routines, and
unusual responses to sensory experiences. (IDEA, 2004).Frequently, children with
autistic characteristics act like children with other disabilities, such as children with
intellectual disabilities, pervasive language disorders, hearing impairments, or
psychiatric disorders. Although children with autism share some characteristics with
children with other disabilities, there are some distinct differences. For example,
children with autism have more severe cognitive and behavioral impairments than those
found among children with pervasive language disorders. Unlike children with other
disabilities, children with autism do not respond to communicative attempts by others,
and unlike children with severe hearing impairments, the sensory impairments of
children with autism fluctuate from one extreme to the other.
Characteristics of Autism Spectrum Disorders

Autism is a disorder that is present from birth or very early in development that affects
social interaction, communication, and the establishment of relationships with others
(National Research Council, 2001). It is one of group of disorders sometimes called
pervasive developmental disorders (PDD) or autism spectrum disorders (ASD).

Impairments in Social Interaction

Withdrawal from contact with others is probably the most salient feature of autism
spectrum disorders. Young children with ASD often are not responsive to parents and
other caregivers. They may remain stiff when picked up and cuddled. In addition,
children with autism fail to make eye contact with others. It sometimes seems as if they
are “looking through” the other person. The rarely reach out to others for comfort,
seeking little or no social interaction (Rutter & Scchopler, 1987).

Impairment in Language and Communication

Children with autism spectrum disorders have severe disorders in language and/or
communication. A significant number of children with autism (up to half, in some
estimates) never develop speech (Tager-Flusberg, Paul, & Lord, 2005). Language and
communication difficulties are evident in most young children with ASD and persist
through adulthood, even in adults with reasonably good language development (Howlin,
2003). There are significant delays in language development, but, even more important,
there are some characteristic differences in language development in most individuals
with autistic spectrum disorders.

Restricted Repertoire of Activities and Interests

Often, children with autism spectrum disorders are described as engaging in ritualistic
behaviors, such as spinning objects, twirling their fingers in front of their face, slapping
their heads, flapping their hands, and the like. This behavior may be self-stimulating.
Children with ASD are not the only individuals with disabilities who engage in such
behaviors, but the behaviors seem to be particularly characteristic of autism spectrum
disorders. In addition, individuals with ASD often have a compelling desire for
sameness and routine. They may become upset if something in their room is out of
place or if their usual schedule is disrupted (Rutter & Schopler, 1987)
Intervention for language and Communication Impairment

Picture Exchange Communication System (PECS)

The Picture Exchange Communication System (PECS) (Bondy & Frost, 1994) uses
pictures as the means of fostering meaningful communicative exchanges. Originally,
developed for individuals with autism, the program has been used successfully with
students with a variety of significant disabilities. The PECS program utilizes a
combination of behavioral methodology and incidental teaching techniques to enhance
social communication. Students progress through six phases in which they are taught to
communicate with a variety of people using increasingly complex language. A typical
PECS Phase I training session might go as follows:

1. The trainer places an object in front of the child that the trainer has previously
observed that the child wants.
2. When the child reaches for the item, the trainer places a picture into the child’s
hand.
3. The trainer then guides the child to hand the picture to the trainer.
4. When the child exchanges the picture, the trainer makes a verbal response and
offers a reinforcer.

Pivotal-Response Model

One of the basic concepts of the pivotal-response intervention model is that instruction
should focus on so-called pivotal areas. These include responsivity to multiple cues,
motivation to initiate and respond appropriately, and self-regulation of behavior. Koegel
and colleagues (1999) suggest that the following techniques can be used to enhance
the language interaction of individuals with autism spectrum disorders:

~ Child choice – materials that the child prefers should be used during instruction.
~ Interspersing previously learned tasks with new tasks- this leads to a higher degree
of success and increases the child’s motivation to respond.
~ Reinforcing the child’s attempts – A loose criterion for correct responding is
preferable to a more narrowly defined goal.
~ natural reinforcers – A natural reinforce is one that is directly related to the task. For
example, in teaching a child to open the lid of a container, the natural reinforce could be
a sticker inside the container.
Developmental, individual-Difference, Relationship-Based (DIR) Intervention Program

-Home based, developmentally appropriate interactions and practices (floor time)

-Spontaneous, follow the child’s lead floor time (20 to 30-minute sessions, eight to ten
times a day)
-Spatial, motor, and sensory activities (15 minutes or more, 4 times a day)
-Running and changing direction, jumping, spinning, swinging, deep tactile pressure
-Perceptual motor challenges, including looking and doing games
-Visual-spatial processing and motor planning games, including treasure hunts and
obstacle courses
[ the above activities can become integrated with the pretend play]

-Sensory integration ~ based occupational therapy and/or physical therapy, typically two
or more times a week

Educational program, daily

●For children who can interact and initiate gestures and/or word and engage in
preverbal problem solving, either an integrated program or a regular preschool program
with an aide

● For children not yet able to engage in preverbal problem solving or imitation, a
special education program where the major focus is on engagement, preverbal
purposeful gestural interaction, preverbal problem solving ( a continues flow of back-
and-forth communication) and learning to imitate actions, sounds, and words.

-Biomedical interventions, including consideration of medication, to enhance motor

planning and sequencing, self-regulation, concentration, and/or auditory processing and
language

-A consideration of nutrition and diet

-technologies geared to improve processing abilities, including auditory processing,

visual spatial processing, sensory modulation, and motor planning
References

Prior,M.,& Werry,J.(1986).Autism, schizophrenia, and allied disorders. In H.Quay&

J.Werry (Eds.), Psychopathological disorders of childhood (pp.156-210). New York:
Wiley.

Brook, S.,&Bowler,D.(1992).Autism by another name? Semantic and Pragmatic

impairments in children. Journal of Autism and Developmental Disorders, 22, 61-81.

S.Jay Kuder (2008).Teaching Students with Language and Communication Disabilities

Third Edition. United States of America,Pearson Education, Inc.

Lovaas, O.(1987) Behavioral treatment and normal educational and intellectual

functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55,
3-9.

Cantwell, D.,Baker, L., &Rutter,M.(1977).Families of autistic and dysphasic children. II.

Mothers’ speech to the children. Journal of Autism and Developmental Disorders,7,313-
327.

Resources on the web

www.nichd.nih.gov/autism/ National Institute of Child Health and Human Development

Autism projects

www.autism-society.org Autism Society of America

www.autismwebsite.com/ari/index.htm Autism Research Institute

www.pecs.com Pyramid Associates, developer of the PECS system.