AUTISM SPECTRUM

DISORDER

KEZIA MATHEW
12C
ACKNOWLEDGMENT
I express my deep sense of gratitude to all those who have been
instrumental in the preparation of this project.

I had been immeasurably enriched to be working under Ms.

Nazneen, Psychology teacher, who has a great level of knowledge
and has an art of encouraging, correcting, and directing me in
every situation possible.

To all friends, relatives, my parents, and others, who in one way

or another shared their support, either morally or physically.

I acknowledge all the people who have been involved and

supported me in making this project.

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 CONTENTS
 INTRODUCTION

 HISTORY OF AUTISM SPECTRUM DISORDER

 DETAILS OF AUTISM SPECTRUM DISORDER

 RISK FACTORS

 SIGNS AND SYMPTOMS

 CAUSES OF AUTISM SPECTRUM DISORDER

 MANAGEMENT AND TREATMENT

 DIAGNOSIS AND TESTS

 CASE STUDY

 CONCLUSION

 BIBLIOGRAPHY

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 1. INTRODUCTION
Autism spectrum disorders are neurodevelopmental disorders, meaning they
are caused by abnormalities in the way the brain develops and works.

There are a range of different disorders covered by this term, including

conditions that used to be considered separately such as autism and
Asperger’s syndrome. Some people still use the term “Asperger’s syndrome”.
It is generally thought to be at the milder end of the ASD spectrum.

People with autism spectrum disorders have problems in social behavior and
communicating with others; they tend to engage in solitary interests and
activities which they do repetitively.

In most cases, autism spectrum disorders become apparent during the first
5 years of a person’s life. They begin in childhood and tend to persist into
adolescence and adulthood. Globally, 1 in 160 children has an autism

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spectrum disorder, and they are more commonly diagnosed in boys than
girls.

People with autism spectrum disorders often also have other conditions,
including epilepsy, depression, anxiety, and attention deficit hyperactivity
disorder (ADHD).

The level of intelligence and cognitive functioning of people with autism

spectrum disorders is extremely variable, ranging from profound impairment
to superior functioning.

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2. HISTORY OF AUTISM SPECTRUM DISORDER
The term autism first was used by psychiatrist Eugen Bleuler in 1908. He
used it to describe a schizophrenic patient who had withdrawn into his
world. The Greek word ''autós'' meant self and the word “autism” was used
by Bleuler to mean morbid self-admiration and withdrawal within self.

The pioneers in research into autism were Hans Asperger and Leo Kanner.
They were working separately in the 1940s. Asperger described very able
children while Kanner described children who were severely affected. Their
views remained useful for physicians for the next three decades.

 Chronological history of autism

 Eugen Bleuler coined the word "autism" in 1908 among severely
withdrawn schizophrenic patients.

 In 1943 American child psychiatrist Leo Kanner studied 11 children. The

children had features of difficulties in social interactions, difficulty in
adapting to changes in routines, good memory, sensitivity to stimuli
(especially sound), resistance and allergies to food, good intellectual
potential, echolalia or propensity to repeat words of the speaker and
difficulties in spontaneous activity.

 In 1944 Hans Asperger, working separately, studied a group of children.

His children also resembled Kanner’s descriptions. The children he
studied, however, did not have echolalia as a linguistic problem but spoke
like grownups. He also mentioned that many of the children were clumsy
and different from normal children in terms of fine motor skills.

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 Next Bruno Bettelheim studied the effect of three therapy sessions with
children who he called autistic. He claimed that the problem in the
children was due to the coldness of their mothers. He separated the
children from their parents. Kanner and Bettelheim both worked towards
making the hypothesis that showed autistic children had frigid mothers

 Bernard Rimland was a psychologist and parent of a child with autism. He

disagreed with Bettelheim. He did not agree that the cause of his son’s
autism was due to either his or his wife’s parenting skills. In 1964,
Bernard Rimland published, Infantile Autism: The Syndrome and its
Implications for a Neural Theory of Behavior.

 Autism came to be better known in the 1970s. The Erica Foundation

started education and therapy for psychotic children at the beginning of
the 80s. Many parents still confused autism with mental retardation and

psychosis.

 It was in the 1980s that Asperger’s work was translated into English and
published and came into knowledge.

 It was in the 1980s that autism research gained momentum. It was

increasingly believed that parenting had no role in the causation of
autism and there were neurological disturbances and other genetic

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 ailments like tuberous sclerosis, metabolic disturbances like PKU, or
chromosomal abnormalities like fragile X syndrome.

 Lorna Wing, along with Christopher Gillberg at BNK (Children's Neuro-

Psychiatric Clinic) in Sweden in the 1980’s found the Wing’s triad of
disturbed mutual contact, disturbed mutual communication, and limited
imagination. In the 1990’s they added another factor making it a square.
The factor was limited planning ability.

 Ole Ivar Lovaas studied and furthered behavioral analysis and treatment
of children with autism. Lovaas achieved limited success at first with his
experimental behavior analysis. He developed it to target younger
children (less than 5 years of age) and implemented treatment at home
and increased the intensity (a measurement of the amount of “therapy
time”) to about 40 hours weekly.

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 3. DETAILS OF AUTISM SPECTRUM DISORDER
 Autism Vs. Autism Spectrum Disorder (ASD) -
What’s the difference?

The American Psychiatric Association changed the term autism to autism

spectrum disorder in 2013. ASD is now an umbrella term that covers the
different levels of autism. The autism spectrum includes conditions that
providers used to consider separate, including:

 Autism
 Asperger Syndrome
 Pervasive developmental disorder – not otherwise specified (PDD-
NOS)

 Asperger Vs. Autism - What’s the difference?

Healthcare providers don’t officially recognize Asperger syndrome as its

condition anymore. They used to consider Asperger’s and autism as different
conditions. The symptoms that were once part of an Asperger’s diagnosis
now fall under the autism spectrum. Providers consider Asperger’s a mild
form of autism. Some people still use the term Asperger’s syndrome to
describe their condition.

 What is high-functioning Autism?

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High-functioning autism isn’t an official medical diagnosis. However, some
people use the term to describe a mild form of autism that requires lower
levels of support. People on the mild end of the autism spectrum can speak,
read, write, and handle basic life skills. Providers used to call this Asperger

syndrome.

 How common is Autism?

According to the Centers for Disease Control and Prevention, ASD affects
about 1 in every 44 8-year-old children.

Autism in boys and children assigned male at birth (AMAB) is much more
likely than autism in girls and children assigned female at birth (AFAB). It’s
more than four times more common in boys and children AMAB than in girls
and children AFAB.

 Reason to wonder if your kid has Autism

Spectrum Disorder

Researchers believe ASD is a disorder of very early brain development. The

behavioral signs of autism characteristics typically surface between the ages
of 1.5 and 3 years old.

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 4. RISK FACTORS
The number of children diagnosed with autism spectrum disorder is rising.
It's not clear whether this is due to better detection and reporting or a real

increase in the number of cases, or both.

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Autism spectrum disorder affects children of all races and nationalities, but
certain factors increase a child's risk. These may include:

 Your child's sex. Boys are about four times more likely to develop
autism spectrum disorder than girls.
 Family history. Families who have one child with autism spectrum
disorder have an increased risk of having another child with the
disorder. It's also not uncommon for parents or relatives of a child
with an autism spectrum disorder to have minor problems with social
or communication skills themselves or to engage in certain behaviors
typical of the disorder.
 Other disorders. Children with certain medical conditions have a
higher-than-normal risk of autism spectrum disorder or autism-like

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 symptoms. Examples include fragile X syndrome, an inherited disorder
that causes intellectual problems; tuberous sclerosis, a condition in
which benign tumors develop in the brain; and Rett syndrome, a
genetic condition occurring almost exclusively in girls, which causes
slowing of head growth, intellectual disability and loss of purposeful
hand use.
 Extremely preterm babies. Babies born before 26 weeks of
gestation may have a greater risk of autism spectrum disorder.
 Parents' ages. There may be a connection between children born to
older parents and autism spectrum disorder, but more research is
necessary to establish this link.

5. SIGNS AND SYMPTOMS

Some children show signs of autism spectrum disorder in early infancy, such
as reduced eye contact, lack of response to their names, or
indifference to caregivers. Other children may develop normally for the
first few months or years of life, but then suddenly become withdrawn or

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aggressive or lose language skills they've already acquired. Signs
usually are seen by age 2 years.

Each child with autism spectrum disorder is likely to have a unique pattern
of behavior and level of severity — from low functioning to high
functioning.

Some children with autism spectrum disorder have difficulty learning, and
some have signs of
lower-than-normal
intelligence. Other
children with the disorder
have normal to high
intelligence — they learn
quickly, yet have trouble
communicating and
applying what they
know in everyday life and
adjusting to social
situations.

Because of the unique mixture of symptoms in each child, severity can

sometimes be difficult to determine. It's generally based on the level of
impairments and how they impact the ability to function.

Below are some common signs shown by people who have autism spectrum
disorder: -

 Social Communication and Interaction

A child or adult with autism spectrum disorder may have problems with
social interaction and communication skills, including any of these signs:

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  Fails to respond to his or her name or appears not to hear you at
times
 Resists cuddling and holding, and seems to prefer playing alone,
retreating into his or her world
 Has poor eye contact and lacks facial expression
 Doesn't speak or has delayed speech, or loses previous ability to say
words or sentences
 Can't start a conversation or keep one going, or only starts one to
make requests or label items
 Speaks with an abnormal tone or rhythm and may use a singsong
voice or robot-like speech
 Repeats words or phrases verbatim, but doesn't understand how to
use them
 Doesn't appear to understand simple questions or directions
 Doesn't express emotions or feelings and appears unaware of others'
feelings
 Doesn't point at or bring objects to share an interest
 Inappropriately approaches a social interaction by being passive,
aggressive, or disruptive
 Has difficulty recognizing nonverbal cues, such as interpreting other
people's facial expressions, body postures, or tone of voice

 Patterns of Behaviour

A child or adult with autism spectrum disorder may have limited, repetitive
patterns of behavior, interests, or activities, including any of these signs:

 Performs repetitive movements, such as rocking, spinning, or hand

flapping

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  Performs activities that could cause self-harm, such as biting or head-
banging
 Develops specific routines or rituals and becomes disturbed at the
slightest change
 Has problems with coordination or has odd movement patterns, such
as clumsiness or walking on toes, and has odd, stiff, or exaggerated
body language
 Is fascinated by details of an object, such as the spinning wheels of a
toy car, but doesn't understand the overall purpose or function of the
object
 Is unusually sensitive to light, sound, or touch, yet may be indifferent
to pain or temperature
 Doesn't engage in imitative or make-believe play
 Fixates on an object or activity with abnormal intensity or focus
 Has specific food preferences, such as eating only a few foods, or
refusing foods with a certain texture.

As they mature, some children with autism spectrum disorder become more
engaged with others and show fewer disturbances in behavior. Some,
usually those with the least severe problems, eventually may lead normal or
near-normal lives. Others, however, continue to have difficulty with
language or social skills, and the teen years can bring worse behavioral and

emotional problems.

6. CAUSES OF AUTISM SPECTRUM DISORDER

There’s no clear-cut cause of ASD. Research supports genetic and
environmental factors as some causes of autism. Scientists believe there

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could be many different causes of ASD that act together to change the ways
people develop. They still have a lot to learn about the causes and how they
impact people with ASD.

 Is Autism Genetic?

Genetics do play a role in autism. But healthcare providers have only

identified specific genetic causes in 10% to 20% of cases. These cases
include specific genetic syndromes associated with ASD, such as fragile X
syndrome, and rare changes in genetic code.

 Are siblings at greater risk for Autism Spectrum

Disorder (ASD)?

Autism is hereditary. When one child receives an ASD diagnosis, the next
child has about a 20% greater risk of developing autism than normal. When
the first two children in a family have ASD, the third child has about a 32%
greater risk of developing ASD.

 Do vaccines cause Autism Spectrum Disorder

(ASD)?

Many scientifically sound studies have proven that vaccines don’t cause
autism. When children suddenly show symptoms of ASD, some parents
mistakenly blame a recent vaccination. No reliable study has found any
proven link between childhood vaccination and autism.

7. MANAGEMENT AND TREATMENT

 When to seek help?

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Autism Spectrum Disorders usually begin in childhood. Some key behaviors
in a child’s development may not occur if a child has an autism spectrum
disorder. Their absence can be a red flag alerting parents of the need to

seek professional help:

 By 6 months: Few or no big smiles or other warm, joyful, and

engaging expressions.
 By 9 months: Little or no back-and-forth sharing of sounds, smiles,
or other facial expressions.
 By 12 months: Little or no babbling and cooing; little or no back-
and-forth gestures such as pointing, showing, reaching, or waving;
little or no response to name.
 By 16 months: Not saying single words.
 By 18 months: Not playing “make-believe” or pretend.
 By 24 months: Not saying two-word phrases.
 Losing language skills or social skills at any age.

 Treating Autism Spectrum Disorder

Autism treatment includes behavioral interventions or therapies. These

teach new skills to address the core deficits of autism and reduce the core
symptoms. Every child with autism is unique. For this reason, your child will
receive an individualized treatment plan to meet their specific needs. It’s
best to begin interventions as soon as possible so the benefits of therapy
can continue throughout your child’s life.

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Many people with ASD have additional medical conditions. These include
gastrointestinal and feeding issues, seizures, and sleep disturbances.
Treatment can involve behavioral therapy, medications, or both.

Early intensive behavioral treatments involve your entire family and possibly
a team of professionals. As your child ages and develops, they may receive
a modified treatment plan to cater to their specific needs.

During adolescence, children may benefit from transition services. These

can promote skills of independence essential in adulthood. The focus at that
point is on employment opportunities and job skill training.

 Therapy Options for Autism Spectrum Disorder

The most effective therapies and interventions are often different for each
person. Because there can be overlap in symptoms between ASD and other
disorders, such as attention deficit hyperactivity disorder (ADHD),2 it's
important that treatment focus on a person's specific needs, rather than the
diagnostic label.

 Behavioural Management Therapy

Behavior management therapy tries to reinforce wanted behaviors and

reduce unwanted behaviors. It also suggests what caregivers can do before,
during, after, and between episodes of problem behaviors.

Behavioral therapy is often based on applied behavior analysis (ABA), a

widely accepted approach that tracks a child's progress in improving his or
her skills.

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Different types of ABA commonly used to treat autism spectrum disorder
(ASD) include:

 Positive Behavioral and Support (PBS)

 Pivotal Response Training (PRT)
 Early Intensive Behavioural Intervention (EIBI)
 Discrete Trial Teaching (DTT)

 Cognitive Behavior Therapy

Cognitive behavior therapy focuses on the connection between thoughts,

feelings, and behaviors.

Together, the therapist, the person with autism spectrum disorder (ASD),
and/or the parents come up with specific goals for the course of therapy.
Throughout the sessions, the
person with autism learns to
identify and change thoughts
that lead to problem feelings
or behaviors in particular
situations.

Cognitive behavior therapy is

structured into specific
phases of treatment.
However, it is also
individualized to patients'
strengths and weaknesses. Research shows that this therapy helps people
with some types of ASD deal with anxiety. It can also help some people with
autism cope with social situations and better recognize emotions.

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  Joint Attention Therapy

Research shows that many people with autism have difficulty with joint
attention, which is the ability to share a focus on an object or area with
another person. Examples of joint attention skills include following someone
else's gaze or pointing a finger to look at something.

Joint attention is important to communication and language learning. Joint

attention therapy focuses on improving specific skills related to shared
attention,1 such as:

 Pointing
 Showing
 Coordinating looks between a person and an object

Improvements from such treatments can last for years.

 Physical Therapy

Physical therapy includes activities and exercises that build motor skills and
improve strength, posture, and
balance.

For example, this type of therapy

aims to help a child build muscle
control and strength so that he or she
can play more easily with other
children.

Problems with movement are

common in autism spectrum disorder
(ASD), and many children with autism
receive physical therapy. However, there is not yet solid evidence that
particular therapies can improve movement skills in those with autism.

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  Speech-Language Therapy

Speech-language therapy can help people with autism spectrum disorder

(ASD) improve their abilities to communicate and interact with others.

 Verbal Skills

This type of therapy can help some people improve their spoken or verbal
skills, such as:

 Correctly naming people and

things
 Better explaining feelings and
emotions
 Using words and sentences
better
 Improving the rate and
rhythm of speech

 Non-verbal Communication

Speech-language therapy can also teach nonverbal communication skills,

such as:

 Using hand signals or sign language

 Using picture symbols to communicate (Picture Exchange
Communication System)

Speech-language therapy activities can also include ways to improve social

skills and social behaviors. For example, a child might learn how to make
eye contact or to stand at a comfortable distance from another person.
These skills make it a little easier to interact with others.

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8. DIAGNOSIS AND TESTS
Diagnosing autism spectrum disorder (ASD) can be difficult because there is
no medical test, like a blood test, to diagnose the disorder. Doctors look at
the child’s developmental history and behavior to make a diagnosis.

ASD can sometimes be detected at 18

months of age or younger. By age 2, a
diagnosis by an experienced
professional can be considered reliable.
However, many children do not receive
a final diagnosis until much older. Some
people are not diagnosed until they are
adolescents or adults. This delay means that people with ASD might not get
the early help they need.

 Diagnostic Tools

There are many tools to assess ASD in young children, but no single tool
should be used as the basis for diagnosis. Diagnostic tools usually rely on
two main sources of information—parents’ or caregivers’ descriptions of
their child’s development and a professional’s observation of the child’s
behavior.

In some cases, the primary care provider might choose to refer the child
and family to a specialist for further assessment and diagnosis. Such
specialists include neurodevelopmental pediatricians, developmental-
behavioral pediatricians, child neurologists, geneticists, and early
intervention programs that provide assessment services.

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Selected examples of diagnostic tools:

 Autism Diagnosis Interview-Revised (ADI-R)

A clinical diagnostic instrument for assessing autism in children and adults.

The instrument focuses on behavior in three main areas: reciprocal social
interaction; communication and language; and restricted and repetitive,
stereotyped interests and behaviors. The ADI-R is appropriate for children
and adults with mental ages about 18 months and above.

 Autism Diagnostic Observation Schedule – Generic (ADOS-G)

A semi-structured, standardized assessment of social interaction,

communication, play, and imaginative use of materials for individuals
suspected of having ASD. The observational schedule consists of four 30-
minute modules, each designed to be administered to different individuals
according to their level of expressive language.

 Childhood Autism Rating Scale (CARS)

Brief assessment suitable for use with any child over 2 years of age. CARS
include items drawn from five prominent systems for diagnosing autism;
each item covers a particular characteristic, ability, or behavior.

 Gilliam Autism Rating Scale – Second Edition (GARS-2)

Assists teachers, parents, and clinicians in identifying and diagnosing autism

in individuals ages 3 through 22. It also helps estimate the severity of the
child’s disorder.

In addition to the tools above, the American Psychiatric Association’s

Diagnostic and Statistical Manual, Fifth Edition (DSM-5) provides
standardized criteria to help diagnose ASD.

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9. CASE STUDY
History
Mikey is an eight-year-old male who was diagnosed with ASD with
a severity requiring substantial support at age four by his
pediatrician. Mikey is in third grade and has seen an occupational
therapist through his public school system for the past two years.
Mikey has difficulty maintaining social interactions and engaging in
age-appropriate play with his peers and sibling.

Reason for Referral

Mikey’s parents have expressed that he is having difficulty with his
morning routine, causing behavioral issues. When Mikey has these
issues his entire day is thrown off, resulting in trouble
concentrating on schoolwork and increasing difficulties interacting
with his peers throughout the day. Mikey’s parents would like a
home evaluation and recommendations from an occupational
therapist to allow him to better function, especially during the
mornings.

Mikey’s family would be willing to purchase accommodations to

better help Mikey function and would commit to occupational
therapy treatment outside of school.

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Evaluation Procedure

Three home visits were conducted to observe the child on the

weekend mornings as well as in the morning and at night on a
school day. The Sensory Profile was conducted.

Evaluation Results

Caregiver interview and observation: Mikey’s parents

revealed that Mikey will sometimes scream when he is awakened
by noises in the house such as the blender, his alarm clock, or his
sister crying. They have found that Mikey has a difficult time
waking, getting ready for school, interacting with peers, and
completing coursework during these days. They have also stated
that Mikey has trouble sleeping through the night and he
frequently appears fatigued but is unable to nap during the day.
Mikey was observed to crave proprioceptive input, as evidenced by
flopping on the floor and demonstrating poor motor coordination.
Mikey was unable to engage in interactive play with his three-year-
old sister, and when asked to share toys with her, he ignored the
request. When observed during play, Mikey was preoccupied with
a single spinning toy, engrossed in ritualistic, repetitive play with
the object. Mikey was observed turning the lights on and off
repetitively in his room for several minutes before transitioning
into a different room.

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Sensory Profile. On the Sensory Profile, Mikey scored as a
“Probable/Definite Difference” in sensory registration, sensory
seeking, and sensory avoiding sections.

Treatment Plan

After evaluating Mikey, it was determined that he has delays in

play skills related to attention, registration, and sensory
processing. It is recommended that Mikey receive intensive
treatment from an occupational therapist outside the school to
work on the management of symptoms to enhance his
participation in occupations. If possible, it is recommended that
Mikey see this occupational therapist at home, to provide
treatment in the least restrictive environment. The following are
examples of what an occupational therapist will focus on during
treatment with Mikey, and some outside referrals that the
occupational therapist may recommend.

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10. CONCLUSION
There seems to be an ever-increasing number of children who are
being diagnosed with autism and this is causing concern, both to
society and to the individuals affected by it. Autism remains a
relatively unknown disorder and this is having an impact on the
quality of life of those individuals who are diagnosed with autism.
It can be understood that autism is a disorder that poses many
challenges, with autistic children demanding individual attention
and guidance at all times. This leads to a greater need for
specialized education and improved quality of life for these
individuals. It seems that the quantitative approach was applicable
because the focus was on the development and evaluation of the
effectiveness of a play technique program in enhancing the social
behavior of autistic children. Applied research, aimed to impact on
and benefit autistic individuals as a population, by providing a
practical outcome to impact the social behavior of autistic children.
To evaluate the effectiveness of the play technique program, the
one-group pre-test–post-test design (i.e.
quasi-experimental/associative design) was applied.

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11. BIBLIOGRAPHY
 https://www.cdc.gov/

 https://scholarworks.wmich.edu/

 https://www.icdl.com/

 https://www.news-medical.net/

 https://www.researchgate.net/

 https://apps.who.int/

 https://www.autismspeaks.org/

 https://my.clevelandclinic.org/

 https://www.mayoclinic.org/

 https://www.nichd.nih.gov/

 https://autismsociety.org/

 https://studycorgi.com/

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