Category — 2.3 Children with Established Risk Conditions: Autism

Autism Spectrum Disorder (ASD) is an umbrella term that describes a group of disorders that have a serious impact on all aspects of the child’s development. It especially affects the areas of communication and social skills. ASD is a lifelong condition that does not have a cure. Children with ASD benefit greatly from a variety of early intervention services. Because ASD is a spectrum disorder, some children will be more seriously affected by this disorder than others.

The causes of ASD are not known. There are many theories about the causes of ASD, but none have been proven. It is believed that ASD may have a genetic component because it sometimes runs in families and because it affects more boys than girls. It is also believed that ASD may be the result of both genetic (see full ECI Glossary) and environmental (see full ECI Glossary) factors.

ASD has a serious impact on almost all aspects of the child’s life:

• Language and communication skills: children with autism struggle with language. Many of them learn how to talk much later than their peers, and a small percentage never talks at all. Some develop language skills and then lose them, while others engage in echolalia (that is, repetitive speech that has no apparent meaning). Children with ASD also struggle with the pragmatic part of language. It is very difficult for them to get their point across to others. Children with ASD are sometimes unable to hold a conversation with others because they either do not stick to a topic, or keep talking about a subject, even when it is clear that the person they are talking to has lost interest in the topic. According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM) (2000) (see full Glossary), a child must have significant difficulties with language and communication if he or she is to be diagnosed with ASD;
• Social/emotional skills: this is an area of great difficulty for children with ASD.
  Most children with ASD have serious difficulties with social skills and find it very difficult to interact with others, both children and adults. They struggle with eye contact (if appropriate to establish eye contact with others in one’s culture) and may not understand personal space (if culturally appropriate to do so); for example, parents have described their child as being almost “on top of their faces” every time they need to communicate something. They have difficulty waiting for their turn and do not like it when there are changes to their routine, especially when there is no prior warning.
  Children with ASD often struggle with emotions and it may be difficult for them to identify their emotions, as well as the emotions of others. According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM) (2000), a child must have significant difficulties with social skills if he or she is to be diagnosed with ASD;
• Cognitive skills: some children with ASD have difficulties with cognitive skills. Some have an intellectual disability, while others may have a learning disability. Many struggle with attention and concentration skills, and most will need help when it comes to learning how to read, write and engage in math. Some children with ASD will struggle with cause and effect relations (for example, the reason why this child is crying is because he fell down and hurt himself; or the reason why you need to go out with your jacket is because it is cold outside)  and may not understand the concept of danger (for example, they may not know that it is not safe to cross the street, unless they look both ways first);
• Motor skills: many children with ASD will achieve motor milestones later than other children. They may sit up and walk later than their peers. Some will experience difficulty with their fine motor skills;
• Adaptive skills: some children with ASD will need help with dressing/undressing, bathing and brushing hair, even when they reach middle childhood;
• Sensory difficulties: some children with ASD have sensory integration (see full ECI Glossary) difficulties. They may be have too much sensitivity, or “hyper-sensitivity,” or little or no sensitivity, that is, hypo-sensitivity to any of the five senses. For example, some children do not like it at all when they hear the siren of an ambulance, because they may be hyper-sensitive to the sense of hearing. Also, some only eat crunchy foods, because they may be hypo-sensitive to the sense of taste;
• Repetitive stereotypic and/or self-stimulatory (see full ECI Glossary) behaviors: children with ASD engage in repetitive stereotypical behaviors, such as lining cars, rocking back and forth, and repetitively turning the light switch off and on. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) (2000) (see full Glossary), a child must engage in such repetitive and stereotypical behaviors if he or she is to be diagnosed with ASD.

There are many types of ASD. Although these types are different from one another, they all include the three core characteristics of ASD: social difficulties,  communication difficulties, and stereotypic repetitive behavior, to one degree or another. The types are:

Autism: it is the most common type of ASD. Children with autism typically exhibit all the developmental characteristics listed above. Most children with autism are diagnosed before the age of three years;
Asperger syndrome: children with Asperger syndrome usually have typical intelligence and language skills. That is why they are sometimes diagnosed after the age of 3 years. They do however struggle with the social and communicative aspects of language. They also engage in stereotypic and/or repetitive behaviors and some of them are fascinated with numbers (Fig. 1);
Rett disorder: children with Rett syndrome start out by developing typically. Then, between the ages of six months and two years, the brain of children with Rett syndrome stops developing. At this time, these children lose many of the skills that have been previously learned. Brain development will resume eventually, but lost skills will need to be re-taught. Rett syndrome mostly affects girls, who for some reason often wring and unwring their fingers (that is, they keep moving their fingers);
Childhood disintegrative disorder (CCD): mostly a boy’s disorder, CDD is a disorder that appears to develop later on in a child’s life. Children with CDD start out developing typically, then sometime in the early or middle childhood years they start to lose previously acquired skills, such as talking. These skills will need to be re-learned;
Pervasive developmental disorder-not otherwise specified(PDD-NOS): children who display some of the symptoms of ASD but not others, and do not fit into any of the other categories are sometimes given the diagnosis of PDD-NOS. They have typical intelligence and are usually diagnosed later in life, usually during the middle childhood years.

Figure 1. Fascinated with numbers

ASD sometimes exist with a number of other conditions (called co-morbidity). They include:

• Epilepsy (especially in children with Rett disorder);
• Fragile X syndrome;
• ADHD;
• Learning disabilities;
• Down syndrome: although quite rare, some children with ASD also have Down syndrome;
• Anxiety disorders.

There is variety of intervention options for children with ASD. Children with all types of ASD can benefit greatly from these intervention options. They include:

• Behavior intervention (BI) (see full ECI Glossary): many children with ASD benefit greatly from behavior intervention therapy. There are many types of behavior intervention therapies, and most of them rely on the principles of Applied Behavior Analysis.
• Speech and language pathology  (SLP): SLPs can greatly help children with ASD learn how to talk and communicate with others. They can also have them with pragmatic language;
• Occupational therapy (OT): OTs can help children with ASD improve their fine motor skills. OTs with special training in sensory integration therapy can help children with ASD with any sensory integration (see full ECI Glossary)  difficulties they may be experiencing;
• Physiotherapy (PT): PTs can help children with ASD improve their gross motor skills. They can also help them with any difficulties with balance that they may be experiencing;
• Relationship Development Intervention (RDI): to read about RDI, please refer to the ASD section of the zero to six part of this course;
• Floortime™: this is an intervention program developed by Stanley Greenspan, in which parents are taught how to meet their children “where they are” in order to connect with them, interact with them, and eventually teach them what they need to be taught. To learn more about floor time, please visit the following website;
• Other therapy options include music and dance therapy and putting the child on a special diet. To learn about these options, please visit the ASD section of the birth to six part of this course;
• Special education: children with ASD will have an Individual Education Plan (IEP) (see full Glossary) and most of the time they will have a special education assistant  present with them in the classroom all or most of the time. The school’s special educator  will serve on their IEP team and will offer them help in all areas of academic development. The special educator will work closely with the regular educator in order to help the child adapt to his or her classroom (Fig. 2).

Figure 2. Helping a child

Many children with ASD are fully integrated into regular classrooms, where they may have part/time or full/time assistants and that is where they belong. The successful integration of children with ASD does not come easily and should be planned ahead, but it must and should be done, because all children, including children with ASD, belong in the regular classroom with everyone else (Fig. 3).

Figure 3. In a regular classroom

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